Chronic pain and post-traumatic stress disorder (PTSD) often occur together, yet good evidence on how to treat both at once has been scarce. A large 2026 review of 30 clinical trials found that trauma-focused talking therapies may reduce both PTSD symptoms and, to a smaller degree, pain intensity. Other non-drug approaches, including standard cognitive behavioural therapy, mind–body therapies and nerve-stimulation techniques, showed no clear benefit for either problem. The evidence is promising but still low in certainty.
Chronic pain and PTSD frequently go hand in hand, particularly in people who have lived through trauma. The two conditions share several biological and psychological risk factors, and researchers think each can help keep the other going. When they overlap, people tend to have a harder time than those living with either condition alone.
Clinical guidelines usually recommend non-drug, multi-strand approaches as first-line care for both conditions. To find out which of these approaches actually work when the two conditions co-occur, an international research team carried out a systematic review and meta-analysis, bringing together the results of every relevant randomised controlled trial. The findings were published in PAIN, the journal of the International Association for the Study of Pain.
Key Takeaways:
- What the study did. Researchers pooled 30 randomised controlled trials (3,245 participants) of non-drug treatments that measured both pain intensity and PTSD symptoms.
- Trauma-focused therapies helped most. Approaches such as Eye Movement Desensitisation and Reprocessing (EMDR), Narrative Exposure Therapy and Trauma-focused CBT showed a medium-sized benefit for PTSD symptoms and a small benefit for pain.
- Other therapies showed no clear benefit. Standard (non-trauma-focused) cognitive behavioural therapies, mind–body therapies and peripheral nerve-modulation techniques did not significantly reduce PTSD symptoms or pain in the pooled results.
- What it means. Treatments for people living with both chronic pain and PTSD should, at a minimum, include a trauma-focused component, though the overall certainty of the evidence remains low.
Why chronic pain and PTSD often occur together
Among people with chronic pain, an estimated 10–20% also have PTSD. The overlap is far higher in trauma-exposed groups: studies of military veterans with PTSD report chronic pain in 66–80% of cases.
When the two conditions co-occur, the impact tends to be greater. Compared with people who have chronic pain or PTSD alone, those with both are more likely to have other physical and mental health conditions, to report poorer psychological and physical functioning, and to have attempted suicide. This combination underlines why effective, joined-up treatment matters.
Researchers have proposed several models to explain the link. In simple terms, shared vulnerabilities, such as heightened anxiety sensitivity, avoidance and cognitive biases, can raise the risk of developing both conditions, and each condition can then reinforce the other through processes like avoidance and constant vigilance.
What the researchers looked at
The team, working as the International Co-occurring Chronic Pain and PTSD Collaboration, included 19 research experts and three people with lived experience of the conditions.
They searched for randomised controlled trials of non-drug treatments in adults, as long as each trial measured both pain intensity and PTSD symptoms. Trials targeting PTSD were identified through the National Center for PTSD’s PTSD-Repository, and trials targeting chronic pain through the Medline, Embase and PsycInfo databases.
The included studies were grouped into four types of treatment:
- Trauma-focused therapies
- Cognitive behavioural therapies (CBT) that were not trauma-focused
- Mind–body therapies
- Peripheral modulation (nerve-stimulation) techniques
What the review found
In total, 30 trials met the criteria. Of these, 12 targeted PTSD (and also measured pain), 11 targeted pain (and also measured PTSD symptoms), and 7 targeted both conditions together. Twenty-five trials were combined in the meta-analyses; the remaining five were reported separately because their treatments did not fit neatly into the four groups.
How reliable were the studies?
Study quality was mixed. Most trials were rated as having a high (11 studies, 37%) or moderate (11 studies, 37%) risk of bias, and only 8 studies (26%) were rated low risk. The main issues were missing detail about how participants were randomised and assigned to groups, or about whether they stuck with their treatment.
Which therapies worked?
Trauma-focused therapies: Pooling seven trials of trauma-focused therapies (including EMDR, Narrative Exposure Therapy and Trauma-focused CBT), the review found significantly greater reductions in PTSD symptoms (a medium effect) and in pain intensity (a small effect) compared with control groups.
Standard cognitive behavioural therapies: Across six trials, CBT that was not trauma-focused showed no significant benefit over control groups for either PTSD symptoms or pain. In one further trial that compared CBT with Emotional Awareness and Expression Therapy (EAET), the two were similar for PTSD symptoms, but EAET reduced pain more.
Mind–body therapies: Across nine trials comparing mind–body therapies with an active control, there was no significant difference in PTSD symptoms or pain.
Peripheral modulation techniques: Across three trials, these nerve-stimulation approaches showed no significant benefit over active controls for either condition.
Treatments reported separately: Four trials sat outside the main groups. Repetitive transcranial magnetic stimulation (rTMS) and pain neuroscience education showed no clear benefit for either condition. A collaborative-care model produced small reductions in PTSD symptoms but not pain, while a four-part resilience programme called RISE reduced pain more than minimal-contact controls but did not improve PTSD symptoms.
What does this tell us?
Overall, the review offers low-certainty evidence that trauma-focused therapies may improve both PTSD symptoms (a medium effect) and pain (a small effect). It found no evidence that standard CBT, mind–body therapies or peripheral modulation techniques reduced either problem.
Despite this signal, trauma-focused therapies are often underused in everyday care. Routinely assessing for trauma and PTSD, and training clinicians to deliver trauma-focused treatments, may therefore be an important direction for improving care in people with co-occurring chronic pain and PTSD.
Limitations to keep in mind
The authors highlight several caveats:
- Pain intensity only. The review focused on how severe pain felt, not on pain interference or day-to-day functioning, which some treatments are designed to improve.
- Not everyone met full diagnostic criteria. Some participants had lower baseline symptoms, which can make a treatment look less effective simply because there was less room to improve.
- Varied studies. The mind–body and peripheral modulation groups in particular combined quite different treatments, populations and types of trauma, which makes their results harder to interpret.
Future research will need to tackle the overlap between chronic pain and PTSD more directly. The formation of the International Co-occurring Chronic Pain and PTSD Collaboration offers a route for the two research fields to work together and move treatment forward.
Frequently asked questions
What is chronic pain?
Chronic pain is pain that lasts longer than three months. It is a central feature of several conditions, including fibromyalgia, and can arise through different underlying mechanisms (for example nociceptive, neuropathic or nociplastic pain).
What is post-traumatic stress disorder (PTSD)?
Post-traumatic stress disorder, or PTSD, is a mental health condition that can develop after a traumatic event. Symptoms can include intrusive memories, avoidance, changes in mood and thinking, and feeling constantly on edge. It often occurs alongside other difficulties such as anxiety and disturbed sleep.
How often do chronic pain and PTSD occur together?
Around 10–20% of people with chronic pain also have PTSD. The overlap is much higher in trauma-exposed groups, with chronic pain reported in 66–80% of military veterans who have PTSD.
Which therapies did this review find most helpful?
Trauma-focused therapies, including EMDR, Narrative Exposure Therapy and Trauma-focused CBT, were the only group to show a significant benefit, reducing PTSD symptoms (a medium effect) and pain intensity (a small effect). The certainty of this evidence was rated low, so findings should be interpreted with caution.
Can medical cannabis be prescribed for chronic pain or PTSD?
Medical cannabis treatments can be considered for prescription by a GMC-registered specialist clinician in the UK for a variety of conditions. If it is judged to be clinically appropriate, medical cannabis may be prescribed for chronic pain and PTSD once licensed treatments have been considered. However, medical cannabis is not a licensed treatment for PTSD or chronic pain.
If you’d like to learn more about your treatment options, complete our online eligibility check to understand if you would be suitable for a consultation.
This article is for information only and is not medical advice or a recommendation to use any medicine.
