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Comorbid Post-Traumatic Stress Disorder, Pain, and Opiate Addiction

  • Bethany KetchenEmail author
  • Pamela Eilender
  • Ayman Fareed
Reference work entry

Abstract

Being exposed to life-threatening physical traumas, for example, a motor vehicle accident or combat-related injury, may also contribute to the development of chronic physical pain and PTSD. The use of opiates to treat chronic pain may result in the development of opiate addiction. Therefore, PTSD, pain, and opiate addiction commonly co-occur. The signs and symptoms of these disorders may overlap, which can make it challenging to determine which led to which. For example, the opioid withdrawal syndrome may mimic the hypervigilance and exacerbated startle response in patients with PTSD. A common neurobiological circuit is suggested for the pathophysiologic mechanism of this comorbidity. There is evidence that opioid substitution therapy may improve opioid addiction and chronic pain outcomes in patients with comorbid PTSD, pain, and opioid use disorder. Further, non-pharmacological approaches utilizing cognitive behavioral therapy (CBT) show promise in addressing the treatment needs of those with co-occurring PTSD, pain, and opioid use disorder; however, additional research is needed to validate these results. In this chapter, the prevalence and etiology of these comorbidities will be reviewed. The neurobiological link between PTSD, pain, and opiate addiction will be discussed. The available treatment options for these comorbidities with a focus on illicit opiate use, PTSD, and pain outcomes will be elaborated. The reader will be updated about the basic and most recent information available about these comorbidities. Then the gap in the current treatment and the need for future research will be mentioned.

Keywords

Post-traumatic Stress Disorder Pain Opiate Addiction Comorbidity 

List of Abbreviations

ACT

Acceptance and commitment therapy

ACTH

Adrenocorticotropic hormone

CBT

Cognitive behavioral therapy

CNCP

Chronic non-cancer pain

COPE

Concurrent Treatment of PTSD and Substance Use Disorders with Prolonged Exposure

CPT

Cognitive Processing Therapy

CRH

Corticotropin-releasing hormone

DSM-IV

Diagnostic Statistical Manual of Mental Disorders – Fourth Edition

HPA axis

Hypothalamic pituitary adrenal axis

ICBT

Integrated Cognitive Behavioral Therapy

MI

Motivational Interviewing

mPFC

Medial prefrontal cortex

OEF/OIF

Operation Enduring Freedom/Operation Iraqi Freedom

OIH

Opioid-induced hyperalgesia

PCP

Primary care physicians

POMC

Proopiomelanocortin

PTSD

Post-traumatic stress disorder

SDPT

Substance Dependence PTSD Therapy

SIT

Stress inoculation training

SL

Sublingual

SS

Seeking Safety

SUD

Substance use disorder

TARGET

Trauma Adaptive Recovery Group Education and Therapy

TREM

Trauma Exposure and Empowerment Model

TSU

Trauma-sensitive usual care

UDS

Urine drug screen

USA

United States

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Copyright information

© Springer International Publishing Switzerland (outside the USA) 2016

Authors and Affiliations

  • Bethany Ketchen
    • 1
    Email author
  • Pamela Eilender
    • 1
  • Ayman Fareed
    • 1
  1. 1.Department of Psychiatry and Behavioral Sciences, Emory University, School of MedicineAtlanta VA Medical Center 116ADecaturUSA

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