The relationship between PTSD and chronic pain: Mediating role of coping strategies and depression
Open accessAbstract
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.
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Cites
Hu, L., & Bentler, P. M. (1999) · Structural Equation Modeling A Multidisciplinary Journal · doi:10.1080/10705519909540118 · Cited by 108,788 · see citing works
Preacher, K. J., & Hayes, A. F. (2008) · Behavior Research Methods · doi:10.3758/brm.40.3.879 · Cited by 34,117 · see citing works
Power analysis and determination of sample size for covariance structure modeling.
MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996) · Psychological Methods · doi:10.1037/1082-989x.1.2.130 · Cited by 10,418 · see citing works
Marsh, H. W., Hau, K.-T., & Wen, Z. (2004) · Structural Equation Modeling: A Multidisciplinary Journal · doi:10.1207/s15328007sem1103_2 · Cited by 6,691 · see citing works
Introduction to Statistical Mediation Analysis
MacKinnon, D. P. (2012) · doi:10.4324/9780203809556 · Cited by 5,618 · see citing works
Discrete Multivariate Analysis: Theory and Practice.
Beniger, J. R., Bishop, Y. M. M., Feinberg, S. E., Holland, P. W., Light, R. J., & Mosteller, F. C. (1975) · Contemporary Sociology A Journal of Reviews · doi:10.2307/2063625 · Cited by 5,119 · see citing works
Sobell, L. C., & Sobell, M. B. (1992) · Measuring Alcohol Consumption · doi:10.1007/978-1-4612-0357-5_3 · Cited by 4,110 · see citing works
Psychometric properties of the PTSD checklist (PCL)
Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996) · Behaviour Research and Therapy · doi:10.1016/0005-7967(96)00033-2 · Cited by 3,997 · see citing works
The biopsychosocial approach to chronic pain: Scientific advances and future directions.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.4.581 · Cited by 3,392 · see citing works
Self-citationThe West Haven-Yale Multidimensional Pain Inventory (WHYMPI)
Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985) · Pain · doi:10.1016/0304-3959(85)90004-1 · Cited by 2,128 · see citing works
Self-citationKessler, R. C. (1997) · Archives of General Psychiatry · doi:10.1001/archpsyc.1997.01830160031005 · Cited by 2,085 · see citing works
Pietrzak, R. H., Goldstein, R. B., Southwick, S. M., & Grant, B. F. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2010.11.010 · Cited by 963 · cited 1× · see citing works
“Patients with PTSD have more risk factors for pain, including higher rates of psychiatric and substance use disorders [29,40], as well as general medical conditions [41].”
BackgroundBisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D., & Turner, S. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.021402 · Cited by 900 · see citing works
Chronic pain and posttraumatic stress disorder: Mutual maintenance?
Sharp, T. J., & Harvey, A. G. (2001) · Clinical Psychology Review · doi:10.1016/s0272-7358(00)00071-4 · Cited by 779 · see citing works
Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art
Asmundson, G. J. G., & Katz, J. (2009) · Depression and Anxiety · doi:10.1002/da.20600 · Cited by 756 · see citing works
Treatment of chronic non-cancer pain
Turk, D. C., Wilson, H. D., & Cahana, A. (2011) · The Lancet · doi:10.1016/s0140-6736(11)60402-9 · Cited by 716 · see citing works
Self-citationAsmundson, G. J., Coons, M. J., Taylor, S., & Katz, J. (2002) · The Canadian Journal of Psychiatry · doi:10.1177/070674370204701004 · Cited by 695 · see citing works
Prevalence Estimates of Combat-Related Post-Traumatic Stress Disorder: Critical Review
Richardson, L., Frueh, B. C., & Acierno, R. E. (2010) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048670903393597 · Cited by 606 · see citing works
Chronic back pain and major depression in the general Canadian population
Currie, S. R., & Wang, J. (2004) · Pain · doi:10.1016/j.pain.2003.09.015 · Cited by 573 · see citing works
Seal, K. H., Shi, Y., Cohen, G., Cohen, B. E., Maguen, S., Krebs, E. E., & Neylan, T. C. (2012) · JAMA · doi:10.1001/jama.2012.234 · Cited by 515 · see citing works
Jensen, M. P., Turner, J. A., & Romano, J. M. (2007) · Pain · doi:10.1016/j.pain.2006.12.007 · Cited by 393 · see citing works
Impact of pain on depression treatment response in primary care
Bair, M. J., Robinson, R. L., Eckert, G. J., Stang, P. E., Croghan, T. W., & Kroenke, K. (2004) · Psychosomatic Medicine · doi:10.1097/01.psy.0000106883.94059.c5 · Cited by 371 · see citing works
The chronic pain coping inventory: development and preliminary validation
Jensen, M. P., Turner, J. A., Romano, J. M., & Strom, S. E. (1995) · Pain · doi:10.1016/0304-3959(94)00118-x · Cited by 353 · see citing works
Physical symptoms in post-traumatic stress disorder
McFARLANE, A. C., Atchison, M., Rafalowicz, E., & Papay, P. S. (1994) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(94)90024-8 · Cited by 344 · see citing works
First onset of common pain symptoms: a prospective study of depression as a risk factor
Von Korff, M., Resche, L. L., & Dworkin, S. F. (1993) · Pain · doi:10.1016/0304-3959(93)90154-h · Cited by 334 · see citing works
Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans
Beckham, J. C., Crawford, A. L., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., Davidson, J. R. T., & Moore, S. D. (1997) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00129-3 · Cited by 306 · see citing works
Coping with chronic pain: a comparison of two measures
Tan, G., Jensen, M. P., Robinson-Whelen, S., Thornby, J. I., & Monga, T. N. (2001) · Pain · doi:10.1016/s0304-3959(00)00395-x · Cited by 230 · see citing works
Veterans seeking treatment for posttraumatic stress disorder: What about comorbid chronic pain?
Shipherd, J. C., Keyes, M., Jovanovic, T., Ready, D. J., Baltzell, D., Worley, V., Gordon-Brown, V., Hayslett, C., & Duncan, E. (2007) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2006.06.0065 · Cited by 230 · see citing works
Geisser, M. E., Roth, R. S., Bachman, J. E., & Eckert, T. A. (1996) · Pain · doi:10.1016/0304-3959(96)03038-2 · Cited by 229 · see citing works
Otis, J. D., Keane, T. M., Kerns, R. D., Monson, C., & Scioli, E. (2009) · Pain Medicine · doi:10.1111/j.1526-4637.2009.00715.x · Cited by 178 · see citing works
The Effects of Model Parsimony and Sampling Error on the Fit of Structural Equation Models
Cheung, G. W., & Rensvold, R. B. (2001) · Organizational Research Methods · doi:10.1177/109442810143004 · Cited by 155 · see citing works
Pietrzak, R., Goldstein, R., Southwick, S., & Grant, B. (2011) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182303775 · Cited by 146 · see citing works
Medical Service Utilization by Veterans Seeking Help for Posttraumatic Stress Disorder
Calhoun, P. S., Bosworth, H. B., Grambow, S. C., Dudley, T. K., & Beckham, J. C. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.12.2081 · Cited by 145 · see citing works
Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms
Liedl, A., O'Donnell, M. L., Creamer, M., Silove, D. M., McFARLANE, A. C., Knaevelsrud, C., & Bryant, R. A. (2009) · Psychological Medicine · doi:10.1017/s0033291709991310 · Cited by 138 · see citing works
Cognitions, Coping, and Social Environment Predict Adjustment to Pain in Spinal Cord Injury
Raichle, K. A., Hanley, M., Jensen, M. P., & Cardenas, D. D. (2007) · Journal of Pain · doi:10.1016/j.jpain.2007.05.006 · Cited by 111 · see citing works
Active avoidance but not activity pacing is associated with disability in fibromyalgia
Karsdorp, P. A., & Vlaeyen, J. W. S. (2009) · Pain · doi:10.1016/j.pain.2009.07.019 · Cited by 104 · see citing works
Pain beliefs, coping, and adjustment to chronic pain
Geisser, M. E., Robinson, M. E., & Riley, J. L. (1999) · Pain Forum · doi:10.1016/s1082-3174(99)70001-2 · Cited by 96 · see citing works
Hickling, E. J., Blanchard, E. B., Silverman, D. J., & Schwarz, S. R. (1992) · Headache The Journal of Head and Face Pain · doi:10.1111/j.1526-4610.1992.hed3203147.x · Cited by 91 · see citing works
Preliminary findings on chronic pain and posttraumatic stress disorder
Benedikt, R. A., & Kolb, L. C. (1986) · American Journal of Psychiatry · doi:10.1176/ajp.143.7.908 · Cited by 90 · see citing works
Pain symptomatology and pain medication use in civilian PTSD
Phifer, J. E., Skelton, K. H., Weiss, T., Schwartz, A. C., Wingo, A. P., Gillespie, C. F., Sands, L. A., Sayyar, S., Bradley, B., Jovanović, T., et al. (2011) · Pain · doi:10.1016/j.pain.2011.04.019 · Cited by 90 · see citing works
Adaptive Versus Maladaptive Coping and Beliefs and Their Relation to Chronic Pain Adjustment
Tan, G., Teo, I., Anderson, K. O., & Jensen, M. P. (2011) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31821d8f5a · Cited by 75 · see citing works
Alschuler, K. N., & Otis, J. D. (2012) · European Journal of Pain · doi:10.1016/j.ejpain.2011.06.010 · Cited by 70 · see citing works
Martin, A. L., Halket, E., Asmundson, G. J. G., Flora, D. B., & Katz, J. D. (2010) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3181e15b98 · Cited by 70 · see citing works
Assessment of pain beliefs and pain coping.
DeGood, D. E., & Tait, R. C. (2001) · Cited by 62 · see citing works
Use of the Chronic Pain Coping Inventory to Assess Older Adults’ Pain Coping Strategies
Ersek, M. T., Turner, J. A., & Kemp, C. A. (2006) · Journal of Pain · doi:10.1016/j.jpain.2006.04.002 · Cited by 59 · see citing works
Miró, J., Raichle, K. A., Carter, G. T., O'Brien, S. A., Abresch, R. T., McDonald, C. M., & Jensen, M. P. (2009) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909109335146 · Cited by 55 · see citing works
Coping with Cerebral Palsy Pain: A Preliminary Longitudinal Study
Jensen, M. P., Engel, J. M., & Schwartz, L. M. (2006) · Pain Medicine · doi:10.1111/j.1526-4637.2006.00086.x · Cited by 54 · see citing works
Further validation of the chronic pain coping inventory
Tan, G., Nguyen, Q., Anderson, K. O., Jensen, M., & Thornby, J. (2005) · The Journal of Pain · doi:10.1016/j.jpain.2004.09.006 · Cited by 51 · see citing works
The Evaluation and Treatment of Comorbid Pain and PTSD in a Military Setting: An Overview
McGeary, D., Moore, M., Vriend, C. A., Peterson, A. L., & Gatchel, R. J. (2011) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-011-9236-5 · Cited by 47 · see citing works
Dunn, A. S., Julian, T., Formolo, L. R., Green, B. N., & Chicoine, D. R. (2011) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2010.05.0104 · Cited by 36 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [17]First MB Spitzer RL Gibbon M Williams JBW 11 2002 Structured Clinical Interview for the DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP) New York Biometrics Research, New York State Psychiatric Institute
- [54]Weathers FW Ford J Stamm BH Psychometric properties of the PTSD Checklist (PCL–C, PCL–S, PCL–M, PCL–PR) Measurement of stress, trauma, and adaptation 250 252 Lutherville, MD Sidran Foundation & Press 1996
Cited by
Sorted by citations
Fishbain, D. A., Pulikal, A., Lewis, J. E., & Gao, J. (2017) · Pain Medicine · doi:10.1093/pm/pnw065 · Cited by 228 · see citing works
Complex PTSD, affect dysregulation, and borderline personality disorder
Ford, J. D., & Courtois, C. A. (2014) · Borderline Personality Disorder and Emotion Dysregulation · doi:10.1186/2051-6673-1-9 · Cited by 182 · see citing works
Benedict, T. M., Keenan, P. G., Nitz, A. J., & Moeller-Bertram, T. (2020) · Military Medicine · doi:10.1093/milmed/usaa052 · Cited by 81 · see citing works
Langford, D. J., Theodore, B. R., Balsiger, D., Tran, C., Doorenbos, A. Z., Tauben, D. J., & Sullivan, M. D. (2018) · The Journal of Pain · doi:10.1016/j.jpain.2017.12.262 · Cited by 41 · see citing works
Åkerblom, S., Perrin, S., Rivano Fischer, M., & McCracken, L. M. (2018) · The Clinical Journal of Pain · doi:10.1097/ajp.0000000000000561 · Cited by 33 · see citing works
Telehealth and Rural-Urban Differences in Receipt of Pain Care in the Veterans Health Administration
Chen, J. A., DeFaccio, R. J., Gelman, H., Thomas, E. R., Indresano, J. A., Dawson, T. C., Glynn, L. H., Sandbrink, F., & Zeliadt, S. B. (2022) · Pain Medicine · doi:10.1093/pm/pnab194 · Cited by 28 · see citing works
Herbert, M. S., Malaktaris, A. L., Dochat, C., Thomas, M. L., Wetherell, J. L., & Afari, N. (2019) · Pain Medicine · doi:10.1093/pm/pny272 · Cited by 27 · see citing works
Åkerblom, S., Perrin, S., Fischer, M. R., & McCracken, L. M. (2020) · European Journal of Pain · doi:10.1002/ejp.1530 · Cited by 19 · see citing works
- Authors
- Morasco, B. J., Lovejoy, T. I., Lu, M., Turk, D. C., Lewis, L., & Dobscha, S. K.
- Affiliations
- Oregon Health & Science University (US)
- Portland VA Medical Center (US)
- University of Washington (US)
- Corresponding author
- Morasco, Benjamin J.
- Venue
- Pain
- Published
- 2013-04
- Volume
- 154
- Issue
- 4
- Pages
- 609-616
- ISSN
- 0304-3959 (ISSN-L)
- PMC
- PMC3609886
- OpenAlex
- W1982033441
- Cited by
- 149
- References
- 50
- Citations by year
- 2026: 4 · 2025: 20 · 2024: 16 · 2023: 10 · 2022: 7 · 2021: 6 · 2020: 20 · 2019: 17 · 2018: 18 · 2017: 7 · 2016: 8 · 2015: 6 · 2014: 7 · 2013: 2 · 2012: 1
- FWCI
- 5.64
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eli Lilly and Company
- Johnson and Johnson
- National Institute on Drug Abuse (K23DA023467)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Keywords
- post-traumatic stress disorder, chronic pain, pain coping, depressive symptoms, pain interference, pain intensity, guarding, veterans, substance use disorders, mediation
- MeSH terms
- Adaptation, Psychological, Aged, Cross-Sectional Studies, Depression, Female, Hospitals, Veterans, Humans, Male, Middle Aged, Models, Theoretical, Surveys and Questionnaires, Stress Disorders, Post-Traumatic, Negotiating, Chronic Pain
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