Skip to main content
SpringerLink
Log in

Trauma and posttraumatic stress disorder in transcultural patients with chronic pain

Trauma und posttraumatische Belastungsstörung bei transkulturellen Patienten mit chronischem Schmerz

  • original article
  • Published:
neuropsychiatrie Aims and scope Submit manuscript

Abstract

Background

Traumatic events are commonly experienced in the general population and can lead to both psychological and physical consequences. While some may process the experienced event without developing trauma related symptoms in the long term, others develop persistent symptomatology in the form of chronic pain depending on the type of trauma as well as various other risk factors.

Objective

The aim of this study was to examine the relationship of the number of lifetime traumas and chronic pain in a sample of transcultural patients to further develop existing research highlighting an association between the number of traumas and chronic pain that may be independent of a categorical diagnosis of PTSD.

Methods

Using a case-control design, this study compared 29 chronic pain patients (Gerbershagen II/III) born in former Yugoslavia (21 female; age: 52.5 years, SD 7.3) to 21 patients of a general psychiatric sample who were matched by age- (±5 years), migratory-background, and gender. The number of traumas and PTSD symptomatology were assessed using the Harvard Trauma Questionnaire (HTQ). Somatisation, social dysfunction and anxiety were assessed by the General Health Questionnaire 28 (GHQ-28). The Beck Depression Inventory (BDI) was used to determine the presence of depression.

Results

96.9 % of the chronic pain patients reported at least one traumatic event compared to 76.2 % within the control group (p = 0.029). Likewise, the mean number of reported traumas was significantly higher among the chronic pain group at 12 vs. 7 respectively (p = 0.024). Regarding anxiety, depression and social dysfunction, no significant difference between the two groups was found.

Conclusions

Chronic pain patients with migratory background report an unusually high number of traumatic events. Clinicians should carefully screen for trauma history in this group of patients. The present study supports prior research suggesting a cumulative effect of trauma on chronic pain.

Zusammenfassung

Hintergrund

Traumatische Ereignisse gehen häufig mit psychischen und physischen Folgen einher. Während ein Teil der Betroffenen die Erlebnisse ohne bleibende Beeinträchtigung bewältigen kann, entwickeln andere in Abhängigkeit der Art des traumatischen Erlebnisses und weiterer Risikofaktoren jedoch langfristig Symptome, unter anderem chronische Schmerzen.

Studienziele

Ziel der vorliegenden Studie war es, den Zusammenhang zwischen der Anzahl erlebter Traumata und chronischer Schmerzen bei PatientInnen mit Migrationshintergrund zu untersuchen. Bisherige Forschung zeigte Hinweise auf einen Einfluss von Traumatisierung auf die Entstehung chronischer Schmerzen unabhängig vom Vorliegen einer PTSD.

Methoden

In einem Fall-Kontroll-Design wurden 29 PatientInnen mit chronischen Schmerzen (Gerbershagen II/III), die im ehemaligen Jugoslawien geboren sind (21 Frauen; Alter 52,5 Jahre, SD 7,3), mit 21 nach Alter (±5 Jahre), Geschlecht und Migrationshintergrund gematchten psychiatrischen PatientInnen verglichen. Die Anzahl an Traumata sowie PTSD-Symptome wurden mit dem Harvard Trauma Questionnaire (HTQ) erfasst. Somatisierung, soziale Dysfunktion und Angst wurden mit dem General Health Questionnaire 28 (GHQ-28) erfasst. Das Beck Depression Inventory (BDI) wurde verwendet, um Depressivität zu messen.

Ergebnisse

96,9 % der SchmerzpatientInnen gaben zumindest ein Trauma an, verglichen mit 76,2 % in der Kontrollgruppe (p = 0,029). Auch die mittlere Anzahl der Traumata war in der Schmerzgruppe deutlich höher (12 vs. 7; p = 0,024). Hinsichtlich Ängstlichkeit, Depressivität und psychosozialer Beeinträchtigung gab es keinen signifikanten Unterschied zwischen den Gruppen.

Schlussfolgerungen

PatientInnen mit Migrationshintergrund und chronischen Schmerzen zeigen eine ungewöhnlich hohe Traumaprävalenz. Eine Traumaanamnese sollte bei dieser PatientInnengruppe besondere Beachtung finden. Die vorliegende Studie unterstützt weiters bisherige Ergebnisse, die einen kumulativen Effekt von Traumatisierung auf Schmerzen fanden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333.

    Article  PubMed  Google Scholar 

  2. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96.

    Article  PubMed  Google Scholar 

  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder. 5th ed. American Psychiatric Association; 2013.

  4. World Health Organization. International Statistical Classification of Diseases. 10th ed. Washington, DC: World Health Organization; 1992.

    Google Scholar 

  5. Demyttenaere K, Bruffaerts R, Lee S, Posada-Villa J, Kovess V, Angermeyer MC, et al. Mental disorders among persons with chronic back or neck pain: results from the World Mental Health Surveys. Pain. 2007;129(3):332–42.

    Article  PubMed  Google Scholar 

  6. McWilliams LA, Cox BJ, Enns MW. Mood and anxiety disorders associated with chronic pain: an examination in a nationally representative sample. Pain. 2003;106(1–2):127–33.

    Article  PubMed  Google Scholar 

  7. Dirkzwager AJE, van der Velden PG, Grievink L, Yzermans CJ. Disaster-related posttraumatic stress disorder and physical health. Psychosom Med. 2007;69(5):435–40.

    Article  PubMed  Google Scholar 

  8. Lew HL, Otis JD, Tun C, Kerns RD, Clark ME, Cifu DX. Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: polytrauma clinical triad. JRehabilRes Dev. 2009;46(6):697–702.

    Google Scholar 

  9. Avdibegovic E, Delic A, Hadžibeganovic K, Selimbašic Z. Somatic diseases in patients with posttraumatic stress disorder. Med Arh. 2010;64(23):154–7.

    PubMed  Google Scholar 

  10. Sledjeski EM, Speisman B, Dierker LC. Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). J Behav Med. 2008;31(4):341–9.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Beckham JC, Crawford AL, Feldman ME, Kirby AC, Hertzberg MA, Davidson JR, et al. Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. J Psychosom Res. 1997;43(4):379–89.

    Article  CAS  PubMed  Google Scholar 

  12. Van Ommeren M, de Jong JT, Sharma B, Komproe I, Thapa SB, Cardeña E. Psychiatric disorders among tortured Bhutanese refugees in Nepal. Arch Gen Psychiatry. 2001;58(5):475–82.

    Article  PubMed  Google Scholar 

  13. Aigner M, Piralic-Spitzl S, Freidl M, Prause W, Lenz G, Friedmann A. Transkulturelle Unterschiede bei somatoformer Schmerzstörung—eine Vergleichsstudie von Patienten mit Herkunft aus dem ehemaligen Jugoslawien und Österreich. J Neurol Neurochirurgie Psychiatr. 2008;7(2):38–42.

    Google Scholar 

  14. Cloitre M, Cohen LR, Edelman RE, Han H. Posttraumatic stress disorder and extent of trauma exposure as correlates of medical problems and perceived health among women with childhood abuse. Women Health. 2001;34(3):1–17.

    Article  CAS  PubMed  Google Scholar 

  15. Husarewycz MN, El-Gabalawy R, Logsetty S, Sareen J. The association between number and type of traumatic life experiences and physical conditions in a nationally representative sample. Gen Hosp Psychiatry. 2014;36(1):26–32.

    Article  PubMed  Google Scholar 

  16. Mollica RF, Caspi-Yavin Y, Bollini P, Truong T, Tor S LJ. The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma, and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Dis. 1992;180(2):111–6.

    Article  CAS  PubMed  Google Scholar 

  17. Ichikawa M, Nakahara S, Wakai S. Cross-cultural use of the predetermined scale cutoff points in refugee mental health research. Soc Psychiatry Psychiatr Epidemiol. 2006;41(3):248–50.

    Article  PubMed  Google Scholar 

  18. Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck depression inventory: twenty-five years of evaluation. Clin Psychol Rev. 1988;8(1):77–100.

    Article  Google Scholar 

  19. Storch EA, Roberti JW, Roth DA. Factor structure, concurrent validity, and internal consistency of the Beck depression inventory-second edition in a sample of college students. Depress Anxiety. 2004;19(3):187–9.

    Article  PubMed  Google Scholar 

  20. Goldberg DP, Hillier VF. A scaled version of the general health questionnaire. Psychol Med. 1979;9(01):139.

    Article  CAS  PubMed  Google Scholar 

  21. Sharp T, Harvey A. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev. 2001;21(6):857–77.

    Article  CAS  PubMed  Google Scholar 

  22. Poundja J. The co-occurrence of posttraumatic stress disorder symptoms and pain: is depression a mediator? J Trauma Stress. 2006;19(5):747–51.

    Article  PubMed  Google Scholar 

  23. Asmundson GJG, Coons MJ, 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;47(10):930–7.

    PubMed  Google Scholar 

  24. López-Martínez AE, Ramírez-Maestre C, Esteve R. An examination of the structural link between post-traumatic stress symptoms and chronic pain in the framework of fear-avoidance models. Eur J Pain. 2014. doi:10.1002/j.1532-2149.2014.00459.x.

  25. Jenewein J, Wittmann L, Moergeli H. Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: a longitudinal study. J Trauma Stress. 2009;22(6):540–8.

    CAS  PubMed  Google Scholar 

  26. Geuze E, Westenberg HGM, Jochims A, de Kloet CS, Bohus M, Vermetten E, et al. Altered pain processing in veterans with posttraumatic stress disorder. Arch Gen Psychiatry. 2007;64(1):76–85.

    Article  PubMed  Google Scholar 

  27. Yehuda R. Status of glucocorticoid alterations in post-traumatic stress disorder. Ann N Y Acad Sci. 2009;1179:56–69.

    Article  CAS  PubMed  Google Scholar 

  28. Meewisse M-L, Reitsma JB, de Vries G-J, Gersons BPR, Olff M. Cortisol and post-traumatic stress disorder in adults: systematic review and meta-analysis. Br J Psychiatry 2007;191(5):387–92.

    Article  PubMed  Google Scholar 

  29. Malan-Müller S, Seedat S, Hemmings SMJ. Understanding posttraumatic stress disorder: insights from the methylome. Genes Brain Behav. 2014;13(1):52–68.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Laboratory of Psychiatric Neuroscience, James Cook University, 1 James Cook Drive, QLD 4811, Townsville, Australia

    Maximus Berger

  2. Department of Anesthesiology and Pain Management, Medical University of Vienna, Währinger Gürtel 18–20, 1090, Vienna, Austria

    Sanela Piralic-Spitzl

  3. Department of Adult Psychiatry, Universitätsklinikum Tulln, Alter Ziegelweg 10, 3430, Tulln, Austria

    Martin Aigner

Authors
  1. Maximus Berger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanela Piralic-Spitzl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Martin Aigner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maximus Berger.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berger, M., Piralic-Spitzl, S. & Aigner, M. Trauma and posttraumatic stress disorder in transcultural patients with chronic pain. Neuropsychiatr 28, 185–191 (2014). https://doi.org/10.1007/s40211-014-0122-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40211-014-0122-x

Keywords

Schlüsselwörter

Search

Navigation