Background Chronic pain in Veterans is a major problem compounded by comorbid posttraumatic stress disorder (PTSD) and depression. Adopting a transdiagnostic framework to understanding “shared territory” among these diagnoses has the potential to inform our understanding of the underlying cognitive processes and mechanisms that transverse diagnostic boundaries. Purpose To examine the associations between pain-related cognitive processes (diversion, distancing, absorption, and openness), pain intensity, PTSD and depressive symptoms, and the extent to which Veterans with chronic pain with and without comorbid PTSD and depression engage in different/similar pain-related cognitive processes. Methods Secondary analysis of pretreatment data with a subsample (n = 147) of Veterans with chronic pain from a larger clinical trial. Pretreatment PCL-5 and PROMIS Depression scales were used to categorize participants into three groups: (a) Pain-only; (b) Pain-PTSD; and (c) Pain-PTSD-DEP. Results Compared to the Pain-only group, the Pain-PTSD and Pain-PTSD-DEP groups reported significantly greater pain intensity, PTSD and depressive symptoms, and ruminative pain absorption. The Pain-PTSD-DEP group had significantly lower pain diversion and pain openness scores. When diversion and openness were used within the Pain-PTSD-DEP group, however, they were both associated with lower pain intensity and openness was additionally associated with lower PTSD scores. However, in the Pain-PTSD group, pain openness was associated with higher depression scores. Conclusions Across increasing complexity of comorbidity profiles (i.e., one vs. two comorbid conditions), ruminative absorption with pain emerged as a cognitive process that transverses diagnoses and contributes to worse outcomes. Nonjudgmental acceptance may not be universally beneficial, potentially depending upon the nature of comorbidity profiles.

中文翻译：

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退伍军人慢性疼痛和共病 PTSD 和抑郁症的跨诊断认知过程

背景 退伍军人的慢性疼痛是一个主要问题，伴随着创伤后应激障碍 (PTSD) 和抑郁症。采用跨诊断框架来理解这些诊断之间的“共享领域”有可能让我们了解跨越诊断边界的潜在认知过程和机制。目的 研究与疼痛相关的认知过程（转移、疏远、吸收和开放）、疼痛强度、PTSD 和抑郁症状之间的关联，以及患有慢性疼痛并伴有和不伴有 PTSD 和抑郁症的退伍军人参与不同/类似的疼痛相关的认知过程。方法 对来自大型临床试验的慢性疼痛退伍军人子样本 (n = 147) 的预处理数据进行二次分析。预处理 PCL-5 和 PROMIS 抑郁量表用于将参与者分为三组：（a）仅疼痛；(b) 疼痛-创伤后应激障碍；(c) 疼痛-PTSD-DEP。结果与仅疼痛组相比，疼痛-PTSD 组和疼痛-PTSD-DEP 组报告的疼痛强度、PTSD 和抑郁症状以及反刍性疼痛吸收显着增加。Pain-PTSD-DEP 组的疼痛转移和疼痛开放性评分显着降低。然而，当在 Pain-PTSD-DEP 组中使用转移和开放性时，它们都与较低的疼痛强度相关，而开放性还与较低的 PTSD 评分相关。然而，在疼痛-PTSD 组中，疼痛开放性与较高的抑郁评分相关。结论 随着合并症谱的复杂性不断增加（即，一种与两种合并症），痛苦的反刍吸收作为一种认知过程出现，它跨越诊断并导致更糟糕的结果。非判断性接受可能不是普遍有益的，这可能取决于合并症的性质。