Innovations in the Treatment of Comorbid Persistent Pain and Posttraumatic Stress Disorder

  • John J. Sellinger
  • Robert D. Kerns

The strong relationship between chronic pain and posttraumatic stress disorder (PTSD) is one that highlights the often intimate relationship that exists between medical and psychiatric conditions. It is easy to recognize the burden that these conditions place on the healthcare system, both financially and logistically. Surveys show that more than 80% of all visits to physicians are pain-related. These include 50 million annual healthcare visits, at a cost of more than $70 billion. Epidemiological studies have shown that chronic pain-related problems affect as much as 40% of the general population. For PTSD, the Diagnostic and Statistical Manual of Mental Disorders-Text Revision reports a lifetime prevalence of roughly 8%. In a national comorbidity study, Kessler et al. found the lifetime prevalence of PTSD to be 7.8%, with higher rates found among women and individuals exposed to combat and sexual violence. To identify the prevalence of PTSD within a primary care setting, Samson et al. evaluated patients who were identified by primary care providers as having symptoms of depression or anxiety. Of the 7,444 patients seen in the setting, 296 (3.9%) were determined to meet these criteria, and 114 met the criteria for PTSD. The authors acknowledged that these findings may underestimate the prevalence of PTSD in primary care settings because the initial identification of depression and anxiety was left to the discretion of the primary care provider, and such a method has historically led to underdetection of these disorders.


Chronic Pain Veteran Affair Pain Management Posttraumatic Stress Disorder Anxiety Sensitivity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gatchel RJ, Turk DC. Psychological Approaches to Pain Management: A Practitioner’s Handbook. New York: Guilford Press; 1996.Google Scholar
  2. 2.
    Verhaak PF, Kerssens JJ, Dekker J, Sorbi MJ, Bensing JM. Prevalence of chronic benign pain disorder among adults: a review of the literature. Pain. 1998;77:231–239.PubMedCrossRefGoogle Scholar
  3. 3.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders—Text Revision. 4th ed. Washington, DC: American Psychiatric Association; 2000.CrossRefGoogle Scholar
  4. 4.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry. 1995;52,;1048–1060.PubMedGoogle Scholar
  5. 5.
    Samson AY, Bensen S, Beck A, Price D, Nimmer C. Posttraumatic stress disorder in primary care. J Fam Pract. 1999;48:222–227.PubMedGoogle Scholar
  6. 6.
    Benedikt RA, Kolb LC. Preliminary findings on chronic pain and posttraumatic stress disorder. Am J Psychiatry. 1986;143:908–910.PubMedGoogle Scholar
  7. 7.
    Muse M. Stress-related, posttraumatic chronic pain syndrome: behavioral treatment approach. Pain. 1986;25:389–394.PubMedCrossRefGoogle Scholar
  8. 8.
    McFarlane AC, Atchison M, Rafalowicz E, Papay P. Physical symptoms in posttraumatic stress disorder. J Psychosom Res. 1994;42:607–617.Google Scholar
  9. 9.
    Beckham JC, Crawford AL, Feldman ME, et al. Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. J Psychosom Res. 1997;43:379–389.PubMedCrossRefGoogle Scholar
  10. 10.
    Geisser ME, Roth RS, Bachman JE, Eckert TA. The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain. Pain. 1996;66:207–214.PubMedCrossRefGoogle Scholar
  11. 11.
    Kerns RD, Turk DC, Rudy TE. West Haven-Yale Multidimensional Pain Inventory (WHYMPI). Pain. 1985;23:345–356.PubMedCrossRefGoogle Scholar
  12. 12.
    Kerns RD, Haythornthwaite J, Rosenberg R, Soutwick S, Giller EL, et al. The Pain Behavior Check List (PBCL): factor structure and psychometric properties. J Behav Med. 1991;14:155–167.PubMedCrossRefGoogle Scholar
  13. 13.
    Roland M, Morris R. A study of the natural history of back pain: development of a reliable and sensitive measure of disability in low-back pain. Spine.1983;8:141–144.PubMedCrossRefGoogle Scholar
  14. 14.
    Jensen MP, Turner JA, Romano JM, Strom SE. The Chronic Pain Coping Inventory: development and preliminary validation. Pain. 1995;60:203 216.PubMedCrossRefGoogle Scholar
  15. 15.
    Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–979.PubMedCrossRefGoogle Scholar
  16. 16.
    Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic back pain. Health Psychol. 2007;26:1–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Asmundson GJG, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002;47:930–937.PubMedGoogle Scholar
  18. 18.
    Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: Mutual maintenance. Clinical Psychology Review. 2001;857–877.Google Scholar
  19. 19.
    Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev. 2003;40:397–406.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • John J. Sellinger
    • 1
  • Robert D. Kerns
    • 1
  1. 1.Psychology ServiceVA Connecticut Healthcare SystemWest HavenUSA

Personalised recommendations