Author: Goldstein E1, McDonnell C2, Atchley R3, Dorado K2, Bedford C3, Brown RL4, Zgierska AE1
Affiliation: <sup>1</sup>University of Wisconsin-Madison School of Medicine and Public Health Department of Family Medicine and Community Health.
<sup>2</sup>Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School.
<sup>3</sup>University of Utah College of Social Work.
<sup>4</sup>University of Wisconsin-Madison Schools of Nursing and School of Medicine and Public Health - Design and Statistics Unit.
Conference/Journal: Clin J Pain.
Date published: 2019 May 27
Other:
Special Notes: doi: 10.1097/AJP.0000000000000730. [Epub ahead of print] , Word Count: 241
OBJECTIVES: Posttraumatic stress disorder (PTSD) and pain often co-occur, introducing clinical challenges and economic burden. Psychological treatments are considered effective for each condition, yet it is not known which therapies have the potential to concurrently address PTSD and pain-related symptoms.
METHODS: To conduct a systematic review and meta-analysis, databases were searched for articles published between January 2007 and December 2017 describing results from clinical trials of interventions addressing PTSD and pain-related symptoms in adults. Two independent reviewers finalized data extraction and risk of bias assessments. A random effects model was used for meta-analysis and to calculate pooled and subgroup effect sizes (ESs) of psychological-only (single modality) and multimodal interventions.
RESULTS: Eighteen trials (7 uncontrolled, 11 randomized controlled trials, RCTs), totaling 1,583 participants, were included in the systematic review. RCT intervention types included exposure-based, cognitive-behavioral, and mindfulness-based therapies. Data from 10 RCTs (N=1,435) were available for meta-analysis, which demonstrated moderate effect for reduced PTSD severity (ES=-0.55, CI: -0.83, -0.26) and non-significant effect for pain intensity (ES=-0.14, CI: -0.43, 0.15) and pain interference (ES=-0.07, CI: -0.35, 0.20) outcomes. Findings from uncontrolled trials supported meta-analytic results from RCTs. Using GRADE assessment, the quality of evidence was deemed as moderate for RCTs and low for non-RCTs.
DISCUSSION: Findings indicated that the majority of the interventions appeared to have greater impact on reducing PTSD rather than pain-related symptoms. There remains a need to further develop interventions that consistently impact PTSD and pain-related outcomes when these two conditions co-occur.
PMID: 31145146 DOI: 10.1097/AJP.0000000000000730