The relationship between PTSD and chronic pain: Mediating role of coping strategies and depression

Benjamin J. Morasco, Travis I. Lovejoy, Mary Lu, Dennis C. Turk, Lynsey Lewis, Steven K. Dobscha

Research output: Contribution to journalArticlepeer-review

71 Scopus citations

Abstract

People with chronic pain and comorbid posttraumatic stress disorder (PTSD) report more severe pain and poorer quality of life than those with chronic pain alone. This study evaluated the extent to which associations between PTSD and chronic pain interference and severity are mediated by pain-related coping strategies and depressive symptoms. Veterans with chronic pain were divided into 2 groups, those with (n = 65) and those without (n = 136) concurrent PTSD. All participants completed measures of pain severity, interference, emotional functioning, and coping strategies. Those with current PTSD reported significantly greater pain severity and pain interference, had more symptoms of depression, and were more likely to meet diagnostic criteria for a current alcohol or substance use disorder (all p-values <.01). Participants with PTSD reported more use of several coping strategies, including guarding, resting, relaxation, exercise/stretching, and coping self-statements. Illness-focused pain coping (i.e., guarding, resting, and asking for assistance) and depressive symptoms jointly mediated the relationship between PTSD and both pain interference (total indirect effect = 0.194, p <.001) and pain severity (total indirect effect = 0.153, p =.004). Illness-focused pain coping also evidenced specific mediating effects, independent of depression. In summary, specific pain coping strategies and depressive symptoms partially mediated the relationship between PTSD and both pain interference and severity. Future research should examine whether changes in types of coping strategies after targeted treatments predict improvements in pain-related function for chronic pain patients with concurrent PTSD.

Original languageEnglish (US)
Pages (from-to)609-616
Number of pages8
JournalPain
Volume154
Issue number4
DOIs
StatePublished - Apr 2013

Keywords

  • Chronic pain
  • Chronic pain coping inventory
  • Coping strategies
  • Mediation
  • Posttraumatic stress disorder
  • Quality of life

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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