Department of Rehabilitation Sciences, University of Kentucky, 900 S. Limestone Ave Lexington, Lexington, KY 40536-0200.
Office of the Chief, Specialist Corps, 3630 Stanley Road, Fort Sam Houston, San Antonio, TX 78234.
Mil Med. 2020 Sep 18;185(9-10):e1481-e1491. doi: 10.1093/milmed/usaa052.
Post-traumatic stress disorder (PTSD) and chronic pain are frequently co-morbid conditions in the U.S. veteran population. Although several theories about the cause of increased pain prevalence in individuals with PTSD have been presented, no synthesis of primary data informing the impact of co-morbid PTSD and pain has been completed. The purpose of this study was to systematically review the literature and quantify disability, function, and pain-related beliefs and outcomes in veterans with PTSD compared to veterans without PTSD.
A systematic search of three electronic databases was conducted. Inclusion criteria required pain-related comparison of veterans with PTSD to those without PTSD. Primary outcome measures and standardized mean differences (SMDs) were assessed for pain, function, disability, pain beliefs, and healthcare utilization using a random effects model.
20 original research studies met inclusion criteria and were assessed for quality and outcomes of interest. The majority of studies were cross-sectional. Veterans with PTSD and pain demonstrated higher pain (SMD = 0.58, 95% CI 0.28-0.89), disability (SMD = 0.52, 95%CI 0.33-0.71), depression (SMD = 1.40, 95%CI 1.2-1.6), catastrophizing beliefs (SMD = 0.95, 95% CI 0.69-1.2), sleep disturbance (SMD = 0.80, 95% CI 0.57-1.02), and healthcare utilization; they had lower function (SMD = 0.41, 95% CI 0.25-0.56) and pain self-efficacy (SMD = 0.77, 95% CI 0.55-0.99) compared to veterans without PTSD.
In veterans with chronic pain, PTSD symptomology has a large effect for many negative health-related outcomes. This review supports the need for clinicians to screen and understand the effects of PTSD symptoms on patients with pain. Clinicians should recognize that veterans with PTSD and pain likely have elevated pain catastrophizing beliefs and decreased self-efficacy that should be targeted for intervention.
创伤后应激障碍（PTSD）和慢性疼痛是美国退伍军人中常见的共病。尽管已经提出了几种关于 PTSD 患者疼痛患病率增加原因的理论，但尚未完成关于 PTSD 和疼痛共病影响的主要数据综合。本研究的目的是系统地回顾文献，并量化 PTSD 退伍军人与无 PTSD 退伍军人相比的残疾、功能和与疼痛相关的信念和结果。
对三个电子数据库进行了系统搜索。纳入标准要求 PTSD 相关疼痛的比较需要与无 PTSD 的退伍军人进行比较。使用随机效应模型评估疼痛、功能、残疾、疼痛信念和医疗保健利用的主要结局测量和标准化平均差异（SMD）。
20 项原始研究符合纳入标准，并对质量和感兴趣的结果进行了评估。大多数研究都是横断面的。患有 PTSD 和疼痛的退伍军人表现出更高的疼痛（SMD=0.58，95%CI 0.28-0.89）、残疾（SMD=0.52，95%CI 0.33-0.71）、抑郁（SMD=1.40，95%CI 1.2-1.6）、灾难化信念（SMD=0.95，95%CI 0.69-1.2）、睡眠障碍（SMD=0.80，95%CI 0.57-1.02）和医疗保健利用；与无 PTSD 的退伍军人相比，他们的功能（SMD=0.41，95%CI 0.25-0.56）和疼痛自我效能（SMD=0.77，95%CI 0.55-0.99）较低。
在患有慢性疼痛的退伍军人中，PTSD 症状对许多负面健康相关结果有很大影响。本综述支持临床医生筛查和了解 PTSD 症状对疼痛患者的影响的必要性。临床医生应认识到，患有 PTSD 和疼痛的退伍军人可能存在较高的疼痛灾难化信念和较低的自我效能，应针对这些问题进行干预。
