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Cited by 81Posttraumatic Stress Disorder ResearchMusculoskeletal pain and rehabilitationTraumatic Brain Injury Research

Post-Traumatic Stress Disorder Symptoms Contribute to Worse Pain and Health Outcomes in Veterans With PTSD Compared to Those Without: A Systematic Review With Meta-Analysis

Benedict, Timothy M, Keenan, Patrick G, Nitz, Arthur J, Moeller-Bertram, Tobias·2020·Military Medicine
DOI 10.1093/milmed/usaa052
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Abstract

Introduction: Post-traumatic stress disorder (PTSD) and chronic pain are frequently co-morbid conditions in the U.S. veteran population. Although several theories about the cause of increased pain prevalence in individuals with PTSD have been presented, no synthesis of primary data informing the impact of co-morbid PTSD and pain has been completed. The purpose of this study was to systematically review the literature and quantify disability, function, and pain-related beliefs and outcomes in veterans with PTSD compared to veterans without PTSD. Materials and Methods: A systematic search of three electronic databases was conducted. Inclusion criteria required pain-related comparison of veterans with PTSD to those without PTSD. Primary outcome measures and standardized mean differences (SMDs) were assessed for pain, function, disability, pain beliefs, and healthcare utilization using a random effects model. Results: 20 original research studies met inclusion criteria and were assessed for quality and outcomes of interest. The majority of studies were cross-sectional. Veterans with PTSD and pain demonstrated higher pain (SMD = 0.58, 95% CI 0.28–0.89), disability (SMD = 0.52, 95%CI 0.33–0.71), depression (SMD = 1.40, 95%CI 1.2–1.6), catastrophizing beliefs (SMD = 0.95, 95% CI 0.69–1.2), sleep disturbance (SMD = 0.80, 95% CI 0.57–1.02), and healthcare utilization; they had lower function (SMD = 0.41, 95% CI 0.25–0.56) and pain self-efficacy (SMD = 0.77, 95% CI 0.55–0.99) compared to veterans without PTSD. Conclusion: In veterans with chronic pain, PTSD symptomology has a large effect for many negative health-related outcomes. This review supports the need for clinicians to screen and understand the effects of PTSD symptoms on patients with pain. Clinicians should recognize that veterans with PTSD and pain likely have elevated pain catastrophizing beliefs and decreased self-efficacy that should be targeted for intervention.

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Crossref · 10.1093/milmed/usaa052

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  • In PTSD, pain-related impairment due to hyperalgesia rather than analgesia is prominent.

    “In PTSD, pain-related impairment due to hyperalgesia rather than analgesia also is prominent [7, 38, 141].”

    From Complex PTSD and borderline personality disorder (2021) · cites this paper as [7]

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Authors
Benedict, T. M., Keenan, P. G., Nitz, A. J., & Moeller-Bertram, T.
Affiliations
  • University of Kentucky (US)
  • Office of the Chief, Specialist Corps, 3630 Stanley Road, Fort Sam Houston, San Antonio, TX 78234
  • Department of Medicine at UC Riverside, Desert Clinic Pain Institute, 36101 Bob Hope Drive, Rancho Mirage, CA 92270
ORCID
Benedict, Timothy M
Venue
Military Medicine
Publisher
Oxford University Press (OUP)
Published
2020-04-06
Volume
185
Issue
9-10
Pages
e1481-e1491
ISSN
  • 0026-4075 (ISSN-L)
  • 1930-613X
DOI
10.1093/milmed/usaa052
OpenAlex
W3014597198
Semantic Scholar
94f4abf46f8f77be9d5ce9f7f684b848143d028c
Cited by
81
References
89
Citations by year
2026: 12 · 2025: 15 · 2024: 22 · 2023: 18 · 2022: 8 · 2021: 5 · 2020: 1
FWCI
0.63
Type
journal article
Language
en
Open access
closed
Locations
  • Military Medicine (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Keywords
post-traumatic stress disorder, chronic pain, veterans, pain catastrophizing, pain self-efficacy, disability, functional disability, depression, sleep disorders, health care utilization, pain beliefs
MeSH terms
Cross-Sectional Studies, Humans, Pain, Stress Disorders, Post-Traumatic, Veterans, Comorbidity, Outcome Assessment, Health Care

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