Post-Traumatic Stress Disorder and Chronic Pain Conditions in Men: A Twin Study, 2020, Gasperi et al

Andy

Andy

Retired committee member
Objectives
Posttraumatic Stress Disorder (PTSD) is highly comorbid with chronic pain conditions that often co-occur such as migraine headaches, temporomandibular disorder, irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, chronic prostatitis/chronic pelvic pain syndrome, and tension headaches. Using a genetically-informative sample, the current study evaluated the genetic and environmental factors contributing to the co-occurrence of PTSD and chronic pain conditions.

Methods
Data from 4,680 male twins in the Vietnam Era Twin Registry were examined. Biometric modeling was used to estimate genetic and environmental variance components and genetic and environmental correlations between PTSD and multiple chronic pain conditions.

Results
Heritability was estimated at 43% (95% CI: 15-63%) for PTSD, 34% (95% CI: 27-41%) for the combined history of any one or more pain condition. Specific pain condition heritabilities ranged from 15% (95% CI: 0 - 48%) for tension headaches to 41% (95% CI: 27 - 54%) for migraine headaches. Environmental influences accounted for the remaining variance in pain conditions. The genetic correlation between PTSD and combined history of any one or more pain condition was rg = 0.61 (95% CI: 0.46; 0.89) and ranged for individual pain conditions from rg = 0.44 (95% CI: 0.24; 0.77) for migraine headache to rg = 0.75 (95% CI: 0.52; 1.00) for tension headaches.

Conclusions
PTSD and chronic pain conditions are highly comorbid, and this relationship can be explained by both genetic and environmental overlap. The precise mechanisms underlying these relationships are likely diverse and multifactorial.
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Paywall, https://journals.lww.com/psychosoma...c_Stress_Disorder_and_Chronic_Pain.98475.aspx
Sci hub, no access
 
PTSD and chronic pain conditions are highly comorbid, and this relationship can be explained by both genetic and environmental overlap. The precise mechanisms underlying these relationships are likely diverse and multifactorial.
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The very obvious explanation is that chronic pain is routinely misrepresented and misdiagnosed as trauma. None of this is surprising given the way people carelessly throw these things around. Roughly the same reason people find "depression" in chronic illness.

It's a creative take on turtles all the way down, building failure on top of failure because of other failures. It's failure all the way down.
 
The abstract didn't say whether the men with PTSD had (combat) injuries that would explain chronic pain. Also, veterans with PTSD have a much higher rate of "accidents" (motor vehicle) than the base male population, as I remember, they have more suicides.

Would have to read the whole report.

Fibromyalgia encompasses many illnesses listed such as: chronic pain, chronic fatigue, IBS, migraine, headache, TMJ, chronic pelvic pain. These all fall under the fibromyalgia umbrella, despite each being given an ICD code in the medical record, assuming this study was retrospective.

I do wonder at what their definition of CFS was, and when that diagnosis was made. Post Vietnam era studies could have ended before the Canadian consensus and IOM definitions.

Were veterans with PTSD more likely to have frequent doctor appointments, and therefore have more diagnoses on their records? In a country that until recently had a huge population of the uninsured, the VA (Veteran's Administration) was probably the main and a frequent source of healthcare for veterans.

Though twin studies always interest me, if you throw a lot of misleading data into the computer program, it's still garbage in, garbage out.
 
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If it is the same person, one of the co-authors Dedra Buchwald, is mentioned quite a lot in Osler's Web.
Visited Incline Village early on with Komaroff, and seems to have had an interest in looking at prevalence rates in health care settings.
 
Michiel Tack said:
4,680 male twins that's a lot. If they looked for ME/CFS with a proper clinical examination this study could hold interesting information (I fear that they simply asked for chronic fatigue with some questionnaire).
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Unfortunately, that's exactly what they did:
Physical health conditions, including chronic pain conditions, were assessed with a questionnaire. Twins were asked, "Have you ever been told by a doctor or other health professional that you had ..." followed by a list of conditions including FM, CFS, IBS, TMD, tension headaches, migraine headaches, chronic prostatitis. Additional health conditions were assessed by asking, "Have you ever had any of the following health problems...," followed by a list of conditions including chronic back and chronic joint pain. To evaluate the relationship between PTSD and all chronic pain conditions, all pain conditions were combined into the "Any Pain" variable. Individuals who reported having any one or more of the pain conditions were identified as having a pain condition in the Any Pain variable.
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The early CFS people, like her, did not know about, or did not consider, energy problems or any of the earlier work on ME.
 
Sounds more like chronic illnesses and their consequences are commonly labeled as PTSD. Which is consistent with how things like MUS are operationalized. It's a common practice, so it would lead to massive over-labeling like this. We find the exact same thing with depression, anxiety and various "mental health" labels.

All this tells us is about the practice of labeling things as PTSD or stress, doesn't tell us anything about the patients themselves. It used to be a thing to label diseases as demonic or the work of evil spirits, all any such study would have told us is about the act of labeling, an action taken by whoever records the label. If you look at historical causes of death, there is so much nonsense in there, this is a long-standing practice.

We see quite a lot of pwLC "diagnosed" as having PTSD or something equivalent, so this is consistent with a known practice that does that for no good reasons

And in most cases, it's not quite accurate, but the constant denigration and disrespect of living with such a condition can lead to something that can be labeled as PTSD, if one wants to. But all this tells us is what the person doing the labeling is thinking, it has basically nothing to do with the patient. In this case it places the blame on the person being failed, a labeling that removes any and all obligations on the physician in those cases. That's the process of de-medicalization.
 
Finding a correlation between PTSD and chronic illness is not surprising. The ACEs study found that childhood trauma raises your risk of many illnesses, including those nobody believes are psuchosomatic, and can take decades off your life. A likely mechanism is that trauma makes it difficult to take care of yourself. Researching a correlation between ME and trauma is this unlikely to be informative.
 
RedFox said:
Finding a correlation between PTSD and chronic illness is not surprising. The ACEs study found that childhood trauma raises your risk of many illnesses, including those nobody believes are psuchosomatic, and can take decades off your life. A likely mechanism is that trauma makes it difficult to take care of yourself. Researching a correlation between ME and trauma is this unlikely to be informative.
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I don't disagree that trauma has a health impact
ACEs methodology is far from robust and frequently misapplied ( it's getting used as a predictor in some places)

James Coyne did a decent blog post on some of the issues .
There's a link on this thread
https://www.s4me.info/threads/aces-and-research.9016/
 
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