Background & Aims
Psychosocial trauma is a robust risk factor for the development, maintenance, and exacerbation of chronic pain(1–8). Individuals who report trauma report more pain symptoms than those without such histories, and individuals with chronic pain are more likely to report trauma than healthy controls(9,10). Despite known links between trauma and pain, research findings have not substantially informed clinical practice in pain management(11,12). The trauma-pain comorbidity may introduce complexities that adversely influence the way patients interact with the healthcare system and with providers(13,14). However, little is known about the pain management experiences of patients with the trauma-pain comorbidity. Thus, this study aimed to explore how individuals with a history of trauma and pain experience interactions with pain providers, shed light on common issues encountered in their care, and elicit their feedback about the integration of trauma-informed care(13) in pain management.
Methods
Patients (N=15) with a history of psychosocial trauma and a diagnosis of at least one chronic pain condition were recruited through the Brigham and Women’s Hospital Pain Management Center. Patients completed qualitative, semi-structured interviews (conducted remotely via Zoom) about their pain management experiences, both challenging and helpful interactions with pain providers as they relate to patients’ trauma history, and their feedback and recommendations for strategies to integrate trauma-informed care into pain management. Interviews were audio recorded, transcribed, and analyzed via thematic analysis.
Results
Preliminary thematic analysis revealed three key themes reflecting’s challenges patients experienced in pain management: (1) Providers not seeking permission or providing notice prior to touching the patient; (2) Providers not explaining physical procedures prior to performing them; (3) Providers not having an understanding of the interaction of trauma, psychological distress, and chronic pain. Key themes related to helpful interactions with pain providers included: (1) Providers showcasing knowledge of the trauma-pain connection; (2) Providers emphasizing patients’ autonomy and involving the patient in treatment planning decisions. Last, patients expressed a wish for providers to: (1) Acknowledge trauma as one factor of several factors that impact patients’ chronic pain experience; (2) Implement trauma screenings early on (e.g., initial intakes); and (3) Offer patients with personalized treatment options, resources, and recommendations appropriate for the trauma-pain comorbidity.
Conclusions
This study revealed that individuals with a history of trauma and chronic pain may encounter unique challenges in pain management, which may hinder their care. Overall, patients expressed a desire for pain providers to demonstrate understanding of the trauma-pain connection, to discuss trauma early on in treatment, and to provide personalized resources and referrals. More research is needed on effective strategies to enhance provider education in the trauma-pain connection, and to integrate trauma-informed care practices into routine pain management.
References
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Presenting Author
Jolin B. Yamin
Poster Authors
Jolin Yamin
PhD
Brigham and Women's Hospital/Harvard Medical Shcool
Lead Author
Robert Edwards
PhD
Brigham & Women's Hospital/Harvard Medical School
Lead Author
SAMANTHA MEINTS
PhD
Dept. of Anesthesiology, Perioperative & Pain Medicine, Brigham & Women’s Hospital, Boston, MA, USA
Lead Author
Topics
- Patient Engagement and Co-Creation in Research and Education