Screening for psychological trauma in patients with chronic pain: An Arizona survey of primary care providers identifies systems-level barriers to implementation.

OBJECTIVE: Efforts to achieve optimal outcomes in patients with chronic pain (CP) are impeded by unaddressed psychological trauma. Primary care offers a practical opportunity to identify patients with unresolved trauma through screening. However, the extent of such screenings in clinical practice remains unclear. This exploratory study aimed to assess trauma screening practices among Arizona primary care providers, examine their understanding of the trauma-CP connection, and investigate perceived barriers and opportunities for improving integration into primary care workflows. METHOD: We conducted a cross-sectional survey of Arizona primary care providers in family and internal medicine. Data on providers' practices, comfort levels, beliefs, and perceived barriers were analyzed. RESULTS: The final sample comprised 71 survey respondents, with some variability in item response rates. Nearly all respondents (93.4%) acknowledged the connection between unresolved psychological trauma and CP, but only 23.9% consistently screened patients with CP for trauma. Screening rates for trauma among patients with CP were significantly lower compared to screening for anxiety/depression, social determinants of health, and substance use disorder. Reported barriers included feasibility concerns related to time and staffing, lack of patient-provider trust, and limited behavioral health access. CONCLUSIONS: While awareness of the CP-trauma link is widespread, trauma screening in Arizona primary care remains insufficient. Systemic barriers, rather than individual provider factors, appear most influential. Addressing time, staffing, and behavioral health integration challenges is critical for improving screening rates. Future research should focus on systemic factors to develop scalable, sustainable solutions for integrating trauma screening into primary care. (PsycInfo Database Record (c) 2026 APA, all rights reserved).