Chronic pain and post-traumatic stress in older patients with psychiatric disorders during the Covid-19 pandemic: co-occurrence and influence of attachment and personality factors – BMC Geriatrics

Report on the Intersection of Chronic Pain, Psychological Trauma, and Global Health Challenges

Introduction: Aligning with Sustainable Development Goal 3

This report synthesizes research findings on the complex interplay between chronic pain, post-traumatic stress disorder (PTSD), and psychological factors, particularly in the context of global health events like the COVID-19 pandemic. The analysis is framed within the context of the United Nations Sustainable Development Goals (SDGs), primarily SDG 3: Good Health and Well-being. Addressing the comorbidity of physical and mental health conditions is fundamental to achieving Target 3.4, which aims to promote mental health and well-being. The findings underscore the need for integrated healthcare systems to manage these multifaceted health challenges effectively.

The Public Health Burden of Chronic Pain and its Comorbidities

Chronic pain represents a significant global health issue, directly impacting the well-being and quality of life for a substantial portion of the population. Achieving SDG 3 requires a comprehensive understanding of not just the prevalence of pain but also its complex nature and associated conditions.

• Research indicates a high prevalence of chronic pain with neuropathic characteristics in the general population, posing a substantial challenge to public health systems.
• A strong comorbidity exists between chronic pain and psychiatric conditions, most notably depression and bipolar disorder. This link is particularly evident in geriatric inpatient populations, highlighting a vulnerable group whose well-being is a key concern for SDG 3.
• The relationship between pain and depression is well-documented, suggesting a bidirectional or mutually reinforcing mechanism that complicates treatment and diminishes overall health outcomes.

Post-Traumatic Stress Disorder (PTSD) as a Barrier to Well-being

Exposure to traumatic events is a widespread experience that can lead to severe mental health conditions like PTSD, undermining progress toward SDG 3.4. The connection between psychological trauma and physical health, especially chronic pain, is a critical area of investigation for developing holistic health interventions.

1. Studies have established a significant comorbidity between chronic pain and PTSD. Models of shared vulnerability and mutual maintenance have been proposed to explain this relationship, suggesting that each condition can exacerbate the other.
2. The prevalence of trauma and PTSD is notable across various populations, including older adults and individuals with severe mental illness, complicating their health profiles and requiring specialized care.
3. The intersection of PTSD and borderline personality disorder further illustrates the complex web of psychiatric comorbidities that must be addressed to ensure comprehensive mental healthcare for all.

The Influence of Psychological Factors on Health Outcomes

Individual psychological characteristics, including personality traits and attachment styles, are crucial determinants of health and resilience. Understanding these factors is essential for designing personalized and effective interventions that promote well-being, in line with the ambitions of SDG 3.

Attachment Theory

• Adult attachment theory provides a valuable framework for understanding how individuals cope with chronic pain and trauma. Insecure attachment styles have been linked to both conditions, potentially influencing help-seeking behaviors and treatment responses.
• Research has specifically reviewed the evidence linking attachment styles to chronic pain and PTSD, suggesting that early relational patterns can have long-term impacts on physical and mental health.

Personality Traits

• The “Big Five” personality traits (neuroticism, extraversion, openness, agreeableness, and conscientiousness) have been shown to play a role in the experience of chronic pain and the development of PTSD.
• Neuroticism, in particular, has been identified as a significant risk factor for both chronic pain and PTSD, highlighting a personality dimension that may confer vulnerability to adverse health outcomes.
• Conversely, other traits may offer protective benefits, influencing coping strategies and overall resilience in the face of stress and illness.

The COVID-19 Pandemic: A Case Study in Global Mental Health Stress

The COVID-19 pandemic served as a global stressor, profoundly impacting mental and physical health and testing the resilience of healthcare systems worldwide. This event highlighted the importance of SDG Target 3.d, which calls for strengthening the capacity for early warning and management of global health risks. The pandemic’s aftermath provides critical lessons for public health policy.

• Systematic reviews and meta-analyses conducted during the pandemic revealed a significant increase in the prevalence of depression, anxiety, and PTSD in the general population.
• Older adults and individuals with pre-existing conditions, such as chronic pain, were identified as particularly vulnerable to the negative psychological impacts of the pandemic, including loneliness and social isolation, which were found to be associated with pain.
• Studies noted an exacerbation of chronic pain symptoms during this period, linked to factors such as fear of COVID-19, reduced physical activity, and disruptions to healthcare access. This demonstrates how a global health crisis can compound existing health burdens, hindering progress toward SDG 3.

Conclusion: An Integrated Approach for Sustainable Health and Well-being

The evidence synthesized in this report points to a clear and urgent need for an integrated approach to healthcare that recognizes the deep connections between chronic pain, trauma, and psychological well-being. To make meaningful progress toward SDG 3, health systems must move beyond siloed treatment models. Future strategies should focus on early identification of at-risk individuals, holistic treatment plans that address both physical and mental health, and strengthening public health infrastructure to manage the psychological fallout of future global crises.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The primary SDG addressed in the provided article references is:

• SDG 3: Good Health and Well-being

Explanation: The list of references consistently focuses on various aspects of physical and mental health. The titles cover topics such as “chronic pain,” “depression,” “post-traumatic stress disorder (PTSD),” “anxiety,” “stress,” and “bipolar disorder.” These are all central to the mission of SDG 3, which is to “ensure healthy lives and promote well-being for all at all ages.” The references explore the prevalence, comorbidity, risk factors, and psychological impact of these conditions, particularly within the general and geriatric populations, directly aligning with the goal of promoting health and well-being.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the themes in the article’s references, the following specific targets under SDG 3 are relevant:

1. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   
   Explanation: The article’s references are heavily concentrated on mental health conditions (depression, PTSD, anxiety) and a significant non-communicable disease: chronic pain. Studies on the “prevalence of chronic pain” (Ref. 1), “depression and pain comorbidity” (Ref. 4), and the “impact of COVID-19 pandemic on mental health” (Ref. 25) all contribute to the body of knowledge needed to treat these conditions and promote mental health and well-being, which is a core component of this target.
2. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
   
   Explanation: While not a direct focus, the research presented in the references is fundamental to achieving this target. Understanding the “prevalence and risk factors of posttraumatic stress disorder in older adults” (Ref. 7) and developing validated assessment tools like the “PTSD checklist” (Ref. 31, 32) are essential first steps for providing quality, essential healthcare services for these specific health issues. The research underpins the development of effective treatments and health policies aimed at managing chronic pain and mental illness.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

The article’s references do not mention official SDG indicators directly, but they strongly imply several metrics that can be used to measure progress towards the identified targets. These are primarily related to the prevalence and assessment of the health conditions discussed.

• Prevalence of chronic pain: The article references studies specifically measuring the “Prevalence of chronic pain with neuropathic characteristics in the general population” (Ref. 1). Tracking this prevalence is a direct way to measure the burden of this non-communicable condition on population well-being (relevant to Target 3.4).
• Prevalence of mental health disorders (Depression, Anxiety, PTSD): Several references focus on measuring the prevalence of mental health issues. For example, “Prevalence of depression, anxiety, and stress during COVID-19 pandemic” (Ref. 21) and “Global prevalence and associated risk factors of posttraumatic stress disorder during COVID-19 pandemic” (Ref. 24). These metrics are crucial for monitoring progress in promoting mental health (Target 3.4).
• Comorbidity rates of physical and mental health conditions: The references highlight the importance of understanding the overlap between conditions, such as in “Depression and pain comorbidity: a literature review” (Ref. 4) and “Chronic pain and PTSD: evolving views on their comorbidity” (Ref. 9). Measuring these rates helps in developing integrated healthcare services (relevant to Target 3.8).
• Use of validated assessment tools: The references mention various psychological assessment tools, such as the “PTSD checklist” (Ref. 31), the “Big Five Inventory” (Ref. 34), and the “Brief COPE” (Ref. 41). The development, validation, and implementation of such tools are indicators of a health system’s capacity to provide quality, evidence-based care for mental health and well-being (relevant to Target 3.8).

SDGs, Targets, and Indicators Table

Source: bmcgeriatr.biomedcentral.com