Posttraumatic Stress Disorder in Children and Adolescents With Chronic Pain

Objective: Despite high comorbidity between posttraumatic stress disorder (PTSD) and chronic pain evident in adult populations, little research has been conducted in the pediatric population to assess this association. Therefore, this study aimed to estimate the prevalence of trauma and PTSD in pediatric patients with chronic pain. Additionally, investigation into whether the Child Report of Posttraumatic Symptoms (CROPS) is a valid PTSD screening tool for this patient population and identification of an appropriate clinical cutoff for screening PTSD was undertaken. Method: Data of N = 297 children and adolescents aged 8 to 17 years were collected during an intensive interdisciplinary pain treatment. At admission, patients self-reported pain characteristics and posttraumatic stress symptoms (assessed with the CROPS). During the inpatient stay, therapists completed a checklist that enabled a PTSD diagnosis according to criteria of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Results: Overall, 18.2% of the patients reported a trauma that met criterion A of DSM-5. Of those patients, approximately 59.3% had a PTSD diagnosis, equivalent to 10.8% of the whole sample. Overall, the CROPS demonstrated good reliability and validity in terms of internal consistency, item characteristics, and factor structure. Patients with PTSD had higher CROPS scores than patients without trauma. To identify patients with PTSD, a CROPS cutoff point of 21 is most appropriate in this population. Conclusions: This study demonstrated high prevalence of PTSD in children and adolescents with severe chronic pain. Regarding PTSD screening in this population, results revealed that valid PTSD assessment and identification of patients with PTSD seems possible despite overlapping symptoms.