Catastrophizing May Help Explain Link Between PTSD, Chronic Pain

By Reuters Staff

April 22, 2019

NEW YORK (Reuters Health) - Pain catastrophizing mediates the relationship between post-traumatic stress disorder (PTSD) symptoms and chronic pain, according to a new study.

"Psychosocial treatment approaches that directly target tendency to catastrophize in response to pain may hold the potential to have salutary effects on both chronic pain and PTSD," Dr. Wesley P. Gilliam of Mayo Clinic in Rochester, Minnesota, and colleagues write in The Clinical Journal of Pain, online April 3.

Chronic pain affects up to three-quarters of individuals with PTSD, while up to a third of those seeking care for chronic pain have PTSD, the authors note.

"Patients who experience both conditions report greater strain, affective distress and disability when compared to those with either chronic pain or PTSD alone," they add.

To investigate whether catastrophizing might mediate the relationship between pain and PTSD, the authors looked at 203 patients starting an interdisciplinary pain-rehabilitation program who reported heterogeneous forms of trauma exposure.

At program admission, all patients had completed a battery of validated measures of pain severity, pain interference, pain catastrophizing, depressive symptoms and PTSD symptoms.

Using multiple-parallel-mediation analysis and adjusting for depressive symptoms, the authors found that catastrophizing mediated the association between PTSD symptoms and pain severity and pain interference.

"Our findings are consistent with a mutual maintenance model of the chronic pain and PTSD comorbidity," Dr. Gilliam and colleagues write. "The possibility of mutual maintenance has been supported by studies revealing that pain has a mediating influence on hyperarousal symptoms of PTSD, and PTSD-hyperarousal mediates pain symptoms."

They conclude: "These results suggest that psychosocial interventions that focus on identifying and modifying catastrophic appraisals of pain may hold the potential to not only improve the functional capacity of an individual with chronic pain but may also alleviate PTSD symptomatology. Future studies are needed to examine the effectiveness of behavioral pain management."


Clin J Pain 2019.