Medically Unexplained Pain in Posttraumatic Stress Disorder: Re-experiencing of Peritraumatic Pain?

Neuroscientific and survey studies have pointed to the existence of ´pain-intrusions´ in posttraumatic stress disorder (PTSD), i.e., medically unexplained re-experiencing of peritraumatic pain in the same body regions as during the traumatic event. Previous survey studies in trauma-survivors have assessed pain-intrusions by directly asking about pain as a re-experience of the traumatic event—an approach susceptible to expectancy effects. Here, we systematically assessed peritraumatic pain and current medically unexplained pain (MUP) to explore whether MUP occurs in the same body regions as during the traumatic event. To shed further light on MUP as a re-experiencing symptom, we analyzed the role of PTSD symptoms and established predictors of intrusions. In a pre-registered online study, survivors of psychologically traumatizing events (N=330) reported peritraumatic pain and current MUP intensity and location in 108 predefined body regions, PTSD symptoms, and intrusion predictors. Thirteen percent of participants experienced likely pain-intrusions (i.e., MUP in the same body region as during the traumatic event). Experienced (vs. non-experienced) peritraumatic pain increased the likelihood of MUP in the same body region (odds-ratio=2.94), but not across all regions. Further, peritraumatic pain intensity predicted MUP intensity in the same body region. PTSD symptom severity as well as known intrusion risk factors (e.g., cumulative traumatic experiences, younger age at the earliest traumatic event, peritraumatic distress and dissociation, trait rumination, and trait anxiety sensitivity) predicted pain-intrusion occurrence. Results support the notion that posttraumatic MUP may constitute pain re-experiencing associated with PTSD symptomatology, and that these pain-intrusions share risk factors with other re-experiencing symptoms.