4 - (SYM 112) Trauma-focused Pain Management: Using Patient-informed and Evidenced-based Knowledge to Transform Standard of Care

Trauma is a robust risk factor for the development and maintenance of chronic pain. Up to 80% of individuals with PTSD endorse chronic pain, and therefore treating trauma and pain together is hypothesized to improve symptoms more than trauma- or pain-specific treatment alone. Yet, trauma-focused care is rarely implemented in pain management. In order to characterize and substantiate the prevalence of comorbid pain and trauma and to provide patient-informed recommendations for integrating trauma care into pain management, we conducted a quality assessment and improvement (QA/QI) survey project in a large academic medical center. Of surveyed patients (N = 702), 54.8% endorsed a lifetime trauma history (DSM-5 Criterion A trauma and/or childhood adversity), which was positively associated with pain intensity (r=.12; p< .001) and interference (r=.25; p< .001). Posttraumatic stress symptoms (PTSS; PTSD Checklist for DSM-5; PCL-5) were also positively (and more strongly) associated with pain intensity (r=.30; p< .001) and interference (r=.46; p< .001), even after controlling for trauma histories. The majority of patients with elevated PTSS (74.0%) and trauma histories (67.6%) endorsed interest in pain-trauma therapy. Together with prior scholarly work, which shows that individuals with pain and trauma experience greater disability and distress compared to individuals with pain without trauma, our QA/QI findings will be utilized to inform pain care within our healthcare system and ideally on a larger scale. For example, we need to recognize the importance of assessing for lifetime trauma histories and PTSS—i.e., going beyond formally assessing for PTSD which does not assess for childhood adversity, an experience strongly associated with chronic pain. Assessments that may be feasibly implemented into pain management include the Adverse Childhood Experiences Questionnaire (ACEs) and PCL-5 with Criterion A. Knowing that many patients are interested in pain-trauma treatment, it is recommended that providers discuss treatment implications with patients who endorse trauma. When available, treatments that target the pain-target comorbidity (e.g., Emotional Awareness and Expression Therapy) can be utilized. Additionally, as lack of training has been cited as a barrier in the implementation of trauma-informed healthcare practices, training in trauma-focused pain management is indicated. Finally, the information presented here will inform pragmatic trials testing the feasibility and effectiveness of trauma-focused pain management.