Symposium 112 - From Synapses to Survival: PTSD, Borderline Personality, and the Disability of Chronic Pain – A Deep Dive into Neurobiology, Clinical Strategies, and the Lived Experiences of Patients

Chair(s)

• NH

  Natalie Hellman, Ph.D. (she/her/hers)

  Postdoctoral Fellow
  Emory University School of Medicine
  Atlanta, Georgia, United States
• 

  Emily Weiss, Ph.D. (she/her/hers)

  Postdoctoral Fellow
  Yale University School of Medicine
  West Haven, Connecticut, United States

Discussant(s)

• jB

  jonathan Bittner, M.S. (he/him/his)

  Immaculata University
  Harleysville, Pennsylvania, United States

Presenter(s)

• JP

  Jennifer Pierce, Ph.D. (she/her/hers)

  University of Michigan
  Ann Arbor, Michigan, United States
• MD

  Margaret Davis, Ph.D. (she/her/hers)

  Assistant Professor
  Yale University School of Medicine
  New Haven, Connecticut, United States
• MS

  Miranda Schaffer, B.A. (she/her/hers)

  Doctoral Student
  Eastern Michigan University
  ANN ARBOR, Michigan, United States
• HT

  Hallie Tankha, Ph.D. (she/her/hers)

  Cleveland Clinic
  Cleveland, Ohio, United States

Pain is the most common cause of disability, affecting more than 30% of the world's population (Cohen et al., 2021). Critically, in the United States, the prevalence of chronic pain is higher than heart disease, diabetes, and cancer combined (National Institutes of Health, 2007). Unfortunately, little is known about this disability’s impact on the etiology and maintenance of psychiatric conditions. PTSD (Sigeland et al., 2017) and Borderline Personality Disorder (BPD; Biskin et al., 2014) are shown to have alarmingly high rates of chronic pain and demonstrate a severe need for further research. Indeed, research shows there are differences in the pain experience for individuals with trauma and borderline personality disorder features (Nanavaty et al., 2023) and this impacts treatment outcomes. Current literature suggests that pain severity significantly lowers treatment response rates, in both the leading PTSD treatments (e.g., Prolonged Exposure and Sertraline; Rauch et al., 2021) and BPD treatment (e.g., Dialectical Behavioral Therapy; Herzog et al., 2020). Thus, there is a significant need to elucidate the impact of pain as a disability on the etiology and maintenance of these psychiatric conditions to improve the quality of life and treatment outcomes for this often-underserved population. The current symposium combines the neuroscientific underpinnings of this complex clinical picture with cutting-edge clinical findings framed by a discussant with lived experience. The symposium will begin by discussing the underlying neurobiology of PTSD, BPD, and chronic pain by presenting patient laboratory data and delineating pain-related processes. This first presentation will discuss data from 94 patients with and without chronic pain and detail psychophysiological pain processing profiles. The second presentation will discuss PET findings exploring the kappa opioid receptors as a promising transdiagnostic treatment target for individuals with chronic pain and trauma-related psychopathology. The remaining talks will then focus on these patients' clinical needs, detailing important aspects of their presenting issues and treatment preferences. The third presentation will discuss data from 82 Veterans seeing trauma-focused treatment and how somatic concerns such as pain impact their posttraumatic stress cognitions. Then, based on data collected from over 700 patients, the fourth presentation will present the unique treatment interests and provide recommendations for clinical intervention strategies. Finally, our lived experience discussant will reflect on these findings and speak as both a patient and provider. Together, this set of presentations from diverse speakers aims to further appreciate the impact of a widespread disability (chronic pain) on the struggles and resilience of patients with traumatic stress and BPD disorder symptoms.

Presentations:

• 8:30 AM – 9:30 AM EST

  (SYM 112) Posttraumatic Stress and Dissociative Symptoms Are Differentially Associated with Pain Sensitivity
  

  Speaker: Jennifer Pierce, Ph.D. (she/her/hers) – University of Michigan

  Co-author: Afton Hassett, Psy.D. (she/her/hers) – University of Michigan

  Co-author: Steven Harte, Ph.D. (he/him/his) – University of Michigan

  Co-author: Guohao Zhu, Ph.D. (he/him/his) – University Of Michigan
• 8:30 AM – 9:30 AM EST

  (SYM 112) An in Vivo Investigation of Kappa Opioid Receptor Availability in Chronic Pain and Trauma-related Psychopathology Using [11C]EKAP PET
  

  Speaker: Margaret T. Davis, Ph.D. (she/her/hers) – Yale University School of Medicine

  Co-author: Emily R. Weiss, Ph.D. (she/her/hers) – Yale University School of Medicine

  Co-author: Natalie Hellman, Ph.D. (she/her/hers) – Emory University School of Medicine

  Co-author: Sylvia Malcore, Ph.D. (she/her/hers) – Ferris state University

  Co-author: Ansel Hillmer, Ph.D. – Yale University School of Medicine

  Co-author: Ashley Wagner, B.S. – Yale University School of Medicine

  Co-author: David Matuskey, M.D. – Yale University School of Medicine

  Co-author: Irina Esterlis, Ph.D. – Yale University School of Medicine
• 8:30 AM – 9:30 AM EST

  (SYM 112) What Can Posttraumatic Cognitions and Non-suicidal Self-injury Tell Us About the Relationships Between Worry and Health Complaints in Veteran Military Sexual Trauma Survivors?
  

  Speaker: Miranda R. Schaffer, B.A. (she/her/hers) – Eastern Michigan University

  Co-author: Natalie Hellman, Ph.D. (she/her/hers) – Emory University School of Medicine

  Co-author: Elizabeth Imbesi, ABPP, Ph.D. – Ann Arbor Veterans Healthcare System

  Co-author: Sylvia Malcore, Ph.D. (she/her/hers) – Ferris state University

  Co-author: Jessica Ellem, Ph.D. – Ann Arbor Veterans Healthcare System

  Co-author: Sheila Rauch, Ph.D, ABPP (she/her/hers) – Atlanta VA Medical Center

  Co-author: Chelsea Cawood, Ph.D. (she/her/hers) – Ann Arbor Veterans Healthcare Administration

  Co-author: Margaret T. Davis, Ph.D. (she/her/hers) – Yale University School of Medicine

  Co-author: Minden Sexton, Ph.D. (she/her/hers) – Ann Arbor Veterans Healthcare Administration
• 8:30 AM – 9:30 AM EST

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

  Speaker: Hallie Tankha, Ph.D. (she/her/hers) – Cleveland Clinic

  Co-author: Jolin Yamin, PhD (she/her/hers) – Brigham and Women’s Hospital, Harvard Medical School

  Co-author: Amanda Shallcross, ND, MPH (she/her/hers) – Cleveland Clinic