title: An examination of the impact of clinically significant levels of posttraumatic stress disorder symptomatology on the classification of pain as mild, moderate, or severe in a sample of veterans with chronic pain.
abstract: Chronic pain affects approximately 50% of veterans, half of whom also suffer from posttraumatic stress disorder (PTSD). Researchers have previously identified a method for translating 0-10 pain scales to categories of pain (mild, moderate, or severe pain) to make pain ratings more meaningful in the context of category-based treatment guidelines. Although one such study focused on veterans with pain, none have considered whether empirically derived cutoffs differ based on the presence of clinically significant levels of PTSD symptomatology. Therefore, the purpose of the study presented here was to replicate previous findings on pain categorization in veterans and to assess whether the cutoffs differ based on the presence or absence of clinically significant levels of PTSD symptomatology. On the basis of the responses of 198 veterans, our results supported the previous finding that scores of 1-4 are classified as mild pain, 5-7 as moderate, and 8-10 as severe. In addition, veterans with comorbid pain and clinically significant levels of PTSD symptomatology were found to have a lower cutoff between mild and moderate pain, but they did not have a different cutoff between moderate and severe pain. These results, which support that lower levels of pain severity are associated with higher levels of pain-related interference for veterans with comorbid pain and clinically significant levels of PTSD symptomatology relative to veterans with pain without clinically significant levels of PTSD symptomatology, highlight the importance of considering contextual factors (e.g., psychosocial factors) when assessing a veteran's pain severity.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine.
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Alschuler
authors.affiliation: VA Boston Healthcare System.
authors.forename: John D
authors.initials: JD
authors.lastname: Otis
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health