Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach

Abstract

Objectives Post‐traumatic stress disorder (PTSD) commonly co‐occurs with chronic pain. Although PTSD symptoms are associated with negative health outcomes in patients with chronic pain, PTSD is typically under‐detected and under‐treated in outpatient pain settings. There is a need for rapid, brief screening tools to identify those at greatest risk for severe PTSD symptoms. To achieve that goal, our aim was to use item response theory (IRT) to identify the most informative PTSD symptoms characterizing severe PTSD in patients with chronic pain. Methods Fifty‐six patients (71% female, 61% White) with mixed etiology chronic pain completed the PTSD Checklist‐Civilian Version (PCL‐C) as part of their appointment with a pain psychologist at a tertiary outpatient pain clinic. We used an IRT approach to evaluate each item's discriminant (a) and severity (b) parameters. Results Findings revealed that “feeling upset at reminders” (a = 3.67, b = 2.44) and “avoid thinking or talking about it” (a = 3.61, b = 2.17) as being highly discriminant for severe PTSD. Conclusions We identified 2 candidate items for a brief PTSD screener as they were associated with severe PTSD symptoms. These 2 items may provide clinical utility in outpatient pain treatment settings to identify those suffering from severe PTSD, enabling physicians to refer them to trauma‐specific evaluation or therapy. Future research is needed to further validate and confirm these candidate PTSD items in a larger clinic sample. Lay Summary The current study used the IRT approach to identify candidate items for a brief screener for severe PTSD. We examined 17 items of the PCL‐C, and identified 2 items that were highly discriminant for severe PTSD. The 2 items were “feeling upset at reminders” and “avoid thinking or talking about it.” These 2 items may provide clinical utility, since they may enable physicians to screen and make a referral for further assessment or treatment for PTSD.

The Association Between Post-Traumatic Stress Disorder and Temporomandibular Disorders: A Systematic Review

“…While pain may be related to physical illness, it is essential to remember that psychological factors have an undeniable effect on pain [ 24 ]. Multiple studies have stated that orofacial pain, when accompanied by PTSD, increases pain intensity and duration and lowers one’s pain threshold [ 20 , 23 ].…”

“…An astounding 80% of these veterans reported chronic pain conditions. Studies show that the oral health status of patients with PTSD is exceedingly affected compared to control subjects, as almost half of the PTSD group were diagnosed with myofascial pain and orofacial pain [ 22 , 23 ]. While pain may be related to physical illness, it is essential to remember that psychological factors have an undeniable effect on pain [ 24 ].…”

Accelerated longitudinal cortical atrophy in OEF/OIF/OND veterans with severe PTSD and the impact of comorbid TBI

“…Furthermore, few studies have investigated the neural correlates and long‐term functional impairments associated with complex and severe PTSD subtypes and it remains unclear to what extent these marked alterations may manifest over time. More severe forms of PTSD have been associated with significant psychiatric comorbidities, worse physical and psychosocial health outcomes, worse interpersonal problems, quality of life at later time points, and neurobiological alterations (Harned et al, 2018 ; Hou et al, 2007 ; Mitchell et al, 2021 ; Mueser et al, 2015 ; Van Woudenberg et al, 2018 ; You et al, 2020 ). This suggests that elevated stress responses could accelerate PTSD‐related cortical alterations.…”