Accelerated Resolution Therapy for treatment of pain secondary to symptoms of combat-related posttraumatic stress disorder

Figures & data

Fig. 1 Descriptive terms used to classify origin of reported pain as somatic, visceral, and/or neuropathic among all study participants.

Fig. 2 Consort diagram of the trial population including those screened, enrolled, randomly assigned, completing treatment, and analyzed.

Table 1 Demographic, military, and clinical characteristics by random assignment

Characteristic	AC (n=21)	ART (n=24)	p
Age in years (mean±SD)	44.0±13.5	38.4±10.9	0.14
Female gender (%)	19.1	20.8	1.0
Race (%)			0.95
White	85.7	83.3
Black or African American	9.5	12.5
Other	4.8	4.2
Hispanic ethnicity (%)	0.0	20.8	0.05
Current military status (%)			0.18
Active duty	16.7	11.1
Reservist	33.3	13.3
Discharged/veteran	50.0	75.6
Primary branch of military service (%)			0.03
Army	42.9	66.7
Navy	14.3	25.0
Air Force	19.0	8.3
Marines	23.8	0.0
On disability for PTSD/other MH disorder	33.3	54.2	0.23
Five or more traumatic memories currently impacting life (%)	38.1	50.0	0.55
Lived with traumatic memories >10 years (%)	52.4	41.7	0.56
Previous treatment for PTSD (%)	76.2	70.8	0.75
Individual therapy	71.4	58.3	0.53
Group therapy	28.6	20.8	0.73
Pharmacotherapy	52.4	62.5	0.56
PCL-M score (mean±SD)	56.6±15.0	57.2±15.1	0.90
PCL-M score ≥50 (%)^a	57.1	70.8	0.37
PCL-M critical items for PTSD (%)^b	71.4	79.2	0.73
PDSQ score (mean±SD) (T-score)	54.4±11.7	54.0±9.5	0.90
Any PTSD screening criteria (%)^c	85.7	95.8	0.33
POQ scores (mean±SD)
Pain intensity	3.8±2.9	3.8±2.3	0.98
Pain-related impairment in mobility	9.2±11.4	8.8±10.2	0.89
Pain-related impairment in completing ADLs	2.8±5.9	3.1±7.4	0.87
Vitality—impairment in activity/energy	14.8±6.3	15.4±12.6	0.76
Negative affect	21.5±10.5	20.3±10.6	0.70
Pain-related fear and avoidance	−0.4±4.0	−1.9±2.8	0.16
Total POQ score	51.6±38.2	49.5±29.9	0.81

PDSQ: Psychiatric Diagnostic Screening Questionnaire; PCL-M: PTSD Checklist, Military Version; POQ: Pain Outcomes Questionnaire. ^aEstablished screening cutpoint score for probable PTSD. ^bDSM-IV symptom criteria for probable PTSD, at least one “B” item (questions 1–5), three “C” items (questions 6–12), and at least two “D” items (questions 13–17) rated as “Moderate” or above. ^cScreening criteria for PTSD from the PCL-M, and/or PDSQ.

Table 2 Frequency and percent of types of injuries and problems reported by service members and veterans (N=45)

Type of injury or problem	Frequency	Percent*
Concussion or dazed	13	29
TBI or head injury	10	22
Arm or leg injury or pain	7	16
Ringing in the ears	7	16
Headaches or migraines	4	9
Dizziness or vertigo	3	7
Memory problems	3	7
Other problems: Paraplegia, fibromyalgia, Meniere's disease, irritability	4	9

*Participants reported more than one problem, so totals add up to more than 100%.

Fig. 3 Plot of change scores on the Pain Outcomes Questionnaire (POQ) before and after treatment with Accelerated Resolution Therapy (ART) versus before and after an attention control (AC) regimen. Each vertical line represents the response of an individual service member or veteran. ITT=intention to treat analysis.

Table 3 Mean pre- to post-assessment differences in POQ scale score by random assignment (all participants)

	AC (n=21)		ART (n=24)		Between group
POQ scale	Mean*	SD	Mean*	SD	Mean*	SD	Effect size	p**
Pain intensity	−0.29	1.59	1.17	1.99	1.45	1.81	0.80	0.006
Mobility	−0.45	6.66	3.88	5.94	4.33	6.29	0.69	0.01
ADL	−0.05	3.32	1.75	4.72	1.80	4.11	0.44	0.10
Vitality	−0.91	4.82	2.79	8.10	3.70	6.74	0.55	0.06
Negative affect	2.18	6.25	9.50	8.10	7.32	7.27	1.01	0.001
Fear	0.55	2.34	−2.17	3.67	−2.71	3.11	−0.87	0.02
Total POQ score	0.71	14.15	16.92	16.62	16.20	15.52	1.04	0.0006

AC: attention control regimen; ART: Accelerated Resolution Therapy intervention; POQ: Pain Outcomes Questionnaire. *Positive values indicate reductions in POQ scale scores. **Adjusted for baseline value.

Table 4 Mean pre- to post-assessment differences in POQ scale score by random assignment (participants with a pain score of four or more at study entry)

	AC (n=9)		ART (n=12)		Between group
POQ scale	Mean*	SD	Mean*	SD	Mean*	SD	Effect size	p**
Pain intensity	0.56	1.13	2.25	1.76	1.69	1.53	1.11	0.08
Mobility	−3.00	8.02	7.08	6.71	10.08	7.29	1.38	0.002
ADL	−0.56	5.22	3.58	6.22	4.14	5.82	0.71	0.05
Vitality	−0.67	4.24	2.58	10.43	3.25	8.40	0.39	0.35
Negative affect	1.56	5.90	7.75	6.97	6.19	6.54	0.95	0.07
Fear	0.56	1.67	−1.92	4.27	−2.47	3.43	−0.72	0.07
Total POQ score	−1.56	12.03	21.33	20.36	22.89	17.35	1.32	0.004

AC: attention control regimen; ART: Accelerated Resolution Therapy intervention; POQ: Pain Outcomes Questionnaire. *Positive values indicate reductions in POQ scale scores. **Adjusted for baseline value.

Fig. 4 Scatter plot and linear regression line of the relationship between baseline PTSD symptom score from the PCL-M and baseline total pain score from the POQ.

Fig. 5 Scatter plot and linear regression line of the relationship between change in PTSD symptom score from the PCL-M and change in total pain score from the POQ before and after treatment with Accelerated Resolution Therapy (ART).