Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden.
Department of Psychology, Lund University, Lund, Sweden.
Eur J Pain. 2020 Apr;24(4):807-817. doi: 10.1002/ejp.1530. Epub 2020 Jan 22.
The relevance of post-traumatic stress disorder (PTSD) symptoms to outcomes of cognitive behavioural therapy (CBT) for chronic pain is unclear. This study examines whether (a) traumatic exposure or the severity of PTSD symptoms at pre-treatment predicts the outcomes (pain intensity/interference), (b) participation in this treatment is associated with reduced PTSD symptoms and (c) any observed changes in PTSD symptoms are mediated by changes in psychological mechanisms that have been shown to be of importance to PTSD and chronic pain.
Participants were 159 chronic pain patients who were consecutively admitted for a multidisciplinary, group-based CBT program at the Pain Rehabilitation Unit at Skåne University Hospital. A self-report measure of traumatic exposure and PTSD symptoms was administered before and after treatment, and at a 12-month follow-up, along with measures of depression, anxiety, pain intensity, pain interference, psychological inflexibility, life control and kinesiophobia.
Traumatic exposure and PTSD symptom severity did not predict pain intensity or interference at 12-month follow-up. There were no overall significant changes in PTSD symptom severity at post-treatment or follow-up, but 24.6% of the participants showed potential clinically significant change at follow-up. Psychological inflexibility mediated the changes that occurred in PTSD symptoms during treatment.
Neither traumatic exposure nor baseline symptoms of PTSD predicted the treatment outcomes examined here. Despite improvements in both comorbid depression and anxiety, participation in this pain-focused CBT program was not associated with improvements in comorbid PTSD. To the extent that changes in PTSD symptoms did occur, these were mediated by changes in psychological inflexibility during treatment.
Pain-focused CBT programs yield clinically meaningful improvements in pain and comorbid symptoms of depression and anxiety, but may have little effect on comorbid PTSD. This raises the issue of whether current pain-focused CBT programs can be modified to improve outcomes for comorbid conditions, perhaps by better targeting of psychological flexibility, and/or whether separate treatment of PTSD may be associated with improved pain outcomes.
创伤后应激障碍（PTSD）症状与慢性疼痛认知行为疗法（CBT）的结果之间的相关性尚不清楚。本研究旨在探讨以下几点：（a）治疗前的创伤暴露或 PTSD 症状严重程度是否可预测结局（疼痛强度/干扰）；（b）是否参与该治疗与 PTSD 症状减轻有关；（c）观察到的 PTSD 症状变化是否通过已证明对 PTSD 和慢性疼痛很重要的心理机制变化来介导。
159 名慢性疼痛患者连续入住斯科讷大学医院疼痛康复科进行多学科小组 CBT 治疗。在治疗前、治疗后和 12 个月随访时，使用创伤暴露和 PTSD 症状的自我报告量表，以及抑郁、焦虑、疼痛强度、疼痛干扰、心理灵活性、生活控制和运动恐惧症的测量。
创伤暴露和 PTSD 症状严重程度均不能预测 12 个月随访时的疼痛强度或干扰。治疗后和随访时 PTSD 症状严重程度均无总体显著变化，但 24.6%的患者在随访时表现出潜在的临床显著变化。治疗过程中 PTSD 症状的变化由心理灵活性来介导。
创伤暴露和 PTSD 症状基线均不能预测此处检查的治疗结果。尽管共病性抑郁和焦虑均有所改善，但参与该以疼痛为重点的 CBT 计划与共病性 PTSD 的改善无关。在 PTSD 症状确实发生变化的情况下，这些变化是通过治疗过程中心理灵活性的变化来介导的。
以疼痛为重点的 CBT 方案可显著改善疼痛和共病性抑郁、焦虑症状，但对共病性 PTSD 可能影响不大。这就提出了一个问题，即当前以疼痛为重点的 CBT 方案是否可以进行修改，以改善共病状况的结果，也许可以通过更好地针对心理灵活性，或者单独治疗 PTSD 是否可以改善疼痛结果。
