Interaction of posttraumatic stress disorder and chronic pain following traumatic brain injury

Objective: To investigate the association between posttraumatic stress diso rder (PTSD) and chronic pain in patients who had sustained a severe traumat ic brain Injury (TBI). Design: Correlational relationships between pain var iables and PTSD measures were examined in a cohort study. Setting: An adult tertiary care center brain injury clinic. Patients: Ninety-six persons wit h severe TBI. Outcome Measures: The Posttraumatic Stress Disorder interview (PTSD-I), a modified McGill Pain Questionnaire, the Beck Depression Invent ory (BDI), the General Health Questionnaire (GHQ), the Community Integratio n Questionnaire (CIQ), the Satisfaction with Life Scale (SWL), and the Copi ng Style Questionnaire (CSQ). Results: More persons with chronic pain repor ted PTSD than did those without pain. The relationship between pain severit y and depression, functional adjustment, and satisfaction with life was med iated 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 posttra umatic stress in the maintenance of dysfunctional reactions. Specific inter ventions that address adaptive coping mechanisms to reduce PTSD may enhance rehabilitation for persons with TDI who suffer chronic pain.