The association of PTSD with burden of chronic overlapping pain conditions

Patients with comorbid PTSD and chronic pain have worse outcomes than patients with either condition alone. Studies measuring the association between PTSD and chronic pain have largely focused on musculoskeletal pain. Chronic overlapping pain conditions (COPCs) are a group of ten pain conditions which commonly co-occur and may have shared pathophysiology. Our study goal was to assess the relationship between PTSD status and COPC prevalence in two epidemiologic datasets. We used the Merative™ MarketScan® Commercial and Multi-State Medicaid insurance claims Databases (2016-2022). We used a validated list of ICD-10 codes to calculate prevalence ratios (PR) of COPCs among individuals with and without PTSD. We used negative binomial regression to estimate the incidental rate ratio of COPCs among individuals with PTSD compared to those without. We identified 62,095,809 unique commercially insured enrollees, of whom 609,526 had a claim for PTSD. Among 24,003,526 unique Medicaid enrollees, 206,523 had a claim for PTSD. Individuals with PTSD had 2.07 (95% CI 2.07 to 2.08) and 3.54 (95% CI 3.50 to 3.58) times the rate of COPCs on average compared to individuals without PTSD in commercial and Medicaid insurance populations, respectively. The observed association between PTSD and COPCs and the larger effect size among Medicaid patients who face greater adversity both lend additional weight to the concept of COPCs as a basis for understanding the pathophysiology of chronic pain. Patients whose pain phenotype is related to their psychosocial context may benefit from a different treatment approach than those for whom psychiatric comorbidities are merely incidental.