Integrating chronic pain and pain re-experiencing into the PTSD symptom network

Background: Posttraumatic stress disorder (PTSD) and chronic pain frequently co-occur. Growing evidence suggests that this comorbidity may be partly attributable to pain-intrusions, defined as chronic pain manifesting in the same body regions as the pain experienced during the traumatic event. This positions chronic pain as potential PTSD re-experiencing symptoms. However, little is known about how chronic pain, and especially pain-intrusions, relate to re-experiencing and other PTSD symptoms.Objective: The present study used a network modeling approach to examine how chronic pain and pain-intrusions are embedded within the established DSM-5 PTSD symptom network consisting of criteria B-E (re-experiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal).Methods: A total of 330 trauma survivors reported on PTSD symptoms and peritraumatic and chronic pain in 108 body regions. Chronic pain was separated into chronic pain in trauma-related (i.e., pain-intrusions) vs. non-trauma-related body regions. We estimated two network models using a Gaussian graphical model approach: (1) with chronic pain in general and (2) with pain-intrusions and non-trauma-related chronic pain as distinct constructs.Results: Chronic pain in general was linked to hyperarousal. When pain-intrusions and non-trauma-related chronic pain were examined as separate constructs, pain-intrusions were associated with re-experiencing, while non-trauma-related chronic pain was associated with hyperarousal. Neither pain construct was related to avoidance or negative alterations in cognitions and mood.Discussion: These findings support the view that pain-intrusions represent a somatosensory component of re-experiencing in PTSD. In contrast, chronic pain in non-trauma-related body regions may reflect broader, more stress-related physiological processes such as autonomic arousal and heightened muscle tension. Results highlight the importance of considering the spatial correspondence between peritraumatic and chronic pain to better identify the underlying mechanisms of posttraumatic chronic pain and to tailor interventions to these processes.