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Ongoing distress from a traumatic event, not the trauma itself, is related to impaired functioning in patients with chronic pain

People who have experienced trauma—including trauma from assault, sexual abuse, or a car accident—may continue to experience varying levels of distress, and some may suffer posttraumatic stress disorder (PTSD). Past studies suggest that trauma history can be a key factor in predicting poor health or poor adjustment to chronic pain. However, preliminary findings from a new study show that ongoing distress from thoughts surrounding a traumatic event, not the trauma itself, is related to impaired physical and psychosocial functioning among primary care patients.

Researchers supported by the Agency for Healthcare Research and Quality (HS09368) and led by Tim A. Ahles, Ph.D., of Dartmouth-Hitchcock Medical Center, mailed a screening questionnaire to patients of four New England primary care practices. They asked respondents to assess their pain during the previous 4 weeks (intensity, duration, location, and adequacy of pain treatment), general health and specific health problems, and demographics (age, sex, etc.), as well as trauma history and whether they were bothered by the trauma.

Half of the patients who said they had pain reported that they had experienced at least one previous emotionally traumatic event. Nearly 31 percent of patients who had experienced trauma continued to be moderately to extremely bothered by the experience. Patients who continued to be bothered by the trauma also reported significantly more pain, emotional distress, poorer social functioning, and more difficulty with engaging in their daily activities than patients who had no trauma history or a trauma history that did not involve ongoing trauma-related distress.

These findings suggest that providers who treat only the pain may not be treating the underlying problem that brought the patient into the office. Treating the range of psychological symptoms associated with a traumatic experience may be the key to managing related chronic pain syndromes and impaired functioning in these patients, conclude the researchers.

See "Ongoing distress from emotional trauma is related to pain, mood, and physical function in a primary care population," by Janette L. Seville, Ph.D., Dr. Ahles, John H. Wasson, M.D., and others, in the March 2003 Journal of Pain and Symptom Management 25(3), pp. 256-263.

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