Chronic Pain and Post-Traumatic Stress Disorder Comorbidities
Summary
Chronic pain and post-traumatic stress disorder (PTSD) frequently co-occur, imposing a compounded burden on individuals and health systems worldwide. The overlap arises from shared neurobiological pathways, including dysregulation of the hypothalamic–pituitary–adrenal axis, central sensitisation of nociceptive circuits and maladaptive emotional processing. Psychological sequelae of trauma, such as hypervigilance and avoidance, can amplify pain perception and interfere with rehabilitation, while persistent pain may serve as a recurrent reminder of the precipitating injury, perpetuating intrusive memories and hyperarousal. This bidirectional relationship contributes to greater functional impairment, heightened disability and poorer quality of life than is observed in either condition alone. Effective management demands routine screening for PTSD symptoms in pain clinics and vice versa, integration of cognitive–behavioural and body-oriented therapies, and multidisciplinary strategies addressing both affective and sensory dimensions. Understanding heterogeneity in clinical presentation, from widespread musculoskeletal discomfort to regionally localised syndromes, remains key to tailoring interventions that mitigate the reciprocal maintenance of pain and trauma responses and to improving long-term outcomes.
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Chronic Pain and Post-Traumatic Stress Disorder Comorbidities publication trend
The graph below shows the total number of articles in chronic pain and post-traumatic stress disorder comorbidities across all publications each year (not limited to Nature Index journals).
Technical terms
Comorbidity: The simultaneous presence of two or more medical or psychological conditions in an individual.
Central sensitization: A state of heightened responsiveness within the central nervous system that amplifies pain signals.
Kinesiophobia: An excessive, irrational fear of movement due to anticipation of pain or reinjury.
Hyperarousal: A persistent state of increased physiological and psychological tension associated with PTSD.
References
- Prevalence of Posttraumatic Stress Disorder in Persons with Chronic Pain: A Meta-analysis. Frontiers in Psychiatry (2017).
- Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment. European Journal of Psychotraumatology (2019).
- Pain management program outcomes in veterans with chronic pain and comparison with nonveterans. Canadian Journal of Pain (2020).
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