Severity of Musculoskeletal Pain and Its Effect on Psychosocial Factors in Veterans With Posttraumatic Stress Disorder

Kwon, Chun-suk;Kim, Suhn-yeop

  • Received : 2015.07.07
  • Accepted : 2015.07.24
  • Published : 2015.08.31


PURPOSE: The aim of this study is to investigate the relationship between psychosocial factors and the severity of musculoskeletal pain in veterans with posttraumatic stress disorder (PTSD). METHODS: A total of 60 subjects were recruited from among the veterans with musculoskeletal pain at D Veterans Hospital. PTSD was evaluated by using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; severity of pain was measured by using the short-form McGill Pain Questionnaire (SF-MPQ); depression and anxiety were measured by using the Symptom Checklist-90-Revision; and the quality of sleep was measured by using the Pittsburgh Sleep Quality Index. All data were analyzed using SPSS 18.0 software for Windows. RESULTS: The averages cores of pain intensity ($7.48{\pm}1.67$), SF-MPQ-sensory ($13.84{\pm}7.52$), SF-MPQ-affective ($4.41{\pm}3.79$), depression ($19.30{\pm}11.37$), anxiety ($13.39{\pm}7.99$), and quality of sleep ($10.05{\pm}5.89$) were obtained in veterans with PTSD. SF-MPQ-sensory measures sleep quality (r=0.346, p<0.01), SF-MPQ-affective measures depression (r=0.318, p<0.01) and anxiety (r=0.404, p<0.01), and these showed a statistically significant positive correlation in veterans with PTSD. Pain levels were observed to be higher in veterans with PTSD. Moreover, in these subjects, physical pain had a significant influence on the anxiety variable among the psychosocial factors. CONCLUSION: These findings suggest that musculoskeletal pain provides meaningful information about depression, anxiety, and sleep disorder in veterans with PTSD. Our data suggest that musculoskeletal pain may need to be addressed as part of the health management process of veterans.


Anxiety;Depression;Pain;Quality of sleep


  1. Asmundson GJ, Wright KD, Stein MB. Pain and PTSD symptoms in female veterans. Eur J Pain. 2004;8(4): 345-50.
  2. Buysse DJ, Reynolds CF, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2): 193-213.
  3. Clark ME, Bair MJ, Buckenmaier CC, et al. Pain and combat injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: implications for research and practice. J Rehabil Res Dev. 2007;44(2):179-94.
  4. Choi MG. I feel the pain of the elderly, chronic condition, and research on the impact on daily life activities. Master's Degree, Hanyang University. 2009.
  5. Derogatis LR, Rickels K, Rock AF. The SCL-90 and the MMPI: a step in the validation of a new self-report scale. Br J Psychiatry. 1976;128:280-9.
  6. Ghanizadeh A. Agreement between Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the proposed DSM-V attention deficit hyperactivity disorder diagnostic criteria: an exploratory study. Compr Psychiatry. 2013;54(1):7-10.
  7. Gironda RJ, Clark ME, Massengale JP, et al. Pain among veterans of Operations Enduring Freedom and Iraqi Freedom. Pain Med. 2006;7(4):339-43.
  8. Hwang HY. The relationship among pain, depression and sleep disturbance of the elderly with chronic low back pain. Master's Degree. Catholic University of Pusan. 2013.
  9. Jun, MH. The Relationship between Pain Coping Strategies and Depression of patients with Chronic Lower Back Pain Department of Counseling & Psychotherapy. Master's Degree. Seoul Women's University. 2004.
  10. Keogh E, McCracken LM, Eccleston C. Gender moderates the association between depression and disability in chronic pain patients. Eur J Pain. 2006;10(5):413-22.
  11. Kim HJ. Chronic pain, Sleep pattern and quality of life in the elderly. Master's Degree. Hanyang University. 2013.
  12. Kim EJ. Reliability and validity of the short-form McGill pain questionnaire (SF-MPQ) Korean version for measuring the old adult's pain. Clinical Nursing Research. 2004;10(1):20-7.
  13. Lew HL, Poole JH, Vanderploeg RD, et al. Program development and defining characteristics of returning military in a VA Polytrauma Network site. J Rehabil Res Dev. 2007;44:1027-34.
  14. Melzack R. The McGill pain questionnaire: from description to measurement. Anesthesiology. 2005;103(1):199-202.
  15. Moeller-Bertram T, Keltner J, Strigo IA. Pain and post traumatic stress disorder - review of clinical and experimental evidence. Neuropharmacology. 2012;62(2):586-97.
  16. Otis JD, Keane TM, Kerns RD, et al. The development of an integrated treatment for veterans with comorbid chronic pain and posttraumatic stress disorder. Pain Med. 2009;10(7):1300-11.
  17. Pietrzak M. Diagnosis and management of acute medial tibial stress syndrome in a 15 year old female surf life-saving competitor. Int J Sports Phys Ther. 2014;9(4):525-39.
  18. Shipherd JC, Keyes M, Jovanovic T, et al. Veterans seeking treatment for posttraumatic stress disorder: what about comorbid chronic pain? J Rehabil Res Dev. 2007; 44(2):153-66.
  19. Stalnacke BM, Ostman A. Post-traumatic stress in patients with injury-related chronic pain participating in a multimodal pain rehabilitation program. Neuropsychiatr Dis Treat. 2010;6:59-66.
  20. Sungur MZ, Gunduz A. A comparison of DSM-IV-TR and DSM-5 definitions for sexual dysfunctions: critiques and challenges. J Sex Med. 2014;11(2):364-73.
  21. Villano CL, Rosenblum A, Magura S, et al. Prevalence and correlates of posttraumatic stress disorder and chronic severe pain in psychiatric outpatients. J Rehabil Res Dev. 2007;44(2):167-78.
  22. Yakut Y, Yakut E, Bayar K, et al. Reliability and validity of the Turkish version short-form McGill pain questionnaire in patients with rheumatoid arthritis. Clin Rheumatol. 2007;26(7):1083-7.
  23. Yokoya T, Demura S, Sato S. Fall risk characteristics of the elderly in an exercise class. J Physiol Anthropol. 2008;27(1):25-32.