On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

What is the relationship between symptoms of post traumatic stress disorder and chronic pain?

1     Stress disorders, post-traumatic/    results= 3048   
2     Chronic disease/    results= 40596   
3     exp Pain/    results= 46718   
4     1 and (2 and 3)    results= 11   

Reference Librarian comments

Your search is perfection. Congrats.

There's a database of references to published literature in post-traumatic stress disorder (PTSD) available at the URL here below...

http://dciswww.dartmouth.edu:50080/?&&&105&s

This database is only about PTSD, and is made at the VA hospital in -- are you ready? -- White River Junction, Vermont. If you go to that site and put "pain" in the "descriptors" field, and "chronic" in the "all indexes" field, you'll get 87 references. I'll put the first 10 here below.

- 1 -
Author: Bryant, Richard A; Marosszeky, Jeno E; Crooks, Jenelle;
Baguley, Ian J; Gurka, Joseph A.
Title: Interaction of posttraumatic stress disorder and chronic pain
following traumatic brain injury.
Source: Journal of Head Trauma Rehabilitation (ISSN: 0885-9701), v.
14, no. 6, pp. 588-594 (December 1999).
Form of matl: Journal Article.
Affiliation: School of Psychology, University of New South Wales, Sydney
NSW, Australia.
Instruments: Beck Depression Inventory (Beck et al). Community Integration
Questionnaire (Willer et al). Coping Reactions Inventory
(Billings and Moos). FAM (Hall). PTSD Interview (Watson et
al). Satisfaction with Life Scale (Diener et al). Westmead
PTA Scale (Shores et al).
Year: 1999.
Language: English.
Availability: General.
Identification: 21712.
Descriptors: Adults. Coping Behavior. Head Injuries. Physical Pain.
PTSD. Survivors.
Abstract: OBJECTIVE: To investigate the association between PTSD and
chronic pain in patients who had sustained a severe traumatic
brain injury (TBI). DESIGN: Correlational relationships between
pain variables and PTSD measures were examined in a cohort
study. SETTING: An adult tertiary care center brain injury
clinic. PATIENTS: 96 persons with severe TBI. OUTCOME MEASURES:
The PTSD Interview (PTSD-I), a modified McGill Pain
Questionnaire, the Beck Depression Inventory (BDI), the General
Health Questionnaire (GHQ), the Community Integration
Questionnaire (CIQ), the Satisfaction with Life Scale (SWL),
and the Coping Style Questionnaire (CSQ). RESULTS: More persons
with chronic pain reported PTSD than did those without pain.
The relationship between pain severity and depression,
functional adjustment, and satisfaction with life was mediated
by severity of PTSD. Pain severity was significantly associated
with an avoidant coping style. CONCLUSIONS: Effective
rehabilitation of persons with chronic pain following severe
TBI should recognize the role of posttraumatic stress in the
maintenance of dysfunctional reactions. Specific interventions
that address adaptive coping mechanisms to reduce PTSD may
enhance rehabilitiation for persons with TBI who suffer chronic
pain. [Author Abstract]

- 2 -
Author: Spertus, Ilyse L; Burns, John; Glenn, Beth; Lofland, Kenneth;
McCracken, Lance.
Title: Gender differences in associations between trauma history and
adjustment among chronic pain patients.
Source: Pain (ISSN: 0304-3959), v. 82, no. 1, pp. 97-102 (July 1999).
Form of matl: Journal Article.
Affiliation: Department of Psychology, Finch University of Health Sciences,
Chicago Medical School, North Chicago IL, USA.
Note: This study was completed as partial fulfillment of requirements
for M.S. degree performed under the supervision of John W.
Burns.
Instruments: Beck Depression Inventory (Beck et al). Pain Anxiety Symptoms
Scale (McCracken et al). Trauma History Questionnaire
Self-Report (Green). West Haven-Yale Multidimensional Pain
Inventory (Kerns et al).
Year: 1999.
Language: English.
Availability: General.
Identification: 21528.
Descriptors: Adults. Epidemiology. Etiology. Females. Males. Physical
Pain. PTSD (DSM-IV). Stressors. Survivors .
Abstract: This study examines the relationship between a trauma history
and emotional functioning in response to a chronic pain
condition. We broadened the traditional study of trauma in
chronic pain from sexual and physical abuse to include a
variety of traumatic events and experiences that occurred not
only during childhood, but during adulthood as well. 73 (51
percent female, 60 percent lower back) chronic pain patients
were administered the Trauma History Questionnaire, the
Multidimensional Pain Inventory, The Beck Depression Inventory,
and the Pain Anxiety Symptoms Scale prior to starting a
multidisciplinary pain program. We hypothesized that high
levels of emotional distress and anxiety would differentiate
patients with a substantial history of trauma from those
without, while levels of pain severity and disability would
not. A MANOVA revealed a significant Trauma Group (low vs.
high) by Gender interaction for the dependent variables, which
included both measures of emotional distress and pain severity
and disability. Univariate tests showed that the interaction
was significant only for emotional distress variables and not
for pain severity and disability. Further, the multivariate
effect of Trauma Group and the univariate effects for emotional
distress variables were significant only among men. Results
indicate that a substantial history of trauma may detrimentally
impact a chronic pain patient's ability to manage their pain
effectively, particularly among men. [Author Abstract] KEY
WORDS: chronic pain; trauma; gender differences; adjustment

- 3 -
Author: Chapman, C Richard; Gavrin, Jonathan.
Title: Suffering: the contributions of persistent pain.
Source: Lancet (ISSN: 0023-7507), v. 353, no. 9171, pp. 2233-2237
(June 26, 1999).
Form of matl: Journal Article.
Affiliation: Department of Anesthesiology, School of Medicine, University
ofWashington, Seattle WA, USA.
Year: 1999.
Language: English.
Availability: General.
Identification: 21289.
Descriptors: Chronic Illness. Cognitive Processes. Etiology. Injuries.
Neuroendocrinology. Neurophysiology. Physical Pain. Self
Concept. Survivors. Treatment Effectiveness .
Abstract: Pain is a perceived threat or damage to one's biological
integrity. Suffering is the perception of serious threat or
damage to the self, and it emerges when a discrepancy develops
between what one expected of one's self and what one does or
is. Some patients who experience sustained unrelieved pain
suffer because pain changes who they are. At a physiological
level, chronic pain promotes an extended and destructive stress
response characterised by neuroendocrine dysregulation,
fatigue, dysphoria, myalgia, and impaired mental and physical
performance. This constellation of discomforts and functional
limitations can foster negative thinking and create a vicious
cycle of stress and disability. The idea that one's pain is
uncontrollable in itself leads to stress. Patients suffer when
this cycle renders them incapable of sustaining productive
work, a normal family life, and supportive social interactions.
Although patients suffer for many reasons, the physician can
contribute substantially to the prevention or relief of
suffering by controlling pain. Suffering is a nebulous concept
for most physicians, and its relation to pain is unclear. This
review offers a medically useful concept of suffering that
distinguishes it from pain, accounts for the contributory
relation of pain to suffering by describing pain as a stressor,
and explores the implications of these ideas for the care of
patients. [Author Abstract]

- 4 -
Author: Fillingim, Roger B; Wilkinson, Chris S; Powell, Tykeysha.
Title: Self-reported abuse history and pain complaints among young
adults.
Source: Clinical Journal of Pain (ISSN: 0749-8047), v. 15, no. 2, pp.
85-91 (June 1999).
Form of matl: Journal Article.
Affiliation: Department of Psychology, University of Alabama, Birmingham AL,
USA.
Instruments: Beck Depression Inventory (Beck et al). Coping Strategies
Questionnaire (Rosenstiel and Keefe). General Temperament
Survey (Watson et al). Kohn Reactivity Scale. Pennebaker
Inventory of Limbic Languidness (Pennebaker). Recent Health
History Questionnaire (Fillingim et al). Sexual and Physical
Abuse History Questionnaire (Leserman et al).
Year: 1999.
Language: English.
Availability: General.
Identification: 21324.
Descriptors: Adults. Americans. Battery. Child Abuse. College Students.
Epidemiology. Etiology. Females. Males. Physical Pain.
Rape. Survivors .
Abstract: OBJECTIVE: Considerable evidence suggests that a self-reported
history of physical and/or sexual abuse is more frequently
reported among chronic pain populations and is associated with
poorer adjustment to pain. However, previous research has
typically included patients seeking treatment for pain, whereas
few population-based studies have explored the association
between abuse history and pain. This purpose of this study was
to examine the association between self-reported history of
sexual or physical abuse and recent pain complaints,
health-related variables, and psychological disturbance among a
nonclinical sample of young adults. DESIGN: Subjects were 426
(275 female, 151 male) college students who completed a series
of questionnaires assessing abuse history, recent pain, health
care utilization, perceived health, and psychological
variables. RESULTS: Females reported a positive history of
abuse (PHA) more frequently than males (43.5 percent vs. 23.8
percent), and females reported significantly higher rates for
all types of abuse except physical abuse during childhood (p <
0.05). PHA subjects reported experiencing pain in more sites
and pain of higher severity over the past month compared to
subjects with a negative history of abuse (NHA) (p < 0.05). PHA
subjects also reported more health care utilization and greater
psychological disturbance, including depression, somatization,
negative temperament, and higher levels of catastrophizing (p <
0.05). Interestingly, when somatization and depression scale
scores were used as covariates, group differences in pain
complaints and health care utilization became nonsignificant (p
> 0.10). CONCLUSION: These findings suggest that a
self-reported history of physical or sexual abuse is associated
with increased pain complaints, health care utilization, and
psychological disturbance even among young adults from a
nonclinical population. Moreover, the association between abuse
and pain complaints appears to be moderated at least in part by
the higher levels of somatization and depression observed in
the PHA group. [Author Abstract] KEY WORDS: abuse; pain;
somatization; depression

- 5 -
Author: Yaari, Ariela; Eisenberg, Elon; Adler, Rivka; Birkhan, Jesmond.
Title: Chronic pain in Holocaust survivors.
Source: Journal of Pain and Symptom Management (ISSN: 0885-3924), v.
17, no. 3, pp. 181-187 (March 1999).
Form of matl: Journal Article.
Affiliation: Pain Relief Unit, Rambam Medical Center, Rappaport Faculty of
Medicine, Technion-Israel Institute of Technology, Haifa,
Israel.
Instruments: Beck Depression Inventory (Beck et al). McGill Pain
Questionnaire (Melzack). Pain Disability Index (Tait et al).
Symptom Checklist 90 (Derogatis et al).
Year: 1999.
Language: English.
Availability: General.
Identification: 21594.
Descriptors: Aged. Anxiety Disorders. Depressive Disorders. Etiology.
Holocaust. Israelis. Jews. Physical Pain. Survivors .
Abstract: There is limited research on the connection between the
Holocaust and chronic pain, despite evidence suggesting that
medical and psychological sequelae are common in survivors. The
goals of this study were: (1) to define Holocaust survivors' (n
= 33) chronic pain characteristics as manifested 50 years after
the war, (2) to compare survivors with controls (n = 33) who
did not experience World War II atrocities, and (3) to
investigate the connection between past trauma and chronic
pain. Data were collected through questionnaires that included
a detailed medical and pain history, visual analog scale (VAS),
McGill Pain Questionnaire (MPQ), Beck Depression Inventory
(BDI), Symptom Check List-90 (SCL-90), and Pain Disability
Index (PDI). A comparison of variables between the two groups
was conducted using multivariate analysis of variance (MANOVA)
and ANOVA, and canonical discriminant analysis. Results showed
that Holocaust survivors reported higher pain levels (73 +/- 18
vs. 56 +/- 21; P < 0.005), more pain sites (4.5 +/- 2.7 vs. 2.7
+/- 1.4; P < 0.05), and significantly higher depression scores
(17.6 +/- 8.4 vs. 9.2 +/- 4.6; P < 0.001); they tended to
utilize more medical services (5.9 +/- 3.0 vs. 5.1 +/- 2.8).
Nonetheless, survivors did not regard themselves more disabled
as compared with controls. They reported a higher activity
level as measured by walking distance capacity, and spent
significantly fewer hours resting (4.3 +/- 3.6 vs. 7 +/- 4.6; P
< 0.05). This paradoxical combination of high pain intensity,
moderate to severe depression, and high activity level
characterizes Holocaust survivors' chronic pain. It is
conceivable that by remaining active Holocaust survivors fight
back their pain, distress, and depression. These findings
suggest that Holocaust atrocities affect survivors' chronic
pain even years later. [Author Abstract] KEY WORDS: Holocaust
survivors; chronic pain; early-life trauma; abuse; depression;
disability; concentration camp; degenerative joint disease;
degenerative spine disease

- 6 -
Author: Goldberg, Richard T; Pachas, William N; Keith, David.
Title: Relationship between traumatic events in childhood and chronic
pain.
Source: Journal of Disability and Rehabilitation (ISSN: 0963-8288), v.
21, no. 1, pp. 23-30 (January 1999).
Form of matl: Journal Article.
Affiliation: Department of Psychiatry, Harvard Medical School, Cambridge MA,
USA.
Note: The text of the Childhood History Questionnaire appears as an
Appendix on pp. 29-30.
Instruments: Childhood History Questionnaire (Goldberg et al). Childhood
Traumatic Events Scale (Pennebaker and Susman). McGill Pain
Questionnaire (Melzack). Pain Disability Index (Tait et al).
Year: 1999.
Language: English.
Availability: General.
Identification: 20758.
Descriptors: Adults. Bereavement. Child Abuse. Drug Abuse. Females.
Fibromyalgia. Physical Pain. Sleep Disorders. Self Report
Instruments. Survivors.
Abstract: PURPOSE: The purpose was to examine the relationships between
traumatic events in childhood, such as sexual and physical
abuse, alcoholism, and drug addiction, and three types of
chronic pain: facial pain, myofascial pain, and fibromyalgia. A
fourth group, a heterogeneous group of other pain, was used as
a comparison group. METHOD: 91 patients with chronic pain, age
range 20-60, were consecutively recruited from the outpatient
clinics of a rehabilitation hospital and a general hospital.
Patients were given four measures for completion at evaluation:
Childhood History Questionnaire; Childhood Traumatic Events
Scale; McGill Melzack Pain Questionnaire; Pain Disability
Index. Chi-square was used to test significant differences
among four pain groups on sexual, physical, and verbal abuse;
alcoholism; drug dependence; medications; major upheaval,
childhood illness, death of a family member or friend, and
separation or divorce of parents. Logistic regression was used
to predict membership in the four pain groups. RESULTS: All
pain groups had a history of abuse exceeding 48 percent:
fibromyalgia, 64.7 percent; myofascial, 61.9 percent; facial,
50 percent; other pain, 48.3 percent. All groups had a history
of family alcohol dependence exceeding 38 percent, and a
history of drug dependence ranging from 5.8 to 19.1 percent. A
combined history of pain, child physical abuse, and alcoholism
was prevalent in 12.9 to 35.3 percent. Logistic regression
showed patients who were female, with an alcoholic parent,
using non-narcotic drugs were more likely to be members of the
facial, myofascial, and fibromyalgia groups. CONCLUSIONS: Child
traumatic events are significantly related to chronic pain.
Since the problem of child abuse is broader than physical and
sexual abuse, health and rehabilitation agencies must shift
from individualized treatment to interdisciplinary treatment of
the family and patient. [Author Abstract]

- 7 -
Author: Ehlert, Ulrike; Heim, Christine; Hellhammer, Dirk H.
Title: Chronic pelvic pain as a somatoform disorder.
Source: Psychotherapy and Psychosomatics (ISSN: 0033-3190), v. 68, no.
2, pp. 87-94 (1999).
Form of matl: Journal Article.
Affiliation: Center of Psychobiological and Psychosomatic Research,
University of Trier, Trier, Germany.
Instruments: Mehrdimensionale Schmerzskala (Lehrl et al).
Screening-Verfaheren zur Identifizierung von Personen mit
Somatoformen Storungen (Rief et al). Self-Rating Depression
Scale (Zung). Sexual Abuse Screening Questionnaire (Russell).
Sexual and Physical Abuse History Questionnaire (Leserman et
al).
Year: 1999.
Language: English.
Availability: General.
Identification: 09269.
Descriptors: Adults. Battery. Child Abuse. Females. Germans.
Gynecological Symptoms. Incest. Physical Pain. PTSD
(DSM-III-R). Rape. Somatoform Disorders. Survivors.
Abstract: BACKGROUND: The purpose of this study was to determine whether
psychiatric disturbances, particularly somatization, and an
increased number of traumatic and critical life events, which
have been found in women with idiopathic chronic pelvic pain
(IPP), can also be observed in women with chronic pelvic pain
and abdominal adhesions (ACPP). METHODS: 40 women who underwent
diagnostic laparoscopy were divided into these groups according
to blind rated somatic pathologies: ICPP patients (n = 16),
ACPP patients (n = 10), infertile controls without pain (n =
14). Besides the standardized assessment of DSM-III-R
diagnosis, questionnaires and semistandardized interviews were
used to estimate depression, somatization, pain, the prevalence
of sexual and physical abuse, and the number of critical life
events. RESULTS: Diagnostic criteria for somatoform pain
disorder were fulfilled in 73.3 percent of the ICPP patients,
60 percent of the ACPP patients and none of the controls. With
respect to the somatization symptom checklist the two pain
groups scored significantly higher than the controls (p <
0.05). Referring to perceived pain, ACPP patients differed from
the ICPP patients by 1 out of 7 subscales (higher persistence
of pain; p < 0.05). No correlation was found between the
intensity of pain and the severity of classified adhesions. The
two groups of pain patients significantly differed from
controls by a higher prevalence of sexual abuse (p < 0.05).
Depression was found neither in the pain groups nor in the
controls. CONCLUSIONS: Because high somatization and high
prevalence rates of abuse were not only found in patients
suffering from ICPP but also in ACPP patients, it seems to be
doubtful that the somatic pathology may fully explain the
psychopathology in patients with ACPP. [Author Abstract]. KEY
WORDS: chronic pelvic pain; adhesions; somatoform disorders;
PTSD; chronic stress; trauma

- 8 -
Author: Heim, Christine; Ehlert, Ulrike; Hanker, Jurgen P; Hellhammer,
Dirk H.
Title: Psychological and endocrine correlates of chronic pelvic pain
associated with adhesions.
Source: Journal of Psychosomatic Obstetrics and Gynaecology (ISSN:
0167-482X), v. 20, no. 1, pp. 11-20 (1999).
Form of matl: Journal Article.
Affiliation: Center for Psychobiological and Psychosomatic Research,
University of Trier, Trier, Germany.
Instruments: Mehrdimensionale Schmerzskala (Lehrl et al). Self-Rating
Depression Scale (Zung). Sexual Abuse Screening Questionnaire
(Russell). Sexual and Physical Abuse History Questionnaire
(Leserman et al).
Year: 1999.
Language: English.
Availability: General.
Identification: 09742.
Descriptors: Adults. Battery. Child Abuse. Etiology. Females. Germans.
Gynecological Symptoms. Hospital Patients. PTSD (DSM-III-R).
Physical Pain. Neuroendocrinology. Rape. Survivors.
Abstract: Chronic pelvic pain (CPP) is a frequent and often unexplained
gynecological complaint. We attempted to evaluate stress
history, psychological features and
hypothalamic-pituitary-adrenal (HPA) axis function in a group
of patients suffering from CPP associated with pelvic
adhesions. We recruited 10 patients with CPP and adhesions and
14 painfree, infertile control patients who underwent
gynecological examination and diagnostic laproscopy in a
general hospital. Psychological assessment included structured
interviews on sexual and physical abuse experiences and major
life events as well as questionnaires on pain characteristics
and depression. To evaluate HPA axis function, we measured
plasma adrenocorticotropin (ACTH) and salivary control
responses to the administration of 100 micrograms of human
corticotropin-releasing factor (CRF). Results revealed high,
but not statistically increased, prevalence rates of sexual and
physical abuse for patients with CPP and adhesions as compared
to controls. Patients with CPP and adhesions reported a
significantly higher total number of major life events. Mean
depression scores were normal in both groups. Patients with CPP
and adhesions demonstrated normal plasma ACTH, but decreased
salivary cortisol levels in the CRF stimulation test. These
preliminary findings suggest that stress and neuroendocrine
changes may also contribute to the pathophysiology of CPP with
an identified organic correlate. [Author Abstract] KEY WORDS:
chronic pelvic pain; adhesions; stress; abuse;
hypothalamic-pituitary-adrenal axis; corticotropin-releasing
factor

- 9 -
Author: Geisser, Michael E; Perna, Robert; Kirsch, Ned L; Bachman, Jan
E.
Title: Classification of chronic pain patients with the Brief Symptom
Inventory: patient characteristics of cluster profiles.
Source: Rehabilitation Psychology (ISSN: 0090-5550), v. 43, no. 4,
pp.313-326 (Winter 1998).
Form of matl: Journal Article.
Affiliation: Department of Physical Medicine and Rehabilitation, University
of Michigan Medical Center, Ann Arbor MI, USA.
Instruments: Brief Symptom Inventory (Derogatis and Spencer). McGill Pain
Questionnaire (Melzack). Pain Disability Index (Tait et al).
Posttraumatic Chronic Pain Test (Muse and Frigola). West
Haven-Yale Multidimensional Pain Inventory (Kerns et al).
Year: 1998.
Language: English.
Availability: General.
Identification: 09731.
Descriptors: Adults. Americans. Chronic Illness. Physical Pain. PTSD
(DSM-IV). Self Report Instruments. Survivors.
Abstract: In this study, the psychological symptom patterns of
individuals with chronic pain on the Brief Symptom Inventory
(BSI) were cluster analyzed. Cluster analysis was initially
performed on a large sample of people with chronic pain (n =
1,489) and then cross-validated on a smaller sample (n = 244).
A 2-cluster solution was deemed more appropriate. The clusters
reflected low- and high-profile elevations on all BSI
subscales. Among persons in the smaller sample, high-profile
participants were more likely to be involved in litigation,
report a higher frequency of posttraumatic stress symptoms, and
display poorer psychosocial functioning. The results suggest
that the BSI subgroups are associated with psychosocial
characteristics that may be important in terms of treatment
planning and outcome. [Author Abstract]

- 10 -
Author: Jaspers, Jan P C.
Title: Whiplash and post-traumatic stress disorder.
Source: Disability and Rehabilitation (ISSN: 0963-8288), v. 20, no. 11,
pp. 397-404 (November 1998).
Form of matl: Journal Article.
Affiliation: Department of Medical Psychology, University Hospital
Groningen, Groningen, The Netherlands.
Note: Review Article: 31 refs.
Instruments: Impact of Event Scale (Horowitz et al). Symptom Checklist 90
(Derogatis et al).
Year: 1998.
Language: English.
Availability: General.
Identification: 20785.
Descriptors: Comorbidity. Head Injuries. Literature Review. Motor
TrafficAccidents. Physical Pain. PTSD. Survivors.
Abstract: PURPOSE: This study examined the comorbidity of whiplash and
PTSD following motor vehicle accidents. A treatment strategy in
cases with both disorders is proposed. METHOD: A review of the
literature on psychological consequences of motor vehicle
accidents and on risk factors associated with developing
chronic whiplash complaints is given. A case report is
presented to illustrate the treatment strategy. RESULTS:
Traffic accidents lead to psychological complaints more often
than is realized in clinical practice. It is estimated that
PTSD occurs in at least 25 percent of traffic accident victims
who sustain physical injuries. This number is probably higher
in patients with chronic whiplash complaints. The case report
shows that improvement in relation with the post-traumatic
stress symptoms can have a beneficial effect on coping with the
chronic whiplash complaints. CONCLUSIONS: The psychotherapeutic
treatment of patients with chronic whiplash complaints and PTSD
should be aimed primarily at coping with the trauma and not at
the chronic pain complaints. [Author Abstract] KEY WORDS: PTSD,
whiplash, neck sprains, motor vehicle accidents, driving phobia