Overview
Although most people recover from acute pain (such as pain caused by injury, surgery, repetitive motion, or unknown causes), many people do not fully recover and will experience chronic pain. Untreated posttraumatic stress disorder (PTSD) appears to be a key risk factor for the transition from acute pain to chronic pain. However, few published studies have addressed the issue of preventing the transition from acute to chronic pain via PTSD reduction. This project will aim to test whether trauma-related PTSD symptoms can be reduced using either Stellate Ganglion Block (SGB) treatment or Cognitive Processing Therapy (CPT), and whether reducing PTSD symptoms can prevent the transition from non-injury based acute pain to chronic pain.
Description
Untreated PTSD appears to be a key risk factor for the transition from acute pain to chronic pain. Thus, reducing PTSD symptoms during an acute pain episode may potentially decrease the likelihood of transitioning to chronic pain. CPT is an evidence-based trauma-focused cognitive behavioral treatment that is hypothesized to reduce PTSD symptoms via reducing negative trauma-related cognitions about oneself, others, and the world. SGB treatment is an injection of a local anesthetic into the stellate ganglion, which is a bundle of nerves located at the base of the neck that is part of the sympathetic nervous system. Previous studies suggest that 1-week massed CPT and SGB treatment can both reduce the severity of PTSD symptoms in short periods of time via two distinct psychological and biological mechanisms.
This 4 year project will test study hypotheses in a sample of 345 individuals with PTSD symptoms who present to the Emergency Department (ED) with non-injury based acute pain. Participants will be randomly assigned to receive 1-week massed CPT, 2 SGB treatments, or usual care. All participants will complete identical self-report and/or clinician administered assessments at baseline (prior to randomization) and on study days 1, 7, 14, 21, 28, 56 (approximately 3 months after the initial ED presentation), and 112 (approximately 6 months after ED presentation).
Eligibility
Inclusion Criteria:
- Age 18 to 70 years
- Ability to read and write English sufficiently to understand and complete study questionnaires and participate in interviews
- Presenting to the Rush Emergency Department (ED) with a medical problem and experiencing non-injury based acute pain
- A primary acute pain site of chest, back, shoulder, abdomen, or pelvis
- Self-reported symptoms consistent with a diagnosis of PTSD
Exclusion Criteria:
- Pain intensity great enough to impair concentration or capacity to understand instructions or nature of being invited into a study, as assessed by a member of medical staff
- Any illness or injury that precludes the ability to understand or follow instructions, as assessed by a member of the medical staff
- Current illness that involves constant or frequent pain
- Self-reported history of chronic pain on presentation to the ED or documented in the electronic medical record
- Pain from the traumatic event that is the source of their PTSD
- Neurological disorder
- Cancer diagnosis
- Blood pressure greater than 160/100 mmHg
- Taking anticoagulants or antiplatelet drugs other than aspirin
- Pregnancy
- Current or lifetime psychotic or bipolar disorders
- Current alcohol or substance dependence
- Receiving treatment for chronic or significant disease such rheumatoid disease, current influenza that may manifest temporary flu-related pain, and heart disease. People with well-controlled diabetes or HIV/AIDS will be included only if there is no self-reported history of chronic or neuropathic pain on presentation to the ED or documented in the electronic medical record.