Combat Posttraumatic Stress Disorder and Chronic Pain

Abstract

Objective: chronic post-traumatic stress disorder (PTSD) is commonly accompanied by depression and anxiety as comorbidity. The psychological states, such as depression and anxiety, can increase pain symptoms. A number of recent research results have shown that chronic post-traumatic stress disorder and chronic pain frequently co-occur and similar mechanisms have been identified that sustain both conditions. Method: the data were collected from medical records of 184 Croatian war veterans diagnosed with chronic PTSD and chronic pain as co-morbid condition. On the basis of medical records, interviews and different types of self-assessment questionnaires the interrelationship between chronic pain and chronic PTSD was analysed. PTSD was assessed by CAPS (Clinical Administered Posttraumatic Scale) and M-PTSD (Mississippi Scale for combat PTSD), whereas pain was measured by Melzack-McGill Pain Questionnaire-short form (MPQ-SF) and Visual Analogue Scale (VAS). Results: the combat veterans with PTSD reported in descending order the following: pain in the head, back pain, widespread pain and limb pain. The patients with chronic PTSD had significantly higher total pain scores as well as affective and sensory pain components when compared to the patients without PTSD. Anxiety and depression were also highly correlated with pain. The relation between pain severity and depression was mediated by the severity of PTSD. Conclusion: our findings are directed towards the need for multidisciplinary approach in the treatment of patients with chronic PTSD and co-morbid chronic pain, which will optimize treatment and result in more cost-effective care.