Trauma matters: psychological interventions for comorbid psychosocial trauma and chronic pain

Lumley, Mark A.; Yamin, Jolin B.; Pester, Bethany; Krohner, Shoshana; Urbanik, Christopher P

doi:10.1097/j.pain.0000000000002425

Cited by 25 publications

(27 citation statements)

References 97 publications

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“…For example, one patient in the class noted that her shoulder pain dropped "from 7 to 0" during the class as she became aware of and gave voice via writing and subsequent sharing with other class members her angry feelings toward a relative who had mistreated her, but toward whom she was reluctant to express anything. More generally, the failure to express adaptive "primary" emotions has been linked to prolonged stress responses as well as increased pain (4,8,50) suggesting the value of this class particularly for people who fear such disclosure and expression. Two other baseline measures did not predict outcomes, however.…”

Section: Discussionmentioning

confidence: 99%

“…It has been proposed that these somewhat limited benefits may be due, in part, to the failure of these therapies to directly address the trauma, interpersonal stressors, psychological conflicts, and emotional problems that are found in many patients with chronic pain and that appear to trigger, amplify, or maintain pain (4,5). A growing body of evidence from trauma-and emotion-focused interventions for chronic pain suggests the possibility of enhanced effects (6)(7)(8). In particular, Emotional Awareness and Expression Therapy (EAET) was developed specifically to target such underlying emotional drivers of pain, especially primary, nociplastic, or centralized pain.…”

Section: Introductionmentioning

confidence: 99%

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“Pain, Stress, and Emotions”: Uncontrolled trial of a single-session, telehealth, emotional awareness and expression therapy class for patients with chronic pain

Ziadni

Sturgeon²,

Lumley³

2022

Front. Pain Res.

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ObjectivesTrauma- and emotion-focused chronic pain interventions, particularly Emotional Awareness and Expression Therapy (EAET), show much promise for reducing pain and improving functioning. We developed a novel, single-session, telehealth-delivered EAET class (“Pain, Stress, and Emotions”; PSE) and tested it on adults with chronic pain of mixed etiology.MethodsAfter an initial developmental phase, we conducted an uncontrolled trial, providing PSE to 74 individuals with chronic pain (63.5% female; 64.9% White; 60.8% with pain duration >5 years) in four class administrations. Participants completed self-report measures (primary outcomes: pain intensity and pain interference) at baseline and multiple follow-ups to 12 weeks. Linear mixed-models examined changes over time, and effect sizes were calculated on change from baseline to 4-week (primary endpoint) and 12-week follow-ups. The trial was registered with clinicaltrials.gov (NCT05014126)ResultsParticipants reported high satisfaction with the PSE class. Pain intensity showed a significant, medium reduction across time (p < .001; d = 0.60 at 4 weeks); one-quarter of participants had clinically meaningful pain reduction (≥30%). Pain interference had a large reduction (p < .001; d = 0.74). There were significant but smaller improvements in most secondary outcomes (ds = 0.15 to 0.55; ps < .01). Effects were generally maintained or increased at 12-week follow-up. Higher education and baseline ambivalence over emotional expression predicted greater pain reductions.ConclusionsPeople taking this EAET class had reduced pain severity and interference and improvements in other pain-related outcomes. The single-session, telehealth class holds promise as an easily delivered, efficient, and potentially impactful intervention for some patients with chronic pain, although controlled trials are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Pain, Stress, and Emotions”: Uncontrolled trial of a single-session, telehealth, emotional awareness and expression therapy class for patients with chronic pain

Ziadni

Sturgeon²,

Lumley³

2022

Front. Pain Res.

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“…The failure to detect clinically significant PTSS might be particularly likely in cases of musculoskeletal injury, where characteristics of the injury incident would not necessarily meet diagnostic criteria for a ‘traumatic event’. Researchers have called for greater attention to detection and treatment of PTSS in individuals seeking care for pain-related conditions [ 61 , 63 ].…”

Section: Discussionmentioning

confidence: 99%

Perceived Injustice as a Determinant of the Severity of Post-traumatic Stress Symptoms Following Occupational Injury

et al. 2022

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Background The present study assessed the role of perceived injustice in the experience and persistence of post-traumatic stress symptoms (PTSS) following work-related musculoskeletal injury. Methods The study sample consisted of 187 individuals who were absent from work as a result of a musculoskeletal injury. Participants completed measures of pain severity, perceived injustice, catastrophic thinking, post-traumatic stress symptoms, and disability on three occasions at three-week intervals. Results Consistent with previous research, correlational analyses revealed significant cross-sectional relations between pain and PTSS, and between perceived injustice and PTSS. Regression analysis on baseline data revealed that perceived injustice contributed significant variance to the prediction of PTSS, beyond the variance accounted for by pain severity and catastrophic thinking. Sequential analyses provided support for a bi-directional relation between perceived injustice and PTSS. Cross-lagged regression analyses showed that early changes in perceived injustice predicted later changes in PTSS and early changes in PTSS predicted later changes in perceived injustice. Conclusions Possible linkages between perceived injustice and PTSS are discussed. The development of effective intervention techniques for targeting perceptions of injustice might be important for promoting recovery of PTSS consequent to musculoskeletal injury.

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“…In some studies, patients with traumatic upper and lower limb amputations have been found to be at increased risk for phantom limb pain (PLP) compared with amputations performed for non-traumatic indications 76 77. The increased risk for PPSP conferred by trauma can be related to concomitant psychosocial trauma, suggesting that timely and targeted psychotherapy and pharmacotherapy that addresses the affective motivational component of pain (eg, ketamine and other antidepressants) may be beneficial 78 79…”

Section: Chronification Of Pain In the Perioperative Settingmentioning

confidence: 99%

Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians

Chen

Wang

Sites

et al. 2023

Reg Anesth Pain Med

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Chronic pain begins with acute pain. Physicians tend to classify pain by duration (acute vs chronic) and mechanism (nociceptive, neuropathic and nociplastic). Although this taxonomy may facilitate diagnosis and documentation, such categories are to some degree arbitrary constructs, with significant overlap in terms of mechanisms and treatments. In clinical practice, there are myriad different definitions for chronic pain and a substantial portion of chronic pain involves mixed phenotypes. Classification of pain based on acuity and mechanisms informs management at all levels and constitutes a critical part of guidelines and treatment for chronic pain care. Yet specialty care is often siloed, with advances in understanding lagging years behind in some areas in which these developments should be at the forefront of clinical practice. For example, in perioperative pain management, enhanced recovery protocols are not standardized and tend to drive treatment without consideration of mechanisms, which in many cases may be incongruent with personalized medicine and mechanism-based treatment. In this educational document, we discuss mechanisms and classification of pain as it pertains to commonly performed surgical procedures. Our goal is to provide a clinical reference for the acute pain physician to facilitate pain management decision-making (both diagnosis and therapy) in the perioperative period.

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Trauma matters: psychological interventions for comorbid psychosocial trauma and chronic pain

Abstract: T here is growing interest in psychosocial trauma and chronic pain (CP). Numerous retrospective studies link trauma or posttraumatic stress disorder (PTSD) to CP,

Cited by 25 publications

References 97 publications

“Pain, Stress, and Emotions”: Uncontrolled trial of a single-session, telehealth, emotional awareness and expression therapy class for patients with chronic pain

“Pain, Stress, and Emotions”: Uncontrolled trial of a single-session, telehealth, emotional awareness and expression therapy class for patients with chronic pain

Perceived Injustice as a Determinant of the Severity of Post-traumatic Stress Symptoms Following Occupational Injury

Integrating mechanistic-based and classification-based concepts into perioperative pain management: an educational guide for acute pain physicians

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