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The Impact of Psychological Interventions on Posttraumatic Stress Disorder and Pain Symptoms

A Systematic Review and Meta-Analysis

Goldstein, Ellen PhD*; McDonnell, Christina MSc; Atchley, Rachel PhD, MCR; Dorado, Kathleen BA; Bedford, Carter BA; Brown, Roger L. PhD§; Zgierska, Aleksandra E. MD, PhD*

doi: 10.1097/AJP.0000000000000730
Review Articles

Objectives: Posttraumatic stress disorder (PTSD) and pain often co-occur, introducing clinical challenges and economic burden. Psychological treatments are considered effective for each condition, yet it is not known which therapies have the potential to concurrently address PTSD and pain-related symptoms.

Materials and Methods: To conduct a systematic review and meta-analysis, databases were searched for articles published between January 2007 and December 2017 describing results from clinical trials of interventions addressing PTSD and pain-related symptoms in adults. Two independent reviewers finalized data extraction and risk of bias assessments. A random-effects model was used for meta-analysis and to calculate pooled and subgroup effect sizes (ESs) of psychological-only (single modality) and multimodal interventions.

Results: Eighteen trials (7 uncontrolled, 11 randomized controlled trials, RCTs), totaling 1583 participants, were included in the systematic review. RCT intervention types included exposure-based, cognitive-behavioral, and mindfulness-based therapies. Data from 10 RCTs (N=1, 35) were available for meta-analysis, which demonstrated moderate effect for reduced PTSD severity (ES=−0.55, confidence interval [CI]: −0.83, −0.26) and nonsignificant effect for pain intensity (ES=−0.14, CI: −0.43, 0.15) and pain interference (ES=−0.07, CI: −0.35, 0.20) outcomes. Findings from uncontrolled trials supported meta-analytic results from RCTs. Using GRADE assessment, the quality of evidence was deemed as moderate for RCTs and low for non-RCTs.

Discussion: Findings indicated that the majority of the interventions appeared to have a greater impact on reducing PTSD rather than pain-related symptoms. There remains a need to further develop interventions that consistently impact PTSD and pain-related outcomes when these 2 conditions co-occur.

*Department of Family Medicine and Community Health, University of Wisconsin-Madison School of Medicine and Public Health

§Design and Statistics Unit, University of Wisconsin-Madison School of Nursing and School of Medicine and Public Health, Madison, WI

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

University of Utah College of Social Work, Salt Lake City, UT

E.G. is a postdoctoral fellow at the University of Wisconsin Department of Family Medicine and Community Health, supported by Health Resources and Services Administration research training grant T32HP10010, Madison, WI. C.M., R.A., K.D., C.B., and A.E.Z.’s work has been supported by the Patient-Centered Outcomes Research Institute Award (OPD-1601-33860), Madison, WI. R.L.B. declares no conflict of interest.

Reprints: Ellen Goldstein, PhD, Department of Family Medicine and Community Health, University of Wisconsin-Madison, 1100 Delaplaine Ct, Madison, WI 53715 (e-mail:

Received August 9, 2018

Received in revised form May 13, 2019

Accepted May 17, 2019

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