Widespread pain in older Germans is associated with posttraumatic stress disorder and lifetime employment status - Results of a cross-sectional survey with a representative population sample

Whether self-reported lifetime civilian and war-related potential traumatic events are associated with widespread pain (WP) and if so, whether the association is attributable to posttraumatic stress disorder (PTSD) and depression has not been studied in a representative sample of the general population. In a randomly selected sample of the German general population, persons aged 60-85 years answered validated self-rating instruments: Regional Pain Scale, trauma list of the Composite International Diagnostic Interview, Posttraumatic Diagnostic Scale, and Patient Health Questionnaire 2. Participants with WP were compared with participants with no or local or regional pain (controls). Stepwise hierarchical logistic regression analyses were performed with WP as the dependent variable and demographic data, potential traumatic events, PTSD, and depressive disorder as independent variables. Of 773 respondents, 147 (19.0%) reported WP. Participants with WP reported rape (4.1% vs 1.0%, P = 0.01), life-threatening illness (11.6% vs 6.1%, P = 0.02), witnessing trauma (19.2% vs 8.4%, P = 0.001), and cumulative potential traumatic events (24.5% vs. 16.5%, P = 0.004) more frequently than the 626 controls. The prevalence of full PTSD (10.9% vs 2.2%; P < 0.0001) and of potential depressive disorder (13.7% vs 6.6%, P = 0.02) was higher in participants with WP than in controls. The significant association between some potential traumatic events and WP was completely abrogated after adjusting for demographic variables and PTSD. In the final model, PTSD (odds ratio 3.43, 95% confidence interval 1.88-6.26) and lifetime employment status as a worker (odds ratio 1.55, 95% confidence interval 1.04-2.31) predicted WP. Prospective studies are necessary to understand the temporal association of PTSD and WP. (c) 2012 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.