Coexistence of PTSD symptoms and pain: a network analysis in a trauma-exposed sample with mixed chronic pain complaints

Objectives Improving treatment outcomes for comorbid chronic pain and posttraumatic stress disorder (PTSD) requires a better understanding of how these conditions interact. Methods This study examined the co-occurrence and interrelations of PTSD symptoms and chronic pain in a trauma-exposed sample recruited from the Pain Rehabilitation Unit at Skåne University Hospital, Sweden. Using a network analysis approach, data from 136 adults with chronic pain and traumatic exposure were analyzed. All DSM-5 PTSD symptoms were assessed at both item and cluster levels, alongside a comprehensive evaluation of chronic pain—covering severity, interference, and extent—as well as common comorbidities, including depression and insomnia. Results The findings revealed significant interconnections between specific PTSD symptoms, particularly those related to arousal and reactivity, and pain severity. Negative trauma-related emotions and detachment emerged as central nodes in the PTSD-pain network, suggesting that these symptoms may represent important targets for integrated treatment approaches. In contrast, pain extent showed weak or non-significant associations with PTSD symptoms and other pain-related variables. Conclusions Overall, these findings underscore the need to address both PTSD and chronic pain concurrently in clinical interventions to improve outcomes for individuals with these comorbid conditions. Targeting arousal and reactivity symptoms, identified as potential bridges between the two disorders, could be a promising strategy for enhancing treatment effectiveness. Further research is needed to clarify the mechanisms linking PTSD and chronic pain and to inform the development of integrated, tailored interventions for this patient population with complex symptoms.