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

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.