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51 Neurobehavioral changes in patients with combat-related posttraumatic stress Disorder and chronic pain

Published online by Cambridge University Press:  24 June 2014

Braš Marijana,
Jančuljak Davor,
Boban Maja and
Jurić Stjepan
Braš Marijana
Affiliation:
Department of Psychological Medicine, Zagreb University Hospital Center, Kišpaticeva 12, 10000 Zagreb, Croatia, E-mail: marijana.bras@kbc-zagreb.hr
Jančuljak Davor
Affiliation:
Department of Psychological Medicine, Zagreb University Hospital Center, Kišpaticeva 12, 10000 Zagreb, Croatia, E-mail: marijana.bras@kbc-zagreb.hr
Boban Maja
Affiliation:
Department of Psychological Medicine, Zagreb University Hospital Center, Kišpaticeva 12, 10000 Zagreb, Croatia, E-mail: marijana.bras@kbc-zagreb.hr
Jurić Stjepan
Affiliation:
Department of Psychological Medicine, Zagreb University Hospital Center, Kišpaticeva 12, 10000 Zagreb, Croatia, E-mail: marijana.bras@kbc-zagreb.hr
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Abstract

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Introduction/Objectives:

In patients with chronic posttraumatic stress disorder (PTSD) depression and anxiety are important psychological features that influence their behavior in every day life. Co-morbid chronic pain may have an additional impact both on their emotional status and cognitive performance. In this study the authors analyzed the interrelationships between depression, quality of life and cognitive processing in patients with combat-related PTSD and chronic pain.

Participants, Materials/Methods:

The subjects were 184 war veterans who had been treated at the Clinic for Psychological Medicine in Zagreb for PTSD and chronic pain. All patients were analyzed according to their medical records, interviews and self reported questionnaires for PTSD (Mississippi Scale for combat-related PTSD, Beck Depression Inventory, WHOQOL-Bref, SCL-90) and pain (McGill Pain questionnaire, Visual Analogue Scale (VAS)). A selected group of 18 patients were evaluated for cognitive processing by event-related evoked potentials.

Results:

Severe symptoms of chronic PTSD were found in 110 patients. Anxiety and depression were highly correlated to pain. ERPs showed significant prolongation of P 300 latency suggesting the slowing of cognitive processing. Patients with chronic PTSD had significantly higher total pain scores as well as affective and sensory pain components compared to the patients without PTSD. We found statistically significant positive correlation between PTSD symptoms and pain intensity that influence everyday activities like walking, personal hygiene and independent dressing.

Conclusions:

The presence of PTSD symptoms, depression and anxiety in combination with chronic pain predicted lower QoL for war veterans. Multidisciplinary approach is needed for the treatment of those patients.