Introducing the Integrated Model of Co-Occurring Chronic Pain and Posttraumatic Stress Disorder: Adding Meaning-Making and Existential Concepts to Current Theory

Objective: Making meaning out of the experience of chronic pain and posttraumatic stress disorder (PTSD) is a core process of recovery and symptom management of the comorbidity and a key active ingredient in the treatment for these conditions. Managing the effects of chronic pain and PTSD symptoms often evokes anxieties that could be considered existential (e.g., loss of meaning in life and concerns about one's identity). However, current theoretical models of co-occurring chronic pain and PTSD do not capture core meaning-making processes involved in either condition, resulting in the potential to overlook their centrality. The objective of the current work is to integrate current theoretical models of co-occurring chronic pain and PTSD with theory and science related to meaning-making and existential anxiety. Method: A targeted literature review was used to develop a novel model of co-occurring chronic pain and PTSD. Results: The present work introduces the integrated model of co-occurring chronic pain and PTSD, which is a first attempt at integrating current theoretical perspectives of co-occurring chronic pain and PTSD with the literature on meaning-making and closely related existential perspectives. We outline model-specific hypotheses and describe model implications and future directions. Conclusions: The model provides clinicians and researchers with a more thorough conceptualization of how chronic pain and PTSD interact, which symptoms to target, and which outcomes may be important for individuals who have both chronic pain and PTSD. As a result, the model has the potential to improve pain and PTSD outcomes, and perhaps health outcomes more broadly, within this population.