Pain is common in trauma patients, with greater frequency and severity of pain found when compared to people without PTSD. Fibromyalgia is also commonly reported, which is a centralised pain syndrome characterised by the presence of chronic widespread pain in association with fatigue, sleep disturbances, and cognitive dysfunction.

What is the evidence for chronic pain in people with PTSD?

Moderate to high quality evidence finds a small association between increased PTSD symptoms and increased chronic widespread pain. Lower quality evidence found a bidirectional associations between pain and PTSD symptoms within six months post-trauma. There were unidirectional patterns found after six months, either from pain to PTSD symptoms or from PTSD symptoms to pain. Moderate to low quality evidence finds medium-sized increases in fibromyalgia and chronic widespread pain in people previously exposed to any trauma, regardless of a PTSD diagnosis.

August 2021

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Fibromyalgia is a centralised pain syndrome characterised by the presence of chronic widespread pain in association with fatigue, sleep disturbances and cognitive dysfunction. Fibromyalgia has been associated with higher rates of mood recurrences and greater disability. The use of antidepressants in fibromyalgia management may promote manic switches and episodes with mixed features.

What is the evidence for comorbid fibromyalgia?

Moderate quality evidence suggests the overall prevalence of bipolar disorder in people with fibromyalgia is ~15%, which represents a large increased risk when compared to people without fibromyalgia.

October 2021

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People with bipolar disorder often have increased rates of co-occurring disorders, including chronic pain and migraine. Pain has a deleterious impact on an individual’s health and wellbeing. Chronic pain in particular is associated with reduced quality of life and difficulties with activities of daily living and often has a negative impact on an individual’s emotional and mental health.

What is the evidence for pain in people with bipolar disorder?

Moderate quality evidence suggests the overall prevalence of migraine in people with bipolar disorder is ~35%. Rates were higher in people with bipolar II disorder than bipolar I disorder, and in studies that used recognised assessments of migraine.

Moderate quality evidence suggests the overall prevalence of pain in people with bipolar disorder is ~30%. Rates were significantly higher in people with bipolar disorder than controls (medium-sized effect).

October 2021

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