Emotional and social reactivity among individuals with comorbid posttraumatic stress disorder and chronic pain: a multi-method study of dysregulation

Comorbid posttraumatic stress disorder (PTSD) and chronic pain create a heavier symptom burden than does chronic pain alone. Individuals with both conditions may exhibit physiological and emotional reactivity that make them susceptible to distressing reactions to negative social-emotional stimuli as well as less able to capitalize on positive social-emotional experiences. The current study examined physiological and emotional reactivity to affective stimuli in a laboratory setting as well as social responses to changes in interpersonal events in daily life among individuals with fibromyalgia (FM) and a history of PTSD symptoms versus those with FM only. The impact of the type of traumatic event experienced was also examined. Participants’ startle reflex responses and emotional reactions to affective stimuli in a laboratory setting and social stress and enjoyment responses to interpersonal events in daily diaries were collected. Results indicated that higher levels of past PTSD symptoms were associated with higher levels of bodily pain, social stress, depression, negative affect, and less positive affect. Higher levels of past PTSD symptoms did not affect physiological or social-emotional reactivity to stimuli either in the laboratory setting or in the daily diaries. Individuals with a history of PTSD symptoms from sexual trauma exhibited lower startle magnitudes to positive emotional stimuli in the laboratory compared to individuals with no trauma or a history of PTSD symptoms from of other types of trauma. There were no differences among trauma types in responsivity to negative stimuli in the laboratory or social-emotional responses in daily life. Findings suggest lasting and stable effects of past PTSD symptoms on physical and emotional health in chronic pain, rather than reactivity to positive and negative changes in the environment. Findings indicate the need to assess for past trauma in pain patients and tailor treatments to account for specific traumas.