Schulz-Heik R Jay, Avery Timothy J, Jo Booil, Mahoney Louise, Bayley Peter J
War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA.
Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
Glob Adv Health Med. 2022 Feb 16;11:21649561221075578. doi: 10.1177/21649561221075578. eCollection 2022.
Individuals with posttraumatic stress disorder PTSD) and chronic pain evince different presentations, coping strategies, and treatment utilization patterns than individuals with chronic pain alone. Theorists have suggested that comorbid PTSD may complicate chronic pain treatment, and that integrated pain and PTSD treatment may be preferable to pain treatment alone.
Assess whether comorbid PTSD moderates Veterans' response to yoga and/or cognitive behavioral therapy (CBT) for pain.
Veterans with Gulf War illness (n = 75) were assessed using the Brief Pain Inventory at baseline and posttreatment as part of a randomized clinical trial. PTSD status was abstracted from participants' medical records.
PTSD+ participants (n = 41) reported more pain at baseline than PTSD- participants (n = 34; = .66, < .01). PTSD+ participants experienced more improvement in pain from baseline to posttreatment than PTSD- participants by a small to moderate, marginally statistically significant amount ( = .39, = .07). The relationship between PTSD and treatment outcome was not moderated by treatment type (yoga vs CBT; = .99). Observation of treatment responses across PTSD status (+ vs -) and treatment (yoga vs CBT) revealed that PTSD+ participants responded well to yoga.
PTSD is not associated with reduced effectiveness of behavioral chronic pain treatment among Veterans with Gulf War illness. Therefore behavioral pain treatment should be made readily available to Veterans with pain and PTSD. Yoga deserves further consideration as a treatment for pain among individuals with PTSD.
与仅患有慢性疼痛的个体相比，患有创伤后应激障碍（PTSD）和慢性疼痛的个体表现出不同的症状、应对策略和治疗利用模式。理论家认为，PTSD共病可能会使慢性疼痛治疗复杂化，综合疼痛和PTSD治疗可能比单纯的疼痛治疗更可取。
评估PTSD共病是否会影响退伍军人对瑜伽和/或认知行为疗法（CBT）治疗疼痛的反应。
作为一项随机临床试验的一部分，对患有海湾战争疾病的退伍军人（n = 75）在基线和治疗后使用简短疼痛问卷进行评估。从参与者的医疗记录中提取PTSD状态。
PTSD+参与者（n = 41）在基线时报告的疼痛比PTSD-参与者（n = 34）更多（t = 0.66；p < 0.01）。从基线到治疗后，PTSD+参与者的疼痛改善程度比PTSD-参与者略大至中等，具有边缘统计学意义（r = 0.39；p = 0.07）。PTSD与治疗结果之间的关系不受治疗类型（瑜伽与CBT）的影响（F = 0.99）。观察PTSD状态（+与-）和治疗（瑜伽与CBT）的治疗反应发现，PTSD+参与者对瑜伽反应良好。
在患有海湾战争疾病的退伍军人中，PTSD与行为性慢性疼痛治疗效果降低无关。因此，应向患有疼痛和PTSD的退伍军人提供行为性疼痛治疗。瑜伽作为PTSD个体疼痛治疗的一种方法值得进一步考虑。
