Trauma matters: psychological interventions for comorbid psychosocial trauma and chronic pain

Chronic pain (CP) and posttraumatic stress disorder (PTSD) frequently co-occur, and emerging evidence suggests that unresolved psychological trauma contributes to chronic pain conditions. However, treatment approaches for these conditions have developed independently, with PTSD typically treated by mental health specialists and chronic pain managed by other providers using disorder-specific interventions. This topical review examines the evidence for psychological interventions that address the comorbidity of trauma and chronic pain, questioning whether traditional PTSD-focused approaches adequately address pain outcomes.

The authors conducted a comprehensive literature review of randomized controlled trials and other studies examining psychological treatments for comorbid PTSD and chronic pain. They identified and analyzed three main treatment approaches: (1) PTSD-targeted interventions such as prolonged exposure therapy and cognitive processing therapy; (2) trauma-focused therapies for people with chronic pain, including emotional disclosure, eye movement desensitization and reprocessing (EMDR), and accelerated resolution therapy; and (3) pain-centered approaches targeting underlying trauma and psychological conflict, such as short-term psychodynamic psychotherapy, intensive short-term dynamic psychotherapy, and emotional awareness and expression therapy (EAET).

Key findings revealed that PTSD-focused treatments produce large reductions in trauma symptoms but only modest improvements in chronic pain. In contrast, therapies that prioritize pain reduction while addressing underlying trauma—particularly EMDR and psychodynamic approaches—showed more substantial benefits for both pain and trauma outcomes. Meta-analyses indicated that trauma-informed psychological interventions led to medium-to-large effect sizes for pain reduction, especially in centralized or nociplastic pain conditions such as fibromyalgia. The authors noted that treatments explicitly linking trauma processing with pain neuroscience education demonstrated the strongest outcomes.

The review suggests clinicians should reconceptualize comorbid trauma and chronic pain as interconnected rather than separate conditions requiring parallel but distinct treatments. The authors recommend integrated, pain-centered interventions that address underlying trauma and psychological conflict while emphasizing the potential reversibility of both conditions. They emphasize the need for better-designed clinical trials with larger samples and improved outcome measures, and highlight the importance of patient selection based on pain type (particularly centralized pain conditions) and trauma history. This integrated approach offers clinical efficiency and provides evidence for the causal role of trauma in chronic pain maintenance and perpetuation.