Study Finds Trauma Widely Overlooked in Chronic Pain Care, Despite High Patient Need

A new survey of Cleveland Clinic patients suggests that trauma is both highly prevalent and underaddressed in chronic pain care, leaving many patients without treatment that meaningfully addresses the intersection between traumatic experiences and pain. Researchers say the findings point to a significant gap in clinical practice and an opportunity for health systems to integrate trauma-responsive approaches into routine pain management.

The quality-improvement study, published in the September 2025 issue of Pain Medicine, analyzed responses from 702 adults with chronic primary pain who completed an anonymous electronic survey in 2022 and 2023. Although all respondents had been treated recently for pain—through primary care, pain management, physical therapy, or chiropractic care—the majority reported experiences that extended far beyond physical symptoms. According to the study, 68.2% of patients said they had experienced at least one traumatic event, and almost one in five reported both trauma exposure and clinically significant trauma symptoms.

“Previous research has shown that pain and trauma tend to intensify each other, but what stood out in our data is just how common trauma is among patients seeking pain care,” explains lead author Hallie Tankha, PhD, a psychologist in the Center for Wellness Research and Training at Cleveland Clinic. “Despite this, pain clinics are not consistently screening for trauma or connecting patients with treatments that address both conditions.”

Seeking Solutions
Patients who had both a trauma history and elevated trauma symptoms—referred to as “trauma-impacted” (TI)—made up 20.5% of the sample. Compared with those without elevated trauma symptoms, TI patients reported higher pain intensity, greater interference in daily functioning, and higher levels of depression and anxiety.

“These patients are coming in with significantly more severe symptoms across the board,” Tankha notes. “Their pain and emotional distress are worse, and yet their treatment patterns look almost identical to those of patients without trauma symptoms.”

Indeed, treatment utilization was largely similar across groups, with one notable exception: TI patients were twice as likely to have engaged in psychological pain management (10.4% vs 5.1%). But even with that higher rate of engagement, TI patients expressed dissatisfaction with how their trauma symptoms were being addressed.

“Patients told us clearly that their trauma symptoms were not being managed well in the course of their pain treatment,” Tankha says. “That shows that even when they do access mental health support, it may not be the type of care that addresses how trauma and pain interact.”

The survey also revealed a strong interest in trauma-responsive pain interventions. Among TI patients, 61.6% expressed interest in a program “focusing on the relationship between pain and trauma.” Nearly one-half preferred virtual delivery, while others favored either in-person or flexible formats.

“We were encouraged to see how open patients were to integrated approaches,” Tankha says. “People want care that acknowledges the connection between past traumatic experiences and their current pain.”

Overcoming Siloed Care
Tankha notes several systemic barriers that may be preventing patients from receiving such care. Many pain and primary care providers lack training in trauma screening, meaning trauma often goes unidentified. Even when clinicians do identify trauma histories, she says, they may not know which treatments are effective or how to refer patients to the appropriate services. Meanwhile, mental health clinicians may receive limited training in therapies specifically designed for pain-trauma comorbidity, such as Emotional Awareness and Expression Therapy.

“These gaps in provider knowledge mean patients can fall through the cracks, even when they are seeing multiple clinicians,” Tankha says. “Unfortunately, the system isn’t set up for integrated treatment, even though that’s what many patients need.”

Researchers say the study’s findings support several policy and practice changes. One is routine trauma screening for chronic pain patients—something Tankha notes would be “a small but high-impact change” in clinical workflow. Another is expanding provider education on pain-trauma interactions so clinicians can better identify patients who may benefit from specialized care.

“A lot of people with pain-trauma histories don’t necessarily need intensive therapy,” she says. “But everyone deserves information about how trauma can influence pain and how different interventions may help. That empowers patients to make decisions that align with their values and needs.”

Customizing Treatment
The study also recommends a stepped-care model, in which patients receive interventions matched to their severity level. Lower-intensity options could include trauma-adapted versions of brief pain education programs or group-based skills interventions, while patients with more severe trauma symptoms could be referred to therapies specifically designed for trauma-related pain.

Although the study’s response rate (3.5%) limits generalizability, the authors say their findings are consistent with existing literature and highlight a persistent gap in trauma-responsive pain care.

“Trauma symptoms are very common among people living with chronic pain, and they’re linked with worse physical and emotional outcomes,” Tankha adds. “Because trauma remains largely unaddressed in routine pain treatment, our hope is that these findings support system-level improvements that make integrated, trauma-informed care accessible for the patients who need it.”

— Source: Cleveland Clinic