Relationship between Post-Traumatic Stress Disorder Symptoms and Chronic Pain Related Symptom Domains among Military Active Duty Service Members.

OBJECTIVE This study examined the relationships between symptom domains relevant to PTSD diagnosis, PTSD screening, and chronic pain-related symptoms (pain intensity, pain interference, physical function, fatigue, depression, anxiety, anger, satisfaction with social roles) experienced by active duty military service members with chronic pain. DESIGN Cross-sectional study. SETTING The Interdisciplinary Pain Management Center (IPMC) at Madigan Army Medical Center between 2014 and 2018. SUBJECTS Active duty service members receiving care at IPMC (N = 2,745). METHODS Independent sample t test was conducted to compare pain intensity and pain-related measures of physical, emotional and social functioning among patients with and without a PTSD diagnosis or PTSD positive screen (≥3 symptoms). Relative weight analysis was used to identify the relative importance of each PTSD symptom cluster (e.g., intrusion, avoidance, hyperarousal, emotional numbness) to pain and related domains. RESULTS Approximately 27.9% patients had a positive screen for PTSD, and 30.5% of the patients had a PTSD diagnosis. Patients with PTSD diagnosis and positive screening had higher Pain Interference and lower Physical Function and Social Satisfaction scores (P < 0.001), and had increased Anger, Anxiety, Fatigue, and Depression scores (P < 0.001). Emotional numbness accounted for the largest proportion of variance in average pain intensity, pain interference, and psychological functioning; while avoidance accounted for the largest proportion of variance in physical function. CONCLUSION To improve treatment effectiveness and overall functioning for active duty military patients, integrated treatment and therapies targeted to reducing chronic pain, and PTSD symptoms (focus on emotional numbness and avoidance) are recommended.