A cross-sectional study of the prevalence and correlates of post-traumatic stress among people attending acceptance and commitment therapy for chronic pain.

Authors

Kezia Kadri, Cara Keating, Madeleine Anderson, David Novelli, Emily McBride, Whitney Scott

Published in

British journal of pain. Pages 20494637261497966. Oct 16, 2026. Epub Oct 16, 2026.

Abstract

Experiences of trauma are common among people with chronic pain, although estimates of comorbid post-traumatic stress vary widely across contexts. Acceptance and commitment therapy (ACT), which targets psychological flexibility to improve pain-related functioning, is increasingly delivered for people with pain. To inform treatment delivery, understanding of the prevalence and correlates of post-traumatic stress among those attending ACT-based treatment for pain is needed. This study aimed to identify the prevalence of post-traumatic stress and its associations with key pain-related outcomes and other relevant psychosocial factors at the start of an ACT-based treatment.
This was a cross-sectional study using data collected within routine clinical care at a speciality pain management service in the UK. Four hundred and fifty-one participants completed standardized self-report questionnaires of post-traumatic stress symptoms (PTSS), pain-related outcomes (pain intensity and interference, work and social adjustment, and depression symptoms), psychological flexibility/inflexibility, and stigma at the start of an interdisciplinary ACT-based treatment for chronic pain.
Forty-seven percent of patients (n = 213) reported a traumatic exposure and 30% of the sample reported clinically meaningful PTSS. Greater severity of PTSS and probable post-traumatic stress disorder (PTSD) were associated with significantly worse pain-related outcomes, psychological flexibility/inflexibility, and stigma in bivariate analyses. PTSS severity and probable PTSD showed significant unique associations with poorer pain outcomes in regression models controlling for covariates and psychological flexibility/inflexibility.
Post-traumatic stress is common among people engaging in ACT-based treatment for pain and associated with adverse pain outcomes. Trauma-informed practice is therefore important when providing ACT-based treatment for pain.

PMID:
42892838
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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