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Little is known about how the individual PTSD symptom clusters relate to intensity and interference of pain and whether these relationships differ across clinical groups. The present study examines relations between PTSD symptom clusters and pain in three trauma-exposed, unique clinical groups: 1) adults seeking treatment for chronic pain with current symptoms of PTSD, 2) trauma affected refugees seeking treatment for PTSD and chronic pain; and 3) individuals identified at admission to the emergency ward after whiplash injury. Network analysis was used to assess unique relations between pain intensity, pain interference, re-experiencing, avoidance, numbing, hyperarousal, depression, and anxiety separately in each sample. Links between PTSD clusters and pain were then compared within and between samples. No within-group differences were identified for the links between pain and any of PTSD clusters in the chronic pain and refugee groups. In the whiplash group, hyperarousal was more strongly related to pain than re-experiencing, avoidance, and numbing. Between group comparisons revealed a more pronounced relationship between hyperarousal and pain in the whiplash group, with no between-group differences between the chronic pain and refugee groups. The findings suggest that when depression and anxiety are accounted for, few unique associations are found between pain and the PTSD symptom clusters in trauma-exposed samples with pain, with the exception of a link between pain and hyperarousal in individuals with whiplash-related PTSD symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Correctly identifying chronic pain patients with posttraumatic stress disorder (PTSD) is important because the comorbidity of a chronic pain condition and PTSD is found to compromise treatment success. In addition, the existence of PTSD is associated with pain sensitisation, elevated levels of pain, and disability. Furthermore, the diagnostic criteria for PTSD has changed dramatically in the last two decades which has had a profound impact on the reported prevalence rates of PTSD in chronic pain samples. To our knowledge, no study has employed the DSM-IV criteria for estimating the prevalence of PTSD in chronic pain patients referred consecutively for multidisciplinary pain rehabilitation. Aim: The aim of the present study was to assess the prevalence of significant traumatic stressors and PTSD in chronic pain patients referred consecutively to multidisciplinary pain rehabilitation. We wanted to investigate whether specific pain diagnoses were more related to PTSD than others. Moreover, we investigated the possible association of altered sensory processing (hypersensitivity or hyposensitivity) and PTSD. Methods: Data were collected from two Scandinavian multidisciplinary pain centres (Denmark and Finland). All patients referred consecutively were assessed for PTSD and sensitisation at admission. A total of 432 patients were assessed, of which 304 (DK, N =220, female n =144; FIN, N =84, female n =44) were admitted and consented to participate. All patients had to be diagnosed with a non-malign chronic pain condition lasting for at least 6 months (median=6.0 years). The Harvard Trauma Questionnaire was employed to measure PTSD symptoms, using the DSM-IV criteria. To measure altered sensory processing, anaesthetists performed quantitative sensory testing on admission. Patients were asked to report if cold, brush, and pinprick mechanical stimulation resulted in decreased or increased sensation or pain. Results: A high prevalence of PTSD was found in both consecutive samples. Using the DSM-IV criteria, 23% fulfilled the criteria for a possible PTSD diagnosis. There were no gender differences in PTSD. The three most reported traumatic events: traffic accidents, serious illness personally or in the family, and the actual loss of someone, were reported as the primary traumatic events by almost 50% of those with PTSD. No particular pain diagnosis was significantly related to PTSD. However, hypersensitivity to cold and hyposensitivity to brush were significantly associated with PTSD. Discussion: The prevalence of PTSD in the present study was 23%. Earlier studies finding a lower prevalence rate of PTSD may reflect the use of older diagnostic criteria for PTSD or other estimates, for instance PTSD symptom cut-off scores. Conclusion: The study emphasised the importance of screening all chronic pain patients for PTSD at admission for pain rehabilitation, using up to date diagnostic tools. Implications: Untreated PTSD may exacerbate or maintain the pain condition and negatively affect outcome of pain rehabilitation. [Copyright &y& Elsevier]