Der Schmerz

, 22:644 | Cite as

PTBS und chronische Schmerzen: Entstehung, Aufrechterhaltung und Zusammenhang – ein Überblick

Übersichten

Zusammenfassung

Neben der posttraumatischen Belastungsstörung (PTBS) leidet eine Vielzahl von Traumatisierten zudem an chronischen Schmerzen. Das Wissen um die Entstehung und Aufrechterhaltung der komorbiden Störungen ist daher von essenzieller Bedeutung für die Behandlung. Der vorliegende Beitrag erläutert anhand eines aktuellen Literaturüberblicks Entstehungs-, Aufrechterhaltungs- und Zusammenhangsmechanismen der PTBS und chronischer Schmerzen. Darüber hinaus wird das „perpetual avoidance model“ vorgestellt und mit Implikationen für die Praxis ergänzt.

Schlüsselwörter

Posttraumatische Belastungsstörung (PTBS) Chronische Schmerzen Komorbidität Prädiktoren Perpetual avoidance model 

PTSD and chronic pain: development, maintenance and comorbidity – a review

Abstract

In addition to posttraumatic stress disorder (PTSD) many traumatized individuals also suffer from chronic pain. Understanding the development and maintenance of these two disorders and how they interact is of crucial importance for treatment. This article provides an overview of the current literature on mechanisms of development, maintenance and comorbidity of PTSD and chronic pain. Moreover the perpetual avoidance model and its implications for practical application are presented.

Keywords

Posttraumatic stress disorder (PTSD) Chronic pain Comorbidity Predictors Perpetual avoidance model 

Literatur

  1. 1.
    Adams TB, Moore MT, Dye J (2007) The ralationship between physical activity and mental health in a national sample of college females. Women Health 45: 69–85PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (1998) Diagnostisches und statistisches Manual psychischer Störungen (DSM IV), deutsche Übersetzung Saß H, Wittchen, HU, Zaudig M, 2. Aufl. Hogrefe, GöttingenGoogle Scholar
  3. 3.
    Amital D, Fostickb L, Polliackb ML et al. (2006) Posttraumatic stress disorder, tenderness, and fibromyalgia syndrome: are they different entities? J Psychosom Res 61: 663–669PubMedCrossRefGoogle Scholar
  4. 4.
    Asmundson GJG, Coons MJ, Taylor S, Katz J (2002) PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry 47: 930–937PubMedGoogle Scholar
  5. 5.
    Beck JG, Freeman JB, Shipered JC et al. (2001) Specificity of Stroop interference in patients with pain an PTSD. J Abnorm Psychol 110: 536–543PubMedCrossRefGoogle Scholar
  6. 6.
    Breivik H, Collett B, Ventafridda V et al. (2006) Survey of chronic pain in Europe: prevalence, impact on daily life and treatment. Eur J Pain 10: 287–333PubMedCrossRefGoogle Scholar
  7. 7.
    Brewin CR, Andrews B, Valentine JD (2002). Meta-analysis of risk factors für posttraumatic stress disorder in trauma exposed adults. J Consult Clin Psychol 68: 748–766Google Scholar
  8. 8.
    Broeckman BFP, Olff M, Boer F (2007) The genetic background to PTSD – Review. Neurosci Biobehav Rev 31: 348–362CrossRefGoogle Scholar
  9. 9.
    Denke C, Knaevelsrud C, Karl A, MüllerJ (2006) Biofeedback-Manual: Trauma and Pain. unpublished manuscriptGoogle Scholar
  10. 10.
    Dirkzwager AJ, van der Velden PG, Grievnik L, Yzermans CJ (2007) Disaster-related posttraumatic stress disorder and physical health. Psychosom Med 69: 435–440PubMedCrossRefGoogle Scholar
  11. 11.
    Dunmore E, Clark DM, Ehlers A (2001) A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault. Behav Res Ther 39: 1063–1084PubMedCrossRefGoogle Scholar
  12. 12.
    Ehlers A, Clark DM (2000) A cognitive model of persistent posttraumatic stress disorder. Behav Res Ther 38: 319–345PubMedCrossRefGoogle Scholar
  13. 13.
    Frost H, Lamb SE, Klaber Moffett JA et al. (1998) A fitness program for patients with chronic low back pain: 2-year follow-up of a randomised controlled trial. Pain 75: 273–279PubMedCrossRefGoogle Scholar
  14. 14.
    Harris IA, Young JM, Rae H et al. (2007) Factors associated with back pain after physical injury. Spine 32: 1561–1565PubMedCrossRefGoogle Scholar
  15. 15.
    Jakupcak M, Osborne T, Cook SM et al. (2006) Anxiety sensitivity and depression: mechanisms for understanding somatic complaints in veterans with posttraumatic stress disorder. J Trauma Stress 19: 471–479PubMedCrossRefGoogle Scholar
  16. 16.
    Karl A, Schaefer M, Malta LS et al. (2006) A meta-analysis of structural brain abnormalities in PTSD – review. Neurosci Biobehav Rev 30: 1004–1031PubMedCrossRefGoogle Scholar
  17. 17.
    Keogh E, Ayres S, Francis H (2004) Does anxiety sensitivity predict posttraumatic stress symptoms following childbirth? A preliminary report. Cogn Behav Ther 31: 145–155CrossRefGoogle Scholar
  18. 18.
    Koegh E, Cochrane M (2002) Anxiety sensitivity, cognitive biases, and the experience of pain. J Pain 3: 320–329CrossRefGoogle Scholar
  19. 19.
    Kessler R, Sonnega A, Bromet E et al. (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52: 1048–1060PubMedGoogle Scholar
  20. 20.
    Koleck M, Mazaux JM, Rascle N, Bruchon-Schweitzer M (2006) Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: a prospective study. Eur J Pain 10: 1–11PubMedCrossRefGoogle Scholar
  21. 21.
    Koren D, Norman D, Cohen A et al. (2005) Increased PTSD risk with combat-relates injury: a matched comparison study of injured an uninjured soldiers experiencing the same combat events. Am J Psychiatry 162: 276–282PubMedCrossRefGoogle Scholar
  22. 22.
    Kröner-Herwig B (2000) Rückenschmerz. Hogrefe, Göttingen Bern Toronto SeattleGoogle Scholar
  23. 23.
    Leeuw M, Goossens MEJB, Linton SJ et al. (2007) The fear-avoidance-model of musculoskeletal pain: current state of scientific evidence. J Behav Med 30: 77–94PubMedCrossRefGoogle Scholar
  24. 24.
    Lethem J, Slade PD, Troup JDG, Bentley G (1983) Outline of a fear avoidance model of exaggerated pain perception-I. Behav Res Ther 21: 401–408PubMedCrossRefGoogle Scholar
  25. 25.
    Linton SJ (2005) Do psychological factors increase the risk for back pain in the general population in both a cross-sectional and prospective analysis? Eur J Pain 9: 355–361PubMedCrossRefGoogle Scholar
  26. 26.
    Maercker A, Michael T, Fehm L et al. (2004) Age of traumatisation as a predictor of posttraumatic stress disorder or major depression in young women. Br J Psychiatry 184: 482–487PubMedCrossRefGoogle Scholar
  27. 27.
    Maetzel A, Li L (2002) The economic burden of low back pain: a review of studies publishes between 1996–2001. Best Pract Res Clin Rheumatol 16: 23–30PubMedCrossRefGoogle Scholar
  28. 28.
    McLean SA, Clauw DJ, Abelson JL, Liberzon I (2005) The development of persistent pain and psychological morbidity after motor vehicle collision: integrating the potential role of stress response systems into a biopsychosocial model. Psychosom Med 67: 783–790PubMedCrossRefGoogle Scholar
  29. 29.
    Meredith P, Strong J, Feeney JA (2006) Adult attachment, anxiety and pain self-efficacy as predictors of pain intensity and disability. Pain 123: 146–154PubMedCrossRefGoogle Scholar
  30. 30.
    Merskey H, Bogduk N (1994) Classifiaction of chronic pain, 2nd edn. IASP Task Force on Taxonomy, SeattleGoogle Scholar
  31. 31.
    Miranda R, Meyerson LA, Marx BP, Tucker PM (2002) Civilian-based posttraumatic stress disorder and physical complaints: evaluation of depression as a mediator. J Trauma Stress 15: 297–301PubMedCrossRefGoogle Scholar
  32. 32.
    Moulin DE, Clark AJ, Speechley M, Morley-Forster PK (2002) Chronic pain in Canada – prevalence, treatment, impact and the role of opioid analgesia. Pain Res Manage 7:179–184Google Scholar
  33. 33.
    Mueller J, Karl A, Denke C, Mathier F et al. (2007) Somatoform pain disorder and PTSD in refugees – initial findings on the feasibility of CBT-biofeedback. submittedGoogle Scholar
  34. 34.
    Nilges P, Traue HC (2007) Psychologische Aspekte des Schmerzes. Verhaltensther Verhaltensmed 3: 302–322Google Scholar
  35. 35.
    Norman SB, Stein MB, Dimsdale JE, Hoyt DB (2007) Pain in the aftermath of trauma is a risk factor for posttraumatic stress disorder. Psycholo Med. DOI 10.1017/S0033291707001389Google Scholar
  36. 36.
    Norton PJ, Asmundson GJG (2003) Amending the fear-avoidance model of chronic pain: what is the role of physiological arousal? Behav Ther 34: 17–30CrossRefGoogle Scholar
  37. 37.
    Olff M, Güzelcan Y, de Vries GJ et al. (2006) HPA- and HPT-axis alterations in chronic posttraumatic stress disorder. Psychoneuroendocrinology 31: 120–130CrossRefGoogle Scholar
  38. 38.
    Otis JD, Keane TM, Kerns RD (2003) An examination of the relationship between chronic pain and posttraumatic stress disorder. J Rehabil Res Dev 40: 397–406PubMedCrossRefGoogle Scholar
  39. 39.
    Perkonigg A, Kessler RC, Storz S, Wittchen HU (2000) Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatric Scand 101: 46–59CrossRefGoogle Scholar
  40. 40.
    Pervanidou P, Kolaitis G, Charitaki S et al. (2007) The natural history of neuroendocrine changes in pediatric posttraumatic stress disorder (PTSD) after motor vehicle accidents: progressive divergence of noradrenaline and cortisol concentrations over time. Doi 10.1016/j.biopsych.2007.02.008 (article in press – online)Google Scholar
  41. 41.
    Picavet HSJ, Vlaeyen JWS, Schouten JSAG (2002) Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 156: 1028–1034PubMedCrossRefGoogle Scholar
  42. 42.
    Poundja J, Fikretoglu D, Brunet A (2006) The co-occurence of posttraumatic stress disorder symptoms and pain: is depression a mediator? J Trauma Stress 19: 747–751PubMedCrossRefGoogle Scholar
  43. 43.
    Rief W, Birbaumer N (2006) Biofeedback – Grundlagen, Indikation, Kommunikation, praktisches Vorgehen in der Therapie, 2. Aufl. Schattauer, Stuttgart New YorkGoogle Scholar
  44. 44.
    Saheeb BD, Oktapor AN (2005) Comorbid psychiatric disorders in Nigerian patients suffering temporomandibular joint pain and dysfunction. Niger J Clin Pract 8: 23–28Google Scholar
  45. 45.
    Sareen J, Cox BJ, Stein MB et al. (2007) Physical and mental comorbidity, disability and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosom Med 69: 242–248PubMedCrossRefGoogle Scholar
  46. 46.
    Sharp TJ, Harvey AG (2001) Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev 21: 857–877PubMedCrossRefGoogle Scholar
  47. 47.
    Shipherd JC, Keyes M, Jovanovic T et al. (2007) Veterans seeking treatment for posttraumatic stress disorder: what about comorbid chronic pain? J Rehabil Res Dev 44: 153–165PubMedCrossRefGoogle Scholar
  48. 48.
    Stein MB, Jang KL, Taylor S et al. (2002) Genetic and enviromental influences on trauma exposure and posttraumatic stress disorder symptoms: a general population twin study. Am J Psychiatry 159: 1675–1681PubMedCrossRefGoogle Scholar
  49. 49.
    Taylor S (2003) Anxiety sensitivity and its implications for understanding and treating PTSD. J Cognitive Psychother 17: 179–186CrossRefGoogle Scholar
  50. 50.
    Turner JA, Holtzman S, Mancl L (2007) Mediators, moderators and predictors of therapeutic change in cognitive behavioral therapy for chronic pain. Pain 127: 276–286PubMedCrossRefGoogle Scholar
  51. 51.
    Vassiliou T, Kaluza G, Putzke C et al. (2006) Physical therapy and active exercises – an adequate treatment for prevention of late whiplash syndrome? Randomized controlled trial in 200 patients. Pain 124: 69–76PubMedCrossRefGoogle Scholar
  52. 52.
    Villano CL, Rosenblum A, Magura S et al. (2007) Prevalence and correlates of posttraumatic stress disorder and chronic severe pain in psychiatric outpatients. J Rehabil Res Dev 44: 167–177PubMedCrossRefGoogle Scholar
  53. 53.
    Von Korff M, Bladerson B, Saunders K et al. (2005) A trial on activating intervention for chronic back pain in primary care and physical therapy settings. Pain 113: 323–330CrossRefGoogle Scholar
  54. 54.
    Wenk-Ansohn M (1996) Die Spur des Schmerzes – Psychosomatische Störungen bei Folterüberlebenden. In: Graessner S, Gurris N, Pross C (Hrsg) Folter – An der Seite der Überlebenden. Unterstützung und Therapien. Beck, München, S 83–98Google Scholar
  55. 55.
    Wessa M, Rohleder N, Kirschbaum C, Flor H (2005) Altered cortisol awakening response in posttraumatic stress disorder. Psychoneuroendocrinology 31: 209–215PubMedCrossRefGoogle Scholar
  56. 56.
    Woby SR, Roach NK, Urmston M, Watson PJ (2007) The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy. Eur J Pain. Doi 10.1016/j.ejpain.2007.01.005Google Scholar
  57. 57.
    Young EA, Breslau N (2004) Cortisol and catecholamines in posttraumatic stress disorder: an epidemiologic community study. Arch Gen Psychiatry 61: 394–401PubMedCrossRefGoogle Scholar
  58. 58.
    Zettl RP, Ruchholtz S, Lewan U, Waydhas C et al. (2004) Lebensqualität ploytraumatisierter Patienten 2 Jahre nach Unfall. Notfall Rettungsmed 7: 547–553CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.Behandlungszentrum für Folteropfer BerlinBerlinDeutschland
  2. 2.Technische Universität DresdenDresdenDeutschland
  3. 3.Freie Universität BerlinBerlinDeutschland

Personalised recommendations