SAN ANTONIO — Post-traumatic stress disorder often is comorbid with chronic pain and is associated with increased levels of pain severity and pain-related disability, according to a new study.

An article in Military Medicine discussed how considering the changes to the PTSD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) could lead to an improved understanding of the relationship between those co-occurring disorders and, ultimately, could aid the development of effective integrated treatments.1

In the current study, researchers from the University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System examined the relationship between the revised PTSD Checklist for DSM-5 (PCL-5) symptom clusters—specifically, intrusion, avoidance, negative alterations in cognition and mood [NACM] and arousal—and chronic pain measurements—severity, interference and disability.

Included in the study were 103 veterans with a mean age of 45.3 participating in a randomized clinical trial examining the efficacy of an interdisciplinary pain management program for chronic musculoskeletal pain.

Results indicated that the 76 participants with a provisional PTSD diagnosis based on PCL-5 responses had significantly greater pain severity, interference and disability than the 23 participants without a provisional diagnosis.

Researchers pointed out that correlations between symptom clusters and pain measurements were mostly significant and positive with varying strengths, adding, “The avoidance symptom cluster, however, had relatively weaker correlations with pain measurements and was not significantly associated with the numeric rating scale of pain severity. Path analyses revealed that, after controlling for avoidance symptoms, significant associations remained between NACM and all the pain measurements. After controlling for NACM symptoms, however, there were no significant associations between avoidance symptoms and pain measurements.”

The authors argued that the current study underscored the need to reexamine the leading theories about the mutual maintenance of these disorders in order to develop effective integrative treatment approaches.

“PTSD-related avoidance may have a relatively weaker role in co-occurring chronic pain than the other symptom clusters and may have a qualitatively different role than chronic pain-related avoidance,” researchers explained. “Future research should explore the relationship between the avoidance in PTSD and the avoidance in chronic pain as well as identify which chronic pain measurements are the most useful when examining the relationship between PTSD and chronic pain.”

They added, “The potential impact of trauma-related cognition and mood on chronic pain indicates that this is an important area for intervention and should be considered in the development of integrated treatments for chronic pain and PTSD among veterans.”


  1. Lehinger E, Reed DE, Nabity P, Brackins N, Villarreal R, McGeary C, Blount T, Cobos B, Jaramillo C, Eapen BC, Pugh MJ, Potter J, Peterson A, Young-McCaughan S, Houle T, McGeary DD. An Examination of Chronic Pain Indices and the Updated Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental-Disorders-Fifth Edition. Mil Med. 2020 Dec 10:usaa529. doi: 10.1093/milmed/usaa529. Epub ahead of print. PMID: 33301040.