The association of probable PTSD at baseline and pain-related outcomes after chronic pain rehabilitation: A comparison of DSM-5 and ICD-11 criteria for PTSD

High level of post-traumatic stress symptoms in patients with chronic neck pain is associated with poor mental health but does not moderate the outcome of a multimodal physiotherapy programme

INTRODUCTION

Chronic traumatic neck pain has a high prevalence of post-traumatic stress symptoms (PTSS). However, whether PTSS moderates treatment effects is unknown. This study investigated: 1) whether PTSS was associated with patient-reported outcomes and clinical test results at baseline; 2) whether PTSS moderated the effect of a multimodal physiotherapy intervention of exercise therapy and patient education; and 3) whether adherence to the intervention differed across PTSS groups.

METHODS

Secondary data analysis from a randomized controlled trial on chronic neck pain with 12-month follow-up was conducted. Patients were divided into three groups (NT = non-traumatic, LT = traumatic low PTSS, HT = traumatic high PTSS) based on self-reported onset of pain and the Impact of Event Scale. The baseline data were used to analyze the association of PTSS with patient demographics and scores of physical and mental health-related quality of life, depression, neck-related disability, kinesiophobia, and clinical tests. Baseline, 4-month and 12-month follow-up data were analyzed to investigate possible moderating effects on outcomes. Data on adherence were collected at four months.

RESULTS

115 participants were included (NT n = 45; LT n = 46; HT n = 24). The HT group reported lower mental health scores and more depressive symptoms at baseline. PTSS did not significantly moderate the treatment effect on any outcomes. The HT group tended to have lower adherence to the multimodal physiotherapy intervention than the LT group.

CONCLUSION

For patients with traumatic neck pain, high levels of PTSS are associated with poorer psychological outcomes but do not affect the outcomes of multimodal physiotherapy intervention.

Validation of the Danish PTSD Checklist for DSM-5 in trauma-exposed chronic pain patients using the Clinician-Administered PTSD Scale for DSM-5

Background: Validation of post-traumatic stress disorder (PTSD) screening tools across various populations to ensure accurate PTSD estimates is important. Because of the high symptom overlap between PTSD and pain, it is particularly important to validate PTSD screening tools in trauma-exposed chronic pain patients.Objective: The present study is the first seeking to validate the PTSD Checklist for DSM-5 (PCL-5) in a sample of trauma-exposed, treatment-seeking chronic pain patients.Method: The validation and optimal scoring of the PCL-5 were investigated using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) in chronic pain patients exposed to traffic or work-related traumas (n = 84). Construct validity was investigated using confirmatory factor analyses testing six competing DSM-5 models in a sample of mixed trauma-exposed chronic pain patients (n = 566), and a subsample of chronic pain patients exposed to traffic or work-related trauma only (n = 202). Furthermore, concurrent validity and discriminant validity were investigated using correlation analysis.Results: The results showed moderate (κ = .46) diagnostic consistency between the PCL-5 and the CAPS-5 using the DSM-5 symptom cluster criteria, and the overall accuracy of the scale (area under the curve = .79) was highly acceptable. Furthermore, the Danish PCL-5 showed excellent construct validity both in the full sample and in the subsample of traffic and work-related accidents, with superior fit of the seven-factor hybrid model. Excellent concurrent validity and discriminant validity were also established in the full sample.Conclusion: The PCL-5 appears to have satisfactory psychometric properties in trauma-exposed, treatment-seeking chronic pain patients.

Psychiatric disorders and pain: The recurrence of a comorbidity

Painful conditions are probably among the most frequent reasons for seeking medical advice and assistance. Although pain is a common complaint among psychiatric patients, clinicians generally separate its presence from the background mental disorder and downplay its importance, trying primarily to control the psychiatric symptomatology. As a sensory modality, the presence of pain and its importance account for an impressive body of scholarly research. Cartesian methodology considered sensations of all modalities in a mechanistic form, which actually sounds obsolete. However, authors have continuously been faced with the same dilemmas plaguing scholars for centuries. We assume that a large portion of the sensory inputs might be generators of distorted perceptions, which subsequently lead to psychopathology. Auditory and visual hallucinations are incontestable examples. Somaesthetic hallucinations also exist, but pain hardly deserves such a denomination. Nevertheless, chronic pain and psychiatric comorbidity is a reality that needs explanation. Painkillers are not effective in treating psychiatric disorders, and antipsychotics do very little, perhaps nothing, to relieve pain. The pharmacological approach opens one door on the horizon and closes many others, while clinicians continue to face a high prevalence of comorbid pain and mental health issues. However, attempts to correlate altered body schemata (as distorted as it may be, for example, in phantom limb pain) with somatic delusions can simplify all these dilemmas, and the basket of psychophysiology, in fact, might be bigger than presumed.