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Strategies for Managing Chronic Pain, Chronic PTSD, and Comorbidities: Reflections on a Case Study Documented over Ten Years

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Abstract

Chronic pain and chronic PTSD are often comorbid sequelae in patients who have experienced life-threatening experiences such as combat, assaults, or motor vehicle accidents, presenting lifelong challenges for patients and for medical management in all settings. This article briefly reviews four models for exploring the interrelationships of chronic pain and chronic PTSD. The article presents a longitudinal case study, documented over 10 years, of a patient with chronic back pain, and delayed-onset chronic PTSD related to sexual trauma experienced as a young adult. Data from the case study are examined for evidence in support of the chronic pain/chronic PTSD models. There is evidence to support all four models, with considerable evidence supporting the Mutual Maintenance Model (Sharp & Harvey, in Clinical Psychology Review 21(6): 857–77, 2001). Data show significant recovery over time from both conditions with improvements in function, work, and relationships, in response to Psychodynamic Therapy (PDT), Cognitive Behavioral Therapy (CBT), and hypnotic interventions, physical therapy, and pilates-based exercise. Notably, both chronic conditions were addressed simultaneously, with providers working collaboratively and sharing information through the patient. Emphasis is on non-pharmaceutical rehabilitative trauma-informed and patient-centered approaches to care.

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Acknowledgements

The authors gratefully acknowledge the cooperation and assistance of Carolyn Daitch, Ph.D., Lisa Elconin, M.D., Kristen Robertson, D.P.T, Amy Kubo Slowik, P.T., and Natalie Kay Wicks, M.S.W. The authors also thank Dr. Cheryl Munday and four anonymous reviewers whose comments on earlier drafts were very helpful. The data presented in Fig. 1 expand on data published in Physical Therapy in 2012. Additional longitudinal data are presented here, and the data are used for a different analysis. The corresponding author for this paper is also the patient; she gives her full, informed consent to have identifying information presented in this paper.

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  1. Psychology Department, University of Detroit Mercy, 4001 West McNichols Road, Detroit, MI, 48219-0900, USA

    Carol Cronin Weisfeld

  2. Department of Physical Therapy, University of Florida, Gainesville, FL, 32610-0154, USA

    Kim Dunleavy

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  1. Carol Cronin Weisfeld
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Correspondence to Carol Cronin Weisfeld.

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Weisfeld, C.C., Dunleavy, K. Strategies for Managing Chronic Pain, Chronic PTSD, and Comorbidities: Reflections on a Case Study Documented over Ten Years. J Clin Psychol Med Settings 28, 78–89 (2021). https://doi.org/10.1007/s10880-020-09741-5

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