Dysfunctional Pain Modulation in Torture Survivors: The Mediating Effect of PTSD

Defrin, Ruth; Lahav, Yael; Solomon, Zahava

doi:10.1016/j.jpain.2016.09.005

Cited by 23 publications

(18 citation statements)

References 77 publications

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“…This finding is theoretically important because congruent with a PTSD diagnosis is a related propensity to experience chronic pain as suggested in previous theoretical models of the PTSD–pain relationship (Asmundson et al, 2002). Another interpretation of the importance of PTSD and its relationship to pain was suggested in a recent study of torture victims (Defrin, Lahav, & Solomon, 2016) where it is suggested that PTSD moderated the relationship between trauma exposure and pain by altering pain modulation.…”

Section: Discussionmentioning

confidence: 97%

Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain

Siqveland

Ruud

Hauff

2017

European Journal of Psychotraumatology

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Background: Trauma exposure and post-traumatic stress disorder (PTSD) are risk factors for chronic pain. Objective: This study investigated how exposure to intentional and non-intentional traumatic events and PTSD are related to pain severity and outcome of treatment in chronic pain patients. Methods: We assessed exposure to potentially traumatizing events, psychiatric diagnosis with structured clinical interview, and pain severity in 63 patients at a secondary multidisciplinary pain clinic at the beginning of treatment, and assessed level of pain at follow up. Exposure to potentially traumatizing events and PTSD were regressed on pain severity at the initial session and at follow up in a set of multiple regression analysis. Results: The participants reported exposure to an average of four potentially traumatizing events, and 32% had PTSD. Exposure to intentional traumatic events and PTSD were significantly associated with more severe pain, and PTSD significantly moderated the relationship between trauma exposure and pain (all p < .05). The treatment programme reduced pain moderately, an effect that was unrelated to trauma exposure and PTSD. Conclusions: Trauma exposure is related to chronic pain in the same pattern as to mental disorders, with intentional trauma being most strongly related to pain severity. PTSD moderated the relationship between trauma exposure and pain. While pain patients with PTSD initially report more pain, they responded equally to specialist pain treatment as persons without PTSD.

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Section: Discussionmentioning

confidence: 97%

Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain

Siqveland

Ruud

Hauff

2017

European Journal of Psychotraumatology

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“…Models including both bottom-up and top-down mechanisms have been suggested (Defrin, Lahav, & Solomon, 2017). Bottom-up influences generally pertain to the cascade of consequences triggered by peripheral tissue damage, such as the experience of pain due to nociceptive stimuli.…”

Section: Models and Predictors For The Development Of Somatic Complaintsmentioning

confidence: 99%

Psychosocial care for hospitalized young survivors after the terror attack on Utøya Island: A qualitative study of the survivors’ experiences

Bugge

Jensen

Nilsen

et al. 2019

Injury

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The origin of the project One peaceful summer day in 2011, Friday the 22nd of July, Norway was hit by two devastating terrorist attacks. A man, dressed as a police officer, detonated a bomb outside the Oslo government building and then entered a political summer camp for adolescents and young adults at Utøya Island one hour's drive outside Oslo. Heavily armed, he hunted down and targeted the camp participants. The perpetrator killed 77 people, eight in the bomb attack and 69 in the Utøya shooting attack. In total, more than 150 victims sustained physical injuries. Ten survivors from the bomb attack and 33 survivors from the Utøya attack were hospitalized due to physical injuries at Oslo University Hospital (OUS) and at local hospitals situated near Utøya Island (Vestre Viken Hospital Trust). Since 2008, I had been working as a child and adolescent psychiatrist at OUS, Department of Child and Adolescent Mental Health in Hospital (S-BUP). Through my daily work, I had met medically ill or injured children and adolescents struggling with how to live with their compromised bodies. Being at work during the critical days in July 2011, I became part of the psychosocial crisis team that was mobilized to handle the extraordinary situation. The psychiatrists, psychologists, nurses, and social workers in the team contributed to providing psychosocial care for the hospitalized youths and their families. We sought to offer empathetic and practical support with a focus on rebuilding the feeling of safety and stabilization of affects and arousal. The team also provided support and supervision to the regular health care personnel. For me, many questions arose subsequently: Was our support helpful? What was important for the youths in this profoundly stressful situation? Would they cope with their challenges of distress and grief, and how would the psychological and physical trauma affect their health over time? Trond H. Diseth, who took part in organizing the psychosocial support in the hospital, and I applied for funding of this doctoral dissertation focusing on the physically injured survivors of the Utøya shooting attack. The project was developed as a part of the Utøya study led by principal investigator Grete Dyb at the Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS). From August 2013, I started my PhD project and took part in the Utøya project group at NKVTS contributing to the conduction of the study. The Faculty of

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“…Indeed, data supports the notion that chronic pain is ongoing and persists at nearly the same level as at the time of the initiating event (Olsen et al, 2006), and survivors have higher lifetime prevalence of psychiatric disorders (Van Ommeren et al, 2001). Psychological or physical torture may inflict ‘pain,’ but memories of pain may also be blunted as a result of impaired memory formation due to stress (Defrin et al, 2017). There seems to be a powerful interaction between pain and emotional processing: on the one hand, the level of pain predicts psychological sequelae (de C Williams and van der Merwe, 2013), while the type of psychological stress, rather than the trauma per se, has a significant effect on pain modulation and perception (Defrin et al, 2014, 2017).…”

Section: When Pain Pops Out To Conscious Awareness – Insights Frommentioning

confidence: 99%

“…Psychological or physical torture may inflict ‘pain,’ but memories of pain may also be blunted as a result of impaired memory formation due to stress (Defrin et al, 2017). There seems to be a powerful interaction between pain and emotional processing: on the one hand, the level of pain predicts psychological sequelae (de C Williams and van der Merwe, 2013), while the type of psychological stress, rather than the trauma per se, has a significant effect on pain modulation and perception (Defrin et al, 2014, 2017). “ Torture appears to induce generalized dysfunctional pain modulation that may underlie the intense chronic pain experienced by torture survivors decades after torture ”.…”

Section: When Pain Pops Out To Conscious Awareness – Insights Frommentioning

confidence: 99%

Subliminal (latent) processing of pain and its evolution to conscious awareness

Borsook

Youssef

Barakat

et al. 2018

Neuroscience & Biobehavioral Reviews

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By unconscious or covert processing of pain we refer to nascent interactions that affect the eventual deliverance of pain awareness. Thus, internal processes (viz., repeated nociceptive events, inflammatory kindling, re-organization of brain networks, genetic) or external processes (viz., environment, socioeconomic levels, modulation of epigenetic status) contribute to enhancing or inhibiting the presentation of pain awareness. Here we put forward the notion that for many patients, ongoing sub-conscious changes in brain function are significant players in the eventual manifestation of chronic pain. In this review, we provide clinical examples of nascent or what we term pre-pain processes and the neurobiological mechanisms of how these changes may contribute to pain, but also potential opportunities to define the process for early therapeutic interventions.

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Dysfunctional Pain Modulation in Torture Survivors: The Mediating Effect of PTSD

Abstract: This article presents the mediation effect of PTSD trajectory on pain modulation among trauma survivors suggesting that it is the duration and severity of PTSD/distress, rather than the exposure to trauma per se, that influence the perception and modulation of pain.

Cited by 23 publications

References 77 publications

Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain

Post-traumatic stress disorder moderates the relationship between trauma exposure and chronic pain

Psychosocial care for hospitalized young survivors after the terror attack on Utøya Island: A qualitative study of the survivors’ experiences

Subliminal (latent) processing of pain and its evolution to conscious awareness

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