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Clinical Trial
. 2011 Oct;152(10):2233-2240.
doi: 10.1016/j.pain.2011.04.019. Epub 2011 Jun 12.

Pain symptomatology and pain medication use in civilian PTSD

Justine Phifer  1 , Kelly Skelton, Tamara Weiss, Ann C Schwartz, Aliza Wingo, Charles F Gillespie, Lauren A Sands, Saleem Sayyar, Bekh Bradley, Tanja Jovanovic, Kerry J Ressler
Affiliations
Clinical Trial

Pain symptomatology and pain medication use in civilian PTSD

Justine Phifer et al. Pain. 2011 Oct.

Abstract

The comorbidity of pain syndromes and trauma-related syndromes has been shown to be high. However, there have been limited data, especially in civilian medical populations, on the role of trauma-related disorders such as posttraumatic stress disorder (PTSD) on chronic pain and pain medication use. We analyzed 647 general hospital patients in primary care and obstetrics and gynecological waiting rooms for the experience of trauma and PTSD-related stress disorders. PTSD symptoms were found to be significantly positively correlated with pain ratings (r=.282, P<0.001) and pain-related functional impairment (r=0.303, P<0.001). Those with a current PTSD diagnosis had significantly higher subjective pain and pain-related impairment ratings than those with no PTSD. Furthermore, those with a current diagnosis of PTSD were significantly more likely to have used opioid analgesics for pain control compared to those without a diagnosis of PTSD (χ(2)=8.98, P=0.011). When analyzing the separate PTSD symptom subclusters (re-experiencing, avoidance, and hyperarousal), all symptom clusters were significantly related to pain and pain-related impairment ratings, but only the avoidance cluster was significantly related to prior opioid pain medication use. We conclude that PTSD and trauma-related disorders are common in impoverished medical populations and that their presence should be examined in patients with pain syndromes. Furthermore, these data suggest that PTSD and pain may share a vulnerability pathway, including the endogenous opioid neurotransmission systems.

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Figures

Fig. 1
Fig. 1
Pain and Pain-Related Impairment as a function of PTSD status. (A) Pain Ratings across the three PTSD groups. (B) Pain Related Functional Impairment across the three PTSD groups. All bar graphs represent mean + sem.
Fig. 2
Fig. 2
PTSD subscale symptoms by history of opioid analgesic use. (A) PTSD re-experiencing symptoms related to presence or absence of opioid analgesic use. (B) PTSD avoidance symptoms related to opioid analgesic use. (C) PTSD hyper-arousal symptoms related to opioid analgesic use. All bar graphs represent mean ± sem.
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