Braš Marijana, Ana Havelka Meštrović, Mladen Havelka, Morana Bilić, Zoran Lončar
DOI: 10.4236/psych.2011.27107   PDF    HTML     4,773 Downloads   9,713 Views   Citations

Abstract

chronic post-traumatic stress disorder (PTSD) is commonly accompanied by depression and anxiety as comorbidity. The psychological states, such as depression and anxiety, can increase pain symptoms. A number of recent research results have shown that chronic post-traumatic stress disorder and chronic pain frequently co-occur and similar mechanisms have been identified that sustain both conditions. Method: the data were collected from medical records of 184 Croatian war veterans diagnosed with chronic PTSD and chronic pain as co-morbid condition. On the basis of medical records, interviews and different types of self-assessment questionnaires the inter-relationship between chronic pain and chronic PTSD was analysed. PTSD was assessed by CAPS (Clinical Administered Posttraumatic Scale) and M-PTSD (Mississippi Scale for combat PTSD), whereas pain was measured by Melzack-McGill Pain Questionnaire—short form (MPQ-SF) and Visual Analogue Scale (VAS). Results: the combat veterans with PTSD reported in descending order the following: pain in the head, back pain, widespread pain and limb pain. The patients with chronic PTSD had significantly higher total pain scores as well as affective and sensory pain components when compared to the patients without PTSD. Anxiety and depression were also highly correlated with pain. The relation between pain severity and depression was mediated by the severity of PTSD. Conclusion: our findings are directed towards the need for multidisciplinary approach in the treatment of patients with chronic PTSD and co-morbid chronic pain, which will optimize treatment and result in more cost-effective care.

Keywords

Chronic Pain, Posttraumatic Stress Disorder, Melzack-McGill Pain Questionnaire, Depression, Anxiety

Share and Cite:

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Arnow, B. A., Hunkeler, E. M., & Blasey C. M. (2006). Comorbid depression, chronic pain, and disability in primary care. Psychosomatic Medicine, 68, 262-268. doi:10.1097/01.psy.0000204851.15499.fc
[2]	Beckham, J. C., Moore, S. D., Feldman, M. E, Hertzberg, M. A., Kirby, A. C, & Fairbank, J. A. (1998). Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder. American Journal of Psychiatry, 155, 1565-1569.
[3]	Bouckoms, A. J. (1999). Chronic pain: Neuropsychopharmacology and adjunctive psychiatric treatment. In J. Rundel, & M. Wise (Eds.), Textbook of consultation-liaison psychiatry (Vol. 41, pp. 1006-1036). Washington: American Psychiatric Press Inc.
[4]	Bryant, R. A., Marosszeky, J. E, Crooks, J., Baguley, I. J., & Gurka, J. A. (1999). Interaction of posttraumatic stress disorder and chronic pain following traumatic brain injury. Journal of Head Trauma Re- habilitation, 14, 588-594. doi:10.1097/00001199-199912000-00007
[5]	Clark, M. R., & Treisman, G. J. (1991). Pain and depression—An Inter- disciplinary patient-centered therapy. Advances in Psychosomatic Medicine, 25, 78-88.
[6]	Davidson, J. T., Stein, D. J., Shalev, A. J., & Yehuda, R. (2004). Post- traumatic stress disorder: Acquisition, recognition, course, and treatment. Journal of Neuropsychiatry and Clinical Neurosciences, 16, 135-147. doi:10.1176/appi.neuropsych.16.2.135
[7]	Defrin, R., Ginzburg, K., Solomon, Z., Polad, E., Bloch, M., Govezensky, M., & Schreiber, S. (2008). Quantitative testing of pain perception in subjects with PTSD—Implications for the mechanism of the coexistence between PTSD and chronic pain. Pain, 138, 450-459. doi:10.1016/j.pain.2008.05.006
[8]	Diatchenko, L., Slade, G. D., Nackley, A. G., Bhalang, K., Sigurdsson, A., Belfer, I., Goldman, D., Xu, K., Shabalina, S. A., Shagin, D., Max, M. B., Makarov, S. S., & Maixner, W. (2005). Genetic basis for individual variations in pain perception and the development of a chronic pain condition. Human Molecular Genetics, 14, 135-143. doi:10.1093/hmg/ddi013
[9]	Fedoroff, I. C., Taylor, S., Asmundson, G. J. G., & Koch, W., J. (2000). Cognitive factors in traumatic stress reactions: Predicting PTSD symptoms from anxiety sensitivity and beliefs about harmful events. Behavioural and Cognitive Psychotherapy, 28, 5-15.
[10]	Geuze, E., Westenberg, H. G., Jochims, A., De Kloet, C. S., Bohus, M., Vermetten, E., & Schmahl, C. (2007). Altered pain processing in vet- erans with posttraumatic stress disorder. Archives of General Psychiatry, 64, 76-85. doi:10.1001/archpsyc.64.1.76
[11]	Harris, I. A., Young, J. M., Rae, H., Jalaludin, B. B., & Solomon, M. J. (2007). Factors associated with back pain after physical injury: A survey of consecutive major trauma patients. Spine, 32, 1561-1565. doi:10.1097/BRS.0b013e318067dce8
[12]	Keefe, F. J., Rumble, M. E., Scipio, C. D., Giordano, L. A., & Perri, L. M. (2004). Psychological aspects of persistent pain: Current state of the science—Invited comentary. The Journal of Pain, 5, 195-211. doi:10.1016/j.jpain.2004.02.576
[13]	Kessler, R. C., Zhao, S., Katz, S. J. (1999). Past-year use of outpatient services for psychiatric problems in the National Co-Morbidity Sur- vey. American Journal of Psychiatry, 156, 115-123.
[14]	Lanius, R. A., Williamson, P. C., Hopper, J., Densmore, M., Boksman, K., Gupta, M. A., Neufeld, R. W., Gati, J. S., & Menon, R. S. (2003). Recall of emotional states in posttraumatic stress disorder: An fMRI investigation. Biological Psychiatry, 53, 204-210. doi:10.1016/S0006-3223(02)01466-X
[15]	Leo, R. J. (2005). Chronic pain and comobid depression. Current Treatment Options in Neurology, 7, 403-412. doi:10.1007/s11940-005-0032-0
[16]	Maruta, T., Swanson, D. W., & Swenson, W. M. (1976). Pain as a psychiatric symptom: Comparison between low back pain and depression. Psychosom, 17, 123-127.
[17]	McWilliams, L. A., Cox, B. J., Enns, M. W. (2003) Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample. Pain, 106, 127-133. doi:10.1016/S0304-3959(03)00301-4
[18]	Melzack, R., & Casey, K. (1968). The skin senses (pp. 423-439). Springfield, IL: Charles C. Thomas.
[19]	N?ring, G. W., Van Lankveld, W., & Geenen, R. (2007). Somatoform dissociation and traumatic experiences in patients with rheumatoid arthritis and fibromyalgia. Clinical and Experimental Rheumatology, 25, 872-877.
[20]	Nemeroff, C. B., Bremner, J. D., Foa, E. B., Mayberg, H. S., North, C. S., & Stein, M. B. (2006). Posttraumatic stress disorder: A state-of- the-science review. Journal of Psychiatric Research, 40, 1-21. doi:10.1016/j.jpsychires.2005.07.005
[21]	Otis, J. D., Keane, T. M., & Kerns, R. D. (2003). An examination of the relationship between chronic pain and post-traumatic stress disorder. Jorunal of Rehabilitation Research and Development, 40, 397-406. doi:10.1682/JRRD.2003.09.0397
[22]	Peterlin, B. L., Tietjen, G., Meng, S., Lidicker, J., & Bigal, M. (2008). Post-traumatic stress disorder in episodic and chronic migraine. Pain in the Head, 48, 517-522. doi:10.1111/j.1526-4610.2008.00917.x
[23]	Roth, R. S., Geisser, M. E., Bates, R. J. (2008). The relation of post-traumatic stress symptoms to depression and pain in patients with accident-related chronic pain. Pain, 9, 588-596. doi:10.1016/j.jpain.2008.01.333
[24]	Salomons, T. V., Osterman, J. E., Gagliese, L., & Katz, J. (2001). Pain flashbacks in posttraumatic stress disorder. Clinical Journal of Pain, 8, 231-234.
[25]	Schmahl, C., Meinzer, M., Zeuch, A., Fichter, M., Cebulla, M., Klein- dienst, N., Ludascher P., Steil, R., & Bohus, M. (2008). Pain sensitivity is reduced in borderline personality disorder, but not in posttraumatic stress disorder and bulimia nervosa. World Journal of Biological Psychiatry, 29, 1-8. doi:10.1080/15622970701849952
[26]	Shalev, A. Y., Orr, S. P, & Peri, T. (1992). Physiological responses to loud tones of Israeli post-traumatic stress disorder patients. Archives of General Psychiatry, 49, 870-875.
[27]	Sharp, T. J., & Harvey, A. G. (2001). Chronic pain and posttraumatic stress disorder: Mutual maintenance? Clinical Psychology Review, 21, 857-877. doi:10.1016/S0272-7358(00)00071-4
[28]	Shin, L. M., Wright, C. I., Cannistraro, P. A., Wedig, M. M., McMullin, K., Martis, B., Macklin, M. L., Lasko, N. B., Cavanagh, S. R., Krangel, T. S., Orr, S. P., Pitman, R. K., Whalen, P. J., & Rauch, S. L. (2005). A functional magnetic resonance imaging study of amygdala and medial prefrontal cortex responses to overtly presented fearful faces in posttraumatic stress disorder. Archives of General Psychiatry, 62, 273-281. doi:10.1001/archpsyc.62.3.273
[29]	Stein, M. B., McQuaid, J. R., & Pedrelli, P. (2000). Post-traumatic stress disorder in the primary care medical setting. General Hospital Psychiatry, 22, 261-269. doi:10.1016/S0163-8343(00)00080-3
[30]	Symreng, I., & Fishman, S. M. (2004). Anxiety and pain. Pain Clinical Updates, 12, 12-13.
[31]	Taylor, S., Fedoroff, I., Koch, W. J., Thordarson, D. S., Fecteau, G., & Nicki, R. M. (2001). Posttraumatic stress disorder arising after road traffic collisions: Patterns of response to cognitive-behavior therapy. Journal of Consulting and Clinical Psychology, 69, 541-551. doi:10.1037/0022-006X.69.3.541
[32]	Wallace, J., & Panch, G. (2001). Pain clinic, a new role for psychiatrists. Psychiatric Bulletin, 25, 473-474. doi:10.1192/pb.25.12.473
[33]	Yehuda, R., Schmeidler, J., Wainberg, M., Binder-Brynes, K., & Du- vdevani, T. (1998). Vulnerability to posttraumatic stress disorder in adult offspring of Holocaust survivors. American Journal of Psychiatry, 155, 1163-1171.