Response of chronic pain patients to terrorism: The role of underlying depression

Abstract

Objectives. This study seeks to identify characteristics of the chronic pain patient population that may increase vulnerability to vicariously experienced psychological trauma. Design. Characteristics, including demographics and psychological measures, were evaluated by modeling change in visit rates to a university pain center immediately after the terrorist attacks of September 11, 2001. Setting. University pain center. Patients. A total of 570 patients with chronic pain. Outcome Measures. Visit rates, psychologists evaluation of depression, Beck Depression Inventory. Results. Evaluation of psychological measures showed that depression was the most effective predictor of the postattack visit rate increase in chronic pain patients. The visit rate for nondepressed patients did not change significantly after the attacks, but approximately doubled for depressed patients. A more detailed analysis, performed by categorizing patients into one of four levels of depression, found that patients classified as "Mild to Moderately" depressed were most likely to show an increase in visits after the attacks. Conclusions. Chronic pain patients represent a vulnerable population, and the current study posits the possibility of predicting the most vulnerable individuals within that population. With information commonly contained in medical records, target populations may be identified for potential psychological trauma intervention to reduce the sequelae of vicariously experienced psychological trauma. © American Academy of Pain Medicine.