Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life
Both posttraumatic stress disorder (PTSD) and depression are highly comorbid with chronic pain and have deleterious effects on pain and treatment outcomes, but the nature of the relationships among chronic pain, PTSD, and depression has not been fully elucidated. This study examined 250 Veterans Affairs primary care patients with moderate to severe chronic musculoskeletal pain who participated in a randomized controlled pain treatment trial. Baseline data were analyzed to examine the independent associations of PTSD and major depression with multiple domains of pain, psychological status, quality of life, and disability. PTSD was strongly associated with these variables and in multivariate models, PTSD and major depression each had strong independent associations with these domains. PTSD demonstrated similar relationships as major depression with psychological, quality of life, and disability outcomes and significant but somewhat smaller associations with pain. Because PTSD and major depression have independent negative associations with pain, psychological status, quality of life, and disability, it is important for clinicians to recognize and treat both mental disorders in patients with chronic pain.
KeywordsChronic pain PTSD Depression Veterans Quality of life Disability
This work was supported by a Department of Veterans Affairs Health Services Research and Development (VA HSR&D) Merit Review award to Dr. Kroenke (IIR 07-119) and Career Development Award to Dr. Krebs (CDA 07-215). The sponsor had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
Conflict of interest
Samantha D. Outcalt, Kurt Kroenke, Erin E. Krebs, Neale R. Chumbler, Jingwei Wu, Zhangsheng Yu, and Matthew J. Bair declare that they have no conflict of interest.
Human and animal rights and informed consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study. Additional informed consent was obtained from all patients for which identifying information is included in this article.
- Asmundson, G. J. G., Coons, M. J., Taylor, S., & Katz, J. (2002). PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models. Canadian Journal of Psychiatry, 47, 930–937.Google Scholar
- Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., et al. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005–2008. Journal of Clinical Epidemiology, 63, 1179–1194.CrossRefPubMedCentralPubMedGoogle Scholar
- Chumbler, N. R., Kroenke, K., Outcalt, S. D., Bair, M. J., Krebs, E. E., Wu, J., & Yu, Z. (2013). Association between sense of coherence and health-related quality of life among primary care patients with chronic musculoskeletal pain. Health Quality of Life Outcomes, 11, 216.CrossRefPubMedCentralPubMedGoogle Scholar
- Haskell, S. G., Gordon, K. S., Mattocks, K., Duggal, M., Erdos, J., Justice, A., & Brandt, C. A. (2010). Gender differences in rates of depression, PTSD, pain, obesity, and military sexual trauma among Connecticut war Veterans of Iraq and Afghanistan. Journal of Women’s Health, 19, 267–271.CrossRefPubMedCentralPubMedGoogle Scholar
- Kroenke, K., Bair, M. J., Damush, T. M., Hoke, S., Nicholas, G., Kempf, C., et al. (2007). Stepped care for affective disorders and musculoskeletal pain (SCAMP) study: Design and practical implications of an intervention for comorbid pain and depression. General Hospital Psychiatry, 29, 506–517.CrossRefPubMedGoogle Scholar
- Otis, J. D., Pincus, D. B., & Keane, T. M. (2006). Comorbid chronic pain and posttraumatic stress disorder across the lifespan: A review of theoretical models. In G. Young, A. W. Kane, & K. Nicholson (Eds.), Psychological knowledge in court: PTSD, pain, and TBI (pp. 242–268). New York: Springer.CrossRefGoogle Scholar
- Runnals, J. J., Van Voorhees, E., Robbins, A. T., Brancu, M., Straits-Troster, K., Beckham, J. C., & Calhoun, P. S. (2013). Self-reported pain complaints among Afghanistan/Iraq era men and women Veterans with comorbid posttraumatic stress disorder and major depressive disorder. Pain Medicine, 14, 1529–1533.CrossRefPubMedGoogle Scholar