%0 Journal Article
%T Conceptualizing and Treating Comorbid Chronic Pain and PTSD
%A Michelle A. Bosco
%A Jessica L. Gallinati
%A Michael E. Clark
%J Pain Research and Treatment
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/174728
%X The purpose of this paper is to review the rationale for concurrent, evidence-based treatment of chronic pain and posttraumatic stress disorder (PTSD). To meet this end, we review pertinent definitions and extant theories related to the two conditions and their correlations with each other. We then synthesize theoretical components into a proposal of a comprehensive conceptual framework for understanding the relationship and clinical complexity of overlapping chronic pain and PTSD. We conclude with an example of an integrated treatment model designed specifically to address a fundamental factor associated with pain and PTSD: avoidance. 1. Introduction The purpose of this paper is to provide sound rationale and clinical recommendations for the concurrent, evidence-based treatment of chronic pain and posttraumatic stress disorder (PTSD). After reviewing current definitions and conceptualizations of both chronic pain and PTSD, the paper elaborates and extends the fear-avoidance model of pain and PTSD to provide a comprehensive explanatory framework for the conceptual, symptomatic, and behavioral overlap of the two conditions. These clinical similarities, coupled with a review of common factors and shared mechanisms evident in the two conditions, are highlighted and are fundamental to the rationale for application of concurrent, evidence-based treatment of co-occurring symptoms or disorders associated with chronic pain and PTSD. Current programs or models applying concurrent treatment for veterans and service members returning from the ongoing conflicts in the Middle East (Operations Enduring and Iraqi Freedom, OEF/OIF; Operation New Dawn, OND) are identified, and preliminary outcomes regarding this approach¡¯s usefulness and effectiveness are summarized. Given the shared psychological and behavioral mechanisms, it may be argued that concurrent treatment of chronic pain and PTSD underway in the veteran population also would be beneficial to nonmilitary/nonveteran populations. 2. Prevalence and Impact of Chronic Pain Turk [1] defines pain as a multidimensional, complex, subjective, perceptual phenomenon, a definition shared by many pain researchers. Chronic pain has been defined in the literature as pain lasting for greater than 3 to 6 months, persisting beyond the healing of the initial injury or disease process [2]. As the chronicity of pain increases, emotional distress, functional limitations, and increased utilization of the healthcare system tend to occur [3¨C6]. Chronic pain may develop gradually over time, seemingly independent of any known trauma, or
%U http://www.hindawi.com/journals/prt/2013/174728/