Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.
Department of Veterans Affairs, South Texas Veterans Health Care System, San Antonio, TX 78229, USA.
Mil Med. 2021 Nov 2;186(11-12):e1199-e1206. doi: 10.1093/milmed/usaa529.
Chronic pain and post-traumatic stress disorder (PTSD) comorbidity is prevalent among veterans and is associated with increased levels of pain severity and pain-related disability. An improved understanding of the relationship between these co-occurring disorders, in addition to effective integrated treatments, will develop by considering the changes to the PTSD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The current study examined the relationship between the revised PTSD Checklist for DSM-5 (PCL-5) symptom clusters (i.e., intrusion, avoidance, negative alterations in cognition and mood [NACM], and arousal) and chronic pain measurements (i.e., pain severity, interference, and disability).
Participants included 103 veterans (ages 26-70, mean = 45.33) participating in a randomized clinical trial examining the efficacy of an interdisciplinary pain management program for chronic musculoskeletal pain. The study was approved by a university system Institutional Review Board and affiliated healthcare system.
The participants with a provisional PTSD diagnosis based on PCL-5 responses (N = 76) had significantly greater pain severity, interference, and disability than the participants without a provisional diagnosis (N = 23). Correlations between symptom clusters and pain measurements were mostly significant and positive with varying strengths. The avoidance symptom cluster, however, had relatively weaker correlations with pain measurements and was not significantly associated with the numeric rating scale of pain severity. Path analyses revealed that, after controlling for avoidance symptoms, significant associations remained between NACM and all the pain measurements. After controlling for NACM symptoms, however, there were no significant associations between avoidance symptoms and pain measurements.
The current study highlights a need to re-examine the leading theories about the mutual maintenance of these disorders in order to develop effective integrative treatment approaches. PTSD-related avoidance may have a relatively weaker role in co-occurring chronic pain than the other symptom clusters and may have a qualitatively different role than chronic pain-related avoidance. Future research should explore the relationship between the avoidance in PTSD and the avoidance in chronic pain as well as identify which chronic pain measurements are the most useful when examining the relationship between PTSD and chronic pain. The potential impact of trauma-related cognition and mood on chronic pain indicates that this is an important area for intervention and should be considered in the development of integrated treatments for chronic pain and PTSD among veterans.
慢性疼痛和创伤后应激障碍（PTSD）共病在退伍军人中很常见，与疼痛严重程度和与疼痛相关的残疾程度增加有关。通过考虑《精神障碍诊断与统计手册》第五版（DSM-5）中 PTSD 诊断标准的变化，除了有效的综合治疗方法外，对这些共病障碍之间关系的深入了解将会得到发展。本研究考察了修订后的 PTSD 检查表 DSM-5（PCL-5）症状群（即侵入、回避、认知和情绪的负性改变[NACM]和觉醒）与慢性疼痛测量（即疼痛严重程度、干扰和残疾）之间的关系。
参与者包括 103 名退伍军人（年龄 26-70 岁，平均 45.33 岁），他们参加了一项随机临床试验，该试验检查了针对慢性肌肉骨骼疼痛的跨学科疼痛管理计划的疗效。该研究得到了大学系统机构审查委员会和附属医疗机构的批准。
根据 PCL-5 反应确定有临时 PTSD 诊断的参与者（N=76）的疼痛严重程度、干扰和残疾显著高于没有临时诊断的参与者（N=23）。症状群与疼痛测量之间的相关性大多是显著的且呈正相关，但其强度各不相同。回避症状群与疼痛测量的相关性相对较弱，与疼痛严重程度的数字评分量表无显著关联。路径分析显示，在控制回避症状后，NACM 与所有疼痛测量仍存在显著关联。然而，在控制 NACM 症状后，回避症状与疼痛测量之间没有显著关联。
本研究强调需要重新检查这些疾病相互维持的主要理论，以制定有效的综合治疗方法。与其他症状群相比，与 PTSD 相关的回避在共患慢性疼痛中的作用可能相对较弱，并且可能与慢性疼痛相关的回避具有不同的作用。未来的研究应该探讨 PTSD 中的回避与慢性疼痛中的回避之间的关系，并确定在检查 PTSD 与慢性疼痛之间的关系时哪些慢性疼痛测量最有用。创伤相关认知和情绪对慢性疼痛的潜在影响表明，这是一个需要干预的重要领域，应在退伍军人慢性疼痛和 PTSD 的综合治疗开发中加以考虑。
