Preventing the Development of Chronic Pain: Treating PTSD at Acute Pain Onset
Abstract
Chronic pain afflicts at least 50 million people in the U.S., markedly reduces their quality of life, and annually costs $150 billion in combined healthcare costs and lost productivity. Chronic pain can develop from acutely painful events, such as injury, repetitive motion and surgery, or from unknown causes. Research also indicates considerable health disparities regarding the co-occurrence of chronic pain and its treatment, and thus represent an even greater public health problem for low-income minority people than for more affluent White Americans. Recent research has identified factors that may increase the risk of transitioning from acute to chronic pain. These risk factors have included elevated negative affect, poor sleep, and symptoms of posttraumatic stress disorder (PTSD). More than 40% of U.S. Service Members with chronic pain also report having PTSD with post-concussive symptoms. Addressing these risk factors at the onset of acute pain may prevent individuals from developing chronic pain. For this project, we propose that treating PTSD during a non-injury-based acute pain episode could reduce the risk of transitioning to chronic pain. There are several interventions that have been shown to effectively reduce the severity of PTSD symptoms. These interventions include psychotherapies, such as Cognitive Processing Therapy (CPT; which can be delivered daily over the course of a single week), and pharmacological interventions, such as Stellate Ganglion Block (SGB; which involves two injections). In this study, we will directly compare CPT, SGB, and usual care (UC) in terms of their ability to prevent the transition from acute to chronic pain by reducing PTSD symptoms. Men and women presenting to the Rush University Medical Center Emergency Department with acute pain of the back/pelvis, chest, shoulder, or abdomen will be recruited. People agreeing to participate will be screened over the phone (within 48 hours of their Emergency Department visit) for high levels of PTSD symptoms. We intend to enroll 345 people. Enrollees will be randomly assigned to 1-week massed CPT delivered via telehealth (1-week CPT; n=115), SGB (n=115), or usual care (UC; n=115). Ratings of pain intensity at the site of the original Emergency Department complaint will comprise the primary outcome measure. PTSD, depressive symptoms, and other factors will also be collected from participants. Over the course of 4 years, the study will address three main aims: Aim 1 is to compare CPT, SGB, and UC on the degree to which participants report reduced pain intensity at the site of their original acute pain complaint from Day 1 to Day 28 during the treatment epoch, and at Days 56 and 112 during follow-up (3 and 6 months following the initial Emergency Department presentation). We expect that participants in the CPT and SGB conditions will report significantly less pain intensity at the site of the original pain complaint at Day 28, 56, and 112 assessments than participants in the UC condition. Aim 2 is to compare the magnitude of PTSD symptom reductions between CPT, SGB, and UC 28 days following pre-treatment assessment and maintenance of these reductions 56 and 112 days after the initial ED pain complaint. We hypothesize that both CPT and SGB will produce significant reductions in PTSD symptoms that will be maintained over time and that both CPT and SGB will produce significantly greater PTSD symptom reductions over time than UC. We expect that improvements in PTSD severity will partly mediate differences between CPT/SGB in pain intensity at the site of the original pain complaint. Aim 3 is to explore whether self-reported negative post-trauma cognitions and pain catastrophizing also improve during CPT and SGB, and whether these changes are associated with pain reductions. We propose that these factors may act as treatment mechanisms. We hypothesize that changes in negative post-trauma cognitions and pain catastrophizing will be greater
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210739
Entities
People
- John A. Burns
Organizations
- Rush University Medical Center
- United States Army