The Development of an Integrated Treatment for Veterans with Comorbid Chronic Pain and Posttraumatic Stress Disorder

Objective. The purpose of this article is to describe the development of the first integrated treatment for Veterans with comorbid chronic pain and posttraumatic stress disorder (PTSD). Design. Descriptive, including pre- and posttreatment assessment results from a pilot study of six veterans with comorbid chronic pain and PTSD. Setting. Northeastern Department of Veterans Affairs Medical Center. Interventions. Using components of cognitive processing therapy (CPT) for PTSD and cognitive behavioral therapy (CBT) for chronic pain management, a 12-session integrated treatment for veterans with comorbid chronic pain and PTSD was developed. A therapist manual and patient workbook that included weekly readings and homework assignments were created. Participants received pre- and posttreatment evaluations using measures of pain, PTSD, physical disability, and psychological distress. The treatment development process is reviewed and the benefits and challenges of implementing this integrated treatment are presented. Results. Several themes emerged over the course of implementing the treatment, including the importance of establishing participant trust, regular therapy attendance, and addressing participant avoidance. Of the six participants recruited for the pilot study, three withdrew from the study and three completed the integrated treatment. Participants reported that they generally liked the format of treatment, appreciated learning about the ways that chronic pain and PTSD share some common symptoms, and ways that the two disorders can interact with one another. The assessment results of those who completed treatment suggest that this treatment approach is feasible and may have clinical benefit. Conclusions. Participants appeared to benefit from receiving the integrated treatment for pain and PTSD. A randomized clinical trial is currently being conducted to evaluate the efficacy of this treatment approach.