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

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


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.


Post-traumatic Stress Disorder Pain Opiate Addiction Comorbidity 

List of Abbreviations


Acceptance and commitment therapy


Adrenocorticotropic hormone


Cognitive behavioral therapy


Chronic non-cancer pain


Concurrent Treatment of PTSD and Substance Use Disorders with Prolonged Exposure


Cognitive Processing Therapy


Corticotropin-releasing hormone


Diagnostic Statistical Manual of Mental Disorders – Fourth Edition

HPA axis

Hypothalamic pituitary adrenal axis


Integrated Cognitive Behavioral Therapy


Motivational Interviewing


Medial prefrontal cortex


Operation Enduring Freedom/Operation Iraqi Freedom


Opioid-induced hyperalgesia


Primary care physicians




Post-traumatic stress disorder


Substance Dependence PTSD Therapy


Stress inoculation training




Seeking Safety


Substance use disorder


Trauma Adaptive Recovery Group Education and Therapy


Trauma Exposure and Empowerment Model


Trauma-sensitive usual care


Urine drug screen


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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