Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder

Kevin E Kip, Laney Rosenzweig, Diego F Hernandez, Amy Shuman, David M Diamond, Sue Ann Girling, Kelly L Sullivan, Trudy Wittenberg, Ann M Witt, Cecile A Lengacher, Brian Anderson, Susan C McMillan, Kevin E Kip, Laney Rosenzweig, Diego F Hernandez, Amy Shuman, David M Diamond, Sue Ann Girling, Kelly L Sullivan, Trudy Wittenberg, Ann M Witt, Cecile A Lengacher, Brian Anderson, Susan C McMillan

Abstract

Background: As many as 70% of veterans with chronic pain treated within the US Veterans Administration (VA) system may have posttraumatic stress disorder (PTSD), and conversely, up to 80% of those with PTSD may have pain. We describe pain experienced by US service members and veterans with symptoms of PTSD, and report on the effect of Accelerated Resolution Therapy (ART), a new, brief exposure-based therapy, on acute pain reduction secondary to treatment of symptoms of PTSD.

Methods: A randomized controlled trial of ART versus an attention control (AC) regimen was conducted among 45 US service members/veterans with symptoms of combat-related PTSD. Participants received a mean of 3.7 sessions of ART.

Results: Mean age was 41.0 + 12.4 years and 20% were female. Most veterans (93%) reported pain. The majority (78%) used descriptive terms indicative of neuropathic pain, with 29% reporting symptoms of a concussion or feeling dazed. Mean pre-/post-change on the Pain Outcomes Questionnaire (POQ) was -16.9±16.6 in the ART group versus -0.7±14.2 in the AC group (p=0.0006). Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, p=0.006), pain-related impairment in mobility (effect size = 0.69, p=0.01), and negative affect (effect size = 1.01, p=0.001).

Conclusions: Veterans with symptoms of combat-related PTSD have a high prevalence of significant pain, including neuropathic pain. Brief treatment of symptoms of combat-related PTSD among veterans by use of ART appears to acutely reduce concomitant pain.

Keywords: PTSD; Psychological trauma; clinical trials; combat; exposure therapy; eye movements; imagery rescripting; pain; prevalence; psychotherapy.

Figures

Fig. 1
Fig. 1
Descriptive terms used to classify origin of reported pain as somatic, visceral, and/or neuropathic among all study participants.
Fig. 2
Fig. 2
Consort diagram of the trial population including those screened, enrolled, randomly assigned, completing treatment, and analyzed.
Fig. 3
Fig. 3
Plot of change scores on the Pain Outcomes Questionnaire (POQ) before and after treatment with Accelerated Resolution Therapy (ART) versus before and after an attention control (AC) regimen. Each vertical line represents the response of an individual service member or veteran. ITT=intention to treat analysis.
Fig. 4
Fig. 4
Scatter plot and linear regression line of the relationship between baseline PTSD symptom score from the PCL-M and baseline total pain score from the POQ.
Fig. 5
Fig. 5
Scatter plot and linear regression line of the relationship between change in PTSD symptom score from the PCL-M and change in total pain score from the POQ before and after treatment with Accelerated Resolution Therapy (ART).

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