Exploring Relations Among Traumatic, Posttraumatic, and Physical Pain Experiences in Methadone-Maintained Patients


      Differences in lifetime trauma exposure and screened symptoms of posttraumatic stress disorder (PTSD) were examined in methadone maintenance treatment (MMT) patients with a variety of pain experiences. Parametric and nonparametric statistical tests were performed on data obtained from 150 patients currently enrolled in MMT. In comparison to MMT patients reporting no pain in the previous week, those with chronic severe pain (CSP) (ie, pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) exhibited comparable levels of trauma involving sexual assault but reported significantly higher levels of trauma involving physical assault, number of traumatic events, and screened symptoms of PTSD. A third group, non-CSP MMT patients reporting some pain in the past week, differed significantly from the CSP group on number of traumatic events but reported comparable levels of sexual assault and physical assault. In comparison to men, women reported higher levels of sexual assault and were more likely to score above the cutoff on the PTSD screener but reported comparable levels of physical assault and number of traumatic events. Pain-related differences in trauma and screened symptoms of PTSD exist in MMT patients and may have implications for program planning and outreach efforts.


      This article demonstrates that trauma and screened symptoms of PTSD vary as a function of sex and pain status in methadone-maintained patients. Future studies may benefit from developing and assessing interventions that address chronic pain, PTSD, and opioid dependence in MMT.

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      1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders.
        4th ed, text revision. American Psychiatric Association, Washington, DC2000
        • Asmundson G.J.G.
        • Coons M.J.
        • Taylor S.
        • Katz J.
        PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models.
        Can J Psychiatry. 2002; 47: 930-937
        • Barry D.T.
        • Beitel M.
        • Garnet B.
        • Joshi D.
        • Rosenblum A.
        • Schottenfeld R.S.
        Relations among psychopathology, substance use, and physical pain experiences in methadone-maintained patients.
        J Clin Psychiatry. 2009; 70: 1213-1218
        • Breslau N.
        • Davis G.C.
        • Andreski P.
        • Peterson E.L.
        • Schultz L.R.
        Sex differences in posttraumatic stress disorder.
        Arch Gen Psychiatry. 1997; 54: 1044-1048
        • Chilcoat H.D.
        • Menard C.
        Epidemiological investigations: comorbidity of posttraumatic stress disorder and substance use disorder.
        in: Ouimette P. Brown P.J. Trauma and Substance Abuse: Causes, Consequences and Treatment of Comorbid Disorders. American Psychological Association, Washington, DC2003: 9-28
        • Clark H.W.
        • Masson C.L.
        • Delucchi K.L.
        • Hall S.M.
        • Sees K.L.
        Violent traumatic events and drug abuse severity.
        J Subst Abuse Treat. 2001; 20: 121-127
        • Cleeland C.S.
        Pain assessment in cancer.
        in: Osaba D. Effect of Cancer on Quality of Life. CRC Press, Boca Raton, FL1991: 293-305
        • Cleeland C.S.
        • Ryan K.M.
        Pain assessment: Global use of the Brief Pain Inventory.
        Ann Acad Med Singapore. 1994; 23: 129-138
        • Cohen S.P.
        • Christo P.J.
        • Moroz L.
        Pain management in trauma patients.
        Am J Phys Med Rehabil. 2004; 83: 142-161
        • Cottler L.B.
        • Compton W.M.
        • Mager D.
        • Spitznagel E.L.
        • Janca A.
        Posttraumatic stress disorder among substance users from the general population.
        Am J Psychiatry. 1992; 149: 664-670
        • Dansky B.S.
        • Roitzsch J.C.
        • Brady K.T.
        • Saladin M.E.
        Posttraumatic stress disorder and substance abuse: Use of research in a clinical setting.
        J Trauma Stress. 1997; 10: 141-148
        • Frans O.
        • Rimmo P.A.
        • Aberg L.
        • Fredrikson M.
        Trauma exposure and post-traumatic stress disorder in the general population.
        Acta Psychiatr Scand. 2005; 111: 291-299
        • Gillock K.L.
        • Zayfert C.
        • Hegel M.T.
        • Ferguson R.J.
        Posttraumatic stress disorder in primary care: Prevalence and relationships with physical symptoms and medical utilization.
        Gen Hosp Psychiatry. 2005; 27: 392-399
        • Gray M.J.
        • Litz B.T.
        • Hsu J.L.
        • Lombardo T.W.
        Psychometric properties of the Life Events Checklist.
        Assessment. 2004; 11: 330-341
        • Hien D.A.
        • Nunes E.
        • Levin F.R.
        • Fraser D.
        Posttraumatic stress disorder and short-term outcome in early methadone treatment.
        J Subst Abuse Treat. 2000; 19: 31-37
        • Jamison R.N.
        • Kauffman J.
        • Katz N.P.
        Characteristics of methadone maintenance patients with chronic pain.
        J Pain Symptom Manage. 2000; 19: 53-62
        • Kessler R.C.
        • Sonnega A.
        • Bromet E.
        • Hughes M.
        • Nelson C.B.
        Posttraumatic stress disorder in the National Comorbidity Survey.
        Arch Gen Psychiatry. 1995; 52: 1048-1060
        • Kimerling R.
        • Trafton J.A.
        • Nguyen B.
        Validation of a brief screen for post-traumatic stress disorder with substance use disorder patients.
        Addict Behav. 2006; 31: 2074-2079
        • Milby J.B.
        • Sims M.K.
        • Khuder S.
        • Schumacher J.E.
        • Huggins N.
        • McLellan A.T.
        • Woody G.
        • Haas N.
        Psychiatric comorbidity: Prevalence in methadone maintenance treatment.
        Am J Drug Alcohol Abuse. 1996; 22: 95-107
        • Mills K.L.
        • Lynskey M.
        • Teesson M.
        • Ross J.
        • Darke S.
        Post-traumatic stress disorder among people with heroin dependence in the Australian Treatment Outcome Study (ATOS): Prevalence and correlates.
        Drug Alcohol Depend. 2005; 77: 243-249
        • Mills K.L.
        • Teesson M.
        • Ross J.
        • Darke S.
        The impact of post-traumatic stress disorder on treatment outcomes for heroin dependence.
        Addiction. 2007; 102: 447-454
        • Mills K.L.
        • Teesson M.
        • Ross J.
        • Peters L.
        Trauma, PTSD, and substance use disorders: Findings from the Australian National Survey of Mental Health and Well-Being.
        Am J Psychiatry. 2006; 163: 652
        • Najavits L.M.
        • Gastfriend D.R.
        • Barber J.P.
        • Reif S.
        • Muenz L.R.
        • Blaine J.
        • Frank A.
        • Crits-Christoph P.
        • Thase M.
        • Weiss R.D.
        Cocaine dependence with and without PTSD among subjects in the National Institute on Drug Abuse Collaborative Cocaine Treatment Study.
        Am J Psychiatry. 1998; 155: 214-219
        • Najavits L.M.
        • Weiss R.D.
        • Shaw S.R.
        The link between substance abuse and posttraumatic stress disorder in women: A research review.
        Am J Addict. 1997; 6: 273-283
        • Norman S.B.
        • Stein M.B.
        • Dimsdale J.E.
        • Hoyt D.B.
        Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder.
        Psychol Med. 2008; 38: 533-542
        • Otis J.D.
        • Keane T.M.
        • Kerns R.D.
        An examination of the relationship between chronic pain and post-traumatic stress disorder.
        J Rehabil Res Dev. 2003; 40: 397-405
        • Peirce J.M.
        • Kindbom K.A.
        • Waesche M.C.
        • Yuscavage A.S.E.
        • Brooner R.K.
        Posttraumatic stress disorder, gender, and problem profiles in substance dependent patients.
        Subst Use Misuse. 2008; 43: 596-611
        • Peterlin B.L.
        • Tietjen G.
        • Meng S.
        • Lidicker J.
        • Bigal M.
        Post-traumatic stress disorder in episodic and chronic migraine.
        Headache. 2008; 48: 517-522
        • Prins A.
        • Ouimette P.
        • Kimerling R.
        • Camerond R.P.
        • Hugelshofer D.S.
        • Shaw-Hegwer J.
        • Thrailkill A.
        • Gusman F.D.
        • Sheikh J.I.
        The primary care PTSD screen (PC-PTSD): Development and operating characteristics.
        Primary Care Psychiatry. 2004; 9: 9-14
        • Rosenblum A.
        • Joseph H.
        • Fong C.
        • Kipnis S.
        • Cleland C.
        • Portenoy R.K.
        Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities.
        JAMA. 2003; 289: 2370-2378
        • Sharp T.J.
        • Harvey A.G.
        Chronic pain and posttraumatic stress disorder: Mutual maintenance?.
        Clin Psychol Rev. 2001; 21: 857-877
        • Sheu R.
        • Lussier D.
        • Rosenblum A.
        • Fong C.
        • Portenoy J.
        • Joseph H.
        • Portenoy R.K.
        Prevalence and characteristics of chronic pain in patients admitted to an outpatient drug and alcohol treatment program.
        Pain Med. 2008; 9: 911-917
        • Shipherd J.C.
        • Keyes M.
        • Jovanovic T.
        • Ready D.J.
        • Baltzell D.
        • Worley V.
        • Gordon-Brown V.
        • Hayslett C.
        • Duncan E.
        Veterans seeking treatment for posttraumatic stress disorder: What about comorbid chronic pain?.
        J Rehabil Res Dev. 2007; 44: 153-166
        • Villagómez R.E.
        • Meyer T.J.
        • Lin M.M.
        • Brown L.S.
        Post-traumatic stress disorder among inner city methadone maintenance patients.
        J Subst Abuse Treat. 1995; 12: 253-257
        • Villano C.L.
        • Rosenblum A.
        • Magura S.
        • Fong C.
        • Cleland C.
        • Betzler T.F.
        Prevalence and correlates of posttraumatic stress disorder and chronic severe pain in psychiatric outpatients.
        J Rehabil Res Dev. 2007; 44: 167-178
        • Yehuda R.
        • LeDoux J.
        Response variation following trauma: A translational neuroscience approach to understanding PTSD.
        Neuron. 2007; 56: 19-32