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Waisman A, Katz J. The autobiographical memory system and chronic pain: A neurocognitive framework for the initiation and maintenance of chronic pain. Neurosci Biobehav Rev 2024; 162:105736. [PMID: 38796124 DOI: 10.1016/j.neubiorev.2024.105736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
Chronic pain affects approximately 20% of the world's population, exerting a substantial burden on the affected individual, their families, and healthcare systems globally. Deficits in autobiographical memory have been identified among individuals living with chronic pain, and even found to pose a risk for the transition to chronicity. Recent neuroimaging studies have simultaneously implicated common brain regions central to autobiographical memory processing in the maintenance of and susceptibility to chronic pain. The present review proposes a novel neurocognitive framework for chronic pain explained by mechanisms underlying the autobiographical memory system. Here, we 1) summarize the current literature on autobiographical memory in pain, 2) discuss the role of the hippocampus and cortical brain regions including the ventromedial prefrontal cortex, anterior temporal lobe, and amygdala in relation to autobiographical memory, memory schemas, emotional processing, and pain, 3) synthesize these findings in a neurocognitive framework that explains these relationships and their implications for patients' pain outcomes, and 4) propose translational directions for the prevention, management, and treatment of chronic pain.
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Affiliation(s)
- Anna Waisman
- Department of Psychology, York University, Toronto, ON, Canada.
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada; Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
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2
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Murray CB, Li R, Kashikar-Zuck S, Zhou C, Palermo TM. Adolescent predictors of young adult pain and health outcomes: results from a 6-year prospective follow-up study. Pain 2024:00006396-990000000-00634. [PMID: 38916525 DOI: 10.1097/j.pain.0000000000003308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/13/2024] [Indexed: 06/26/2024]
Abstract
ABSTRACT Adolescent chronic pain may lead to persistent disability and long-term health impairments in adulthood. However, our understanding of which youth are more likely to experience adverse outcomes remains limited. To address this gap, this longitudinal cohort study examined adolescent predictors of various dimensions of young adult health and functioning, including pain, physical health, depression, anxiety, social isolation, and sleep disturbance. As part of a previous clinical trial, we recruited a cohort of adolescents (ages 11-17 years, M age = 14 years) with non-disease-related chronic pain from 15 tertiary pain clinics in North America. Approximately 6 years later, 229 of the original 273 individuals (81% participation rate) completed a follow-up survey as young adults (ages 18-25 years, M age = 21 years). At the young adult follow-up, 73% reported continued chronic pain, with two-thirds experiencing moderate-to-severe pain interference. Youth reported several adverse health outcomes, including below-average physical health (37%), clinically elevated depression (42%), clinically elevated anxiety (48%), and sleep disturbances (77%). Multivariate regression analyses controlling for sociodemographic characteristics revealed that higher pain intensity, more pain locations, lower sleep quality, and greater anxiety symptoms in adolescence predicted worse pain outcomes in young adulthood. Moreover, lower sleep quality, greater anxiety symptoms, and worse family functioning predicted worse physical and psychosocial health in adulthood. These findings represent an important first step toward identifying ways to optimize psychological pain interventions. Tailored psychological pain interventions can directly target adolescent vulnerabilities, including mood, sleep, and family risk factors, with the potential to disrupt a lifelong trajectory of pain and suffering.
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Affiliation(s)
- Caitlin B Murray
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Rui Li
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Susmita Kashikar-Zuck
- University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States
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Schneider J, Rukundo-Zeller AC, Bambonyé M, Lust S, Mugisha H, Muhoza JA, Ndayikengurukiye T, Nitanga L, Rushoza AA, Crombach A. The impact of parental acceptance and childhood maltreatment on mental health and physical pain in Burundian survivors of childhood sexual abuse. CHILD ABUSE & NEGLECT 2024; 154:106906. [PMID: 38917765 DOI: 10.1016/j.chiabu.2024.106906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/13/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Parental support has been suggested to mitigate mental and physical consequences following childhood sexual abuse (CSA). However, many CSA survivors experience parental rejection post-CSA. OBJECTIVE We aimed to understand the impact of abuse-specific parental acceptance on post-traumatic stress disorder (PTSD) and physical pain in Burundian CSA-survivors. We further assessed the significance of parental acceptance among known risk factors for predicting PTSD. METHODS, PARTICIPANTS, AND SETTINGS Participants (N = 131, 80.9 % female, mean age 16.21 years) were recruited via primary health care centers for survivors of sexual violence which survivors approached post-CSA. Survivors reported on PTSD symptoms, daytime/nighttime pain, and adverse childhood experiences in semi-structured interviews. Parental acceptance levels were categorized (acceptance, no acceptance, no contact) for mothers and fathers separately. Kruskal-Wallis tests assessed group differences. Conditional random forests (CRF) evaluated the significance of parental acceptance in predicting PTSD symptom severity. RESULTS No significant differences regarding PTSD symptoms and physical pain between levels of maternal acceptance were obtained. Pairwise comparisons revealed significant differences in PTSD symptom severity between paternal acceptance and no acceptance (d = 1.04) and paternal acceptance and no contact (d = 0.81). The CRF identified paternal acceptance as important variable for the prediction of PTSD symptom severity. Even though results were less conclusive, medium effect sizes hint at less pain perception within the paternal acceptance group. CONCLUSIONS The results highlight paternal acceptance as a potential risk or protective factor regarding psychological and possibly physical well-being in the aftermath of CSA, even in the context of other known risk factors.
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Affiliation(s)
- Julia Schneider
- Saarland University, Psychology, Clinical Psychology and Psychotherapy for Children and Adolescents, Saarbrücken, Germany.
| | - Anja C Rukundo-Zeller
- University of Konstanz, Psychology, Clinical Psychology and Clinical Neuropsychology, Konstanz, Germany; Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi; Non-Governmental Organization vivo international e.V., Konstanz, Germany
| | - Manassé Bambonyé
- Université Lumière de Bujumbura, Clinical Psychology, Bujumbura, Burundi; Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | - Sarah Lust
- University of Konstanz, Psychology, Clinical Psychology and Clinical Neuropsychology, Konstanz, Germany
| | - Hervé Mugisha
- Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | - Jean-Arnaud Muhoza
- Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | | | - Lydia Nitanga
- Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | - Amini Ahmed Rushoza
- Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi
| | - Anselm Crombach
- Saarland University, Psychology, Clinical Psychology and Psychotherapy for Children and Adolescents, Saarbrücken, Germany; Non-Governmental Organization Psychologues sans Frontières Burundi, Bujumbura, Burundi; Non-Governmental Organization vivo international e.V., Konstanz, Germany
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McGrew SJ, Thai JM, Woller SJ, Smit T, Rogers AH, Vujanovic AA, Zvolensky MJ. Posttraumatic Stress and Opioid Use and Pain among Individuals with Probable Posttraumatic Stress Disorder and Self-Reported Chronic Pain: The Role of Health Literacy. Subst Use Misuse 2024:1-8. [PMID: 38914534 DOI: 10.1080/10826084.2024.2369164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Chronic pain and opioid misuse are a prevalent comorbidity with deleterious health outcomes. Growing work indicates that posttraumatic stress disorder (PTSD) can increase the risk for chronic pain and opioid misuse and dependence. However, there is little understanding of social determinants of health (SDoH) that may account for interrelations of PTSD with chronic pain and opioid misuse and dependence. Health literacy is one relevant SDoH construct, reflecting the ability to gather, process, and comprehend health-related information required to engage in a healthcare setting. OBJECTIVE The purpose of the present cross-sectional study was to examine the indirect effect of health literacy in the association between PTSD and opioid misuse, opioid dependence, pain intensity, and pain disability. METHOD The sample included 142 adults (Mage = 35.2, SD = 9.9; 67.4% female; 70.1% White/Caucasian) with self-reported chronic pain and probable PTSD who were using opioid medication. RESULTS Results demonstrated that PTSD symptom severity had a small indirect effect on opioid misuse and opioid dependence via health literacy; no indirect effects were evident for pain intensity and disability. CONCLUSION The present investigation provides evidence that health literacy may serve as an important explanatory factor in associations between PTSD symptom severity and opioid misuse and dependence among adults with co-occurring probable PTSD and chronic pain.
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Affiliation(s)
- Shelby J McGrew
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Jessica M Thai
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Savannah J Woller
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Andrew H Rogers
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Hospital, Seattle Children's Research Institute, Seattle, WA, USA
| | - Anka A Vujanovic
- Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- Department of Behavioral Science, The University of Texas Maryland Anderson Cancer Center, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
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Wu LH, Li J, Jia SF, Guo YJ. The effect of narrative nursing on improving the negative emotions and quality of life of patients with moderate to severe cancer pain. Clin Transl Oncol 2024:10.1007/s12094-024-03549-7. [PMID: 38898352 DOI: 10.1007/s12094-024-03549-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE This study aimed to explore the effect of narrative nursing on improving the negative emotions, sleep quality, and quality of life of patients with moderate to severe cancer pain. METHODS A total of 80 patients with moderate to severe cancer pain who had been hospitalized in the lymphoma oncology department in our hospital from March 2019 to September 2021 were selected as the study subjects and randomly divided into the conventional nursing and narrative nursing groups, with 40 cases in each group. A conventional nursing intervention was conducted for one group, and narrative nursing was provided for the second group in addition to the conventional nursing. The anxiety and depression, sleep quality, quality of life, and satisfaction with pain management of the patients in the two groups were compared before and after the intervention. RESULTS In the narrative nursing group, the self-rating anxiety scale and self-rating depression scale scores were significantly lower than those in the conventional nursing group after the intervention (P < 0.05). The scores for sleep quality, sleep duration, sleep efficiency, and daytime dysfunction and the total Pittsburgh Sleep Quality Index scores were significantly lower in the narrative nursing group compared with the conventional care group (P < 0.05). The scores for the physical function, living ability, social adaptation, and psychological status items in the Quality of Life Questionnaire Core 30 were significantly higher in the narrative nursing group than in the conventional care group (P < 0.05). The patients' satisfaction with pain management was higher in the narrative nursing group than in the conventional care group (P < 0.05). CONCLUSION Narrative nursing can alleviate the negative emotions of anxiety and depression in patients with moderate to severe cancer pain and improve their sleep quality, quality of life, and pain management satisfaction.
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Affiliation(s)
- Li-Hua Wu
- Department of Lymphatic Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China.
| | - Jia Li
- Department of Lymphatic Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
| | - Shao-Fen Jia
- Department of Lymphatic Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
| | - Yan-Jing Guo
- Department of Lymphatic Oncology, Cancer Center, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, No. 99 of Longcheng Street, Xiaodian District, Taiyuan, 030032, China
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Hadlandsmyth K, Zhuang C, Driscoll MA, Lund BC. Comorbid Chronic Pain and Post-traumatic Stress Disorder: Current Rates and Psychiatric Comorbidities Among U.S. Military Veterans. Mil Med 2024:usae313. [PMID: 38869274 DOI: 10.1093/milmed/usae313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/21/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION This study reports rates of comorbid chronic pain and post-traumatic stress disorder (PTSD) among U.S. military veterans and rates of psychiatric comorbidities among those with both chronic pain and PTSD. MATERIALS AND METHODS This study utilized National Veterans Affairs (VA) administrative data to identify all veterans treated for chronic pain or PTSD in 2023. Multivariable logistic regression models determined the likelihood of each psychiatric comorbidity for those with chronic pain and PTSD relative to those with chronic pain only and separately to those with PTSD only, after adjusting for demographic variables and all other psychiatric comorbidities. RESULTS Of the 5,846,453 service users of the VA in 2023, a total of 2,091,391 (35.8%) met the criteria for chronic pain and 850,191 (14.5%) met the criteria for PTSD. Furthermore, 21.6% of those with chronic pain also had PTSD and over half (53.2%) of those with PTSD also met the criteria for chronic pain (n = 452,113). Veterans with chronic pain and PTSD were significantly more likely to be women, Black or African American, Hispanic or Latina, and urban dwelling. Veterans with chronic pain and PTSD had significantly higher rates of all selected comorbidities relative to veterans with chronic pain only. CONCLUSIONS Patients with comorbid chronic pain and PTSD may benefit from tailored treatments to address the additive impact of these conditions.
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Affiliation(s)
- Katherine Hadlandsmyth
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, IA 52246, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA 52246, USA
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Caywin Zhuang
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA
| | - Mary A Driscoll
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA
| | - Brian C Lund
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, Iowa City VA Health Care System, Iowa City, IA 52246, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, IA 52246, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA 52242, USA
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Strigo IA, Craig ADB, Simmons AN. Expectation of pain and relief: A dynamical model of the neural basis for pain-trauma co-morbidity. Neurosci Biobehav Rev 2024; 163:105750. [PMID: 38849067 DOI: 10.1016/j.neubiorev.2024.105750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 06/09/2024]
Abstract
Posttraumatic Stress Disorder (PTSD) is highly co-morbid with chronic pain conditions. When present, PTSD significantly worsens chronic pain outcomes. Likewise, pain contributes to a more severe PTSD as evidenced by greater disability, more frequent use of harmful opioid analgesics and increased pain severity. The biomechanism behind this comorbidity is incompletely understood, however recent work strongly supports the widely-accepted role of expectation, in the entanglement of chronic pain and trauma symptoms. This work has shown that those with trauma have a maladaptive brain response while expecting stress and pain, whereas those with chronic pain may have a notable impairment in brain response while expecting pain relief. This dynamical expectation model of the interaction between neural systems underlying expectation of pain onset (traumatic stress) and pain offset (chronic pain) is biologically viable and may provide a biomechanistic insight into pain-trauma comorbidity. These predictive mechanisms work through interoceptive pathways in the brain critically the insula cortex. Here we highlight how the neural expectation-related mechanisms augment the existing models of pain and trauma to better understand the dynamics of pain and trauma comorbidity. These ideas will point to targeted complementary clinical approaches, based on mechanistically separable neural biophenotypes for the entanglement of chronic pain and trauma symptoms.
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Affiliation(s)
- Irina A Strigo
- Emotion and Pain Laboratory, San Francisco Veterans Affairs Health Care Center, 4150 Clement Street, San Francisco, CA 94121, USA; Department of Psychiatry, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA.
| | | | - Alan N Simmons
- Center of Excellence in Stress and Mental Health, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Dr, San Diego, CA 92161, USA; Stress and Neuroimaging Laboratory, San Diego Veterans Affairs Health Care Center, 3350 La Jolla Village Drive, MC 151-B, San Diego, CA 92161, USA; Department of Psychiatry, University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
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Vieira WF, Coelho DRA, Litwiler ST, McEachern KM, Clancy JA, Morales-Quezada L, Cassano P. Neuropathic pain, mood, and stress-related disorders: A literature review of comorbidity and co-pathogenesis. Neurosci Biobehav Rev 2024; 161:105673. [PMID: 38614452 DOI: 10.1016/j.neubiorev.2024.105673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/02/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
Neuropathic pain can be caused by multiple factors, and its prevalence can reach 10% of the global population. It is becoming increasingly evident that limited or short-lasting response to treatments for neuropathic pain is associated with psychological factors, which include psychiatric comorbidities known to affect quality of life. It is estimated that 60% of patients with neuropathic pain also experience depression, anxiety, and stress symptoms. Altered mood, including stress, can be a consequence of several painful conditions but can also favor pain chronicization when preexisting. Despite the apparent tight connection between clinical pain and mood/stress disorders, the exact physiological mechanisms remain unclear. This review aims to provide an overview of state-of-the-art research on the mechanisms of pain related to the pathophysiology of depression, anxiety, and stress disorders.
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Affiliation(s)
- Willians Fernando Vieira
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA; Department of Psychiatry, Harvard Medical School (HMS), Boston, USA; Department of Anatomy, Institute of Biomedical Sciences (ICB), University of São Paulo (USP), São Paulo, Brazil.
| | - David Richer Araujo Coelho
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA; Department of Psychiatry, Harvard Medical School (HMS), Boston, USA; Harvard T. H. Chan School of Public Health (HSPH), Boston, USA
| | - Scott Thomas Litwiler
- Center for Computational and Integrative Biology (CCIB), Massachusetts General Hospital (MGH), Boston, USA
| | - Kayla Marie McEachern
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA
| | - Julie A Clancy
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA
| | - Leon Morales-Quezada
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, USA
| | - Paolo Cassano
- Division of Neuropsychiatry and Neuromodulation, Massachusetts General Hospital (MGH), Boston, USA; Department of Psychiatry, Harvard Medical School (HMS), Boston, USA
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Friedman JK, Taylor BC, Campbell EH, Allen K, Bangerter A, Branson M, Bronfort G, Calvert C, Cross LJS, Driscoll MA, Evans R, Ferguson JE, Haley A, Hennessy S, Meis LA, Burgess DJ. Gender differences in PTSD severity and pain outcomes: Baseline results from the LAMP trial. PLoS One 2024; 19:e0293437. [PMID: 38753651 PMCID: PMC11098421 DOI: 10.1371/journal.pone.0293437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 05/01/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD symptoms. AIM Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial. METHODS Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms. RESULTS Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting gender differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05). CONCLUSION These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.
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Affiliation(s)
- Jessica K. Friedman
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health Care System (VAGLACS), Los Angeles, California, United States of America
| | - Brent C. Taylor
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Emily Hagel Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
| | - Kelli Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VAHCS, Durham, North Carolina, United States of America
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ann Bangerter
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
| | - Mariah Branson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
| | - Gert Bronfort
- Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Collin Calvert
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Lee J. S. Cross
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
| | - Mary A. Driscoll
- VA Connecticut Healthcare System, West Haven, Connecticut, United States of America
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Ronni Evans
- Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - John E. Ferguson
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
| | - Alex Haley
- Integrative Health & Wellbeing Research Program, Earl E. Bakken Center for Spirituality & Healing, School of Nursing, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sierra Hennessy
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
| | - Laura A. Meis
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
- Women’s Health Sciences Division, National Center for PTSD, Boston, Massachusetts, United States of America
| | - Diana J. Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, Minnesota, United States of America
- University of Minnesota Medical School, Minneapolis, Minnesota, United States of America
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10
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Shields RE, Teckchandani TA, Andrews KL, Ahlgrim B, Caissie DM, Hembroff CC, Nisbet J, Asmundson GJG, Krätzig GP, Carleton RN. Prevalence of current chronic pain in Royal Canadian Mounted Police cadets. Can J Pain 2024; 8:2354394. [PMID: 38915304 PMCID: PMC11195451 DOI: 10.1080/24740527.2024.2354394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/08/2024] [Indexed: 06/26/2024]
Abstract
Background Nearly half of active duty Royal Canadian Mounted Police (RCMP) officers report experiencing current chronic pain (43%; i.e. pain lasting longer than 3 months). Most RCMP officers who report chronic pain indicate that the pain started after working as RCMP officers (91%). Baseline data on chronic pain prevalence among RCMP cadets has not been available. Aims The current study was designed to provide cross-sectional estimates of chronic pain prevalence among RCMP cadets starting the Cadet Training Program and to assess for sociodemographic differences among participants. Methods The RCMP Study uses a longitudinal prospective sequential experimental cohort design to create a clustered randomized trial that engages individual participants for 5.5 years. The current article provides cross-sectional associations between chronic pain prevalence and sociodemographic characteristics. Participants were RCMP cadets starting the Cadet Training Program (n = 770). Location, intensity (on a 0-10 scale and days per week experienced), and duration (number of months) of chronic pain were reported. Differences across sociodemographic characteristics were examined. Results Few RCMP cadets reported experiencing chronic pain (10%); lower back pain was rated as the most severe in terms of intensity and duration and second most frequently reported in number of days experienced per week. Prevalence of chronic pain was lower among RCMP cadets than among RCMP officers. Conclusions Chronic pain prevalence among active duty RCMP officers may result from or be moderated by operational duties, as well as routine aging. Future researchers could examine ways to mitigate chronic pain development during RCMP officer careers.
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Affiliation(s)
- Robyn E. Shields
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Taylor A. Teckchandani
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
| | - Katie L. Andrews
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
| | - Billea Ahlgrim
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Danielle M. Caissie
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Chet C. Hembroff
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Jolan Nisbet
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
| | - Gordon J. G. Asmundson
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Gregory P. Krätzig
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - R. Nicholas Carleton
- Canadian Institute for Public Safety Research and Treatment–Institut Canadien de recherché et de traitement en sécurité publique (CIPSRT-ICRTSP), Regina, Saskatchewan, Canada
- Anxiety and Illness Behaviours Lab, Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
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11
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Duque RH, Andrade CVC, Campos VR, Moulaz IR, Albertino LF, de Oliveira Gavi MBR. Cross-sectional study of psychiatric disorders in patients with chronic musculoskeletal pain and individuals without pain. Adv Rheumatol 2024; 64:40. [PMID: 38730423 DOI: 10.1186/s42358-024-00375-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Musculoskeletal chronic pain is a leading cause of global disability and laboral incapacity. However, there is a lack of population-based studies that investigate the relationship between chronic pain and mental disorders with a control group, particularly among low- and middle-income countries. Chronic pain is a serious public health problem in terms of human suffering, and in terms of socioeconomic implications. Frequent association with different mental disorders increases disability, decreases quality of life, and makes diagnosis and treatment challenging. The present study aimed to evaluate the presence of mental disorders in patients with chronic musculoskeletal pain and compare with a control group without pain. METHODS We selected 100 patients in a regular follow-up at the Musculoskeletal Pain Outpatient Clinic of the University Hospital and compared them with 100 painless individuals from the control group from June 2016 to June 2018. The instruments used were the Mini International Neuropsychiatric Interview (MINI-PLUS) and a structured questionnaire to collect sociodemographic data. Statistical analysis used t-test, chi-square, Fisher's exact test, Mann-Whitney, Kolmogorov-Smirnov tests, and multiple logistic regression. RESULTS In the sample evaluated, the majority of patients were women (83%), of brown color (54%), with lower-level education (51%), lower salary range (73%) and high absenteeism rate at work (60,7%). Patients with chronic pain had more psychiatric disorders (88% vs. 48% in the control group; p < 0.001). The most frequent diagnoses were anxiety disorders with panic attacks (44%), generalized anxiety (36%), mixed anxiety and depression disorder (33%), social phobia (30%), agoraphobia (29%), suicide risk (28%), and major depression (27%). CONCLUSION Positive correlations of mental disorders and chronic musculoskeletal pain have been documented. This suggests that psychiatric components must be taken into account in the management of chronic pain syndromes. The use of Mini Plus as a diagnostic tool for psychiatric disorders can contribute to optimizing the diagnosis and treatment of patients with chronic pain and encourage the creation of policies with strategies and criteria for quick access to Multi-professional Services.
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Affiliation(s)
- Ruben Horst Duque
- Rheumatology Department, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Carla Vasconcelos Cáspar Andrade
- Neuromusculoskeletal Unit, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Vitoria, ES, Brazil
| | - Valdir Ribeiro Campos
- Psychiatry Service, Internal Medicine Department, University Hospital Cassiano Antonio Moraes, Federal University of Espirito Santo, Vitoria, ES, Brazil
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12
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Tutelman PR, Noel M, Bernier E, Schulte FSM, Kopala-Sibley DC. Adverse Childhood Experiences Moderate the Relationship Between Pain and Later Suicidality Severity Among Youth: A Longitudinal High-Risk Cohort Study. THE JOURNAL OF PAIN 2024:104554. [PMID: 38719156 DOI: 10.1016/j.jpain.2024.104554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/22/2024] [Accepted: 04/27/2024] [Indexed: 06/16/2024]
Abstract
Pain in adolescence can lead to the development of serious mental health issues, including suicidality. This risk may be strengthened among youth exposed to more adverse childhood experiences (ACEs; abuse, neglect, household challenges). This longitudinal study examined the role of ACEs in the relationship between pain and later suicidality onset and severity among a cohort of adolescents at risk for developing mental health problems. Participants were 139 healthy youth (Mage = 13.74 years, standard deviation = 1.56, 64% female) between the ages of 11 to 17 years, recruited based on parental history of depression or anxiety. Youth completed validated measures of internalizing symptoms, ACEs, and pain characteristics at baseline and follow-up diagnostic interviews 9 and/or 18 months later to assess for onset and severity of suicidality. After controlling for demographics, baseline internalizing symptoms, and ACEs, worse pain interference and increased ACEs at baseline predicted increased suicidality severity at follow-up. Moderation analyses revealed that there was a significant interaction between ACEs and pain interference and pain intensity. Increased pain interference (b = 7.65, P < .0001) or intensity (b = 6.96, P = .0003) was only associated with increased suicidality severity at follow-up in youth with high levels of ACEs. This study demonstrates that ACEs strengthen the relationship between pain and later suicidality severity among youth at risk of developing mental health problems. Findings underscore the critical need to adopt a trauma-informed lens to pediatric pain prevention and treatment (eg, screening for ACEs) and for the pain to be on the child's mental health agenda. PERSPECTIVE: This article provides evidence that, while pain is a risk factor for future increased suicidality severity, it is a particularly strong risk factor in youth who experienced increased childhood adversity. These results may help identify youth at greatest risk for suicidality.
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Affiliation(s)
- Perri R Tutelman
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada; Owerko Centre, Calgary, Alberta, Canada
| | - Emily Bernier
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Fiona S M Schulte
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Daniel C Kopala-Sibley
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada; Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada; Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
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13
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Olayinka O, Alemu BT, Nkemjika S, Barry DT. Nationwide Assessment of Chronic Pain among Hospitalized Individuals with Co-occurring Post Traumatic Stress Disorder and Substance Use Disorder in the United States. J Dual Diagn 2024:1-10. [PMID: 38704860 DOI: 10.1080/15504263.2024.2347489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Objective: Chronic pain (CP) is independently associated with substance use disorders (SUD) and posttraumatic stress disorder (PTSD). However, little is known about factors associated with CP among patients with co-occurring PTSD and SUD. Patterns of hospital resource usage should also be explored further. Methods: Using the 2019 National Inpatient Sample (NIS), we identified 216,125 hospital discharges with co-occurring diagnoses of PTSD and SUD in 2019 and examined their association with CP. Multivariable logistic regression models were used to identify factors associated with an increased likelihood of CP in this cohort. Results: Among those with co-occurring PTSD and SUD (N = 216,125), 35,450 had associated CP, a prevalence of 164.02 cases per 1,000 discharges (95% CI [160.54, 167.52]). Individuals aged 55-64 with co-occurring PTSD and SUD were approximately 7.2 times more likely to experience CP, compared to those aged 16-24 (OR = 7.2; 95% CI [6.09, 8.60]). Being in the CP group was associated with 50% increased odds of insomnia and obesity (OR = 1.5; 95% CI [1.12, 2.03] and OR = 1.5; 95% CI [1.38, 1.55], respectively), 30% increased odds of anxiety (OR = 1.3; 95% CI [1.24, 1.38]), 20% increased odds of attention deficit disorder (ADD;OR = 1.2; 95% CI [1.12, 1.38]) and 10% increased odds of depression (OR = 1.1; 95% CI [1.01, 1.14]). Compared with females, being male was associated with slightly decreased odds of CP (OR = 0.9; 95% CI [0.84, 0.94]). Conclusions: Among hospitalized Americans with co-occurring PTSD and SUD, advanced age, being female, and the presence other mental health disorders were associated with an increased risk of CP. Providers treating co-occurring PTSD/SUD should evaluate for and consider evidence-based management of CP if present.
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Affiliation(s)
- Olaniyi Olayinka
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Brook T Alemu
- Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, New York, USA
| | - Declan T Barry
- The APT Foundation, New Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Child Study Center, Yale School of Medicine, New Haven, Connecticut, USA
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14
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Tandon T, Piccolo M, Ledermann K, McNally RJ, Gupta R, Morina N, Martin-Soelch C. Mental health markers and protective factors in students with symptoms of physical pain across WEIRD and non-WEIRD samples - a network analysis. BMC Psychiatry 2024; 24:318. [PMID: 38658915 PMCID: PMC11044470 DOI: 10.1186/s12888-024-05767-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Studies conducted in Western societies have identified variables associated with chronic pain, but few have done so across cultures. Our study aimed to clarify the relationship between specific mental health markers (i.e., depression, anxiety, posttraumatic stress disorder [PTSD], perceived stress) as well as specific protective factors (i.e., social support and self-efficacy) related to physical pain among university students across non-WEIRD and WEIRD samples. METHOD A total of 188 university students (131 women and 57 men) were included in the study. We used network analysis to ascertain mental health markers especially central to the experience of physical pain. RESULTS No statistically significant difference was found between mental health markers (i.e., depression, anxiety, perceived stress, and PTSD) and protective factors (i.e., social support and self-efficacy) associated with physical pain symptoms for Swiss students versus Indian students (M = 0.325, p = .11). In addition, networks for Swiss versus Indian students did not differ in global strength (S = 0.29, p = .803). Anxiety was the most central mental health marker, and social support was the most important protective factor related to physical pain in both countries. However, for Swiss students, perceived stress, and for Indian students, PTSD symptoms were central mental health markers related to physical pain. CONCLUSION Our results identify factors that may serve as important treatment targets for pain interventions among students of both countries before it becomes chronic.
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Affiliation(s)
- Tanya Tandon
- Unit of Clinical and Health Psychology, University of Fribourg, Rue de Faucigny 2, CH-1700, Fribourg, Switzerland.
| | - Mayron Piccolo
- Department of Psychology, Harvard University, Cambridge, USA
| | - Katharina Ledermann
- Unit of Clinical and Health Psychology, University of Fribourg, Rue de Faucigny 2, CH-1700, Fribourg, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Rashmi Gupta
- Cognitive and Behavioural Neuroscience Laboratory, Department of Humanities and Social, Sciences, Indian Institute of Technology Bombay, Mumbai, India
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Chantal Martin-Soelch
- Unit of Clinical and Health Psychology, University of Fribourg, Rue de Faucigny 2, CH-1700, Fribourg, Switzerland
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15
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Lund T, Bernier E, Roman-Juan J, Kopala-Sibley DC, Soltani S, Noyek S, Nania C, Beveridge J, Hoppe T, O'Connor R, O'Connor C, Clemens J, Mychasiuk R, Asmundson G, Stinson J, Noel M. Pain and Post-traumatic Stress Disorder Symptoms: Dyadic Relationships Between Canadian Armed Forces Members/Veterans With Chronic Pain and Their Offspring. THE JOURNAL OF PAIN 2024:104516. [PMID: 38580101 DOI: 10.1016/j.jpain.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/29/2024] [Accepted: 03/24/2024] [Indexed: 04/07/2024]
Abstract
Chronic pain and mental health issues occur at higher rates in Veterans than the general population. One widely recognized mental health issue faced by Veterans is post-traumatic stress disorder (PTSD). Trauma symptoms and pain frequently co-occur and are mutually maintained due to shared mechanisms. Many Veterans are also parents. Parental physical and mental health issues significantly predict children's chronic pain and related functioning, which can continue into adulthood. Only 1 U.S.-based study has examined pain in the offspring of Veterans, suggesting a heightened risk for pain. Research to date has not examined the associations between trauma and pain and the dyadic influences of these symptoms, among Veterans, and their children. The current study aimed to describe pain characteristics in Canadian Armed Forces Members/Veterans with chronic pain and their offspring (youth and adult children aged 9-38). Cross-lagged panel models were conducted to examine dyadic relationships between pain interference and trauma symptoms of Canadian Armed Forces Members/Veterans and their offspring. Over half of adult offspring and over one-quarter of youth offspring reported chronic pain. Results revealed effects between one's own symptoms of PTSD and pain interference. No significant effects of parents on offspring or offspring on parents were found. The findings highlight the interconnection between pain and PTSD consistent with mutual maintenance models and a lack of significant interpersonal findings suggestive of resiliency in this unique population. PERSPECTIVE: We characterized chronic pain in the offspring of Canadian Armed Forces Members/Veterans with chronic pain and examined dyadic relationships between PTSD symptoms and chronic pain interference. Findings revealed that PTSD symptoms and pain interference were related within Veterans and offspring, but no dyadic relationships were found, which could reflect resiliency.
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Affiliation(s)
- Tatiana Lund
- Department of Psychology, University of Calgary, Calgary, Canada.
| | - Emily Bernier
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Josep Roman-Juan
- Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | | | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Samantha Noyek
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Cara Nania
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Jaimie Beveridge
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Tom Hoppe
- The Chronic Pain Centre of Excellence for Canadian Veterans, Hamilton, Canada; Person with Lived Experience, Canada
| | | | | | | | | | | | - Jennifer Stinson
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
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16
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Polhill SE, Lape EC, Deyo AG, Smit T, Zvolensky MJ, Zale EL, Ditre JW. Pain Intensity, Pain-Related Anxiety, and Hazardous Drinking Among Individuals With PTSD. J Dual Diagn 2024; 20:122-131. [PMID: 38408374 DOI: 10.1080/15504263.2024.2319034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
OBJECTIVE Evidence suggests that pain intensity may be indirectly linked to hazardous drinking and PTSD symptom severity via pain-related anxiety. The goal of this analysis was to test the hypotheses in a population with PTSD symptoms that pain intensity would be positively and indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via pain-related anxiety. METHODS Heavy drinkers with probable PTSD were recruited via Qualtrics panels (N = 371, 53% Female, Mage = 39.68, SD = 10.86). Linear regression and conditional process models were conducted to examine indirect associations between pain intensity and primary outcomes via pain-related anxiety. RESULTS Pain intensity was found to be indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via greater pain-related anxiety. CONCLUSION These initial findings suggest that pain-related anxiety may play an important role in relations between the experience of pain and hazardous patterns of alcohol consumption among individuals with probable PTSD. Future research is needed to determine the temporal nature of these associations and to examine the potential utility of treatments that address pain-related anxiety in the context of comorbid pain, PTSD, and hazardous drinking.
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Affiliation(s)
- Sarah E Polhill
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Emma C Lape
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - T Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - M J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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17
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Hadlandsmyth K, Driscoll MA, Johnson NL, Mares JG, Mengeling MA, Thomas EBK, Norman SB, Lund BC. Veterans with chronic pain: Examining gender differences in pain type, overlap, and the impact of post-traumatic stress disorder. Eur J Pain 2024. [PMID: 38450917 DOI: 10.1002/ejp.2258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/08/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Women are more likely to experience multiple overlapping pain conditions (MOPCs) relative to men. Post-traumatic stress disorder can negatively impact the severity and trajectory of chronic pain and its treatment. Specific associations between gender, post-traumatic stress disorder (PTSD), and MOPCs require further examination. METHODS A cohort of all Veterans in 2021 who met criteria for one or more of 12 chronic pain types was created using national Veterans Health Administration administrative data. MOPCs were defined as the number of pain types for which each patient met criteria. Multivariable logistic regression models estimated gender differences in frequency for each of the 12 pain subtypes, after controlling for demographics and comorbidities. Negative binomial regression was used to estimate gender differences in the count of MOPCs and to explore moderation effects between gender and PTSD. RESULTS The cohort included 1,936,859 Veterans with chronic pain in 2021, which included 12.5% women. Among those with chronic pain, women Veterans had higher rates of MOPCs (mean = 2.3) relative to men (mean = 1.9): aIRR = 1.31, 95% CI: 1.30-1.32. PTSD also served as an independent risk factor for MOPCs in adjusted analysis (aIRR = 1.23, 95% CI: 1.23-1.24). The interaction term between gender and PTSD was not significant (p = 0.87). Independent of PTSD, depressive disorders also served as a strong risk factor for MOPCs (aIRR = 1.37, 95% CI: 1.36-1.37). CONCLUSIONS Individuals with MOPCs and PTSD may have complex treatment needs. They may benefit from highly coordinated trauma-sensitive care and integrated interventions that simultaneously address pain and PTSD. SIGNIFICANCE Women were significantly more likely than men to experience MOPCs. PTSD was also significantly, independently, associated with MOPCs. Patients, particularly women, may benefit from tailored interventions that address both trauma and MOPCs.
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Affiliation(s)
- Katherine Hadlandsmyth
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Mary A Driscoll
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nicole L Johnson
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Jasmine G Mares
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
| | - Michelle A Mengeling
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Emily B K Thomas
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Psychological and Brain Sciences, University of Iowa College of Liberal Arts and Sciences, Iowa City, Iowa, USA
| | - Sonya B Norman
- National Center for PTSD, White River Junction, Vermont, USA
- University of California San Diego School of Medicine, La Jolla, California, USA
| | - Brian C Lund
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa, USA
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, Iowa, USA
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18
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Emrich M, Gnall KE, Garnsey CL, George JR, Park CL, Mazure CM, Hoff RA. Associations of Posttraumatic Stress Disorder Symptom Clusters and Pain Interference in Post-9/11 Veterans: Exploring Sleep Impairment and Physical Activity as Underlying Mechanisms. Int J Behav Med 2024:10.1007/s12529-024-10268-4. [PMID: 38438749 DOI: 10.1007/s12529-024-10268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptoms and pain are highly prevalent and comorbid, particularly in veterans, but mechanisms explaining their linkage remain unclear. The aims of this study were to determine: (1) whether sleep impairment and physical activity (PA) mediate relations between PTSD symptoms and pain interference (assessed both longitudinally and as residual change) and (2) the unique roles of each PTSD symptom cluster in those relationships. METHODS The present study is a secondary analysis of a longitudinal observational investigation of 673 post-9/11 veterans (45.8% women). Surveys were administered at baseline and 3-month and 6-month follow-ups. RESULTS PTSD symptoms were significantly associated with pain interference longitudinally and worsening pain interference over time. Sleep impairment, but not PA, significantly mediated the relationship between PTSD symptoms and subsequent pain interference. Hyperarousal symptoms were found to be the primary driver of the relationship between PTSD symptoms and pain interference and re-experiencing symptoms were associated with change in pain interference via sleep impairment. Men and women did not differ on any of the study variables with the exception of PA. CONCLUSION Findings underscore the importance of targeting sleep as a key modifiable health factor linking PTSD symptoms to pain interference in post-9/11 veterans.
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Affiliation(s)
- Mariel Emrich
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA.
| | - Katherine E Gnall
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Camille L Garnsey
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Jamilah R George
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269-1020, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Women's Health Research at Yale, Yale University School of Medicine, New Haven, CT, USA
| | - Rani A Hoff
- Northeast Program Evaluation Center (NEPEC), VA Connecticut Healthcare System, West Haven, CT, USA
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19
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Samant P, Tawde P, Tawde DN. Understanding How Patients With Lumbar Radiculopathy Make Sense of and Cope With Their Symptoms. Cureus 2024; 16:e56987. [PMID: 38665744 PMCID: PMC11045257 DOI: 10.7759/cureus.56987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Lumbar radiculopathy, characterized by pain radiating along a nerve root, significantly diminishes the quality of life due to its neuropathic nature. Patients' understanding of their illness and the coping strategies they employ directly influence how they manage their condition. Understanding these illness representations from the patient's perspective is crucial for healthcare providers seeking to optimize treatment outcomes. This study adopted a qualitative interpretive/constructive paradigm to explore this dynamic. A qualitative evidence synthesis approach, utilizing best-fit framework synthesis for data extraction, was applied to analyze primary qualitative studies focused on patient experiences with lumbar radiculopathy. Using SPiDER (Sample, Phenomenon of interest, Design, Evaluation, Research type) to guide the search strategy, extracted data was mapped against the Common-Sense Model of Self-Regulation (CSM) framework. Sixteen studies, with moderate to minor methodological quality concerns, were included in the analysis. Data mapping across CSM domains generated 14 key review findings. Results suggest that patients with high-threat illness representations often exhibit maladaptive coping behaviors (e.g., activity avoidance) driven by emotional responses. In contrast, problem-solving techniques appear to contribute to positive outcomes (e.g., exercise adherence and effective self-management) in patients who perceive their condition as less threatening. These findings highlight the potential benefits of interventions designed to reduce perceived threat levels and enhance self-efficacy in patients with lumbar radiculopathy, leading to improved self-management and ultimately better health outcomes.
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Affiliation(s)
- Pooja Samant
- Physical Therapy, Cardiff University, Cardiff, GBR
| | - Poonam Tawde
- Medicine, Avalon University School of Medicine, Willemstad, CUW
- Medicine, Chandler Regional Medical Center, Chandler, USA
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20
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Vock S, Delker A, Rinderknecht J, Engel F, Wieland S, Beiner E, Friederich HC, Jarero IN, Seidler GH, Tesarz J. Group eye movement desensitization and reprocessing (EMDR) in chronic pain patients. Front Psychol 2024; 15:1264807. [PMID: 38455119 PMCID: PMC10919217 DOI: 10.3389/fpsyg.2024.1264807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
The prevalence of chronic pain is increasing, and conventional pain therapies often have limited efficacy in individuals with high levels of psychological distress and a history of trauma. In this context, the use of Eye Movement Desensitization and Reprocessing (EMDR), an evidence-based psychotherapy approach for the treatment of posttraumatic stress disorder, is becoming increasingly important. EMDR shows promising results, particularly for patients with pain and high levels of emotional distress. Although group therapy is becoming increasingly popular in pain management, EMDR has mainly been studied as an individual treatment. However, a systematic review suggests that group therapy can be an effective tool for improving mental health outcomes, especially when trauma is addressed together. Based on these findings, an outpatient EMDR group program was developed for patients with chronic pain. The program consists of a total of four treatment days with 5-5.5 h therapy sessions each day and provides patients with a supportive environment in which they can learn effective pain management strategies and interact with other patients with similar experiences. Initial pilot evaluations indicate high efficacy and adequate safety for patients with chronic pain.
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Affiliation(s)
- Stephanie Vock
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Anna Delker
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Janna Rinderknecht
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Felicitas Engel
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Sebastian Wieland
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Eva Beiner
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | | | | | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
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21
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Boyle SH, Upchurch J, Gifford EJ, Redding TS, Hauser ER, Malhotra D, Press A, Sims KJ, Williams CD. Military exposures and Gulf War illness in veterans with and without posttraumatic stress disorder. J Trauma Stress 2024; 37:80-91. [PMID: 37997023 DOI: 10.1002/jts.22994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 11/25/2023]
Abstract
Gulf War illness (GWI) is a chronic multisymptom disorder of unknown etiology that is believed to be caused by neurotoxicant exposure experienced during deployment to the Gulf War. Posttraumatic stress disorder (PTSD) covaries with GWI and is believed to play a role in GWI symptoms. The present study examined the association between self-reported military exposures and GWI, stratified by PTSD status, in veterans from the Gulf War Era Cohort and Biorepository who were deployed to the Persian Gulf during the war. Participants self-reported current GWI and PTSD symptoms as well as military exposures (e.g., pyridostigmine [PB] pills, pesticides/insecticides, combat, chemical attacks, and oil well fires) experienced during the Gulf War. Deployed veterans' (N = 921) GWI status was ascertained using the Centers for Disease Control and Prevention definition. Individuals who met the GWI criteria were stratified by PTSD status, yielding three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression, adjusted for covariates, was used to examine associations between GWI/PTSD groups and military exposures. Apart from insect bait use, the GWI+/PTSD+ group had higher odds of reporting military exposures than the GWI+/PTSD- group, adjusted odds ratio (aOR) = 2.15, 95% CI [1.30, 3.56]-aOR = 6.91, 95% CI [3.39, 14.08]. Except for PB pills, the GWI+/PTSD- group had a higher likelihood of reporting military exposures than the GWI- group, aOR = 2.03, 95% CI [1.26, 3.26]-aOR = 4.01, 95% CI [1.57, 10.25]. These findings are consistent with roles for both PTSD and military exposures in the etiology of GWI.
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Affiliation(s)
- Stephen H Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Julie Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Elizabeth J Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - Thomas S Redding
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Elizabeth R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, North Carolina, USA
| | | | - Ashlyn Press
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Kellie J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - Christina D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
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22
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Kovacevic M, Montes M, Tirone V, Pridgen S, Smith DL, Burns JW, Held P. Treating a common comorbidity: Pain outcomes following a 3-week cognitive processing therapy-based intensive treatment for posttraumatic stress disorder address. J Trauma Stress 2024; 37:47-56. [PMID: 38091254 DOI: 10.1002/jts.22979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/15/2023] [Accepted: 09/28/2023] [Indexed: 02/13/2024]
Abstract
Posttraumatic stress disorder (PTSD) commonly co-occurs with pain and has been implicated in the maintenance of chronic pain. However, limited research has examined whether intervening for PTSD can hinder or optimize treatment outcomes for co-occurring pain and PTSD. In the present study, we examined changes in pain, PTSD, and depressive symptoms among 125 veterans completing a 3-week cognitive processing therapy (CPT)-based intensive treatment program (ITP) for PTSD. We also explored whether pretreatment pain interference predicted changes in PTSD and depressive symptom severity and whether larger changes in pain interference over the course of treatment were associated with larger changes in PTSD and depressive symptom severity. Linear mixed models revealed that participants' pain interference decreased throughout treatment, d = 0.15, p = .039. Higher levels of pretreatment pain interference were associated with higher PTSD, p = .001, and depressive symptom severity, p = .014, over time. Larger reductions in pain interference corresponded to more improvement in PTSD symptoms, β = -.03; p < .001, but not depressive symptoms. These findings indicate that ITPs for PTSD can reduce pain interferences, albeit to a small degree, and that reductions in pain interference can contribute to reductions in PTSD symptom severity. Future studies should examine which treatment components contribute to larger changes in symptom severity for veterans with co-occurring pain and PTSD.
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Affiliation(s)
- Merdijana Kovacevic
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Mauricio Montes
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Vanessa Tirone
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sarah Pridgen
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Dale L Smith
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - John W Burns
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
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23
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Gao Q, Liu MQ, Li JX, Wang Y, Zhang Y, Zhu H. Sex differences in stress-induced hyperalgesia and its mechanisms. J Neurosci Res 2024; 102:e25266. [PMID: 38284853 DOI: 10.1002/jnr.25266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/26/2023] [Accepted: 10/08/2023] [Indexed: 01/30/2024]
Abstract
Chronic stress induces a variety of physiological and/or psychological abnormalities, including hyperalgesia. Researchers have discovered sex differences in the prevalence of stress-induced hyperalgesia (SIH) in recent years. Sex differences may be one of the reasons for the heterogeneity of susceptibility to stress-related diseases. In this review, the potential mechanisms of sex differences in SIH are discussed, such as hypothalamus-pituitary-adrenal axis responses, regulation of sex hormones, and immune system responses.
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Affiliation(s)
- Qiang Gao
- Department of Physiology, Harbin Medical University, Harbin, P. R. China
| | - Mei-Qi Liu
- Department of Physiology, Harbin Medical University, Harbin, P. R. China
| | - Jia-Xin Li
- Department of Physiology, Harbin Medical University, Harbin, P. R. China
| | - Yi Wang
- Biotechnology Experimental Teaching Center, Harbin Medical University, Harbin, P. R. China
| | - Ying Zhang
- Department of Physiology, Harbin Medical University, Harbin, P. R. China
| | - Hui Zhu
- Department of Physiology, Harbin Medical University, Harbin, P. R. China
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24
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Kupin AAH, Banerjee S, Banerjee N, Roy SH, Kline JC, Shiwani B. System Architecture for VR Yoga Therapy Platform with 6-DoF Whole-Body Avatar Tracking. ... IEEE INTERNATIONAL CONFERENCE ON ARTIFICIAL INTELLIGENCE AND VIRTUAL REALITY. IEEE INTERNATIONAL CONFERENCE ON ARTIFICIAL INTELLIGENCE AND VIRTUAL REALITY 2024; 2024:360-366. [PMID: 38737316 PMCID: PMC11086690 DOI: 10.1109/aixvr59861.2024.00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Chronic pain is a leading cause of morbidity among children and adolescents affecting 35% of the global population. Pediatric chronic pain management requires integrative health methods spanning physical and psychological subsystems through various mind-body interventions. Yoga therapy is one such method, known for its ability to improve the quality of life both physically and psychologically in chronic pain conditions. However, maintaining the clinical outcomes of personalized yoga therapy sessions at-home is challenging due to fear of movement, lack of motivation, and boredom. Virtual Reality (VR) has the potential to bridge the gap between the clinic and home by motivating engagement and mitigating pain-related anxiety or fear of movement. We developed a multi-modal algorithmic architecture for fusing real-time 3D human body pose estimation models with custom developed inverse kinematics models of physical movement to render biomechanically informed 6-DoF whole-body avatars capable of embodying an individual's real-time yoga poses within the VR environment. Experiments conducted among control participants demonstrated superior movement tracking accuracy over existing commercial off-the-shelf avatar tracking solutions, leading to successful embodiment and engagement. These findings demonstrate the feasibility of rendering virtual avatar movements that embody complex physical poses such as those encountered in yoga therapy. The impact of this work moves the field one step closer to an interactive system to facilitate at-home individual or group yoga therapy for children with chronic pain conditions.
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Drusko A, Renz M, Schmidt H, Schlömp L, Papaiannou V, Schmidt N, Tost H, Treede RD, Eich W, Tesarz J. Clinical Phenomenology of Fibromyalgia Syndrome in Male Patients: Same But Different. THE JOURNAL OF PAIN 2023; 24:2162-2174. [PMID: 37422159 DOI: 10.1016/j.jpain.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/25/2023] [Accepted: 06/30/2023] [Indexed: 07/10/2023]
Abstract
The majority of knowledge about fibromyalgia syndrome (FMS) derives from studies of female patients. Little is known about the clinical characteristics and treatment outcomes of male patients with FMS. In this retrospective cohort study with a prospective posttreatment follow-up, we investigated whether male patients with FMS differ from female patients in terms of 1) symptom burden, 2) psychological characteristics, and 3) clinical treatment response. We identified 263 male (4%) out of 5,541 patients with FMS completing a 3-week multimodal pain-treatment program. Male patients (51.3 ± 9.1 years) were age- and time-matched (1:4) with female patients (N = 1,052, 51.3 ± 9.0 years). Data on clinical characteristics, psychological comorbidities, and treatment responses were obtained from medical records and validated questionnaires. Levels of perceived pain, psychological comorbidity, and functional capacity were similar between genders, although male patients with FMS showed a higher prevalence of alcohol abuse. Compared to female patients, male patients experienced themselves less often as overly accommodating (Cohen's d = -.42) but more often as self-sacrificing (d = .26) or intrusive (d = .23). Regarding pain coping, male patients were less likely to utilize mental distraction, rest- and relaxation techniques, or counteractive activities (d = .18-.27). Male patients showed a slightly worse overall response rate than women (69% vs 77%), although differences between individual outcome measures were small (d < .2). Although male and female patients in our cohort were similar in clinical presentation and treatment response, the gender-specific differences in interpersonal problems and pain coping suggest consideration of these aspects in the treatment of male patients with FMS. PERSPECTIVE: Knowledge about fibromyalgia mostly derives from studies of female patients. Identifying and understanding gender-specific differences in fibromyalgia is an important roadmap in the treatment of this syndrome by focusing on specific gender aspects such as differences in interpersonal problems and pain coping mechanisms.
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Affiliation(s)
- Armin Drusko
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Malika Renz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Hannah Schmidt
- Department of Neurophysiology, MCTN, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Lea Schlömp
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | | | - Norbert Schmidt
- ACURA Clinic of Psychosomatic Medicine, Baden-Baden, Baden-Württemberg, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Rolf-Detlef Treede
- Department of Neurophysiology, MCTN, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Wolfgang Eich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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Saba SK, Davis JP, Bricker JB, Christie NC, Pedersen ER. Pain Trajectories among U.S. Veterans During COVID-19. THE JOURNAL OF PAIN 2023; 24:2093-2102. [PMID: 37414327 PMCID: PMC10615718 DOI: 10.1016/j.jpain.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
Physical pain is highly prevalent among military veterans. As stress can impact pain, COVID-19-related stressors may have heightened pain among veterans. A prospective analysis of pain could advance understanding of how veterans fared during COVID-19 and lend knowledge of risk factors important beyond the pandemic. The present study employs growth mixture modeling with a sample of U.S. veterans high in pain (N = 1,230) followed from just before COVID-19 (February 2020) to 12 months later (February 2021; 81.7% retention). We explored heterogeneous pain trajectories as well as baseline and COVID-19-related predictors of pain. Results revealed 4 pain trajectory classes: 1) Chronic Pain (17.3% of the sample); 2) Decreasing Pain (57.2% of the sample); 3) Stable Mild Pain (19.8% of the sample); and 4) Increasing Pain (5.7% of the sample). Those with childhood trauma exposure were especially likely to report chronic pain. Female and racial/ethnic minority veterans were also relatively likely to fare poorly in pain. Loneliness was associated with subsequent pain among several classes. Most veterans in our sample fared better than expected in terms of pain. However, as those with childhood trauma and certain disadvantaged groups were less likely to fare well, we add to the important literature on disparities in pain. Clinicians should identify whether loneliness and other factors impacted pain during COVID-19 among their patients to inform ongoing, person-centered pain management approaches. PERSPECTIVE: This article presents pain trajectories and correlates of pain among a high-pain sample of U.S. veterans surveyed prior to and during COVID-19. Pain clinicians should screen for childhood trauma and remain vigilant in addressing health disparities.
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Affiliation(s)
- Shaddy K. Saba
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34 St, Los Angeles, CA 90089
| | - Jordan P. Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society; USC Center for Mindfulness Science; USC Institute for Addiction Science, 669 W. 34 St, Los Angeles, CA 90089
| | - Jonathan B. Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences; University of Washington, Department of Psychology, 1100 Fairview Avenue North, Seattle, WA 98109
| | - Nina C. Christie
- University of Southern California, Department of Psychology, 3620 McClintock Avenue, Los Angeles, CA 90089
| | - Eric R. Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 2250 Alcazar Street, Suite 2200, Los Angeles, CA 90033
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27
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Turner AP, Arewasikporn A, Hawkins EJ, Suri P, Burns SP, Leipertz SL, Haselkorn JK. Risk Factors for Chronic Prescription Opioid Use in Multiple Sclerosis. Arch Phys Med Rehabil 2023; 104:1850-1856. [PMID: 37137460 DOI: 10.1016/j.apmr.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 01/31/2023] [Accepted: 04/10/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To characterize patterns of prescription opioid use among individuals with multiple sclerosis (MS) and identify risk factors associated with chronic use. DESIGN Retrospective longitudinal cohort study examining US Department of Veterans Affairs electronic medical record data of Veterans with MS. The annual prevalence of prescription opioid use by type (any, acute, chronic, incident chronic) was calculated for each study year (2015-2017). Multivariable logistic regression was used to identify demographics and medical, mental health, and substance use comorbidities in 2015-2016 associated with chronic prescription opioid use in 2017. SETTING US Department of Veterans Affairs, Veteran's Health Administration. PARTICIPANTS National sample of Veterans with MS (N=14,974). MAIN OUTCOME MEASURE Chronic prescription opioid use (≥90 days). RESULTS All types of prescription opioid use declined across the 3 study years (chronic opioid use prevalence=14.6%, 14.0%, and 12.2%, respectively). In multivariable logistic regression, prior chronic opioid use, history of pain condition, paraplegia or hemiplegia, post-traumatic stress disorder, and rural residence were associated with greater risk of chronic prescription opioid use. History of dementia and psychotic disorder were both associated with lower risk of chronic prescription opioid use. CONCLUSION Despite reductions over time, chronic prescription opioid use remains common among a substantial minority of Veterans with MS and is associated with multiple biopsychosocial factors that are important for understanding risk for long-term use.
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Affiliation(s)
- Aaron P Turner
- VA Puget Sound Health Care System, Seattle, WA; VA MS Center of Excellence West, Seattle, WA; Center of Excellence in Substance Addiction Treatment and Education, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
| | | | - Eric J Hawkins
- VA Puget Sound Health Care System, Seattle, WA; Center of Excellence in Substance Addiction Treatment and Education, Seattle, WA; Health Services Research & Development (HSR&D), Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Pradeep Suri
- VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA; Clinical Learning, Evidence, and Research Center (CLEAR), University of Washington, Seattle, WA
| | - Stephen P Burns
- VA Puget Sound Health Care System, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Steve L Leipertz
- VA Puget Sound Health Care System, Seattle, WA; VA MS Center of Excellence West, Seattle, WA
| | - Jodie K Haselkorn
- VA Puget Sound Health Care System, Seattle, WA; VA MS Center of Excellence West, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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28
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Friedman JK, Taylor BC, Hagel Campbell E, Allen K, Bangerter A, Branson M, Bronfort G, Calvert C, Cross L, Driscoll M, Evans R, Ferguson JE, Haley A, Hennessy S, Meis LA, Burgess DJ. Gender differences in PTSD severity and pain outcomes: baseline results from the LAMP trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.13.23296998. [PMID: 37873176 PMCID: PMC10593051 DOI: 10.1101/2023.10.13.23296998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD. Aim Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial. Methods Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms. Results Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05). Conclusion These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.
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Affiliation(s)
- J K Friedman
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - B C Taylor
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - E Hagel Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - K Allen
- Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VAHCS, Durham, NC
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Bangerter
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - M Branson
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - G Bronfort
- Integrative Health & Wellbeing Research Program, Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN
- University of Minnesota School of Nursing, Minneapolis, MN
| | - C Calvert
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - Ljs Cross
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - M Driscoll
- VA Connecticut Healthcare System, West Haven, CT
- Yale School of Medicine, New Haven, CT
| | - R Evans
- Integrative Health & Wellbeing Research Program, Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN
- University of Minnesota School of Nursing, Minneapolis, MN
| | - J E Ferguson
- University of Minnesota Medical School, Minneapolis, MN
| | - A Haley
- Integrative Health & Wellbeing Research Program, Bakken Center for Spirituality & Healing, University of Minnesota, Minneapolis, MN
- University of Minnesota School of Nursing, Minneapolis, MN
| | - S Hennessy
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
| | - L A Meis
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
- Women's Health Sciences Division, National Center for PTSD, Boston, MA
| | - D J Burgess
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
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29
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Choi SS, Yang SB, Lim MH, Lim JY, Kim KM, Lee Y, Shim SH, Kim MS, Chang HY. Psychological aftereffects experienced by sexually abused children: Psychopathological characteristics revealed by the K-CBCL. Medicine (Baltimore) 2023; 102:e34699. [PMID: 37747024 PMCID: PMC10519488 DOI: 10.1097/md.0000000000034699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/14/2023] [Accepted: 07/20/2023] [Indexed: 09/26/2023] Open
Abstract
Children who have been sexually abused may experience various short- and long-term psychological sequelae and behavioral problems. This study assessed the mental health of sexually abused children using the Korean-Child Behavior Checklist (K-CBCL) and examined differences from a control group. The participants were 97 children who had been sexually abused and who visited a local Sunflower Center, and 178 control participants. Data were collected via the K-CBCL and analyzed using SPSS version 25.0. T-tests, cross-tabulation, and logistic regression analyses were performed. Scores from the K-CBCL Problem Behavior Syndrome scale were compared between sexually abused children and the control participants. Significant differences were observed between the 2 groups in all the subscales. Compared to the control group, children who were sexually abused showed statistically significant differences in the total problem behavior, internalization, anxiety/depression, withdrawal/depression (withdrawn), somatic symptoms, externalization, rule-breaking behavior (delinquency), aggressive behavior, social immaturity, thought problems, attention problems, and other subscale scores. Sexual violence hurts the overall mental health of children who are abused, including their emotional, behavioral, and social factors. Our findings suggest that multidisciplinary assessment and treatment are required for children who have experienced sexual abuse.
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Affiliation(s)
- Sam Sik Choi
- Department of Psychology, Graduate School, Dankook University, Cheonan, Korea
| | - Saet Byeol Yang
- Department of Psychology, Graduate School, Dankook University, Cheonan, Korea
| | - Myung Ho Lim
- Department of Psychology, Graduate School, Dankook University, Cheonan, Korea
- Department of Psychology and Psychotherapy, College of Public Health Science, Dankook University, Cheonan, South Korea
| | - Ja Young Lim
- Sunflower Center of Southern Gyeonggi, Suwon, Korea
| | - Kyoung Min Kim
- Department of Psychiatry, College of Medicine, Dankook University, Cheonan, Korea
| | - Youngil Lee
- Department of Anatomy, College of Medicine, Dankook University, Cheonan, Korea
| | - Se-Hoon Shim
- Department of Psychiatry, College of Medicine, Soonchunhyang University, Asan, Korea
| | - Min Sun Kim
- Department of Psychology, Graduate School, Dankook University, Cheonan, Korea
- Department of Psychology and Psychotherapy, College of Public Health Science, Dankook University, Cheonan, South Korea
| | - Hyoung Yoon Chang
- Department of Psychiatry and Behavioral Sciences; Department of Mental Health Medicine, Ajou University School of Medicine, Suwon, Korea
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30
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Giummarra MJ, Reeder S, Williams S, Devlin A, Knol R, Ponsford J, Arnold CA, Konstantatos A, Gabbe BJ, Clarke H, Katz J, Mitchell F, Robinson E, Zatzick D. Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial. Disabil Rehabil 2023:1-17. [PMID: 37706486 PMCID: PMC10937328 DOI: 10.1080/09638288.2023.2254235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/29/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. MATERIALS AND METHODS Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. RESULTS Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. CONCLUSIONS Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma.IMPLICATIONS FOR REHABILITATIONAfter hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns.Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers.We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia.The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.
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Affiliation(s)
- Melita J. Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandra Reeder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Scott Williams
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia
| | - Anna Devlin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rose Knol
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Social Work, Alfred Health, Melbourne, Victoria, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, Victoria, Australia
| | - Carolyn A. Arnold
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia
- Academic Board of Anaesthesia & Perioperative Medicine, School of Medicine Nursing & Health Sciences, Monash University, Clayton, VIC, Australia
| | - Alex Konstantatos
- Department of Anaesthesia, The Alfred Hospital, Melbourne, VIC 3004, Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea, Wales, UK SA2 8PP
| | - Hance Clarke
- Department of Anaesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario Canada M5G 2C4
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Ontario Canada M5G 2C4
| | - Joel Katz
- Department of Anaesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario Canada M5G 2C4
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Ontario Canada M5G 2C4
- Department of Psychology, York University, Toronto, ON M3J 1P3
| | - Fiona Mitchell
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Patient and carer coinvestigators with lived experience of trauma
| | - Elizabeth Robinson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Patient and carer coinvestigators with lived experience of trauma
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
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Delgado-Sanchez A, Brown C, Sivan M, Talmi D, Charalambous C, Jones AKP. Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models. J Pain Res 2023; 16:3145-3166. [PMID: 37727681 PMCID: PMC10506671 DOI: 10.2147/jpr.s411628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/27/2023] [Indexed: 09/21/2023] Open
Abstract
Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.
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Affiliation(s)
- Ariane Delgado-Sanchez
- Division of Human Communication, Development, and Hearing, University of Manchester, Manchester, UK
| | - Christopher Brown
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Deborah Talmi
- Department of Psychology, University of Cambridge, Cambridge, UK
| | | | - Anthony K P Jones
- Division of Human Communication, Development, and Hearing, University of Manchester, Manchester, UK
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Hicks EM, Niarchou M, Goleva S, Kabir D, Ciarcia J, Smoller JW, Davis LK, Nievergelt CM, Koenen KC, Huckins LM, Choi KW. Comorbidity Profiles of Posttraumatic Stress Disorder Across the Medical Phenome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.25.23294572. [PMID: 37693435 PMCID: PMC10491282 DOI: 10.1101/2023.08.25.23294572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Prior epidemiological research has linked PTSD with specific physical health problems, but the comprehensive landscape of medical conditions associated with PTSD remains uncharacterized. Electronic health records (EHR) provide an opportunity to overcome prior clinical knowledge gaps and uncover associations with biological relevance that potentially vary by sex. Methods PTSD was defined among biobank participants (total N=123,365) in a major healthcare system using two ICD code-based definitions: broad (1+ PTSD or acute stress codes versus 0; NCase=14,899) and narrow (2+ PTSD codes versus 0; NCase=3,026). Using a phenome-wide association (PheWAS) design, we tested associations between each PTSD definition and all prevalent disease umbrella categories, i.e., phecodes. We also conducted sex-stratified PheWAS analyses including a sex-by-diagnosis interaction term in each logistic regression. Results A substantial number of phecodes were significantly associated with PTSDNarrow (61%) and PTSDBroad (83%). While top associations were shared between the two definitions, PTSDBroad captured 334 additional phecodes not significantly associated with PTSDNarrow and exhibited a wider range of significantly associated phecodes across various categories, including respiratory, genitourinary, and circulatory conditions. Sex differences were observed, in that PTSDBroad was more strongly associated with osteoporosis, respiratory failure, hemorrhage, and pulmonary heart disease among male patients, and with urinary tract infection, acute pharyngitis, respiratory infections, and overweight among female patients. Conclusions This study provides valuable insights into a diverse range of comorbidities associated with PTSD, including both known and novel associations, while highlighting the influence of sex differences and the impact of defining PTSD using EHR.
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Affiliation(s)
- Emily M Hicks
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Niarchou
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Slavina Goleva
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Dia Kabir
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Julia Ciarcia
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jordan W Smoller
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA
| | - Lea K Davis
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Caroline M Nievergelt
- University of California San Diego, Department of Psychiatry, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA
| | - Karestan C Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, US
| | - Laura M Huckins
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Karmel W Choi
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
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Edwards KA, Reed DE, Anderson D, Harding K, Turner AP, Soares B, Suri P, Williams RM. Opening the black box of psychological treatments for chronic pain: A clinical perspective for medical providers. PM R 2023; 15:999-1011. [PMID: 36633497 DOI: 10.1002/pmrj.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Karlyn A Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Division of Pain Medicine, Stanford University, Stanford, California, USA
| | - David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Administration Puget Sound Health Care, Seattle, Washington, USA
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Derek Anderson
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Kaitlin Harding
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
| | - Aaron P Turner
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Bosco Soares
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Pradeep Suri
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
- Clinical Learning, Evidence, and Research (CLEAR) Center, University of Washington, Seattle, Washington, USA
| | - Rhonda M Williams
- Rehabilitation Care Services, Veterans Administration Puget Sound Health Care System, Seattle, Washington, USA
- Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA
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Pless Kaiser A, Moye J, Baird L, Sager Z, Wachterman M. Factors Associated With Distress Related to Posttraumatic Stress Disorder at the End of Life Among U.S. Veterans. J Pain Symptom Manage 2023; 66:102-115. [PMID: 37084828 PMCID: PMC10524384 DOI: 10.1016/j.jpainsymman.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/15/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
CONTEXT Posttraumatic stress disorder (PTSD) may emerge or re-emerge at end of life (EOL), increasing patient suffering. Understanding factors associated with PTSD at EOL may assist clinicians in identifying high risk veterans. OBJECTIVES To determine rates of and variables associated with PTSD-related distress at EOL. METHODS Retrospective observational cohort study including veterans who died within a Veterans Affairs (VA) inpatient setting between October 1, 2009 and September 30, 2018 whose next-of-kin completed the Bereaved Family Survey (BFS; N = 42,474). Our primary outcome was PTSD-related distress at EOL, as reported by veteran decedents' next-of-kin on the BFS. Predictors of interest included combat exposure, demographic variables, medical and psychiatric comorbidity, primary serious illness, and palliative care support. RESULTS Veteran decedents were majority male (97.7%), non-Hispanic white (77.2%), 65 years or older (80.5%), without combat exposure (80.1%). Almost one in ten (8.9%) veteran decedents experienced PTSD-related distress at EOL. In adjusted analyses, combat exposure, younger age, male sex, and non-white race were associated with PTSD-related distress at EOL. High overall medical comorbidity, dementia, and psychiatric comorbidities including both substance use disorder and depression, were also associated with PTSD-related distress at EOL. Palliative care consultation and emotional support were associated with decreased odds of PTSD-related distress, while pain was associated with increased odds of PTSD-related distress at EOL. CONCLUSION Trauma and PTSD screening, pain management, and providing palliative care and emotional support at EOL, particularly in at-risk groups such as veterans from racial/ethnic minority backgrounds and those with dementia, are critical to decreasing PTSD-related distress at EOL.
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Affiliation(s)
- Anica Pless Kaiser
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA; VA National Center for PTSD (A.P.K.), Boston Massachusetts, USA; Boston University Chobanian & Avedisian School of Medicine (A.P.K.), Boston Massachusetts, USA.
| | - Jennifer Moye
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA; New England Geriatric Research Education and Clinical Center (J.M., Z.S.), Boston Massachusetts, USA; Harvard Medical School (J.M., J.S., M.W.), Boston Massachusetts, USA
| | - Lola Baird
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA
| | - Zachary Sager
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA; New England Geriatric Research Education and Clinical Center (J.M., Z.S.), Boston Massachusetts, USA; Harvard Medical School (J.M., J.S., M.W.), Boston Massachusetts, USA; Dana-Farber Cancer Institute (Z.S., M.W.), Boston Massachusetts, USA
| | - Melissa Wachterman
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA; Harvard Medical School (J.M., J.S., M.W.), Boston Massachusetts, USA; Center for Healthcare Organization & Implementation Research (M.W.), Boston Massachusetts, USA; Dana-Farber Cancer Institute (Z.S., M.W.), Boston Massachusetts, USA
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Åkerblom S, Cervin M, Nordin L, Andersen TE, Thøgersen MH, Perrin S. Relations between PTSD symptom clusters and pain in three trauma-exposed samples with pain. Scand J Pain 2023; 23:483-493. [PMID: 37327349 DOI: 10.1515/sjpain-2022-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/26/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Little is known about how the individual PTSD symptom clusters relate to intensity and interference of pain and whether these relationships differ across clinical groups. The present study examines relations between PTSD symptom clusters and pain in three trauma-exposed, unique clinical groups: 1) adults seeking treatment for chronic pain with current symptoms of PTSD, 2) trauma affected refugees seeking treatment for PTSD and chronic pain; and 3) individuals identified at admission to the emergency ward after whiplash injury. METHODS Network analysis was used to assess unique relations between pain intensity, pain interference, re-experiencing, avoidance, numbing, hyperarousal, depression, and anxiety separately in each sample. Links between PTSD clusters and pain were then compared within and between samples. RESULTS No within-group differences were identified for the links between pain and any of PTSD clusters in the chronic pain and refugee groups. In the whiplash group, hyperarousal was more strongly related to pain than re-experiencing, avoidance, and numbing. Between group comparisons revealed a more pronounced relationship between hyperarousal and pain in the whiplash group, with no between-group differences between the chronic pain and refugee groups. CONCLUSIONS The findings suggest that when depression and anxiety are accounted for, few unique associations are found between pain and the PTSD symptom clusters in trauma-exposed samples with pain, with the exception of a link between pain and hyperarousal in individuals with whiplash-related PTSD symptoms.
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Affiliation(s)
- Sophia Åkerblom
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Matti Cervin
- Faculty of Medicine, Lund University, Lund, Sweden
| | - Linda Nordin
- Department of Psychology, Lund University, Lund, Sweden
- Department of Rehabilitation, DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark
| | | | - Marie Høgh Thøgersen
- Department of Rehabilitation, DIGNITY - Danish Institute Against Torture, Copenhagen, Denmark
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
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36
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Pratt AA, Hadlandsmyth K, Mengeling MA, Thomas EBK, Miell K, Norman SB, Lund BC. The Impact of Comorbid Chronic Pain on Pharmacotherapy for Veterans with Post-Traumatic Stress Disorder. J Clin Med 2023; 12:4763. [PMID: 37510878 PMCID: PMC10380889 DOI: 10.3390/jcm12144763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/22/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVE Chronic pain can worsen PTSD symptomatology and may increase the risk of the prescription of multiple central nervous system (CNS)-active medications. The objective is to determine the impact of chronic pain on the number of CNS medications, including psychiatric medications, as well as the amount of medication changes. METHODS Veterans Affairs (VA) administrative data were used to identify VA-served Veterans with PTSD (N = 637,428) who had chronic pain (50.3%) and did not have chronic pain (49.7%) in 2020. The outcomes included the number of changes in psychiatric medications and the number of currently prescribed CNS-active mediations during a one-year observation period. RESULTS The number of changes in psychiatric medications was significantly higher for those with chronic pain (mean (M) = 1.8) versus those without chronic pain (M = 1.6) (Z = 38.4, p < 0.001). The mean number of concurrent CNS-active medications were significantly higher for those with chronic pain (M = 2.7) versus those without chronic pain (M = 2.0) (Z = 179.7, p < 0.001). These differences persisted after adjustment for confounding factors using negative binomial regression. CONCLUSIONS Veterans with comorbid chronic pain and PTSD are at increased risk for a higher number of medication changes and for receiving CNS-active polytherapy.
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Affiliation(s)
- Alessandra A Pratt
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA
| | - Katherine Hadlandsmyth
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA
- Department of Anesthesia, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Michelle A Mengeling
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA
| | - Emily B K Thomas
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA
- Department of Psychological and Brain Sciences, University of Iowa College of Liberal Arts and Sciences, 340 Iowa Ave, Iowa City, IA 52246, USA
| | - Kelly Miell
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA
| | - Sonya B Norman
- National Center for PTSD, 215 North Main Street, White River Junction, VT 05009, USA
- Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Brian C Lund
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, 601 Highway 6 West, Building 42, Iowa City, IA 52246, USA
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, 601 Highway 6 West, Iowa City, IA 52246, USA
- Department of Biostatistics, University of Iowa College of Public Health, 145 N Riverside Drive, Iowa City, IA 52242, USA
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Tan L, Strudwick J, Deady M, Bryant R, Harvey SB. Mind-body exercise interventions for prevention of post-traumatic stress disorder in trauma-exposed populations: a systematic review and meta-analysis. BMJ Open 2023; 13:e064758. [PMID: 37438059 PMCID: PMC10347470 DOI: 10.1136/bmjopen-2022-064758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE Mind-body exercise (MBE) interventions, such as yoga, are increasingly recognised as an adjunct treatment for trauma-related mental disorders but less is known about their efficacy as a preventative intervention. We aimed to systematically review if, and what type of, MBE interventions are effective at preventing the development of post-traumatic stress disorder (PTSD) or acute stress disorder (ASD) in trauma-exposed populations. DESIGN Systematic review and meta-analysis. METHODS A systematic search of MEDLINE, PsycINFO, EMBASE and CENTRAL databases was conducted to identify controlled trials of MBE interventions aimed at preventing the development of PTSD or ASD in high-risk populations. Risk of bias was assessed using the revised Cochrane risk-of-bias and ROBINS-I tools. Pooled effect sizes using Hedges' g and 95% CIs were calculated using random effects modelling for the main meta-analysis and planned subgroup and sensitivity analyses. RESULTS Six studies (N analysed=399) were included in the final meta-analysis. Overall, there was a small effect for MBE interventions in preventing the development of PTSD (g=-0.25, 95% CI -0.56 to 0.06) among those with previous or ongoing exposure to trauma. Although a prespecified subgroup analyses comparing the different types of MBE intervention were conducted, meaningful conclusions could not be drawn due to the small number of studies. None of the included studies assessed ASD symptoms. CONCLUSION Limited evidence was found for MBE interventions in reducing PTSD symptomology in the short term. Findings must be interpreted with caution due to the small number of studies and possible publication bias. PROSPERO REGISTRATION NUMBER CRD42020180375.
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Affiliation(s)
- Leona Tan
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Black Dog Institute, Randwick, New South Wales, Australia
| | | | - Mark Deady
- Black Dog Institute, Randwick, New South Wales, Australia
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Rogers AH, Garey L, Viana AG, Williams MW, Zvolensky MJ. Posttraumatic stress and pain-related anxiety among trauma-exposed adults with chronic pain in terms of opioid misuse and dependence. Addict Behav 2023; 142:107668. [PMID: 36868055 DOI: 10.1016/j.addbeh.2023.107668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/16/2022] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
Trauma-exposure and posttraumatic stress symptoms increase risk for opioid-related problems in the context of chronic pain. Yet, there has been little exploration of moderators of the posttraumatic stress-opioid misuse association. Pain-related anxiety, defined as worry about pain and the negative consequences of pain, has shown relations to both posttraumatic stress symptoms and opioid misuse, and it may moderate the association between posttraumatic stress symptoms and opioid misuse, as well as dependence. The current study examined the moderating role of pain-related anxiety on the relationship between posttraumatic stress symptoms and opioid misuse and dependence among 292 (71.6 % female, Mage = 38.03 years, SD = 10.93) trauma exposed adults with chronic pain. Results indicated that pain-related anxiety significantly moderated the observed relations, such that compared to those with low pain-related anxiety, the relationship between posttraumatic stress symptoms and opioid misuse and dependence was stronger for those with elevated pain-related anxiety. These results highlight the importance of assessing and targeting pain-related anxiety among this trauma-exposed segment of the chronic pain population with elevated posttraumatic stress symptoms.
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Affiliation(s)
| | - Lorra Garey
- Department of Psychology, University of Houston, USA
| | | | | | - Michael J Zvolensky
- Department of Psychology, University of Houston, USA; Department of Behavioral Sciences, University of Texas MD Anderson Cancer Center, USA; Health Institute, University of Houston, USA.
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Yu HC, Kleiman V, Kojic K, Slepian PM, Cortes H, McRae K, Katznelson R, Huang A, Tamir D, Fiorellino J, Ganty P, Cote N, Kahn M, Mucsi I, Selzner N, Rozenberg D, Chaparro C, Rao V, Cypel M, Ghanekar A, Kona S, McCluskey S, Ladak S, Santa Mina D, Karkouti K, Katz J, Clarke H. Prevention and Management of Chronic Postsurgical Pain and Persistent Opioid Use Following Solid Organ Transplantation: Experiences From the Toronto General Hospital Transitional Pain Service. Transplantation 2023; 107:1398-1405. [PMID: 36482750 DOI: 10.1097/tp.0000000000004441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND With >700 transplant surgeries performed each year, Toronto General Hospital (TGH) is currently one of the largest adult transplant centers in North America. There is a lack of literature regarding both the identification and management of chronic postsurgical pain (CPSP) after organ transplantation. Since 2014, the TGH Transitional Pain Service (TPS) has helped manage patients who developed CPSP after solid organ transplantation (SOT), including heart, lung, liver, and renal transplants. METHODS In this retrospective cohort study, we describe the association between opioid consumption, psychological characteristics of pain, and demographic characteristics of 140 SOT patients who participated in the multidisciplinary treatment at the TGH TPS, incorporating psychology and physiotherapy as key parts of our multimodal pain management regimen. RESULTS Treatment by the multidisciplinary TPS team was associated with significant improvement in pain severity and a reduction in opioid consumption. CONCLUSIONS Given the risk of CPSP after SOT, robust follow-up and management by a multidisciplinary team should be considered to prevent CPSP, help guide opioid weaning, and provide psychological support to these patients to improve their recovery trajectory and quality of life postoperatively.
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Affiliation(s)
- Hai Chuan Yu
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Valery Kleiman
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Katarina Kojic
- Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesia, Providence Health Care/St. Paul's Hospital, Vancouver, BC, Canada
| | - P Maxwell Slepian
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
| | - Henry Cortes
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Alex Huang
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Tamir
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Joseph Fiorellino
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Praveen Ganty
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Nathalie Cote
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Michael Kahn
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Nazia Selzner
- Ajmera Transplant Center, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Dmitry Rozenberg
- Temerty Faculty of Medicine, Division of Respirology, Ajmera Transplant Program, Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Cecilia Chaparro
- Division of Respirology, Department of Medicine, Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Division of Respirology, Adult Cystic Fibrosis Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Vivek Rao
- Peter Munk Cardiac Centre of the University Health Network, Toronto, ON, Canada
- Ted Rogers Centre for Heart Research, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Department of Cardiovascular Surgery, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Marcelo Cypel
- Division of Thoracic Surgery, Toronto General Hospital, Toronto, ON, Canada
| | - Anand Ghanekar
- Ajmera Transplant Center, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Sharath Kona
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Stuart McCluskey
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Salima Ladak
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Daniel Santa Mina
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Keyvan Karkouti
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Joel Katz
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychology, York University, Toronto, ON, Canada
- University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Transitional Pain Service, Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
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40
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Linnemørken LTB, Stangeland H, Reme SE, Stensland SØ. Performance and acceptability of the Stressful Life Events Screening Questionnaire in a chronic pain population: a mixed-methods study. Pain Rep 2023; 8:e1072. [PMID: 37114243 PMCID: PMC10129107 DOI: 10.1097/pr9.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/28/2022] [Accepted: 12/23/2022] [Indexed: 04/29/2023] Open
Abstract
Introduction Pain-related fear, anxiety, and avoidance may play key roles in the chronification of pain and related disability. For practitioners, knowledge about the source or drivers of these fears, including patients' exposure to potentially traumatic events (PTEs) and related posttraumatic stress symptoms, could be particularly helpful in guiding their treatment approach. Objectives We aimed to investigate whether the use of a brief screening for PTEs could help inform chronic pain treatment. Methods The performance and acceptability of the Stressful Life Events Screening Questionnaire (SLESQ) was assessed among 567 adult patients (59% women, mean age 48.1 years) meeting at a hospital outpatient pain clinic. The sensitivity, specificity, and 20 months temporal stability of the SLESQ, assessing exposure to 14 specific trauma types followed by a 15th item capturing exposure to "other events," were assessed through digital administration and follow-up interviews with 55 participants. The qualitative responses of 158 participants reporting exposure to "other events" were reviewed and assessed based on fulfillment of the A Criterion for traumatic events in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The acceptability of the SLESQ was assessed in clinical interviews with 12 participants. Results The SLESQ demonstrated acceptable sensitivity (70.0%), high specificity (94.9%), and moderate temporal stability (κ = 0.66, P < 0.001). Participants' qualitative elaborations of "other events" were largely (76.3%) consistent with Criterion A events. The screening was well accepted and welcomed. Conclusion The results indicate that the use of a brief screening for potential trauma may be helpful to guide clinical practice in chronic pain settings.
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Affiliation(s)
- Lene Therese Bergerud Linnemørken
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Division for Health Services, Department of Health Services Research, Norwegian Institute of Public Health, Oslo, Norway
- Corresponding author. Address: Division of Emergencies and Critical Care, Department of Research and Development, Building 18, Oslo University Hospital, POB 4956 Nydalen, 0424 Oslo, Norway. Tel.: +4747313851. E-mail address: (L.T.B. Linnemørken)
| | - Helle Stangeland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Silje Endresen Reme
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Synne Øien Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Development, Oslo University Hospital, Oslo, Norway
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41
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Pavilanis A, Truchon M, Achille M, Coté P, Sullivan MJ. Perceived Injustice as a Determinant of the Severity of Post-traumatic Stress Symptoms Following Occupational Injury. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:134-144. [PMID: 35852696 PMCID: PMC10025196 DOI: 10.1007/s10926-022-10056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The present study assessed the role of perceived injustice in the experience and persistence of post-traumatic stress symptoms (PTSS) following work-related musculoskeletal injury. METHODS The study sample consisted of 187 individuals who were absent from work as a result of a musculoskeletal injury. Participants completed measures of pain severity, perceived injustice, catastrophic thinking, post-traumatic stress symptoms, and disability on three occasions at three-week intervals. RESULTS Consistent with previous research, correlational analyses revealed significant cross-sectional relations between pain and PTSS, and between perceived injustice and PTSS. Regression analysis on baseline data revealed that perceived injustice contributed significant variance to the prediction of PTSS, beyond the variance accounted for by pain severity and catastrophic thinking. Sequential analyses provided support for a bi-directional relation between perceived injustice and PTSS. Cross-lagged regression analyses showed that early changes in perceived injustice predicted later changes in PTSS and early changes in PTSS predicted later changes in perceived injustice. CONCLUSIONS Possible linkages between perceived injustice and PTSS are discussed. The development of effective intervention techniques for targeting perceptions of injustice might be important for promoting recovery of PTSS consequent to musculoskeletal injury.
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Affiliation(s)
- Antonina Pavilanis
- Department of Psychology, McGill University, 2001 McGill College, H3A 1G1, Montréal, QC, Canada
| | | | | | | | - Michael Jl Sullivan
- Department of Psychology, McGill University, 2001 McGill College, H3A 1G1, Montréal, QC, Canada.
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Sauer KS, Wendler-Bödicker C, Boos A, Niemeyer H, Palmer S, Rojas R, Hoyer J, Hitzler M. Treatment of Comorbid Disorders, Syndromes, and Symptoms of Posttraumatic Stress Disorder Related to Childhood Maltreatment with STAIR-NT. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2023. [DOI: 10.1026/1616-3443/a000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Abstract. Background: Early interpersonal traumatic events, such as childhood maltreatment, increase the risk of developing complex posttraumatic stress symptoms. The biphasic treatment program STAIR-NT (Skills Training for Affective and Interpersonal Regulation with Narrative Therapy), developed specifically for this patient group, combines interventions to improve emotion regulation and interpersonal skills with narrative therapy. Objective: Many affected patients with PTSD after childhood maltreatment also suffer from various comorbid mental disorders and symptoms that can affect and impede the course and outcome of treatment with STAIR-NT. Method: Based on experience from a current treatment study, we provide recommendations for integrating treatment of comorbid mental symptoms into STAIR-NT. Results / Conclusion: Training affective and interpersonal regulation skills in the first treatment phase offers various interventions to efficiently adapt transdiagnostic mechanisms such as emotion dysregulation. In cases of severe comorbid mental disorders or symptoms, adding disorder-specific interventions to STAIR-NT may be indicated.
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Affiliation(s)
- Karoline Sophie Sauer
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University of Mainz, Germany
| | | | - Anne Boos
- Psychotherapy Practice in Großhartau, Germany
| | - Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Germany
| | - Sebastian Palmer
- Department of Psychotherapy and Systems Neuroscience, Justus Liebig University Gießen, Germany
| | - Roberto Rojas
- University Psychotherapeutic Outpatient Clinic, Institute of Psychology and Education, Ulm University, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Melissa Hitzler
- Clinical and Biological Psychology, Institute of Psychology and Education, Ulm University, Germany
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43
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Dobscha SK, Luther SL, Kerns RD, Finch DK, Goulet JL, Brandt CA, Skanderson M, Bathulapalli H, Fodeh SJ, Hahm B, Bouayad L, Lee A, Han L. Mental Health Diagnoses are Not Associated With Indicators of Lower Quality Pain Care in Electronic Health Records of a National Sample of Veterans Treated in Veterans Health Administration Primary Care Settings. THE JOURNAL OF PAIN 2023; 24:273-281. [PMID: 36167230 PMCID: PMC9898089 DOI: 10.1016/j.jpain.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/08/2022] [Accepted: 08/25/2022] [Indexed: 02/06/2023]
Abstract
Prior research has demonstrated disparities in general medical care for patients with mental health conditions, but little is known about disparities in pain care. The objective of this retrospective cohort study was to determine whether mental health conditions are associated with indicators of pain care quality (PCQ) as documented by primary care clinicians in the Veterans Health Administration (VHA). We used natural language processing to analyze electronic health record data from a national sample of Veterans with moderate to severe musculoskeletal pain during primary care visits in the Fiscal Year 2017. Twelve PCQ indicators were annotated from clinician progress notes as present or absent; PCQ score was defined as the sum of these indicators. Generalized estimating equation Poisson models examined associations among mental health diagnosis categories and PCQ scores. The overall mean PCQ score across 135,408 person-visits was 8.4 (SD = 2.3). In the final adjusted model, post-traumatic stress disorder was associated with higher PCQ scores (RR = 1.006, 95%CI 1.002-1.010, P = .007). Depression, alcohol use disorder, other substance use disorder, schizophrenia, and bipolar disorder diagnoses were not associated with PCQ scores. Overall, results suggest that in this patient population, presence of a mental health condition is not associated with lower quality pain care. PERSPECTIVE: This study used a natural language processing approach to analyze medical records to determine whether mental health conditions are associated with indicators of pain care quality as documented by primary care clinicians. Findings suggest that presence of a diagnosed mental health condition is not associated with lower quality pain care.
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Affiliation(s)
- Steven K Dobscha
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon; VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, Oregon.
| | - Stephen L Luther
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida; College of Public Health, University of South Florida, Tampa, Florida
| | - Robert D Kerns
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Psychiatry and Neurology, New Haven, Connecticut
| | - Dezon K Finch
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida
| | - Joseph L Goulet
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
| | - Melissa Skanderson
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut
| | - Harini Bathulapalli
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut
| | - Samah J Fodeh
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Emergency Medicine, New Haven, Connecticut
| | - Bridget Hahm
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida
| | - Lina Bouayad
- Research Service, James A. Haley Veterans Hospital, Tampa, Florida; Information Systems and Business Analytics, College of Business, Florida International University, Miami, Florida
| | - Allison Lee
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Psychiatry and Neurology, New Haven, Connecticut
| | - Ling Han
- VA Connecticut Healthcare System, Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, West Haven, Connecticut; Yale School of Medicine Department of Internal Medicine, New Haven, Connecticut
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44
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Jadhakhan F, Evans DW, Falla D. The role of post-trauma stress symptoms in the development of chronic musculoskeletal pain and disability: A systematic review. Eur J Pain 2023; 27:183-200. [PMID: 36317593 PMCID: PMC10099552 DOI: 10.1002/ejp.2048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Traumatic injuries are amongst the leading causes of death and disability in the world across all age groups. This systematic review aimed to (1) describe the role of post-traumatic stress symptoms (PTSS) on the development of chronic pain and/or pain-related disability following musculoskeletal trauma and (2) report pain and or pain-related disability by injury severity/type. DATABASE AND DATA TREATMENT Electronic databases were searched, from inception to 31 November 2021 and updated on 10 May 2022, to identify studies in which: participants were adults aged ≥16 years sustaining any traumatic event that resulted in one or more musculoskeletal injuries; an outcome measure of PTSS was used within 3 months of a traumatic event; the presence of pain and/or pain-related disability was recorded at a follow-up of 3 months or more. Two reviewers independently screened papers and assessed the quality of included studies. RESULTS Eight studies were included. Owing to between-study heterogeneity, the results were synthesized using a narrative approach. Five studies investigated the relationship between PTSS and pain. Participants with PTSS were more likely to develop persistent pain for at least 12 months post-injury. Six studies assessed the relationship between PTSS and pain-related disability. The results suggest that patients with PTSS had significantly higher disability levels for at least 12 months post-injury. CONCLUSION Findings from this comprehensive systematic review support a clear relationship between PTSS post-injury and future pain/disability, with the potential importance of certain PTSS clusters (hyper-arousal and numbing). SIGNIFICANCE The findings of this systematic review indicate an association between PTSS reported within 3 months of a traumatic musculoskeletal injury and the development of longer-term pain and disability. The PTSS clusters of 'hyper-arousal' and 'numbing' appear to be of particular importance in this relationship. PROSPERO REGISTRATION NUMBER CRD42021285243.
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Affiliation(s)
- Ferozkhan Jadhakhan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Gevaudan L, Broc G, Chauchard E, Porro B, Le Borgne M. Endometriosis diagnosis buffers reciprocal effects of emotional distress on pain experience. Scand J Pain 2023; 23:200-207. [PMID: 35607728 DOI: 10.1515/sjpain-2022-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/29/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Emotional profile is involved in the experience of chronic pain related to endometriosis. Following the Örebro Model of Behavioral Emotion Regulation of Pain, the aim of this study was to understand the processes involved in the psychological adaptation to pain experienced during menstruations in women either diagnosed or not diagnosed with endometriosis. METHODS The study was conducted on a sample of 545 women, either diagnosed with endometriosis or not, during their menstruations. Functional repercussions and intensity of pain, catastrophic thinking, difficulties in emotional regulation and emotional distress were assessed through an online questionnaire. Structural equation modeling (SEM) was carried out. RESULTS Women diagnosed with endometriosis experience more suffering than women who have not had such a diagnosis. The model we adapted from Örebro's model fits the data well. A differential effect is observed regarding the retroactive effect of depression on pain. Although emotional distress increases functional repercussions among women both with and without the diagnosis, growing pain intensity only occurs among those without. CONCLUSIONS A woman presenting pain during menstruation faces emotional regulation issues that make her more vulnerable to the development of emotional distress. Pain impacts emotional distress, but emotional distress does not impact pain among women for whom the origin of the pain was known (i.e., a diagnosis of endometriosis). Having a diagnosis allows women to externalize the origin of their pain, attributing it to the disease and not to their psychological state.
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Affiliation(s)
- Lucie Gevaudan
- Nantes Université, University Angers, Laboratoire de Psychologie des Pays de la Loire, LPPL, UR 4638, F-44000Nantes, France
| | - Guillaume Broc
- Paul Valéry Montpellier 3, University of Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Emeline Chauchard
- Nantes Université, University Angers, Laboratoire de Psychologie des Pays de la Loire, LPPL, UR 4638, F-44000Nantes, France
| | - Bertrand Porro
- University Angers, University Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, SFR ICAT, SIRIC ILIAD, F-49000Angers, France
| | - Margaux Le Borgne
- Nantes Université, University Angers, Laboratoire de Psychologie des Pays de la Loire, LPPL, UR 4638, F-44000Nantes, France
- Université de Nantes, Faculté de Psychologie, Chemin de la Censive du Tertre, BP 81227, Nantes, 44312, France
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46
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Bhalla A, Bamer AM, Temes C, Roaten K, Carrougher GJ, Schneider JC, Stoddard FJ, Stewart B, Gibran NS, Wiechman SA. Posttraumatic Stress Disorder Symptom Clusters as Predictors of Pain Interference in Burn Survivors: A Burn Model System National Database Study. J Burn Care Res 2023; 44:27-34. [PMID: 35866527 PMCID: PMC9990905 DOI: 10.1093/jbcr/irac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Individuals who experience burns are at higher risk of developing posttraumatic stress disorder and chronic pain. A synergistic relationship exists between posttraumatic stress disorder and chronic pain. We sought to evaluate the role of individual posttraumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two posttraumatic stress disorder symptom clusters, pain intensity, and other covariates. Multivariate linear regression analyses were completed using data from the Burn Model System National Database. A total of 439 adult participants had complete responses on self-report measures assessing posttraumatic stress disorder symptoms, pain intensity, and pain interference at 6-month after discharge and were included in analyses. Results indicate hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) posttraumatic stress disorder symptom clusters were each significantly associated with pain interference, even when accounting for pain intensity (B = .64, p < .001). Results highlight the importance of the emotional numbing and hyperarousal posttraumatic stress disorder symptom clusters in explaining pain interference. Findings suggest that when posttraumatic stress disorder symptoms or chronic pain are present, screening for and treating either condition may be warranted to reduce pain interference. Further, psychological interventions that target emotional numbing and hyperarousal posttraumatic stress disorder symptoms may be fruitful for promoting better coping with chronic pain and reducing pain interference.
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Affiliation(s)
- Arjun Bhalla
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Christina Temes
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick J. Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Shelley A. Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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47
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Choi JJ, Martins JS, Hwang S, Sinha R, Seo D. Neural correlates linking trauma and physical symptoms. Psychiatry Res Neuroimaging 2022; 327:111560. [PMID: 36327865 PMCID: PMC9757618 DOI: 10.1016/j.pscychresns.2022.111560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 10/13/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Trauma and chronic pain frequently co-occur, but the underlying neurological mechanisms are poorly understood. The current study investigated the neural correlates of stress and physical symptoms in trauma patients using functional magnetic resonance imaging (fMRI) and follow-up smartphone surveys. Participants were 10 patients diagnosed with Trauma- and Stressor-Related Disorders and 18 demographically-matched healthy controls who completed a fMRI stress provocation task in which they viewed stressful and neutral-relaxing images. Subsequently, participants completed daily smartphone surveys which prospectively monitored their stress and physical symptoms for 30 days. The trauma group experienced a significantly higher frequency of physical symptoms than controls during the follow-up period. During stress, trauma patients exhibited increased activity in the hippocampus, insula, and sensorimotor areas, but decreased activity in the ventromedial prefrontal cortex (vmPFC), lateral prefrontal cortex (LPFC), and dorsal striatum relative to controls. In all participants, higher physical symptom frequency was significantly associated with a hyperactive left hippocampal response to stress. The current study reports that trauma is characterized by greater physical symptoms and decreased prefrontal but increased limbic responses to stress. Our findings suggest that trauma may increase physical health symptoms by compromising hippocampal function, which could also increase vulnerability to stress- and pain-related disorders.
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Affiliation(s)
- Justin J Choi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
| | - Jorge S Martins
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; William James Center for Research, ISPA-Instituto Universitário, Lisbon, Portugal
| | - Seungju Hwang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; Department of Neuroscience, Yale University School of Medicine, New Haven, CT, United States of America
| | - Dongju Seo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
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48
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Short NA, van Rooij SJH, Murty VP, Stevens JS, An X, Ji Y, McLean SA, House SL, Beaudoin FL, Zeng D, Neylan TC, Clifford GD, Linnstaedt SD, Germine LT, Bollen KA, Rauch SL, Haran JP, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Swor RA, McGrath ME, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, O'Neil BJ, Sergot P, Sanchez LD, Bruce SE, Pietrzak RH, Joormann J, Barch DM, Pizzagalli DA, Sheridan JF, Smoller JW, Harte SE, Elliott JM, Kessler RC, Koenen KC, Jovanovic T. Anxiety sensitivity as a transdiagnostic risk factor for trajectories of adverse posttraumatic neuropsychiatric sequelae in the AURORA study. J Psychiatr Res 2022; 156:45-54. [PMID: 36242943 PMCID: PMC10960961 DOI: 10.1016/j.jpsychires.2022.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/16/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023]
Abstract
Anxiety sensitivity, or fear of anxious arousal, is cross-sectionally associated with a wide array of adverse posttraumatic neuropsychiatric sequelae, including symptoms of posttraumatic stress disorder, depression, anxiety, sleep disturbance, pain, and somatization. The current study utilizes a large-scale, multi-site, prospective study of trauma survivors presenting to emergency departments. Hypotheses tested whether elevated anxiety sensitivity in the immediate posttrauma period is associated with more severe and persistent trajectories of common adverse posttraumatic neuropsychiatric sequelae in the eight weeks posttrauma. Participants from the AURORA study (n = 2,269 recruited from 23 emergency departments) completed self-report assessments over eight weeks posttrauma. Associations between heightened anxiety sensitivity and more severe and/or persistent trajectories of trauma-related symptoms identified by growth mixture modeling were analyzed. Anxiety sensitivity assessed two weeks posttrauma was associated with severe and/or persistent posttraumatic stress, depression, anxiety, sleep disturbance, pain, and somatic symptoms in the eight weeks posttrauma. Effect sizes were in the small to medium range in multivariate models accounting for various demographic, trauma-related, pre-trauma mental health-related, and personality-related factors. Anxiety sensitivity may be a useful transdiagnostic risk factor in the immediate posttraumatic period identifying individuals at risk for the development of adverse posttraumatic neuropsychiatric sequelae. Further, considering anxiety sensitivity is malleable via brief intervention, it could be a useful secondary prevention target. Future research should continue to evaluate associations between anxiety sensitivity and trauma-related pathology.
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Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Psychology, University of Nevada, Las Vegas, NV, 89154, USA.
| | - Sanne J H van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Vishnu P Murty
- Department of Psychology, Temple University, Philadelphia, PA, 19121, USA
| | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Yinyao Ji
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA; Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Stacey L House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Francesca L Beaudoin
- Department of Epidemiology, The Brown University School of Public Health, Providence, RI, 02930, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27559, USA
| | - Thomas C Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, 30332, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30332, USA
| | - Sarah D Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Laura T Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; The Many Brains Project, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Kenneth A Bollen
- Department of Psychology and Neuroscience & Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27559, USA
| | - Scott L Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA
| | - John P Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, 01655, USA
| | | | - Paul I Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Phyllis L Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, 32209, USA
| | - Christopher W Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, 08103, USA
| | - Brittany E Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, 43210, USA; Ohio State University College of Nursing, Columbus, OH, 43210, USA
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, 48309, USA
| | - Meghan E McGrath
- Department of Emergency Medicine, Boston Medical Center, Boston, MA, 02118, USA
| | - Lauren A Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, 30329, USA
| | - Jose L Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mark J Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Elizabeth M Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, 19141, USA; Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, 48202, USA
| | - David A Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Robert M Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, 48197, USA
| | - Niels K Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, 01107, USA
| | - Brian J O'Neil
- Department of Emergency Medicine, Wayne State University, Detroit Receiving Hospital, Detroit, MI, 48202, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, 77030, USA
| | - Leon D Sanchez
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA; Department of Emergency Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Steven E Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, 63121, USA
| | - Robert H Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, 06516, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06510, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, 06510, USA
| | - Deanna M Barch
- Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO, 63130, USA
| | - Diego A Pizzagalli
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, 02478, USA
| | - John F Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, 43210, USA; Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, 43211, USA
| | - Jordan W Smoller
- Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA, 02114, USA; Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA, 02142, USA
| | - Steven E Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA; Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - James M Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, 2065, Australia; Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, 2006, Australia; Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, 60208, USA
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, 02115, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, 02115, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, 48202, USA
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49
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The Helplessness Dimension of Pain Catastrophizing Mediates the Relation between PTSD Symptoms and Pain Rehabilitation Measures. Pain Res Manag 2022; 2022:2112698. [PMID: 36504758 PMCID: PMC9729044 DOI: 10.1155/2022/2112698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 10/26/2022] [Accepted: 11/10/2022] [Indexed: 12/02/2022]
Abstract
Background Comorbid chronic pain and post-traumatic stress disorder (PTSD) complicate the treatment of both conditions. Previous research has identified pain catastrophizing as a potentially important variable contributing to the relationship between chronic pain and PTSD. However, little is known regarding how the different dimensions of pain catastrophizing-rumination, magnification, and helplessness-uniquely contribute to the relationship between PTSD symptomatology and measures of pain outcome. Methods 491 treatment seeking participants were admitted to a three-week interdisciplinary pain rehabilitation program between July 2016 and March 2020. The patients completed measures of pain severity, pain interference, pain catastrophizing, depressive symptoms, quality of life (QOL), and PTSD symptoms at pretreatment. Results Parallel mediation analyses were conducted to evaluate the mediating effect of the Pain Catastrophizing Scale subscales on the relationship between PTSD symptomatology and pain-relevant variables. The helplessness subscale accounted for significant unique variance in the relationship between PTSD symptomatology and pain severity (b = 0.010, SE = 0.002, 95% CI: 0.006, 0.014), pain interference (b = 0.004, SE = 0.002, 95% CI: 0.001, 0.008), and mental health QOL (b = -0.117, SE = 0.031, 95% CI: -0.179, -0.059), while the rumination and magnification subscales had no significant influence. Conclusions Pain catastrophizing is a multifaceted construct. These results suggest that the helplessness dimension of pain catastrophizing may be the primary target when treating patients with comorbid chronic pain and PTSD symptoms. This study represents the first to evaluate the influence of the individual dimensions of pain catastrophizing on the relationship between PTSD symptomatology and chronic pain outcome.
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50
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Ranney RM, Maguen S, Bernhard PA, Holder N, Vogt D, Blosnich JR, Schneiderman AI. Moral injury and chronic pain in veterans. J Psychiatr Res 2022; 155:104-111. [PMID: 36027646 DOI: 10.1016/j.jpsychires.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent and co-morbid among veterans. Moral injury (MI), which results from traumatic experiences that conflict with deeply held moral beliefs, is also associated with pain. However, relationships between different types of exposures to potentially morally injurious events (PMIEs) and pain have not yet been investigated. In the current study, we investigated these relationships between exposure to PMIEs (betrayal, witnessing, and perpetration) and different types of pain (joint pain, muscle pain, and overall pain intensity), while controlling for other relevant variables (including PTSD symptoms, combat exposure, adverse childhood experiences, age, gender, and race/ethnicity). We also examined gender differences in these associations. Participants were 11,871 veterans drawn from a nationwide, population-based survey who self-reported exposure to PMIEs, PTSD symptoms, frequency of adverse childhood experiences, combat exposure, sociodemographic information, past six-month joint pain, past six-month muscle pain, and past week overall pain intensity. Population weighted regression models demonstrated that PMIEs were not significantly associated with joint or muscle pain, but that betrayal was associated with past week overall pain intensity, even when controlling for all other variables. Models investigating men and women separately found that for women, betrayal was associated with joint pain and pain intensity, but for men, betrayal was not associated with any pain outcome. These findings suggest that it may be especially important to assess betrayal when treating patients with a history of trauma and chronic pain.
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Affiliation(s)
- Rachel M Ranney
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA; University of California - San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA; Sierra Pacific Mental Illness Research Education, and Clinical Center, 4150 Clement St, San Francisco, CA, 94121, USA.
| | - Shira Maguen
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA; University of California - San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Paul A Bernhard
- Health Outcomes of Military Exposures, Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, 810 Vermont Ave NW, Washington, DC, 2057, USA
| | - Nicholas Holder
- San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA; University of California - San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Dawne Vogt
- VA Boston Health Care System, 150 S Huntington Ave, Boston, MA, 02130, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| | - John R Blosnich
- University of Southern California, 669 W 34th St, Los Angeles, CA, 90089-0411, USA; VA Pittsburgh Healthcare System, 4100 Allequippa St, Pittsburgh, PA, 15240, USA
| | - Aaron I Schneiderman
- Health Outcomes of Military Exposures, Epidemiology Program, Office of Patient Care Services, Veterans Health Administration, 810 Vermont Ave NW, Washington, DC, 2057, USA
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