Posttraumatic stress disorder symptoms and chronic orofacial pain: An empirical examination of the mutual maintenance model

Aims: As there is a high correspondence between the experience of trauma and posttraumatic stress disorder (PTSD) symptoms among chronic orofacial pain patients, study objectives included: (1) to document the nature of traumatic experiences and severity of PTSD symptoms among a female sample of orofacial pain patients, (2) to examine the relationship between PTSD symptoms and both pain-related and psychosocial outcomes, and (3) to use structural equation modeling (SEM) to test hypotheses of mediation derived from the Mutual Maintenance Model of chronic pain and PTSD. Methods: The study design was a cross-sectional, retrospective case series of 411 female patients (mean age 41.0, SD 13.1) who were seen at the University of Kentucky Orofacial Pain Center between 1997 and 2007. A series of correlational and SEM analyses were conducted to test study hypotheses. Results: Of the total sample, 23.6% (n = 97) reported PTSD symptoms consistent with a diagnosis of PTSD. Higher PTSD symptom reports were associated significantly (P < .01) with the following outcomes: symptoms of psychological and affective distress, life interference due to pain, receipt of punishing responses from one's spouse, limited activity levels, and poor sleep quality. SEM analyses indicated PTSD symptoms likely exert their influence on pain severity through depression and sleep quality. Conclusion: PTSD and depression screening as well as thorough sleep evaluations should be included in the routine assessment for orofacial pain patients and, if appropriate, referrals for treatment of PTSD symptoms should be considered part of the standard of care.