The spatial association between peritraumatic and chronic pain and its relation to posttraumatic stress disorder among trauma survivors

Chronic pain frequently co-occurs with posttraumatic stress disorder (PTSD). One theory proposes that some chronic pain may reflect pain reexperiencing (i.e., reactivation of somatosensory trauma memories). Although some research supports this theory, evidence from clinical survey studies is limited and methodologically constrained. In this study, 330 trauma survivors reported chronic pain and retrospectively reported peritraumatic pain using digital body maps (108 predefined regions). To reduce confounding from tissue damage-related pain, chronic pain assessment was confined to pain unattributed to injury/illness, and the role of peritraumatic injuries was evaluated. Participants were assessed for PTSD symptoms, age at first trauma exposure, and beliefs about trauma-related origins of their pain. Approximately 67% of participants reported peritraumatic pain, 50% reported chronic pain, and 11% reported chronic pain in the same region(s) as peritraumatic pain (i.e., spatial overlap). Multilevel logistic regression across participants and regions indicated a strong association between peritraumatic and same-region chronic pain, OR = 2.94, independent of trauma-related injuries. PTSD symptom severity and earlier age at trauma were associated with a higher likelihood of spatial overlap. Participants with overlapping pain were particularly likely to endorse a trauma-related pain origin. Results demonstrate spatial associations between peritraumatic and chronic pain, especially among individuals with elevated PTSD symptoms and earlier age at trauma, not attributable solely to injuries. The observed pattern provides support for the pain reexperiencing theory and highlights areas warranting further research. It may be clinically important to distinguish between pain reexperiencing and other posttraumatic pain, as specific trauma-informed approaches may be required.