Comorbid PTSD and pain: Why is it so common among our patients and how can we best treat both disorders?

​1. Title:

Comorbid PTSD and pain: Why is it so common among our patients and how can we best treat both disorders?

2. Project period:

2018-2022; 2022-2025​

3. Investigator:

​Maria Lurenda Westergaard ​

4.  Supervisors and collaborative partners:

Jessica Carlsson (CTP) and Rigmor Jensen (Danish Headache Center)​

5. Introduction:

Pain is a very common complaint among traumatized refugees and yet there are very few studies in this area.1 In our clinical experience at the Competence Centre for Transcultural Psychiatry (CTP), most patients have pain complaints.  Headache, for example, is reported by over 95% of our patients, a much higher prevalence than what is seen in the general population (26.1% for tension-type headache, and 14.4% for migraine).2 Pain measured using the Brief Pain Inventory (BPI) shows that over 80% of our patients have a severity score at or above the scale midpoint.  Furthermore, those with higher baseline pain score are more likely to have a poorer treatment response compared to those who report less impairment and lower levels of pain.3 Understanding the link between PTSD and pain could contribute to the development of interventions that better address the needs of our patients.  

5.1 Aims

  1. To describe the prevalence of pain among refugees with PTSD referred to CTP
  2. To compare severity of PTSD symptoms and treatment outcomes among those with and without pain
  3. To review the literature on treatments and interventions for comorbid PTSD and pain in the general population and specifically among refugees
  4. To pilot nonpharmacologic and pharmacologic treatments that target both PTSD and pain

6. Methods:

  1. Analysis of relevant data in the Danish Database on Refugees with Trauma (DART) collected since 2009
  2. Literature reviews on specific interventions that target both PTSD and pain. These include nonpharmacologic interventions (e.g., psychotherapy) and medications (e.g., SSRIs / SNRIs, tricyclic antidepressants, gabapentinoids)
  3. Development of a treatment manual targeting both PTSD and pain

7. Expected findings:

Our hypotheses are:

  1. Pain is highly prevalent among refugees with PTSD
  2. Patients with comorbid PTSD and pain are refractory to treatment
  3. New approaches targeting both PTSD and pain could improve outcomes

8. Dissemination of results:

  1. Journal articles on pain prevalence and treatment outcomes in our patients
  2. Treatment protocol (manual) for comorbid PTSD and pain among traumatized refugees
  3. Reports of pilot studies on treatment interventions

9. References:

  1. Rometsch-Ogioun El Sount C, Windthorst P, Denkinger J, et al. Chronic pain in refugees with posttraumatic stress disorder (PTSD): A systematic review on patients' characteristics and specific interventions. J Psychosom Res 2019; 118:83‒97.
  2. GBD 2016 Headache Collaborators. Global, regional, and national burden of migraine and tension-type headache, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.Lancet Neurol2018; 17: 954–76.
  3. Nordbrandt MS, Vindbjerg E, Mortensen EL, Carlsson J. Chronicity of posttraumatic stress disorder and comorbid pain as predictors of treatment response for trauma-affected refugees. J Trauma Stress. 2022 Apr 21.​

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