Comorbid chronic pain and post-traumatic stress disorder in UK veterans: a lot of theory but not enough evidence

Introduction: Chronic pain and post-traumatic stress disorder (PTSD) are strongly correlated in military veteran populations. The aim of this article is to review what is known about the comorbidity of the two conditions. Methods: A literature search was carried out to establish evidence for current explanatory models of why the two conditions frequently co-occur, the most appropriate treatments and current UK service provision for veterans and to identify gaps in research. Results: Chronic pain and PTSD share a number of features, yet the mechanisms behind their comorbidity are not well understood, and while each condition alone has extensive literature, there is limited evidence to support specific care and treatment for the two conditions simultaneously. In addition, there is currently no UK data for veterans with comorbid chronic pain and PTSD so it is not possible to gauge the numbers affected or to predict the numbers who will be affected in the future, and there appear to be no co-located services within the United Kingdom for the management of the two conditions simultaneously in this population. Conclusion: This review highlights a paucity of evidence in all areas of comorbid chronic pain and PTSD. Further work needs to consider fully the nature of the event that led to the development of the two conditions and examine further the possible mechanisms involved, and clinics need to establish routine and systematic evaluations of how any interventions work in practice.

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Post-traumatic stress disorder and risky opioid use among persons living with HIV and chronic pain

AIDS Care ◽

10.1080/09540121.2021.1876838 ◽

2021 ◽

pp. 1-8

Author(s):

Elenore Bhatraju ◽

Jane M. Liebschutz ◽

Sara Lodi ◽

Leah S. Forman ◽

Marlene C. Lira ◽

...

Keyword(s):

Chronic Pain ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Post Traumatic Stress ◽

Opioid Use ◽

Persons Living With Hiv ◽

Post Traumatic ◽

Living With Hiv

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Post-traumatic stress disorder among patients with chronic pain and chronic fatigue

Psychological Medicine ◽

10.1017/s0033291703008894 ◽

2004 ◽

Vol 34 (2) ◽

pp. 363-368 ◽

Cited By ~ 69

Author(s):

P. ROY-BYRNE ◽

W. R. SMITH ◽

J. GOLDBERG ◽

N. AFARI ◽

D. BUCHWALD

Keyword(s):

Chronic Pain ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

Clinical Care ◽

Chronic Fatigue ◽

Psychiatric Evaluation ◽

Post Traumatic Stress ◽

Tender Points ◽

Post Traumatic

Background. Fibromyalgia (FM), a chronic pain condition of unknown aetiology often develops following a traumatic event. FM has been associated with post-traumatic stress disorder (PTSD) and major depression disorder (MDD).Method. Patients seen in a referral clinic (N=571) were evaluated for FM and chronic fatigue syndrome (CFS) criteria. Patients completed questionnaires, and underwent a physical examination and a structured psychiatric evaluation. Critical components of the diagnostic criteria of FM (tender points and diffuse pain) and CFS (persistent debilitating fatigue and four of eight associated symptoms) were examined for their relationship with PTSD.Results. The prevalence of lifetime PTSD was 20% and lifetime MDD was 42%. Patients who had both tender points and diffuse pain had a higher prevalence of PTSD (OR=3·4, 95% CI 2·0–5·8) compared with those who had neither of these FM criteria. Stratification by MDD and adjustment for sociodemographic factors and chronic fatigue revealed that the association of PTSD with FM criteria was confined to those with MDD. Patients with MDD who met both components of the FM criteria had a three-fold increase in the prevalence of PTSD (95% CI 1·5–7·1); conversely, FM patients without MDD showed no increase in PTSD (OR=1·3, 95% CI 0·5–3·2). The components of the CFS criteria were not significantly associated with PTSD.Conclusion. Optimal clinical care for patients with FM should include an assessment of trauma in general, and PTSD in particular. This study highlights the importance of considering co-morbid MDD as an effect modifier in analyses that explore PTSD in patients with FM.

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Post-traumatic Stress Disorder and Chronic Pain in the Military

Overlapping Pain and Psychiatric Syndromes ◽

10.1093/med/9780190248253.003.0014 ◽

2020 ◽

pp. 189-202

Author(s):

Jordana L. Sommer ◽

Rachel Roy ◽

Pamela L. Holens ◽

Renée El-Gabalawy

Keyword(s):

Chronic Pain ◽

Post Traumatic Stress Disorder ◽

Traumatic Stress ◽

Stress Disorder ◽

The United States ◽

Post Traumatic Stress ◽

Psychosocial Effects ◽

The United Kingdom ◽

Military Populations ◽

Post Traumatic

This chapter summarizes the current literature on post-traumatic stress disorder (PTSD) and chronic pain among military personnel in Canada, the United States, and the United Kingdom, including an overview of clinical features, prevalence, correlates, comorbidity, assessment, and intervention. PTSD and chronic pain are both prevalent among military populations and commonly co-occur; however, prevalence estimates tend to vary in the literature, according to type of assessment, timing of assessment, and subsample of interest. Both PTSD and chronic pain are independently associated with various adverse correlates such as psychiatric and physical health comorbidity, and research suggests there are poorer health and adverse psychosocial effects when these conditions co-occur. These findings highlight the importance of adequate prevention, screening, and interventions among this population.

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