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Cited by 181Posttraumatic Stress Disorder ResearchMusculoskeletal pain and rehabilitationPain Management and Treatment

The development of an integrated treatment for veterans with comorbid chronic pain and posttraumatic stress disorder

Otis, John D., Keane, Terence M., Kerns, Robert D., Monson, Candice, Scioli, Erica·2009·Pain Medicine
DOI 10.1111/j.1526-4637.2009.00715.x
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Abstract

OBJECTIVE: The purpose of this article is to describe the development of the first integrated treatment for Veterans with comorbid chronic pain and posttraumatic stress disorder (PTSD). DESIGN: Descriptive, including pre- and posttreatment assessment results from a pilot study of six veterans with comorbid chronic pain and PTSD. SETTING: Northeastern Department of Veterans Affairs Medical Center. INTERVENTIONS: Using components of cognitive processing therapy (CPT) for PTSD and cognitive behavioral therapy (CBT) for chronic pain management, a 12-session integrated treatment for veterans with comorbid chronic pain and PTSD was developed. A therapist manual and patient workbook that included weekly readings and homework assignments were created. Participants received pre- and posttreatment evaluations using measures of pain, PTSD, physical disability, and psychological distress. The treatment development process is reviewed and the benefits and challenges of implementing this integrated treatment are presented. RESULTS: Several themes emerged over the course of implementing the treatment, including the importance of establishing participant trust, regular therapy attendance, and addressing participant avoidance. Of the six participants recruited for the pilot study, three withdrew from the study and three completed the integrated treatment. Participants reported that they generally liked the format of treatment, appreciated learning about the ways that chronic pain and PTSD share some common symptoms, and ways that the two disorders can interact with one another. The assessment results of those who completed treatment suggest that this treatment approach is feasible and may have clinical benefit. CONCLUSIONS: Participants appeared to benefit from receiving the integrated treatment for pain and PTSD. A randomized clinical trial is currently being conducted to evaluate the efficacy of this treatment approach.

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  • There is a growing body of research showing the benefits of simultaneously treating post-traumatic stress and chronic pain.

    “There is a growing body of research showing the benefits of simultaneously treating post-traumatic stress and chronic pain in particular.30-35”

    From An updated audit of the patient selection process for pain management programmes in a speciality care service before and during the COVID-19 pandemic (2023) · cites this paper as [30]

    The Quantitative Information Obtained from Pilot Participants section reports reduced pain symptoms and no longer meeting PTSD criteria in two veterans after integrated treatment. But the Discussion calls this a descriptive pilot study without a comparison group and says a randomized trial had only been initiated. The paper therefore suggests possible benefits, not a growing body of research demonstrating them. (LLM, conf=0.88)

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4 of the 46 references couldn’t be matched to a known paper.

Research works printed but not linked: 8

  1. [2]2. Gironda RJ, Clark ME, Massengale JP, Walker RL. Pain among veterans of Operation Enduring Freedom and Iraqi Freedom. Pain Med 2006;7:339- 43.
  2. [3]3. Lew HL, Poole JH, Vanderploeg RD, et al. Program development and defining characteristics of returning military in a VA Polytrauma Network Site. J Rehabil Res Dev 2007;44(7):1027-34.
  3. [10]10. Merskey H, Bogduk N. IASP Task Force on Tax- onomy. Seattle, WA: IASP Press; 1994:209-14.
  4. [22]22. Foa EB, Davidson JRT, Frances A. Expert Consen- sus Guide: Treatment of traumatic stress disorder. J Clin Psychiatry 1999;60(16):60-6.
  5. [29]29. McFarlane AC, Atchison M, Rafalowicz E, Papay P. Physical symptoms in posttraumatic stress disorder. J Psychosom Res 1994;42:607-17.
  6. [33]33. Barlow DH. Anxiety and Its Disorders. New York, NY: Guilford Press; 2002.
  7. [35]35. Jeffrey S, Ph.D. Mogil (ed.) The Genetics of Pain. Seattle, WA: IASP Press; 2004.
  8. [38]38. Mueser KT, Noordsy DL, Drake RE, Fox L. Inte- grated Treatment for Dual Disorders: A Guide to Effective Practice. New York, NY: The Guilford Press; 2003.

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Authors
Otis, J. D., Keane, T. M., Kerns, R. D., Monson, C., & Scioli, E.
Affiliations
VA Boston Healthcare System (US)
Corresponding author
Otis, John D.
ORCID
Venue
Pain Medicine
Publisher
Oxford University Press (OUP)
Published
2009-10
Volume
10
Issue
7
Pages
1300-1311
ISSN
  • 1526-2375 (ISSN-L)
  • 1526-4637
DOI
10.1111/j.1526-4637.2009.00715.x
OpenAlex
W1966659648
Cited by
178
References
46
Citations by year
2026: 6 · 2025: 11 · 2024: 10 · 2023: 9 · 2022: 12 · 2021: 6 · 2020: 17 · 2019: 9 · 2018: 14 · 2017: 7 · 2016: 17 · 2015: 20 · 2014: 6 · 2013: 9 · 2012: 8
FWCI
8.86
Type
journal article
Language
en
Open access
closed
Licence
doi.wiley.com/10.1002/tdm_license_1 (tdm, 2161 d)
Locations
  • Pain Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Department of Veterans Affairs (C3322R)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords
chronic pain, post-traumatic stress disorder, comorbidities, veterans, integrated treatment, cognitive processing therapy, cognitive behavioral therapy, treatment development, therapist manual, patient workbook, treatment feasibility, participant trust, avoidance
MeSH terms
Chronic Disease, Female, Humans, Male, Middle Aged, Pain, Pain Measurement, Pilot Projects, Stress Disorders, Post-Traumatic, United States, Veterans, Cognitive Behavioral Therapy, Treatment Outcome, Delivery of Health Care, Integrated

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