Goldstein E, McDonnell C, Atchley R, et al. The Impact of Psychological Interventions on Posttraumatic Stress Disorder and Pain Symptoms: A Systematic Review and Meta-Analysis. Clin J Pain. 2019 Aug;35(8):703-712. doi: 10.1097/AJP.0000000000000730. (Systematic review)

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.

MATERIALS AND 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 1583 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, 35) were available for meta-analysis, which demonstrated moderate effect for reduced PTSD severity (ES=-0.55, confidence interval [CI]: -0.83, -0.26) and nonsignificant 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 a 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 2 conditions co-occur.

Discipline Area Score
Physician 6 / 7
Rehab Clinician (OT/PT) 6 / 7
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Comments from MORE raters

Physician rater

The treatment of somatic comorbidities in PTSD is a critical issue that requires more attention in the literature.

Physician rater

This is an important set of questions though somewhat outside the scope of practice for many primary care providers.

Physician rater

Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury have significant long-term implications. Altogether, exposure- and CBT-based psychological interventions had the greatest impact on PTSD and depression symptoms postinjury when delivered within three months of injury, with risk-stratified, stepped care having the greatest population impact potential.

Rehab Clinician (OT/PT) rater

Although my specialty is with persons with chronic and persistent mental illness, PTSD often is considered in this category and PTSD linked to pain is a common co-occurrence. Therefore, I believe this article would probably be relevant and useful to those in my specialty.
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