Conceptualizing and treating the polytrauma clinical triad as a complex chronic pain syndrome

The polytrauma clinical triad (PCT) - comprised of posttraumatic stress disorder (PTSD), chronic pain syndromes (CPS), and traumatic brain injury (TBI) - is a significant problem among US Service Members and Veterans (SMV). Many SMV treated for PCT improve within 5 years of initial presentation, but a significant fraction show declining health despite extensive care, underscoring the necessity for enhanced management strategies in this population. Since PCT commonly presents as a distressing and debilitating polysymptomatic experience centered around pain, the proposed Functional Recovery Enabling Inter-Disciplinary Evaluation and Management (FREIDEM) model conceptualizes PCT as a complex CPS that emerged and persisted in association with PTSD, TBI, and several other comorbidities. The FREIDEM model integrates several recent clinical advances in conceptualizing and treating complex CPSs and proposes that a complex CPS like PCT represents a state of inadequate or suspended self-healing and recovery due to the cumulative impact of several biopsychosocial impediments (multimorbidity) accrued over a lifetime. The treatment of such complex CPSs is theorized as the advancement of self-recovery with functional interventions, therapeutic mitigation of biopsychosocial impediments to recovery and judicious time-limited use of symptom management including pain management. The FREIDEM model offers a clinical evaluation strategy to identify the biopsychosocial impediments and develop a comprehensive structured treatment plan based on the theoretical model. More research is needed to determine if the FREIDEM model reliably improves outcomes for SMVs with PCT, but it offers a solid framework for treating PCT as a complex chronic pain syndrome and to foster further discussion about new treatment approaches.