Current Pain and Headache Reports

, Volume 8, Issue 2, pp 111–115 | Cite as

The prevalence of post-traumatic stress disorder in chronic pain patients

  • Timothy J. Sharp

Abstract

Several of the more common causes of chronic pain include traumatic events such as motor vehicle accidents and workrelated incidents. Therefore, it is not unusual for patients presenting with chronic pain to also describe significant levels of distress including post-traumatic symptomatology and, in the more severe cases, post-traumatic stress disorder (PTSD). Throughout the past few decades, the literature relating to chronic pain and PTSD has become progressively more sophisticated, resulting in well-supported theories and treatments for sufferers. However, only a handful of studies have specifically attended to the co-occurrence of these two disorders. This review presents a summary of the literature relating to the two disorders in terms of symptoms, prevalence, and comorbidity. It also briefly describes the main empirically supported psychologic theories of chronic pain and PTSD and briefly reviews the evidence regarding what factors maintain the disorders. Treatment implications and issues for future research are considered.

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References and Recommended Reading

  1. 1.
    Sharp T, Harvey A: Chronic pain and post-traumatic stress disorder: mutual maintenance? Clin Psychol Rev 2001, 21:857–877. This reference is recommended because it reviews the literature on pain and PTSD and proffers a model in which suggestions are made regarding the means by which certain common variables may lead to the mutual maintenance of the two disorders.PubMedCrossRefGoogle Scholar
  2. 2.
    Asmundson G, Norton G, Allerdings M, et al.: Post-traumatic stress disorder and work-related injury. J Anxiety Disord 1998, 12:57–69.PubMedCrossRefGoogle Scholar
  3. 3.
    Crombie I, Croft P, Linton S, et al.: Epidemiology of Pain. Seattle: IASP Press; 1999.Google Scholar
  4. 4.
    Fordyce W: Back Pain in the Workplace: Management of Disability in Nonspecific Conditions. Seattle: IASP Press; 1995.Google Scholar
  5. 5.
    Blanchard E, Hickling E: After the Crash: Assessment and Treatment of Motor Vehicle Accident Survivors. Washington DC: American Psychological Association; 1997.Google Scholar
  6. 6.
    van der Kolk B, McFarlane A, Weisaeth L: Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York: The Guilford Press; 1996.Google Scholar
  7. 7.
    Modlin HC: Traumatic neuroses and other injuries. Symposium on Forensic Psychiatry 1983, 6:661–682.Google Scholar
  8. 8.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 1. Washington, DC: American Psychiatric Association; 1952.Google Scholar
  9. 9.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders edn 2. Washington, DC:Google Scholar
  10. 10.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3. Washington, DC: American Psychiatric Association; 1980.Google Scholar
  11. 11.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 3, revised. Washington, DC: American Psychiatric Association; 1987.Google Scholar
  12. 12.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4. Washington, DC: American Psychiatric Association; 1994.Google Scholar
  13. 13.
    Koopman C, Classen C, Cardena E, Spiegel D: When disaster strikes, acute stress disorder may follow. J Trauma Stress 1995, 8:29–46.PubMedCrossRefGoogle Scholar
  14. 14.
    Bryant RA, Harvey AG: Acute stress disorder: a critical review of diagnostic and theoretical issues. Clin Psychol Rev 1997, 17:757–773.PubMedCrossRefGoogle Scholar
  15. 15.
    Harvey AG, Bryant RA: Relationship of acute stress disorder and post-traumatic stress disorder following motor vehicle accidents. J Consult Clin Psychol 1998a, 66:507–512.PubMedCrossRefGoogle Scholar
  16. 16.
    Fishbain D: DSM-IV: Implications and issues for the pain clinician. Am Pain Soc Bull 1995, March/April:6–18.Google Scholar
  17. 17.
    King S, Strain J: Revising the category of somatoform pain disorder. Hosp Community Psychiatry 1992, 43:217–219.PubMedGoogle Scholar
  18. 18.
    Blanchard EB, Hickling EJ, Barton KA, et al.: One-year prospective follow-up of motor vehicle accident victims. Behav Res Ther 1996, 34:775–786.PubMedCrossRefGoogle Scholar
  19. 19.
    Resnick HS, Foy DW, Donahoe CP, Miller EN: Antisocial behavior and postraumatic stress disorder in Vietnam veterans. J Clin Psychol 1989, 45:860–866.PubMedCrossRefGoogle Scholar
  20. 20.
    Kilpatrick DG, Amick A, Resnick HS: Treating the Trauma of Rape: Cognitive-Behavioral Therapy for PTSD. Edited by Foa EB, Rothbaum BO. Guilford Press: London; 1988.Google Scholar
  21. 21.
    Schlenger WE, Kulka RA, Fairbank JA, Hough RL: The prevalence of post-traumatic stress disorder in the Vietnam generation: a multimethod, multisource assessment of psychiatric disorder. J Trauma Stress 1992, 5:333–363.CrossRefGoogle Scholar
  22. 22.
    Rothbaum BO, Foa EB, Riggs DS, et al.: A prospective examination of post-traumatic stress disorder in rape victims. J Trauma Stress 1992, 5:455–475.CrossRefGoogle Scholar
  23. 23.
    Solomon Z, Laor N, McFarlane A: Acute post-traumatic reactions in soldiers and civilians. In Traumatic Stress: The Effects of Overwhelming Experience on Body, Mind, and Society. Edited by van der Kolk B, McFarlane A, Weisaeth L. New York: The Guilford Press; 1996:102–114.Google Scholar
  24. 24.
    Brewin CR, Andrews B, Rose S, Kirk M: Acute stress disorder and post-traumatic stress disorder in victims of violent crime. Am J Psychiatry 1999, 156:360–366.PubMedGoogle Scholar
  25. 25.
    Classen C, Koopman C, Hales R, Spiegel D: Acute stress disorder as a predictor of post-traumatic stress symptoms. Am J Psychiatry 1998, 155:620–624.PubMedGoogle Scholar
  26. 26.
    Brady KT: Post-traumatic stress disorder and comorbidity: recognizing the many faces of PTSD. J Clin Psychiatry 1997, 58(suppl 9):12–15.PubMedGoogle Scholar
  27. 27.
    Kessler RC, Sonnega A, Bromet E, et al.: Post-traumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995, 52:1048–1060.PubMedGoogle Scholar
  28. 28.
    Barton KA, Blanchard EB, Hickling EJ: Antecedents and consequences of acute stress disorder among motor vehicle accident victims. Behav Res Ther 1996, 34:805–813.PubMedCrossRefGoogle Scholar
  29. 29.
    Shore JH, Vollmer WM, Tatum EL: Community patterns of post-traumatic stress disorders. J Nerv Ment Dis 1989, 177:681–685.PubMedCrossRefGoogle Scholar
  30. 30.
    Hendin H, Haas AP: Suicide and guilt as manifestations of PTSD in Vietnam combat veterans. Am J Psychiatry 1991, 148:586–591.PubMedGoogle Scholar
  31. 31.
    Keane TM, Wolfe J: Comorbidity in post-traumatic stress disorder: an analysis of community and clinical studies. J Appl Soc Psychol 1990, 20:1776–1788.CrossRefGoogle Scholar
  32. 32.
    Asmundson G, Coons M, Taylor S, Katz J: PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry 2002, 46:930–937. Recommended because of its comprehensive and thought-provoking coverage of theoretical issues with regard to shared vulnerability.Google Scholar
  33. 33.
    Cox B, McWilliams L: Mood and anxiety disorders in relation to chronic pain: evidence from the National Comorbidity Study. Pain Res Manag 2002, 7(suppl A):11A.Google Scholar
  34. 34.
    De Loos WS: Psychosomatic manifestations of chronic posttraumatic stress disorder. In Post-traumatic Stress Disorder: Etiology, Phenomenology, and Treatment. Edited by Wolf ME, Mosnaim AD. Washington, DC: American Psychiatric Press; 1990:95–104.Google Scholar
  35. 35.
    McFarlane AC, Atchison M, Rafalowicz E, Papay P: Physical symptoms in post-traumatic stress disorder. J Psychosom Res 1987, 38:715–726.CrossRefGoogle Scholar
  36. 36.
    Shalev A, Bleich A, Ursano RJ: Post-traumatic stress disorder: somatic comorbidity and effort tolerance. Psychosomatics 1990, 31:197–203.PubMedGoogle Scholar
  37. 37.
    van der Kolk BA: Trauma and memory. In Traumatic Stress: The effects of Overwhelming Experience on Mind, Body, and Society B. Edited byvan der Kolk A, McFarlane AC, Weisaeth L. New York: Guilford Press; 1996:279–301.Google Scholar
  38. 38.
    Beckham JC, Crawford AL, Feldman ME, et al.: Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. J Psychosom Res 1997, 43:379–389.PubMedCrossRefGoogle Scholar
  39. 39.
    Bryant RA, Marosszeky JE, Crooks J, et al.: The interaction of post-traumatic stress disorder and chronic pain following traumatic brain injury. J Nerv Ment Dis 2001, 189:109–113.PubMedCrossRefGoogle Scholar
  40. 40.
    Benedikt RA, Kolb LC: Preliminary findings on chronic pain and post-traumatic stress disorder. Am J Psychiatry 1986, 143:908–910.PubMedGoogle Scholar
  41. 41.
    Muse M: Stress-related post-traumatic chronic pain syndrome: criteria for diagnosis and preliminary report on prevalence. Pain 1985, 23:295–300.PubMedCrossRefGoogle Scholar
  42. 42.
    White P: Coexisting physical conditions among inpatients with post-traumatic stress disorder. Mil Med 1989, 154:66–71.PubMedGoogle Scholar
  43. 43.
    Bryant RA, Harvey AG: Processing threatening information in post-traumatic stress disorder. J Abnorm Psychol 1995, 104:537–541.PubMedCrossRefGoogle Scholar
  44. 44.
    Pearce J, Morley S: An experimental investigation of the construct validity of the McGill Pain Questionnaire. Pain 1989, 39:115–121.PubMedCrossRefGoogle Scholar
  45. 45.
    McCracken L, Gross R, Sorg P, Edmunds T: Prediction of pain in patients with chronic low back pain: effects of inaccurate prediction and pain-related anxiety. Behav Res Ther 1993, 31:647–652.PubMedCrossRefGoogle Scholar
  46. 46.
    Warda G, Bryant RA: Cognitive bias in acute stress disorder. Behav Res Ther 1998a, 36:1177–1183.PubMedCrossRefGoogle Scholar
  47. 47.
    Crombez G, Eccleston C, Beayens F, Eelen P: When somatic information threatens, catastrophic thinking enhances attentional interference. Pain 1998, 75:187–198.PubMedCrossRefGoogle Scholar
  48. 48.
    Blanchard EB, Kolb LC, Gerardi RJ, et al.: Cardiac response to relevant stimuli as an adjunctive tool for diagnosing posttraumatic stress disorder in Vietnam veterans. Behav Ther 1986, 17:592–606.CrossRefGoogle Scholar
  49. 49.
    Horowitz MJ: Stress Response Syndromes, edn 2. New York: Jason Aronson; 1986.Google Scholar
  50. 50.
    Harvey AG, Bryant RA: The effect of attempted thought suppression in acute stress disorder. Behav Res Ther 1998b, 36:583–590.PubMedCrossRefGoogle Scholar
  51. 51.
    Sharp T: The safety behaviors construct and its application to chronic pain. Behav Cogn Psychotherapy 2001, 29:241–244.CrossRefGoogle Scholar
  52. 52.
    Waddell G, Newton M, Henderson I, et al.: A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993, 52:157–168.PubMedCrossRefGoogle Scholar
  53. 53.
    Foa EB, Steketee G, Rothbaum BO: Behavioral/cognitive conceptualizations of post-traumatic stress disorder. Behav Ther 1989, 20:155–176.CrossRefGoogle Scholar
  54. 54.
    Difede J, Jaffe AB, Musngi G, et al.: Determinants of pain expression in hospitalized burn patients. Pain 1997, 72:245–251.PubMedCrossRefGoogle Scholar
  55. 55.
    Harvey AG, McGuire BE: Suppressing and attending to painrelated thoughts in chronic pain patients. Behav Res Ther 2000, 38:1117–1124.PubMedCrossRefGoogle Scholar
  56. 56.
    Smith TW, Aberger EW, Follick MJ, Ahern DK: Cognitive distortion and psychological distress in chronic low back pain. J Consult Clin Psychol 1986, 54:573–575.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2004

Authors and Affiliations

  • Timothy J. Sharp
    • 1
  1. 1.University of SydneySydneyAustralia

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