Paradoxical Pain Perception In PTSD: The Unique Role of Anxiety and Dissociation

Highlights from the paper published in Journal of Pain:

  • PTSD patients exhibited hypo-sensitivity along with hyper-responsiveness to experimental pain
  • PTSD patients exhibited more intense and widespread chronic pain than controls
  • Pain hypo-sensitivity associated with dissociation while pain hypo-responsiveness with anxiety
  • Chronic pain intensity associated with both dissociation and anxiety
  • These paradoxical facets of PTSD seem to underlie the paradoxical pain profile & chronic pain

Posttraumatic stress disorder (PTSD) and chronic pain often co-occur and exacerbate each other. Elucidating the mechanism of this co-occurrence therefore has clinical importance. Previously, PTSD patients with chronic pain were found to demonstrate a unique, paradoxical pain profile: hyper-responsiveness together with hyposensitivity to pain. Our aim was to examine whether two seemingly paradoxical facets of PTSD – anxiety and dissociation – underlie this paradoxical profile.

PTSD patients (n=32) and healthy controls (n=43) underwent psychophysical testing and completed questionnaires. PTSD patients had higher pain thresholds and higher pain ratings to suprathreshold stimuli than controls. Pain thresholds were positively associated with dissociation levels and negatively associated with anxiety sensitivity levels. Experimental pain ratings were positively associated with anxiety sensitivity and negatively related to dissociation levels. Chronic pain intensity was associated with anxiety, anxiety sensitivity and pain catastrophizing.

It appears that reduced conscious attention towards incoming stimuli, resulting from dissociation, causes delayed response in pain threshold measurement while biases towards threatening stimuli and decreased inhibition, possibly due to elevated anxiety, are responsible for the intensification of experimental and chronic pain. The paradoxical facets of PTSD and their particular influences over pain perception seem to reinforce the coexistence of PTSD and chronic pain, and should be considered when treating traumatized individuals.

This article provides new information regarding the underlying mechanism of the coexistence of PTSD and chronic pain. This knowledge could potentially help to provide better management of PTSD and chronic pain among individuals in the aftermath of trauma.


Ed: unfortunately the article costs $31.50 just to read.

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