Opioid and Nonpharmacologic Treatments Among Soldiers With Chronic Pain and Posttraumatic Stress Disorder

Objective To date, treatment options (i.e. psychotherapy, antidepressant medications) for patients with posttraumatic stress disorder (PTSD), are relatively few, and considering their limited efficacy, novel therapies have gained interest among researchers and treatment providers alike. Among patients with chronic pain (CP) about one third experience comorbid PTSD, which further complicates their already challenging pharmacological regimens. Low dose ketamine infusion has shown promise in PTSD, and in treatment of CP, however they have not been studied in comorbid population and under rigorous control conditions. Methods We compared the effects of a single dose of either ketamine (0.5 mg/kg) or ketorolac (15 mg) over a 40-minute of IV infusion in CP patients with and without PTSD, in double blind, randomized study. Measures were collected before, during, one day and seven days after the infusion. A planned sample size of 40 patients randomly assigned to treatment order was estimated to provide 80% power to detect a hypothesized treatment difference after the infusion. Main Outcome and Measures: The primary outcome measures were change in PTSD symptom severity assessed with the Impact of Event Scale–Revised (IES-R) and Visual Analogue Scale (VAS) for pain administered by a study clinician 24 hours post infusion. Secondary outcome measures included Impact of Event Scale–Revised (IES-R), VAS and Brief Pain Inventory (Short Form) for pain 1 week after the infusion. Results Both treatments offered comparable improvement of PTSD and CP symptoms that persisted for 7 days after the infusion. Patients with comorbid PTSD and CP experienced less dissociative side effects compared to the CP group. Surprisingly, ketorolac infusion resulted in dissociative symptoms in CP patients only. Conclusions This first prospective study comparing effects of subanesthetic ketamine versus ketorolac infusions for comorbid PTSD and CP, suggests that both ketamine and ketorolac might offer meaningful and durable response for both PTSD and CP symptoms.

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Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder

Frontiers in Psychology ◽

10.3389/fpsyg.2021.643869 ◽

2021 ◽

Vol 12 ◽

Author(s):

David E. Reed ◽

Elizabeth Lehinger ◽

Briana Cobos ◽

Kenneth E. Vail ◽

Paul S. Nabity ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Chronic Pain ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Brief Pain Inventory ◽

The Novel ◽

Ptsd Symptoms ◽

Physical Conditions ◽

Resilience Factors ◽

Novel Coronavirus

ObjectiveThe novel coronavirus (2019; CV-19) is linked to increases in emotional distress and may be particularly problematic for those with pre-existing mental and physical conditions, such as chronic pain and posttraumatic stress disorder (PTSD). However, little empirical research has been published on resilience factors in these individuals. The present study aims to examine authenticity as a resilience factor among those with chronic pain and/or PTSD.MethodsPrior to the national response to the pandemic (January 10-24, 2020), participants were screened for pain-related disability (Oswestry Disability Index; ODI) and PTSD symptoms (Posttraumatic Checklist for DSM-5; PCL-5), and on the basis of those responses were categorized into one of four groups: healthy, chronic pain only, PTSD only, or comorbid chronic pain and PTSD. During the CV-19 pandemic (May 5-May 13, 2020), participants responded again to the ODI and PCL-5, in addition to the Wood Authenticity Scale, Brief Pain Inventory, and items related to the CV-19 pandemic.ResultsA total of 110 participants (54.55% women), aged 42.19 (SD = 13.16), completed the survey during the pandemic. The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Authenticity moderated this relationship relevant to CV-19 Threat among those in the chronic pain only group, and not in any other group.ConclusionThe comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Importantly, greater authenticity was associated with less CV-19 Threat in the chronic pain only group, and not in any other group. The present study also highlights the importance of engaging authentically for those with chronic pain during the pandemic.

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Chronic pain and posttraumatic stress disorder

American Journal of Psychiatry ◽

10.1176/ajp.144.1.120a ◽

1987 ◽

Vol 144 (1) ◽

pp. 120a-120

Keyword(s):

Posttraumatic Stress Disorder ◽

Chronic Pain ◽

Posttraumatic Stress ◽

Stress Disorder

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Combat related posttraumatic stress disorder and chronic pain

Journal of Pain ◽

10.1016/j.jpain.2010.01.051 ◽

2010 ◽

Vol 11 (4) ◽

pp. S11

Author(s):

M. Bras ◽

Z. Loncar

Keyword(s):

Posttraumatic Stress Disorder ◽

Chronic Pain ◽

Posttraumatic Stress ◽

Stress Disorder

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Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans

Journal of Psychosomatic Research ◽

10.1016/s0022-3999(97)00129-3 ◽

1997 ◽

Vol 43 (4) ◽

pp. 379-389 ◽

Cited By ~ 180

Author(s):

Jean C. Beckham ◽

Angela L. Crawford ◽

Michelle E. Feldman ◽

Angela C. Kirby ◽

Michael A. Hertzberg ◽

...

Keyword(s):

Posttraumatic Stress Disorder ◽

Chronic Pain ◽

Posttraumatic Stress ◽

Combat Veterans ◽

Stress Disorder ◽

Vietnam Combat Veterans

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Preliminary findings on chronic pain and posttraumatic stress disorder

American Journal of Psychiatry ◽

10.1176/ajp.143.7.908 ◽

1986 ◽

Vol 143 (7) ◽

pp. 908-910 ◽

Cited By ~ 59

Keyword(s):

Posttraumatic Stress Disorder ◽

Chronic Pain ◽

Posttraumatic Stress ◽

Stress Disorder

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Chronic Pain and Chronic Stress: Two Sides of the Same Coin?

Chronic Stress ◽

10.1177/2470547017704763 ◽

2017 ◽

Vol 1 ◽

pp. 247054701770476 ◽

Cited By ~ 32

Author(s):

Chadi G Abdallah ◽

Paul Geha

Keyword(s):

Decision Making ◽

Posttraumatic Stress Disorder ◽

Chronic Pain ◽

Posttraumatic Stress ◽

Chronic Stress ◽

Stress Disorder ◽

Internal State ◽

Critical Role ◽

Well Being

Pain and stress share significant conceptual and physiological overlaps. Both phenomena challenge the body’s homeostasis and necessitate decision-making to help animals adapt to their environment. In addition, chronic stress and chronic pain share a common behavioral model of failure to extinguish negative memories. Yet, they also have discrepancies such that the final brain endophenotype of posttraumatic stress disorder, depression, and chronic pain appears to be different among the three conditions, and the role of the hypothalamic-pituitary-adrenal axis remains unclear in the physiology of pain. Persistence of either stress or pain is maladaptive and could lead to compromised well-being. In this brief review, we highlight the commonalities and differences between chronic stress and chronic pain, while focusing particularly on the central role of the limbic brain. We assess the current attempts in the field to conceptualize and understand chronic pain, within the context of knowledge gained from the stress literature. The limbic brain—including hippocampus, amygdala, and ventromedial prefrontal cortex—plays a critical role in learning. These brain areas integrate incoming nociceptive or stress signals with internal state, and generate learning signals necessary for decision-making. Therefore, the physiological and structural remodeling of this learning circuitry is observed in conditions such as chronic pain, depression, and posttraumatic stress disorder, and is also linked to the risk of onset of these conditions.

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