Background & Aims

Chronic pain in patients with posttraumatic stress disorder (PTSD) is a frequent symptom and a complicating factor in the treatment of patients. Ukrainians faced numerous traumatic factors caused by war exposure and witnessing, from the danger of death and physical injury to various symptoms of mental trauma. Many studies investigating the management of chronic pain often exclude the participation of people from refugee and immigrant backgrounds.
The study aimed to examine the associations between chronic pain and mental distress among adult Ukrainians after the invasion at baseline and 6-month follow-up and assess whether associations changed significantly with time.

Methods

The assessment was conducted on three different groups of participants: not displaced persons (NDP) from the Zaporizhzhia region (active hostile zone), internally displaced persons (IDP), and Ukrainian refugees in Poland, Warsaw. The study included gathering socio-demographic data (age, sex, education, location) and validated self-report questionnaires for assessment of physical health conditions, including chronic pain conditions (CPC) and pain indicators, anxiety, and PTSD levels. Thus, 147 adults 43-74 years old were included in this study: 48 participants in the NDP group, 45 subjects in the IDP group, and 54 refugees from Ukraine who are now in Warsaw. Females were the largest numbers in all three groups (82%). Participants denied previously diagnosed mental health issues. A repeat survey was conducted after 6 months. We managed to contact 103 participants Data analysis was performed in SPSS 24.0 (IBM, Armonk, NY, USA).

Results

Group comparison showed that the largest number of PTSD+ individuals was in the group of refugees (70,4%) and the smallest number was in group NDP (42,7%). There were no significant differences between NDP and IDP. Chronic pain prevalence ranged from 28,4% to 60,3% in all groups. The highest level was registered in the refugees group (53,7%), especially in the PTSD+ refugees subgroup (60,3%). The lowest level was in the IDP, PTSD- subgroup (28,4%). Chronic pain was described as moderate to intense in all groups. Correlation for the full PTSD-positive sample between PTSD –like symptoms and pain indicator were moderate and positive (R=0,46-0,62, p?0.001). There was registered significant increasing the number of participants who reached the criteria for PTSD in 6 months in the IDP group, an insignificant increase in the NDP group, and an insignificant decrease in the refugee group. There was a registered increase in reported chronic pain in the NDP and IDP groups.

Conclusions

Conclusions. Participants with comorbid PTSD often reported the presence of chronic pain, increased levels of anxiety, and pain intensity. Refugees were the most vulnerable group in our study, but participants of all groups require further monitoring. Evidence-based interventions addressing both physical and emotional distress are important in improving outcomes.

References

1. Lushchak O, Velykodna M, Bolman S, Strilbytska O, Berezovskyi V, Storey KB. Prevalence of stress, anxiety, and symptoms of post-traumatic stress disorder among Ukrainians after the first year of Russian invasion: a nationwide cross-sectional study. Lancet Reg Health Eur. 2023 Nov 6;36:100773. doi: 10.1016/j.lanepe.2023.100773. PMID: 38019977; PMCID: PMC10665943.
2.Altun A, Brown H, Sturgiss L, Russell G. Evaluating chronic pain interventions in recent refugees and immigrant populations: A systematic review. Patient Educ Couns. 2022 May;105(5):1152-1169. doi: 10.1016/j.pec.2021.08.021. Epub 2021 Aug 27. PMID: 34483005.
3. Kind S, Otis JD. The Interaction Between Chronic Pain and PTSD. Curr Pain Headache Rep. 2019 Nov 28;23(12):91. doi: 10.1007/s11916-019-0828-3. PMID: 31781875.
4. Fishbain DA, Pulikal A, Lewis JE, Gao J. Chronic Pain Types Differ in Their Reported Prevalence of Post -Traumatic Stress Disorder (PTSD) and There Is Consistent Evidence That Chronic Pain Is Associated with PTSD: An Evidence-Based Structured Systematic Review. Pain Med. 2017 Apr 1;18(4):711-735. doi: 10.1093/pm/pnw065. PMID: 27188666.
5.Weisfeld CC, Dunleavy K. Strategies for Managing Chronic Pain, Chronic PTSD, and Comorbidities: Reflections on a Case Study Documented over Ten Years. J Clin Psychol Med Settings. 2021 Mar;28(1):78-89. doi: 10.1007/s10880-020-09741-5. PMID: 32889675.
6. Elmose Andersen T, Hansen M, Lykkegaard Ravn S, Bjarke Vaegter H. The association of probable PTSD at baseline and pain-related outcomes after chronic pain rehabilitation: A comparison of DSM-5 and ICD-11 criteria for PTSD. Eur J Pain. 2022 Mar;26(3):709-718. doi: 10.1002/ejp.1899. Epub 2021 Dec 22. PMID: 34939270.
7.Rometsch-Ogioun El Sount C, Windthorst P, Denkinger J, Ziser K, Nikendei C, Kindermann D, Ringwald J, Renner V, Zipfel S, Junne F. Chronic pain in refugees with posttraumatic stress disorder (PTSD): A systematic review on patients’ characteristics and specific interventions. J Psychosom Res. 2019 Mar;118:83-97. doi: 10.1016/j.jpsychores.2018.07.014. Epub 2018 Jul 30. PMID: 30078503.
8.Müller M, Khamis D, Srivastava D, Exadaktylos AK, Pfortmueller CA. Understanding Refugees’ Health. Semin Neurol. 2018 Apr;38(2):152-162. doi: 10.1055/s-0038-1649337. Epub 2018 May 23. PMID: 29791941.
9. Nordbrandt MS, Vindbjerg E, Mortensen EL, Carlsson J. Chronicity of posttraumatic stress disorder and comorbid pain as predictors of treatment response for trauma-affected refugees. J Trauma Stress. 2022 Oct;35(5):1393-1404. doi: 10.1002/jts.22839. Epub 2022 Apr 21. PMID: 35446986.
10. Mishori R, Aleinikoff S, Davis D. Primary Care for Refugees: Challenges and Opportunities. Am Fam Physician. 2017 Jul 15;96(2):112-120. PMID: 28762707.
11. Teodorescu DS, Heir T, Siqveland J, Hauff E, Wentzel-Larsen T, Lien L. Chronic pain in multi-traumatized outpatients with a refugee background resettled in Norway: a cross-sectional study. BMC Psychol. 2015 Mar 15;3(1):7. doi: 10.1186/s40359-015-0064-5. PMID: 25815196; PMCID: PMC4369066.
12. Gasperi M, Panizzon M, Goldberg J, Buchwald D, Afari N. Posttraumatic Stress Disorder and Chronic Pain Conditions in Men: A Twin Study. Psychosom Med. 2021 Feb-Mar 01;83(2):109-117. doi: 10.1097/PSY.0000000000000899. PMID: 33337593; PMCID: PMC7858228.

Presenting Author

Iana Andreieva

Poster Authors

Iana Andreieva

MD, PhD

National Geriatrics, Rheumatology and Rehabilitation Institute,

Lead Author

Oleksander Tokarenko

MD

Zaporizhzhia Medical and Pharmaceutical University

Lead Author

Topics

  • and War
  • Organized Violence
  • Pain in Special Populations: Torture