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

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. 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. 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 (<i>p</i>=0.0006). Among POQ subscales, treatment effects with ART were reported for pain intensity (effect size = 1.81, <i>p</i>=0.006), pain-related impairment in mobility (effect size = 0.69, <i>p</i>=0.01), and negative affect (effect size = 1.01, <i>p</i>=0.001). 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.

在美国退伍军人事务部（Veterans Administration, VA）系统内接受慢性疼痛治疗的退伍军人中，多达70%可能共患创伤后应激障碍（posttraumatic stress disorder, PTSD）；反之，创伤后应激障碍患者中亦有高达80%可能伴随疼痛症状。本研究针对存在创伤后应激障碍症状的美国现役军人与退伍军人所经历的疼痛展开描述，并探讨加速解决疗法（Accelerated Resolution Therapy, ART）——一种新型短时暴露疗法——针对治疗创伤后应激障碍症状所继发的急性疼痛的缓解效果。本研究纳入45名存在战斗相关创伤后应激障碍症状的美国现役军人/退伍军人，开展了加速解决疗法与注意力对照（attention control, AC）方案的随机对照试验。受试者平均接受3.7次加速解决疗法治疗，平均年龄为41.0±12.4岁，女性占比20%。绝大多数退伍军人（93%）自述存在疼痛症状；其中78%的受试者使用了指向神经性疼痛（neuropathic pain）的描述性词汇，另有29%报告存在脑震荡症状或意识恍惚感。加速解决疗法组受试者的疼痛结局问卷（Pain Outcomes Questionnaire, POQ）前后平均变化值为-16.9±16.6，而注意力对照组为-0.7±14.2（*p*=0.0006）。在疼痛结局问卷各分量表中，加速解决疗法展现出显著治疗效应的维度包括：疼痛强度（效应量=1.81，*p*=0.006）、疼痛相关活动能力受损（效应量=0.69，*p*=0.01）以及负性情绪（效应量=1.01，*p*=0.001）。存在战斗相关创伤后应激障碍症状的退伍军人，其显著疼痛（含神经性疼痛）的患病率较高；通过加速解决疗法对退伍军人的战斗相关创伤后应激障碍症状进行短时干预，似乎可快速缓解其伴随的疼痛症状。