PTSD treatment impacts on pain: secondary analysis of sertraline, prolonged exposure, and their combination

Background: Although posttraumatic stress disorder (PTSD) and pain commonly co-occur, interventions often target them separately. No studies have compared the impact of PTSD psychotherapy, pharmacotherapy, and their combination on pain.Objectives: This secondary analysis of a PTSD effectiveness trial examined the impact of PTSD treatments on pain complaints in 196 veterans randomized to three conditions: Prolonged Exposure plus placebo (PE + PLB), PE + Sertraline (PE + SERT), and SERT with enhanced medication management, overall and among those who reported clinically significant pain at baseline.Method: Linear mixed models assessed change on the Brief Pain Inventory (Pain Severity and Interference subscales) over 52 weeks across treatments in the overall sample, and in those with clinically significant baseline pain interference (≥ 5, n = 70) and baseline pain severity (≥ 5, n = 93).Results: Veterans overall, and those with clinically significant baseline pain interference and severity, showed significant reductions in pain interference and severity scores across time in all treatments. The PE + PLB group showed greater reductions in pain interference during treatment than SERT and PE + SERT. Veterans with clinically significant baseline pain severity showed significant reduction in pain severity across time in all treatments, with no evidence for differential rates across treatments.Conclusion: While it is uncertain reduced pain was due to the treatments themselves, lower scores for all treatments suggest that PTSD-focused treatments may reduce pain even without a specific pain focus. Research is needed to isolate, if present, mechanistic pathways between PTSD treatment and pain reduction.Trial registration: ClinicalTrials.gov identifier: NCT01524133.