Background & Aims
An estimated 35% of people with chronic pain also have Post Traumatic Stress Disorder (PTSD) compared to compared to 4.4 % of the general population (Kessler, Chui, Demler, Merikangas & Walters 2005: Creamer, Burgess, & McFarlane 2001). Understanding the prevalence of trauma experiences of pain patients can inform care and focus patient education and treatment.
The aims of the study were to determine:
1.The prevalence of trauma history in Kingston Pain Clinic patients
2.Understand how long ago the trauma took place, ie childhood, adolescent, adulthood, recent?
3.Has a formal diagnosis of PTSD been noted in the file
4.What was the nature of the trauma?
Methods
A Traumatic Events Checklist was completed by staff involved in the initial joint interdisciplinary pain assessment for all patients seen in a designated time period at the Monash Specialist Pain Clinic in Victoria Australia. The checklist was designed to indicate if patients mentioned any specific traumatic life events during the course of assessment and NOT to probe for information. The checklist also asked if a formal diagnosis of PTSD had been given or if a trauma history was mentioned in their file.
Results
The results highlighted high levels of trauma both in childhood/adolescence and particularly in adulthood. Many of these experiences were not reflected in the file or referral information. In many cases a formal diagnosis of PTSD had not been made despite signs suggestive of the disorder.
When compared to studies of the general population, people with chronic pain in this sample reported at least double the rates of trauma in their past (Elliott, Mok, & Briere, 2004).
Conclusions
All clinicians in the treatment team need to be aware of the issues facing pain patients who have experienced trauma in order to facilitate effective pain management. Strategies to manage the personal effects of vicarious trauma is also recommended. Arguably a team based approach using common language and understanding of how fear and pain based avoidance behaviour serve to perpetuate both physical and psychological distress is essential to effective management. This information is important for the treatment planning of patients with chronic pain and PTSD as there is some evidence that PTSD treatment can improve pain (Fishbain et al; 2017) as the fear related avoidance behaviours usually manifest in every part of their lives and maybe related to the severity of chronic pain (Siqveland et. Al; 2017).
References
Creamer M, Burgess P, McFarlane AC (2001). Posttraumatic stress disorder: findings from the Australian National Survey of Mental Health and Wellbeing. Psychol Med;31: 1237–47.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62: 617-627
Elliott, D. M., Mok, D. S., & Briere, J. (2004). Adult sexual assault: Prevalence, symptomatology, and sex differences in the general population. Journal of Traumatic Stress, 17, 203-211.
Fishbain, D. A., Pulikal, A., Lewis, J. E., & Gao, J. (2017). 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 Medicine (Malden, Mass.), 18(4), 711-735.
McEvoy PM, Grove R, Slade T. (2011) Epidemiology of anxiety disorders in the Australian general population: findings of the 2007 Australian National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry;45: 957–67.
Rosenman, S (2002 ) Trauma and posttraumatic stress disorder in Australia: findings in the population sample of the Australian National Survey of Mental Health and Wellbeing, Australian and New Zealand Journal of Psychiatry, Volume36, Issue 4
Siqveland, J., Ruud, T., & Hauff, E. (2017). Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain. European Journal of Psychotraumatology, 8(1), 1-9.
Walker, E. A., Keegan, D., Gardner, G., Sullivan, M., Bernstein, D., & Katon, W. J. (1997). Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II Sexual, physical, and emotional abuse and neglect. Psychosomatic Medicine, 59, 572-577.
Presenting Author
Sharryn Lydall-Smith
Poster Authors
Topics
- Assessment and Diagnosis