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Levy Gigi E, Rachmani M, Defrin R. The relationship between traumatic exposure and pain perception in children: the moderating role of posttraumatic symptoms. Pain 2024:00006396-990000000-00599. [PMID: 38728536 DOI: 10.1097/j.pain.0000000000003266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 03/07/2024] [Indexed: 05/12/2024]
Abstract
ABSTRACT Adverse childhood experiences (ACEs) affect approximately half of all children worldwide. These experiences have been linked to increased pain sensitivity in adulthood and a higher likelihood of developing severe chronic pain. However, most studies have assessed the effects of ACEs retrospectively, long after they occurred, leaving room for other factors to influence the observed outcomes. We investigated, for the first time, the association between ACEs and concurrent pain perception among young children who live in a conflict zone and are consistently exposed to potentially traumatic experiences. Participants were 60 elementary school children (ages 8-11 years) living in conflict regions (n = 39) or nonconflict regions (n = 21). Posttraumatic stress symptom (PTSS) severity, traumatic exposure, pressure pain threshold (PPT), and mechanical detection threshold (MDT) were measured. Trauma-exposed children had significantly lower PPT than did controls, but MDT was similar across groups. Pressure pain threshold correlated positively with proximity to the conflict zone and inversely with traumatic exposure magnitude and PTSS severity. In addition, PTSSs moderated the relationship between repeated traumatic exposure and PPT. Children with higher PTSS severity displayed pain hypersensitivity regardless of their traumatic exposure level, whereas in children with lower PTSS severity, greater traumatic exposure correlated with pain hypersensitivity. The results suggest that ACEs among children lead to concurrent pain hypersensitivity and distress and may put them at elevated risk of chronic pain early in life. In addition, our findings emphasize the need for identifying children with various PTSS levels to provide tailored interventions and mitigate the long-term negative effects of ACEs.
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Affiliation(s)
- Einat Levy Gigi
- Faculty of Education, Bar-Ilan University, Ramat Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Moriya Rachmani
- Faculty of Education, Bar-Ilan University, Ramat Gan, Israel
| | - Ruth Defrin
- Department of Physical Therapy, Faculty of Medicine & Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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Nehme A, Moussa S, Fekih-Romdhane F, Yakın E, Hallit S, Obeid S, Haddad G. Expressive suppression moderates the relationship between PTSD from COVID-19 and somatization and validation of the Arabic version of Patient Health Questionnaire-15 (PHQ-15). PLoS One 2024; 19:e0293081. [PMID: 38271356 PMCID: PMC10810523 DOI: 10.1371/journal.pone.0293081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 10/01/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Lebanese adults have been crippled for years by several crises, including the lately COVID-19 pandemic. These massive civilian traumas have increased the risk of post-traumatic stress disorder (PTSD) in this population. Extensive literature pointed to the association between PTSD and somatization; however, the nature of this relationship remains unknown. We sought to contribute further to work in this area by testing the moderating role of emotion regulation in the relationship between COVID-19- related PTSD and somatization. As a secondary objective, we aimed to examine the psychometric properties of an Arabic translation of the somatization measure Patient Health Questionnaire-15 (PHQ-15) in terms of factorial validity and internal consistency before its use in the present study. METHODS This cross-sectional study was conducted between September and October 2021. A total of 403 Lebanese adults residing in Lebanon were recruited. Eligible participants received an online link to the survey. The Patient Health Questionnaire-15 was used to assess somatization, PTSD Checklist-Civilian Version for PTSD and Emotion Regulation Questionnaire for emotion regulation. RESULTS The results of the exploratory factor analysis (EFA) revealed a three-factor solution explaining 48.79% of the common variance. Confirmatory Factor Analysis results of the three-factor model obtained in the EFA indicated a good fit with a significant CFI of 0.98, TLI 0.98 and a GFI of .97, a RMSEA of .04 [90% CI .01, .06]. Higher PTSD symptoms were associated with somatization. In addition, we found that one specific ER component, i.e. expressive suppression, significantly moderated the relationship between PTSD from the COVID pandemic and somatization. In particular, the interaction PTSD from the COVID-19 pandemic by expressive suppression was significantly associated with somatization; at low, medium and high levels of expressive suppression, higher PTSD from the COVID-19 pandemic was significantly associated with higher somatization scores. As for our secondary objective, findings revealed that the Arabic version of the PHQ-15 exhibited good psychometric properties. In particular, the scale yielded a three-factor structure, and good internal consistency (Cronbach's alpha = 0.87). CONCLUSION The moderating role of expressive suppression on the link between PTSD and somatization presents a novel finding in the field of trauma. Additionally, making a psychometrically sound Arabic version of the PHQ-15 available is a valuable addition to the literature.
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Affiliation(s)
- Antonio Nehme
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
| | - Sara Moussa
- Faculty of Medicine, University of Balamand, Koura, Lebanon
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry “Ibn Omrane”, Razi Hospital, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ecem Yakın
- Centre d’Études et de Recherches en Psychopathologie et Psychologie de la Santé, Université de Toulouse-Jean Jaurès, UT2J, Toulouse, France
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Georges Haddad
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
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Delgado-Sanchez A, Brown C, Sivan M, Talmi D, Charalambous C, Jones AKP. Are We Any Closer to Understanding How Chronic Pain Develops? A Systematic Search and Critical Narrative Review of Existing Chronic Pain Vulnerability Models. J Pain Res 2023; 16:3145-3166. [PMID: 37727681 PMCID: PMC10506671 DOI: 10.2147/jpr.s411628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/27/2023] [Indexed: 09/21/2023] Open
Abstract
Identifying biopsychosocial factors underlying chronic pain vulnerability is essential for the design of preventative efforts. Multiple chronic pain vulnerability models exist, however, there is a lack of comprehensive evaluation of these models in the literature, potentially due to the lack of guidelines that specify the criteria by which these types of work should be assessed. In this work, we created evaluation criteria (based on the general goals of conceptual models), and we then used them to critically review the chronic pain vulnerability models available in the current peer-reviewed literature (identified through a systematic search). Particularly, we evaluated the models on the basis of conceptual clarity/specificity of measures, depth of description of aetiological and mechanistic factors, use of a whole system approach, and quality of the evidence associated with the models. We found nine conceptual models that have been explored in detail (eg, fear avoidance model, diathesis-stress model). These models excel at clarity and are supported mostly by self-report evidence of a psychological nature (anxiety sensitivity, pain catastrophizing, etc.), but provide little explanation of mechanistic and aetiological factors. In the future, models could be improved by complementing them with proposals from other models and exploring potential causal factors and mechanisms maintaining the condition. This task could be carried out through prospective cohort studies, and computational approaches, amongst others.
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Affiliation(s)
- Ariane Delgado-Sanchez
- Division of Human Communication, Development, and Hearing, University of Manchester, Manchester, UK
| | - Christopher Brown
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Deborah Talmi
- Department of Psychology, University of Cambridge, Cambridge, UK
| | | | - Anthony K P Jones
- Division of Human Communication, Development, and Hearing, University of Manchester, Manchester, UK
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Pless Kaiser A, Moye J, Baird L, Sager Z, Wachterman M. Factors Associated With Distress Related to Posttraumatic Stress Disorder at the End of Life Among U.S. Veterans. J Pain Symptom Manage 2023; 66:102-115. [PMID: 37084828 PMCID: PMC10524384 DOI: 10.1016/j.jpainsymman.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/15/2023] [Accepted: 04/08/2023] [Indexed: 04/23/2023]
Abstract
CONTEXT Posttraumatic stress disorder (PTSD) may emerge or re-emerge at end of life (EOL), increasing patient suffering. Understanding factors associated with PTSD at EOL may assist clinicians in identifying high risk veterans. OBJECTIVES To determine rates of and variables associated with PTSD-related distress at EOL. METHODS Retrospective observational cohort study including veterans who died within a Veterans Affairs (VA) inpatient setting between October 1, 2009 and September 30, 2018 whose next-of-kin completed the Bereaved Family Survey (BFS; N = 42,474). Our primary outcome was PTSD-related distress at EOL, as reported by veteran decedents' next-of-kin on the BFS. Predictors of interest included combat exposure, demographic variables, medical and psychiatric comorbidity, primary serious illness, and palliative care support. RESULTS Veteran decedents were majority male (97.7%), non-Hispanic white (77.2%), 65 years or older (80.5%), without combat exposure (80.1%). Almost one in ten (8.9%) veteran decedents experienced PTSD-related distress at EOL. In adjusted analyses, combat exposure, younger age, male sex, and non-white race were associated with PTSD-related distress at EOL. High overall medical comorbidity, dementia, and psychiatric comorbidities including both substance use disorder and depression, were also associated with PTSD-related distress at EOL. Palliative care consultation and emotional support were associated with decreased odds of PTSD-related distress, while pain was associated with increased odds of PTSD-related distress at EOL. CONCLUSION Trauma and PTSD screening, pain management, and providing palliative care and emotional support at EOL, particularly in at-risk groups such as veterans from racial/ethnic minority backgrounds and those with dementia, are critical to decreasing PTSD-related distress at EOL.
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Affiliation(s)
- Anica Pless Kaiser
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA; VA National Center for PTSD (A.P.K.), Boston Massachusetts, USA; Boston University Chobanian & Avedisian School of Medicine (A.P.K.), Boston Massachusetts, USA.
| | - Jennifer Moye
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA; New England Geriatric Research Education and Clinical Center (J.M., Z.S.), Boston Massachusetts, USA; Harvard Medical School (J.M., J.S., M.W.), Boston Massachusetts, USA
| | - Lola Baird
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA
| | - Zachary Sager
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA; New England Geriatric Research Education and Clinical Center (J.M., Z.S.), Boston Massachusetts, USA; Harvard Medical School (J.M., J.S., M.W.), Boston Massachusetts, USA; Dana-Farber Cancer Institute (Z.S., M.W.), Boston Massachusetts, USA
| | - Melissa Wachterman
- VA Boston Healthcare System (A.P.K., J.M., L.B., Z.S., M.W.), Boston Massachusetts, USA; Harvard Medical School (J.M., J.S., M.W.), Boston Massachusetts, USA; Center for Healthcare Organization & Implementation Research (M.W.), Boston Massachusetts, USA; Dana-Farber Cancer Institute (Z.S., M.W.), Boston Massachusetts, USA
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5
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Banerjee S, Lev-Wiesel R, De S. Poverty, Somatisation Tendency and Potency in Low-Income Adolescent Groups of India and Israel: Explorations from the Field. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1104. [PMID: 37508601 PMCID: PMC10377797 DOI: 10.3390/children10071104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023]
Abstract
Poverty increases vulnerability towards somatisation and influences the sense of mastery and well-being. The present study on adolescents living in relative poverty in a high-income group country (Israel) and a low-middle-income group country (India) explored the nature of somatisation tendency (ST) and its relationship with potency and perception of poverty (PP). Potency, a buffer against stress-induced negative health effects, was hypothesized to be negatively related to ST and mediate the link between PP and ST. Purposive sampling was used to collect questionnaire-based data from community youth (12-16 years) of two metropolitan cities-Kolkata (India, N = 200) and Tel-Aviv (Israel, N = 208). The nature of ST, PP and potency was analysed using descriptive and inferential statistics and correlation-regression statistics and mediation analysis were used to understand the relationship among them. A clinically significant level of ST was reported by both Indian and Israeli youth experiencing 5-7 somatic symptoms on average. Potency was found to be a significant predictor of ST in both countries (p < 0.05) and emerged as a significant mediator (p < 0.001) in the PP and ST relationship among Indian adolescents. The present study highlights potency as a protective buffer in economically vulnerable community adolescents and re-establishes a high prevalence of ST among them, irrespective of their country's global economic position.
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Affiliation(s)
- Saoni Banerjee
- Emili Sagol Research Center for CAT (Creative Arts Therapies), University of Haifa, Haifa 3498838, Israel
| | - Rachel Lev-Wiesel
- Emili Sagol Research Center for CAT (Creative Arts Therapies), University of Haifa, Haifa 3498838, Israel
- Body & Mind Psychotherapy Track, Social Work, Tel Hai Academic Center, Qiryat Shemona 1220800, Israel
- National Center for Children at Risk Assessment, The Sagol Center for Hyperbaric Treatment and Research, Shamir Hospital, Be'er Ya'akov 60930, Israel
- FAA-Emili Sagol Creative Arts Research and Innovation for Well-Being Center at Chulalongkorn University (CARIW), Bangkok 10330, Thailand
| | - Sonali De
- Department of Psychology, Calcutta University, Kolkata 700009, India
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Lawrence-Wolff KM, Higgs JB, Young-McCaughan S, Mintz J, Foa EB, Resick PA, Kelly KM, Maurer DM, Borah AM, Yarvis JS, Litz BT, Hildebrand BA, Williamson DE, Peterson AL. Prevalence of Fibromyalgia Syndrome in Active-Duty Military Personnel. Arthritis Care Res (Hoboken) 2023; 75:667-673. [PMID: 34606694 DOI: 10.1002/acr.24801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Previous research with civilian populations has found strong associations between fibromyalgia (FM) and posttraumatic stress disorder (PTSD). We undertook this study to investigate the prevalence of FM in military service members with and without PTSD. METHODS Participants were active duty military personnel recruited into either an epidemiologic cohort study of service members before a military deployment or 1 of 3 PTSD treatment trials. Instruments used to document FM and PTSD included the PTSD Checklist-Stressor-Specific Version, the PTSD Symptom Scale-Interview, and the 2012 American College of Rheumatology FM questionnaire. RESULTS Across the 4 studies, 4,376 subjects completed surveys. The prevalence of FM was 2.9% in the predeployment cohort, and the prevalence was significantly higher in individuals with PTSD (10.8%) compared with those without PTSD (0.8%). In the treatment trials, all of the participants met criteria for PTSD before starting treatment, and the prevalence of FM was 39.7%. CONCLUSION The prevalence of FM in active duty service members preparing to deploy is similar to that reported for the general population of the US but is higher than expected for a predominantly male cohort. Furthermore, the prevalence of FM was significantly higher in service members with comorbid PTSD and was highest among those seeking treatment for PTSD. Further investigation is needed to determine the factors linking PTSD and FM.
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Affiliation(s)
| | - Jay B Higgs
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
| | - Stacey Young-McCaughan
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas
| | - Jim Mintz
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas
| | - Edna B Foa
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Kevin M Kelly
- Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | | | - Adam M Borah
- Carl R. Darnall Army Medical Center, Fort Hood, Texas
| | | | - Brett T Litz
- VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
| | - Bernard A Hildebrand
- Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, and University of the Incarnate Word School of Osteopathic Medicine, San Antonio, Texas
| | | | - Alan L Peterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System, San Antonio, Texas
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Jadhakhan F, Evans DW, Falla D. The role of post-trauma stress symptoms in the development of chronic musculoskeletal pain and disability: A systematic review. Eur J Pain 2023; 27:183-200. [PMID: 36317593 PMCID: PMC10099552 DOI: 10.1002/ejp.2048] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Traumatic injuries are amongst the leading causes of death and disability in the world across all age groups. This systematic review aimed to (1) describe the role of post-traumatic stress symptoms (PTSS) on the development of chronic pain and/or pain-related disability following musculoskeletal trauma and (2) report pain and or pain-related disability by injury severity/type. DATABASE AND DATA TREATMENT Electronic databases were searched, from inception to 31 November 2021 and updated on 10 May 2022, to identify studies in which: participants were adults aged ≥16 years sustaining any traumatic event that resulted in one or more musculoskeletal injuries; an outcome measure of PTSS was used within 3 months of a traumatic event; the presence of pain and/or pain-related disability was recorded at a follow-up of 3 months or more. Two reviewers independently screened papers and assessed the quality of included studies. RESULTS Eight studies were included. Owing to between-study heterogeneity, the results were synthesized using a narrative approach. Five studies investigated the relationship between PTSS and pain. Participants with PTSS were more likely to develop persistent pain for at least 12 months post-injury. Six studies assessed the relationship between PTSS and pain-related disability. The results suggest that patients with PTSS had significantly higher disability levels for at least 12 months post-injury. CONCLUSION Findings from this comprehensive systematic review support a clear relationship between PTSS post-injury and future pain/disability, with the potential importance of certain PTSS clusters (hyper-arousal and numbing). SIGNIFICANCE The findings of this systematic review indicate an association between PTSS reported within 3 months of a traumatic musculoskeletal injury and the development of longer-term pain and disability. The PTSS clusters of 'hyper-arousal' and 'numbing' appear to be of particular importance in this relationship. PROSPERO REGISTRATION NUMBER CRD42021285243.
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Affiliation(s)
- Ferozkhan Jadhakhan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - David W Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
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Joseph AP, Wallman M, Scott E, Ilchef R, Harris N, Jackson A, Bryant RA. A proof-of-concept randomized controlled trial of follow-up mental health care for traumatic injury patients following hospital discharge. Injury 2023; 54:1362-1368. [PMID: 36858896 DOI: 10.1016/j.injury.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/14/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Traumatic injuries account for a huge burden of disease. Many patients develop persistent mental health problems in the months following hospital discharge. This proof-of-concept trial investigated whether Stepped Care comprising follow-up assessment telephone calls and appropriate referral information would lead to better mental health and functioning in traumatic injury patients. METHODS Patients admitted to the Trauma Service at Royal North Shore Hospital were randomized to either Stepped Care (n = 84) or Treatment as Usual (n = 90). All patients were assessed for anxiety, depression, and posttraumatic stress prior to hospital discharge. Those in Stepped Care received a telephone call at 1-month and 3-months after hospital discharge in which they were administered a brief assessment; patients who reported mental health or pain difficulties were provided with information for local specialists to address their specific problem. All patients were independently assessed by telephone interview 9- months after hospital discharge for posttraumatic stress disorder (PTSD) (primary outcome), as well as for anxiety, depression, disability, and pain. RESULTS There were 58 (73%) patients that could be contacted at either the 1-month or 3-month assessments. Of those contacted, 28 patients (48% of those contacted) were referred for specialist assistance. There were no differences between treatment arms on PTSD symptoms at follow-up [F1,95 = 0.55, p = 0.46]. At the 9-month assessment, patients in the Stepped Care condition reported significantly less anxiety [F1,95 = 5.07, p = 0.03] and disability [F1,95 = 4.37, p = 0.04] relative to those in Treatment as Usual. At 9 months there was no difference between conditions on depression [F1,95 = 1.03, p = 0.31]. There were no differences between conditions on self-reported pain difficulties. CONCLUSIONS This proof-of-concept trial suggests that brief screening assessments of traumatic injury patients following hospital discharge, combined with appropriate referral information, may lead to better functional outcomes. Further research is needed with larger sample sizes and greater verification of referral uptake to validate this finding.
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Affiliation(s)
- Anthony P Joseph
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Matthew Wallman
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Elliot Scott
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Ralf Ilchef
- Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW 2065
| | - Newman Harris
- Department of Pain Management, Royal North Shore Hospital, St Leonards, NSW 2065
| | - Alicia Jackson
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
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Bhalla A, Bamer AM, Temes C, Roaten K, Carrougher GJ, Schneider JC, Stoddard FJ, Stewart B, Gibran NS, Wiechman SA. Posttraumatic Stress Disorder Symptom Clusters as Predictors of Pain Interference in Burn Survivors: A Burn Model System National Database Study. J Burn Care Res 2023; 44:27-34. [PMID: 35866527 PMCID: PMC9990905 DOI: 10.1093/jbcr/irac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Individuals who experience burns are at higher risk of developing posttraumatic stress disorder and chronic pain. A synergistic relationship exists between posttraumatic stress disorder and chronic pain. We sought to evaluate the role of individual posttraumatic stress disorder symptom clusters as predictors of pain interference. We hypothesized that the hyperarousal and emotional numbing symptom clusters would be predictive of pain interference, even when accounting for the other two posttraumatic stress disorder symptom clusters, pain intensity, and other covariates. Multivariate linear regression analyses were completed using data from the Burn Model System National Database. A total of 439 adult participants had complete responses on self-report measures assessing posttraumatic stress disorder symptoms, pain intensity, and pain interference at 6-month after discharge and were included in analyses. Results indicate hyperarousal (B = .10, p = .03) and emotional numbing (B = .13, p = .01) posttraumatic stress disorder symptom clusters were each significantly associated with pain interference, even when accounting for pain intensity (B = .64, p < .001). Results highlight the importance of the emotional numbing and hyperarousal posttraumatic stress disorder symptom clusters in explaining pain interference. Findings suggest that when posttraumatic stress disorder symptoms or chronic pain are present, screening for and treating either condition may be warranted to reduce pain interference. Further, psychological interventions that target emotional numbing and hyperarousal posttraumatic stress disorder symptoms may be fruitful for promoting better coping with chronic pain and reducing pain interference.
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Affiliation(s)
- Arjun Bhalla
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Alyssa M. Bamer
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Christina Temes
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Roaten
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Research Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Frederick J. Stoddard
- Department of Psychiatry, Massachusetts General Hospital, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Nicole S. Gibran
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Shelley A. Wiechman
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
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Vaillant J, Kalra N, Gurbuz Cuneo A, Rouanet L. Losing ground in the field: An exploratory analysis of the relationship between work and mental health amongst women in conflict affected Democratic Republic of the Congo. PLoS One 2023; 18:e0284088. [PMID: 37083679 PMCID: PMC10121043 DOI: 10.1371/journal.pone.0284088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/23/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Conflict affected populations, in particular women in such settings, face an increased risk of developing mental health disorders as well as well as economic vulnerability and reduced productivity. However, the link between the two has rarely been studied. DATA AND METHODS The data in this paper come from a cross-sectional dataset (n = 1053) and a panel dataset of (n = 499) women suffering from post-traumatic stress disorder (PTSD) in eastern Democratic Republic of the Congo. This paper investigates the association between mental health disorders (PTSD, depression and/or anxiety) and employment for women in a conflict-affected setting. RESULTS The study finds that worsened local functioning is associated with reduced likelihood of working, earnings, and engagement in paid work. Reduction in probable depression and/or anxiety and PTSD are both associated with increased likelihood of engaging in paid work compared to unpaid work. Reduction in probable depression and/or anxiety is also associated with engaging in a secondary economic activity, as well as with higher productivity. However, when controlling for daily (local) functioning impairment, the primary pathway through which mental health may impact working, we detect a positive relationship between work or working hours and increased symptoms of PTSD and depression and/or anxiety. Working women with worse PTSD and depression and/or anxiety symptoms are also less likely to be self-employed, especially in an off-farm setting, and more likely to be engaged in farming. CONCLUSION A complex relationship between working and mental health emerges. Our findings also suggest that in this population farming, particularly farm-based wage work, is positively associated with worse mental health even after accounting for wealth and other relevant socio-demographic factors. These findings highlight the importance of paying close attention to the mental health of beneficiaries of livelihood support projects in post-conflict settings, where the relationship between mental health and employment is not straightforward.
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Affiliation(s)
- Julia Vaillant
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, D.C., United States of America
| | - Naira Kalra
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, D.C., United States of America
| | - Alev Gurbuz Cuneo
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, D.C., United States of America
| | - Léa Rouanet
- Gender Innovation Lab, Office of the Chief Economist, Africa Region, World Bank, Washington, D.C., United States of America
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Uhlin K, Persson E, Stålnacke BM, Löfgren M. Healthcare professionals' experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study. Disabil Rehabil 2022:1-12. [PMID: 35996890 DOI: 10.1080/09638288.2022.2111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE There is a lack of knowledge about interprofessional rehabilitation for culturally diverse patients with chronic pain. This study explores experiences of healthcare professionals developing and working with rehabilitation with patients in need of an interpreter and their experience of working with interpreters. METHODS Twelve healthcare professionals at two Swedish specialist rehabilitation centres were interviewed. Grounded theory principles were used for the data collection and analysis. RESULTS The main category "Demanding and Meaningful Work" represents three concurrently interacting categories: "Frustration" includes the informants' doubts regarding the benefits of the rehabilitation, lack of care for patients and cultural dissonance between professionals and patients. "Challenges" describes problems in the rehabilitation work due to the need for interpreted mediated communication, the complexity in health status and social aspects among the patients. "Solutions" represents practical working methods and personal approaches developed by the informants for managing frustrations and challenges. CONCLUSIONS The informants' frustration and challenges when working with a new group of patients, vulnerable and different in their preconceptions, led to new solutions in working methods and approaches. When starting a pain rehabilitation programme for culturally diverse patients, it is important to consider the rehabilitation team's need for additional time and support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who encounter immigrants with chronic pain need resources to develop their own skills in order to handle complex ethical questions as the patients represent a vulnerable patient group with many low status identitiesIn order to adapt rehabilitation programmes to patient groups with different languages and pre-understandings of chronic pain, there is a need for a team with specific qualities, i.e., close cooperation, an innovative atmosphere, time and also support from expertsFor appropriate language interpretation it is important to have a professional interpreter and a healthcare professional who are aware of and adopt the rules, possibilities and restrictions of interpretationThe rehabilitation of patients in need of language interpretation needs more time and organisation compared to the rehabilitation of patients who speak the national language.
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Affiliation(s)
- Karin Uhlin
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Elisabeth Persson
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Britt-Marie Stålnacke
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Monika Löfgren
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
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12
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Evans DW, Rushton A, Middlebrook N, Bishop J, Barbero M, Patel J, Falla D. Estimating Risk of Chronic Pain and Disability Following Musculoskeletal Trauma in the United Kingdom. JAMA Netw Open 2022; 5:e2228870. [PMID: 36018591 PMCID: PMC9419019 DOI: 10.1001/jamanetworkopen.2022.28870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
IMPORTANCE Serious traumatic injury is a leading cause of death and disability globally, with most survivors known to develop chronic pain. OBJECTIVE To describe early variables associated with poor long-term outcome for posttrauma pain and create a clinical screening tool for this purpose. DESIGN, SETTING, AND PARTICIPANTS This was a prospective cohort study at a major trauma center hospital in England. Recruitment commenced in December 2018 and ceased in March 2020. Participants were followed up for 12 months. Patients aged 16 years or older who were hospitalized because of acute musculoskeletal trauma within the preceding 14 days were included. Data were analyzed from March to December 2021. EXPOSURE Acute musculoskeletal trauma requiring admittance to a major trauma center hospital. MAIN OUTCOMES AND MEASURES A poor outcome was defined as Chronic Pain Grade II or higher and measured at both 6 months (primary time point) and 12 months. A broad range of candidate variables potentially associated with outcomes were used, including surrogates for pain mechanisms, quantitative sensory testing, and psychosocial factors. Univariable models were used to identify the variables most likely to be associated with poor outcome, which were entered into multivariable models. A clinical screening tool (nomogram) was derived from 6-month results. RESULTS In total, 1590 consecutive patients were assessed for eligibility, of whom 772 were deemed eligible and 124 (80 male [64.5%]; mean [SD] age, 48.9 [18.8] years) were recruited. At 6 months, 19 of 82 respondents (23.2%) reported a good outcome, whereas at 12 months 27 of 44 respondents (61.4%) reported a good outcome. At 6 months on univariable analysis, an increase in total posttraumatic stress symptoms (odds ratio [OR], 2.09; 95% CI, 1.33-3.28), pain intensity average (OR, 2.87; 95% CI, 1.37-6.00), number of fractures (OR, 2.79; 95% CI, 1.02-7.64), and pain extent (OR, 4.67; 95% CI, 1.57-13.87) were associated with worse outcomes. A multivariable model including those variables had a sensitivity of 0.93, a specificity of 0.54, and C-index of 0.92. CONCLUSIONS AND RELEVANCE A poor long-term pain outcome from musculoskeletal traumatic injuries may be estimated by measures recorded within days of injury. These findings suggest that posttraumatic stress symptoms, pain spatial distribution, perceived average pain intensity, and number of fractures are good candidates for a sensitive multivariable model and derived clinical screening tool.
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Affiliation(s)
- David W. Evans
- College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Alison Rushton
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Nicola Middlebrook
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Jon Bishop
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Marco Barbero
- Department of Business Economics, Health and Social Care, Rehabilitation Research Laboratory, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
| | - Jaimin Patel
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
- University Hospitals Birmingham, Birmingham, United Kingdom
| | - Deborah Falla
- College of Life and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom
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13
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Webb EK, Ward RT, Mathew AS, Price M, Weis CN, Trevino CM, deRoon-Cassini TA, Larson CL. The role of pain and socioenvironmental factors on posttraumatic stress disorder symptoms in traumatically injured adults: A 1-year prospective study. J Trauma Stress 2022; 35:1142-1153. [PMID: 35238074 PMCID: PMC9357124 DOI: 10.1002/jts.22815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 01/29/2023]
Abstract
Approximately 20% of individuals who experience a traumatic injury will subsequently develop posttraumatic stress disorder (PTSD). Physical pain following traumatic injury has received increasing attention as both a distinct, functionally debilitating disorder and a comorbid symptom related to PTSD. Studies have demonstrated that both clinician-assessed injury severity and patient pain ratings can be important predictors of nonremitting PTSD; however, few have examined pain and PTSD alongside socioenvironmental factors. We postulated that both area- and individual-level socioeconomic circumstances and lifetime trauma history would be uniquely associated with PTSD symptoms and interact with the pain-PTSD association. To test these effects, pain and PTSD symptoms were assessed at four visits across a 1-year period in a sample of 219 traumatically injured participants recruited from a Level 1 trauma center. We used a hierarchal linear modeling approach to evaluate whether (a) patient-reported pain ratings were a better predictor of PTSD than clinician-assessed injury severity scores and (b) socioenvironmental factors, specifically neighborhood socioeconomic disadvantage, individual income, and lifetime trauma history, influenced the pain-PTSD association. Results demonstrated associations between patient-reported pain ratings, but not clinician-assessed injury severity scores, and PTSD symptoms, R2( fvm ) = .65. There was a significant interaction between neighborhood socioeconomic disadvantage and pain such that higher disadvantage decreased the strength of the pain-PTSD association but only among White participants, R2( fvm ) = .69. Future directions include testing this question in a larger, more diverse sample of trauma survivors (e.g., geographically diverse) and examining factors that may alleviate both pain and PTSD symptoms.
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Affiliation(s)
- E. Kate Webb
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin, USA
| | - Richard T. Ward
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin, USA
| | - Abel S. Mathew
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin, USA
| | - Matthew Price
- Department of Psychology, University of Vermont, Burlington, Vermont, USA
| | - Carissa N. Weis
- Department of Psychology, University of Vermont, Burlington, Vermont, USA
| | - Colleen M. Trevino
- Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Terri A. deRoon-Cassini
- Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Christine L. Larson
- Department of Psychology, University of Wisconsin–Milwaukee, Milwaukee, Wisconsin, USA
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14
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AAOS/Major Extremity Trauma and Rehabilitation Consortium Clinical Practice Guideline Summary for Evaluation of Psychosocial Factors Influencing Recovery From Orthopaedic Trauma. J Am Acad Orthop Surg 2022; 30:e307-e312. [PMID: 34714783 DOI: 10.5435/jaaos-d-21-00777] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/02/2021] [Indexed: 02/01/2023] Open
Abstract
The Clinical Practice Guideline for Evaluation of Psychosocial Factors Influencing Recovery from Adult Orthopaedic Trauma is based on a systematic review of current scientific and clinical research. The purpose of this clinical practice guideline is to improve outcomes after adult orthopaedic trauma by evaluating, and addressing, the psychosocial factors that affect recovery. This guideline contains one recommendation to address eight psychosocial factors after military and civilian adult orthopaedic trauma that may influence clinical, functional, and quality of life recovery. Furthermore, it addresses additional factors that may be associated with greater biopsychosocial symptom intensity, limitations, and/or diminished health-related quality of life. However, this guideline did not evaluate effective treatment strategies for the treatment or prevention of psychosocial factors. This guideline cannot be fully extrapolated to the treatment of children or adolescents. In addition, the work group highlighted the need for additional research because studies of general traumatic injuries do not always generalize to specific orthopaedic populations.
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15
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"Did You Think You Would Die?": Fear of Death and Its Relationship to the Development of Posttraumatic Stress Disorder After Traumatic Injury. J Am Acad Orthop Surg 2022; 30:e272-e278. [PMID: 34669650 DOI: 10.5435/jaaos-d-20-01438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/12/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Patient-specific factors may influence posttraumatic stress disorder (PTSD) development and warrant further examination. This study investigates potential association between patient-reported fear of death at the time of injury and development of PTSD. METHODS Over 35 months, 250 patients were screened for PTSD at their first posthospitalization clinic visit and were asked "Did you think you were going to die from this injury?" (yes or no). PTSD screening was conducted using the PTSD checklist for DSM-5 questionnaire. A score ≥33 was considered positive for PTSD, and patients were offered ancillary psychiatric services. Retrospectively, medical records were reviewed for baseline demographics and injury information. RESULTS Forty-three patients (17%) indicated a fear of death. The mean age was 46 years, with patients who feared death being younger (36 versus 48, P < 0.001), and 62% were male. The most common mechanisms of injury were motor vehicle or motorcycle collisions (30%) and ground-level falls (21%). Gunshot wounds were more common among patients who feared death from trauma (44% versus 7%, P < 0.001). PTSD questionnaires were completed a median of 26 days after injury, with an average score of 12.6. PTSD scores were higher for patients with fear of death (32.7 versus 8.5), and these patients required more acute interventions (47% versus 7%), both P < 0.001. After multivariable logistic regression, patients who thought that they would die from their trauma had >13 times higher odds of developing PTSD (odds ratios: 13.42, P < 0.0001). Apart from positive psychiatric history (OR: 5.46, P = 0.001), no factors (ie, age, sex, mechanism, or any injury or treatment characteristic) were predictive of positive PTSD scores on regression. DICUSSION Patients who reported fear of death at the time of injury were 13 times more likely to develop PTSD. Simply asking patients whether they thought that they would die at the time of injury may prospectively identify PTSD risk. LEVEL OF EVIDENCE Prognostic Level II.
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16
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Short NA, Tungate AS, Bollen KA, Sullivan J, D'Anza T, Lechner M, Bell K, Black J, Buchanan J, Reese R, Ho JD, Reed GD, Platt MA, Riviello RJ, Rossi CH, Martin SL, Liberzon I, Rauch SAM, Kessler RC, Nugent N, McLean SA. Pain is common after sexual assault and posttraumatic arousal/reactivity symptoms mediate the development of new or worsening persistent pain. Pain 2022; 163:e121-e128. [PMID: 34224498 DOI: 10.1097/j.pain.0000000000002329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 04/22/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Clinically significant new or worsening pain (CSNWP) is a common, yet often overlooked, sequelae of sexual assault. Little is known regarding factors influencing the development of CSNWP in sexual assault survivors. The current study used data from a recently completed prospective study to evaluate whether posttraumatic alterations in arousal and reactivity in the early aftermath of sexual assault influence the transition from acute to clinically significant new or worsening persistent pain. Women ≥ 18 years of age (n = 706) presenting for emergency care after sexual assault to 13 emergency care sites were enrolled in the study. Women completed assessments at the time of presentation as well as at 1 week (n = 706, 100%) and 6 weeks (n = 630, 91%). Nearly 70% of women reported CSNWP at the time of emergency care (n = 475, 69%), which persisted to 6 weeks in approximately 2 in 5 survivors (n = 248, 41%). A structural equation model adjusted for age, race, past trauma exposure, and preassault pain levels suggested that posttraumatic alterations in arousal/reactivity symptoms 1 week after assault partially mediated the transition from acute to persistent CSNWP. A significant portion (41%) of women sexual assault survivors develop CSNWP 6 weeks postassault. Posttraumatic arousal/reactivity symptoms in the early aftermath of assault contribute to CSNWP development; such symptoms are potential targets for secondary preventive interventions to reduce chronic postassault pain.
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Affiliation(s)
- Nicole A Short
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Andrew S Tungate
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Kenneth A Bollen
- Psychology and Neuroscience, and Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jenyth Sullivan
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
| | - Teresa D'Anza
- Albuquerque SANE Collaborative, Albuquerque, NM, United States
| | - Megan Lechner
- Emergency Deprtment, UC Health Memorial Hospital, Colorado Springs, CO, United States
| | - Kathy Bell
- Tulsa Forensic Nursing Services, Tulsa, OK, United States
| | | | - Jennie Buchanan
- Department of Emergency Medicine, Denver Health, Denver, CO, United States
| | - Rhiannon Reese
- Crisis Center of Birmingham, Birmingham, AL, United States
| | - Jeffrey D Ho
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
| | - Gordon D Reed
- Department of Emergency Medicine, Christiana Care, Newark, DE, United States
| | - Melissa A Platt
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Ralph J Riviello
- Department of Emergency Medicine, University of Texas Health San Antonio, TX, United States
| | | | - Sandra L Martin
- Department of Maternal and Child Health, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, Bryan, TX, United States
| | - Sheila A M Rauch
- Department of Psychiatry, Emory University, Atlanta, GA, VA Atlanta Healthcare System, Atlanta, GA, United States
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, United States
| | - Nicole Nugent
- Departments of Psychiatry and Human Behavior, Pediatrics, and Emergency Medicine, Brown University, Providence, RI, United States
| | - Samuel A McLean
- Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Departments of Anesthesiology and
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17
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Roth M, King L, Richardson D. Depression and Anxiety as Mediators of PTSD Symptom Clusters and Pain in Treatment-Seeking Canadian Forces Members and Veterans. Mil Med 2021; 188:e1150-e1155. [PMID: 34966945 DOI: 10.1093/milmed/usab532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/28/2021] [Accepted: 12/14/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Chronic pain (CP) commonly presents alongside psychiatric conditions such as depression, PTSD, and generalized anxiety. The current study sought to better understand this complex relationship by determining whether anxiety and depression symptom severity mediated the relationship between DSM-5 PTSD symptom clusters and pain symptoms in a sample of 663 Canadian Armed Forces (CAF) personnel and veterans seeking treatment for mental health conditions. MATERIALS AND METHODS Generalized anxiety disorder, depression, and PTSD symptom severity were measured using self-report scales provided as part of a standard intake protocol. Pain symptoms were measured using the Bodily Pain subscale of the SF-36 (SF-36 BPS). Linear regressions were used to explore the relationship between PTSD symptom clusters, depression, anxiety, and pain. Bootstrapped resampling analyses were employed to test mediation effects. RESULTS The average SF-36 BPS score in this sample was 36.6, nearly 1.5 SDs below the population health status, enforcing the salience of pain symptoms as a concern for veterans and CAF seeking treatment for military-related psychiatric conditions. The effects of PTSD symptom clusters avoidance, negative mood and cognitions, and arousal on pain were fully mediated by anxiety and depression severity. However, the effect of intrusion on pain was not mediated by depression and only partly mediated by anxiety. CONCLUSION Findings emphasize the importance of including anxiety and depression in models of PTSD and pain, particularly in samples where psychiatric comorbidity is high. Clinically, results highlight the need for improved treatment regimens that address pain symptoms alongside common psychiatric comorbidities.
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Affiliation(s)
- Maya Roth
- St. Joseph's Operational Stress Injury Clinic, St. Joseph's Health Care London, London, ON N6C 5J1, Canada
| | - Lisa King
- St. Joseph's Operational Stress Injury Clinic, St. Joseph's Health Care London, London, ON N6C 5J1, Canada
| | - Don Richardson
- St. Joseph's Operational Stress Injury Clinic, St. Joseph's Health Care London, London, ON N6C 5J1, Canada
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18
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Nelson S, Beveridge JK, Mychasiuk R, Noel M. Adverse Childhood Experiences (ACEs) and Internalizing Mental Health, Pain, and Quality of Life in Youth With Chronic Pain: A Longitudinal Examination. THE JOURNAL OF PAIN 2021; 22:1210-1220. [PMID: 33798732 DOI: 10.1016/j.jpain.2021.03.143] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 12/11/2022]
Abstract
The aims of this longitudinal study were to 1) identify categories of adverse childhood experiences (ACEs) (ie, neglect, abuse, household dysfunction in childhood) that increase risk for internalizing mental health problems, pain-related impairment, and poorer quality of life and 2) examine the moderating role of posttraumatic stress symptoms (PTSS) in these associations, in a clinical sample of youth with chronic pain. At 2 timepoints, youth (N = 155; aged 10-18 years) completed measures of exposure to ACEs, PTSS, depressive and anxiety symptoms, pain intensity, pain interference, and quality of life. Multivariate analyses of variance, linear mixed modeling, and moderation analyses were conducted. Results from cross-sectional and longitudinal analyses were similar; youth with a history of 3+ ACEs reported significantly higher PTSS, depressive and anxiety symptoms, and poorer quality of life than youth with no ACE history. Results also revealed differences in functioning between youth exposed to different types of ACEs (ie, maltreatment only, household dysfunction only, both, none). Finally, PTSS was found to moderate the association between ACEs and anxiety and depressive symptoms. Findings underscore the influence that ACEs can have on the long-term functioning of youth with chronic pain as well as the important role of current PTSS in this association. PERSPECTIVE: This study found that the risk of poorer outcomes imposed by ACEs at baseline remains longitudinally and that posttraumatic stress symptoms (PTSS) moderate the relationship between ACEs and anxiety and depressive symptoms in youth with chronic pain. These results underscore the importance of assessing for ACEs and PTSS alongside chronic pain in youth.
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Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Jaimie K Beveridge
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Richelle Mychasiuk
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada; Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Alberta, Canada.
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19
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Giordano NA, Richmond TS, Farrar JT, Buckenmaier CCT, Gallagher RM, Polomano RC. Differential Pain Presentations Observed Across Post-Traumatic Stress Disorder Symptom Trajectories After Combat Injury. PAIN MEDICINE 2021; 22:2638-2647. [PMID: 34181003 DOI: 10.1093/pm/pnab204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study evaluated the association between pain outcomes and post-traumatic stress disorder (PTSD) symptom trajectories after combat-related injury, while adjusting for receipt of regional anesthesia (RA) soon after injury. METHODS The PTSD symptom trajectories of N = 288 combat-injured service members were examined from within a month of injury up to two-years after. Linear mixed-effects models evaluated the association between PTSD symptom trajectories and average pain and pain interference outcomes while adjusting for receipt of RA during combat casualty care. RESULTS Four PTSD trajectories were characterized: resilient, recovering, worsening, and chronic. Differential pain presentations were associated with PTSD symptom trajectories, even after adjusting for receipt of RA. Compared to those with a resilient PTSD symptom trajectory, individuals presenting with chronic PTSD trajectories were estimated to experience average pain scores 2.61 points higher (95% CI: 1.71, 3.14). Participants presenting with worsening (β = 1.42; 95% CI: 0.77, 1.78) and recovering PTSD trajectories (β = 0.65; 95% CI: 0.09, 1.08) were estimated to experience higher average pain scores than participants with resilient PTSD trajectories. Significant differences in pain interference scores were observed across PTSD trajectories. Receiving RA was associated with improved pain up to two years after injury (β =-0.31; 95% CI: -0.90, -0.04), however no statistically significant association was detected between RA and PTSD trajectories. CONCLUSIONS PTSD trajectories were associated with greater pain intensity and interference following combat injury even when accounting for receipt of early RA for pain management. These findings underscore the need to jointly assess pain and PTSD symptoms across the trauma care continuum.
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Affiliation(s)
| | | | - John T Farrar
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Chester C Trip Buckenmaier
- Defense and Veterans Center for Integrative Pain Management, Uniformed Services University, Bethesda, MD
| | - Rollin M Gallagher
- Center for Health Equities Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Rosemary C Polomano
- University of Pennsylvania School of Nursing, Philadelphia, PA.,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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20
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de Vries V, de Jong AEE, Hofland HWC, Van Loey NE. Pain and Posttraumatic Stress Symptom Clusters: A Cross-Lagged Study. Front Psychol 2021; 12:669231. [PMID: 34135828 PMCID: PMC8201070 DOI: 10.3389/fpsyg.2021.669231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Pain and posttraumatic stress disorder (PTSD) frequently co-occur but underlying mechanisms are not clear. This study aimed to test the development and maintenance of pain and PTSD symptom clusters, i.e., intrusions, avoidance, and hyperarousal. The longitudinal study included 216 adults with burns. PTSD symptom clusters, indexed by the Impact of Event Scale-Revised (IES-R), and pain, using a graphic numerical rating scale (GNRS), were measured during hospitalization, 3 and 6 months post-burn. Cross-lagged panel analysis was used to test the relationships between pain and PTSD symptom clusters. Cross-lagged results showed that in-hospital intrusions predicted pain and avoidance 3 months post-burn. In-hospital pain predicted intrusions and avoidance 3 months post-burn and a trend was found for hyperarousal (90% CI). In the second wave, intrusions predicted pain and hyperarousal. Pain predicted hyperarousal. This study provides support for an entangled relationship between pain and PTSD symptoms, and particularly subscribes the role of intrusions in this bidirectional relationship. To a lesser extent, hyperarousal was unidirectionally related to pain. These results may subscribe the driving role of PTSD, particularly intrusions, which partly supports the Perpetual Avoidance Model.
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Affiliation(s)
- Vivian de Vries
- Department of Medical Psychology, Red Cross Hospital, Beverwijk, Netherlands
| | - Alette E E de Jong
- Burn Center, Red Cross Hospital, Beverwijk, Netherlands.,Association of Dutch Burn Centers, Department Psychological and Nursing Research, Beverwijk, Netherlands
| | - Helma W C Hofland
- Burn Center, Maasstad Hospital, Rotterdam, Netherlands.,Association of Dutch Burn Centers, Department Psychological and Nursing Research, Rotterdam, Netherlands
| | - Nancy E Van Loey
- Association of Dutch Burn Centers, Department Psychological and Nursing Research, Beverwijk, Netherlands.,Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands
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21
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Beaudoin FL, Kessler RC, Hwang I, Lee S, Sampson NA, An X, Ressler KJ, Koenen KC, McLean SA. Pain after a motor vehicle crash: The role of socio-demographics, crash characteristics and peri-traumatic stress symptoms. Eur J Pain 2021; 25:1119-1136. [PMID: 33458880 PMCID: PMC10913946 DOI: 10.1002/ejp.1733] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 01/13/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND The vast majority of individuals who come to the emergency department (ED) for care after a motor vehicle collision (MVC) are diagnosed with musculoskeletal strain only and are discharged to home. A significant subset of this population will still develop persistent pain and posttraumatic psychological sequelae may play an important role in pain persistence. METHODS We conducted a multisite longitudinal cohort study of adverse post-traumatic neuropsychiatric sequelae among patients seeking ED treatment in the aftermath of a traumatic life experience. We report on a sub-group of patients (n = 666) presenting after an MVC, the most common type of trauma and we examine associations of socio-demographic and MVC characteristics, and persistent pain 8 weeks after MVC. We also examine the degree to which these associations are related to peritraumatic psychological symptoms and 2-week acute stress reactions using an applied approach. RESULTS Eight-week prevalence of persistent moderate or severe pain was high (67.4%) and positively associated with patient sex (female), older age, low socioeconomic status (education and income) and pain severity in the ED. Peritraumatic stress symptoms (distress and dissociation) appear to exert some influence on both acute pain and the transition from acute to persistent pain. DISCUSSION AND CONCLUSIONS The early aftermath of an MVC may be an important time period for intervening to prevent and reduce persistent pain. Substantial variation in mediating pathways across predictors also suggests potential diverse and complex underlying biological and psychological pathogenic processes are at work in the early weeks following trauma. SIGNIFICANCE The first several days after trauma may dictate recovery trajectories. Persistent pain, pain lasting beyond the expected time of recovery, is associated with pain early in the recovery period, but also mediated through other pathways. Future work is needed to understand the complex neurobiological processes in involved in the development of persistent and acute post-traumatic pain.
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Affiliation(s)
- Francesca L. Beaudoin
- Department of Emergency Medicine & Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - I. Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - S. Lee
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - X. An
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K. J. Ressler
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S. A. McLean
- Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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22
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Hou T, Zhang R, Song X, Zhang F, Cai W, Liu Y, Dong W, Deng G. Self-efficacy and fatigue among non-frontline health care workers during COVID-19 outbreak: A moderated mediation model of posttraumatic stress disorder symptoms and negative coping. PLoS One 2020; 15:e0243884. [PMID: 33301523 PMCID: PMC7728176 DOI: 10.1371/journal.pone.0243884] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/30/2020] [Indexed: 02/07/2023] Open
Abstract
PURPOSES Since a considerable number of health care workers (HCWs) were sent to Wuhan to aid COVID-19 control during the epidemic, non-frontline HCWs who stayed in local hospitals had to work overload to provide daily health care services for other health issues, which makes them more vulnerable to experience fatigue. Self-efficacy is suggested as a protective factor for fatigue. Nonetheless, less is known regarding the underlying mechanisms. This research aimed to explore the prevalence of fatigue among non-frontline HCWs during the pandemic, investigate the mediating effect of posttraumatic stress disorder (PTSD) symptoms and moderating effect of negative coping in the association between self-efficacy and fatigue. METHODS General Self-Efficacy Scale, PTSD Checklist-Civilian Version, Simplified Coping Style Questionnaire and 14-item Fatigue Scale were administrated to 527 non-frontline HCWs from Anhui Province, China. The mediating effect was examined by Mackinnon's four-step procedure, while Hayes PROCESS macro was used to test the moderated mediation model. RESULTS The prevalence of fatigue among non-frontline HCWs was 56.7%. The effect of self-efficacy on fatigue was partially mediated by PTSD symptoms (ab = -0.146, SE = 0.030, 95% CI = [-0.207, -0.095]). Additionally, negative coping moderated both the direct effect of self-efficacy on fatigue (β = -0.158, P<0.001) and the mediating effect of PTSD symptoms (β = 0.077, P = 0.008). When the standard score of negative coping increased to 1.49 and over, the direct association between self-efficacy and fatigue became insignificant. Likewise, the effect of self-efficacy on PTSD symptoms had no statistical significance when the standard score of negative coping was -1.40 and lower. CONCLUSIONS More than half non-frontline HCWs suffered from fatigue during COVID-19. For those who tend to use negative coping, it might be crucial to design programs combining the enhancement of self-efficacy, preventions for PTSD symptoms and interventions for fatigue.
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Affiliation(s)
- Tianya Hou
- Faculty of Psychology, Second Military Medical University, Shanghai, China
| | - Ruike Zhang
- Faculty of Psychology, Second Military Medical University, Shanghai, China
| | - Xiangrui Song
- Faculty of Psychology, Second Military Medical University, Shanghai, China
| | - Fan Zhang
- Faculty of Psychology, Second Military Medical University, Shanghai, China
| | - Wenpeng Cai
- Faculty of Psychology, Second Military Medical University, Shanghai, China
| | - Ying Liu
- Faculty of Psychology, Second Military Medical University, Shanghai, China
| | - Wei Dong
- Faculty of Psychology, Second Military Medical University, Shanghai, China
| | - Guanghui Deng
- Faculty of Psychology, Second Military Medical University, Shanghai, China
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23
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Stensland SØ, Thoresen S, Jensen T, Wentzel-Larsen T, Dyb G. Early Pain and Other Somatic Symptoms Predict Posttraumatic Stress Reactions in Survivors of Terrorist Attacks: The Longitudinal Utøya Cohort Study. J Trauma Stress 2020; 33:1060-1070. [PMID: 32662140 DOI: 10.1002/jts.22562] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/10/2020] [Accepted: 03/24/2020] [Indexed: 11/10/2022]
Abstract
Survivors of traumatic events commonly suffer from long-term pain and related somatic symptomatology. To test the predominant hypothesis that survivors' pain comprises sequela of persistent posttraumatic stress symptoms (PTSS), we assessed the sequential order of symptom development among young survivors of a terrorist attack. All 490 survivors of the 2011 Utøya (Norway) attacks were invited to the longitudinal Utøya cohort study; 355 (72.4%) participated. The mean survivor age was 19.3 years (SD = 4.6) and 169 were female (47.6%). Somatic symptoms, including headache, other pain and fatigue, and PTSS, were measured 4-5 months (T1), 14-16 months (T2), and 32-33 months (T3) after the attack. Longitudinal associations between somatic symptoms and PTSS were assessed in cross-lagged structural equation model (SEM) analyses, which were adjusted for known confounders. Higher pain levels and other somatic symptoms at T1 consistently predicted PTSS at T2 in SEM analyses, r = .473, p < .001. Beyond this early-to-intermediate posttraumatic phase, somatic symptoms did not significantly predict PTSS: T2-T3, r = .024, p = .831; T1-T3, r = -.074, p = .586. PTSS did not significantly predict later somatic symptomatology at T1-T2, r = .093, p = .455; T2-T3, r = .272, p = .234; or T1-T3, r = -.279, p = .077. The findings indicate that survivors' early pain and related somatic symptoms strongly and consistently predict later psychopathology. After severe psychological trauma, early interventions may need to address individuals' pain to hinder chronification.
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Affiliation(s)
- Synne Øien Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Siri Thoresen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Tine Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Psychology, Faculty of Social Sciences, University of Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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24
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The Co-occurrence of Pediatric Chronic Pain and Anxiety: A Theoretical Review of a Developmentally Informed Shared Vulnerability Model. Clin J Pain 2020; 35:989-1002. [PMID: 31513056 DOI: 10.1097/ajp.0000000000000763] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The shared vulnerability model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Although many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry.
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25
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Abstract
OBJECTIVES After injury, many children experience posttraumatic stress symptoms (PTSS) that negatively impact recovery. Acute pain and PTSS share neurobiological pathways, and acute dosage of morphine has been linked to reduced PTSS in naturalistic studies. However, the complex interactions between pain, morphine and other opioid use, and PTSS have yet to be investigated in robust pediatric samples.This prospective, longitudinal study examined relationships between acute pain, opioid medications, and PTSS after pediatric injury. METHODS Ninety-six children aged 8 to 13 years (mean = 10.60, SD = 1.71), hospitalized for unintentional injury, completed assessments at baseline (T1) and 12 weeks (T2) later. Pain ratings and opioid administration data were obtained via chart review. RESULTS Structural equation modeling revealed that worst pain endorsed during hospitalization was positively associated with concurrent and later PTSS when controlling for evidence-based risk factors (ie, age, sex, prior trauma history, traumatic appraisals of injury event, heart rate). Neither opioid medications overall nor morphine specifically (milligram/kilogram/day) administered during hospitalization mediated the relationship between pain and T2 PTSS. CONCLUSIONS Pain during hospitalization may increase susceptibility for persistent PTSS above and beyond the influence of other empirical risk factors. Findings suggest that pain assessment may be a useful addition to pediatric PTSS screening tools and highlight the need for additional research on pharmacological secondary prevention approaches. Given that inadequate pain control and persistent PTSS each hinder recovery and long-term functioning, better understanding of interactions between acute pain and PTSS after injury is essential for improving screening, prevention, and early intervention efforts.
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26
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How are pain and traumatic stress symptoms related in acute whiplash-associated disorders? An investigation of the role of pain-related fear in a daily diary study. Pain 2020; 160:1954-1966. [PMID: 30985618 DOI: 10.1097/j.pain.0000000000001581] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Comorbidity of pain and posttraumatic stress disorder is well recognized, but the reason for this association is unclear. This study investigated the direction of the relationship between pain and traumatic stress and the role that pain-related fear plays, for patients with acute whiplash-associated disorder. Participants (n = 99) used an electronic diary to record hourly ratings of pain, traumatic stress, and fear of pain (FOP) symptoms over a day. Relationships between pain, traumatic stress, and pain-related fear symptoms were investigated through multilevel models including variables lagged by 1 hour. Traumatic stress was associated with previous pain, even after controlling for previous traumatic stress and current pain; current pain was not associated with previous traumatic stress. The relationship between traumatic stress and previous pain became negligible after controlling for FOP, except for traumatic stress symptoms of hyperarousal that were driven directly by pain. Overall, these results support a pain primacy model, and suggest that pain-related fear is important in the maintenance and development of comorbid pain and traumatic stress symptoms. They also confirm that traumatic stress symptoms of hyperarousal are central in this relationship. Differences between this study and others that reported mutual maintenance can be understood in terms of different stages of whiplash-associated disorder and different intervals between repeated measurements. Traumatic stress may affect pain over longer time intervals than measured in this study. Future research could explore how relationships between traumatic stress symptoms, pain, and FOP change over time, and whether previous experiences of traumatic stress influence these relationships.
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27
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Sager ZS, Wachen JS, Naik AD, Moye J. Post-Traumatic Stress Disorder Symptoms from Multiple Stressors Predict Chronic Pain in Cancer Survivors. J Palliat Med 2020; 23:1191-1197. [PMID: 32228350 DOI: 10.1089/jpm.2019.0458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Despite the association between chronic pain and post-traumatic stress disorder (PTSD), little is known about the longitudinal course of pain and PTSD during cancer treatment. Objectives: We examined the prevalence of PTSD and chronic pain at three time periods in veterans with a diagnosis of cancer, and the relationship between the experience of pain and PTSD. Methods: Participants (N = 123) with oral-digestive cancers were recruited from the Veterans Healthcare System (age M = 65.31 and SD = 9.13; 98.4% male) and completed face to face interviews at 6, 12, and 18 months post-diagnosis. Measures included the Post-traumatic Stress Disorder Checklist-Stressor-Specific version (PCL-S), Primary care PTSD (PC-PTSD), and the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Impact Scale. Results: About one-third (26.8%) of the sample had chronic pain, defined as elevated pain at two time periods. About one-fifth (20.3%) endorsed symptoms of combat-related PTSD at 6 months, and 22.8% endorsed symptoms of cancer-related PTSD, exceeding a clinical cutoff for older adults (12 months = 21.1%, 18 months = 23.1%). Changes over time were observed for cancer-related PTSD symptom clusters of hyperarousal (F = 3.85 and p = 0.023) and emotional numbing (F = 4.06 and p = 0.018) with a statistically significant quadratic function increasing at 18 months. In logistic regression, individuals with both combat and cancer-related PTSD symptoms at six months had 8.49 times higher odds of experiencing chronic pain (χ2 = 25.91 and p < 0.001; R2 = 0.28). Conclusions: Persisting pain may be a concern in veterans with cancer. Individuals who have experienced traumatic events with persisting PTSD symptoms may be at elevated risk for chronic pain. Veterans with PTSD symptoms from both cancer and combat are at the highest risk to experience chronic pain.
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Affiliation(s)
- Zachary S Sager
- VA New England GRECC and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Wachen
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System and Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Aanand D Naik
- Health Services Research and Development, Michael E. DeBakey VAMC and Baylor College of Medicine, Houston, Texas, USA
| | - Jennifer Moye
- VA New England GRECC and Harvard Medical School, Boston, Massachusetts, USA
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28
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Nordbrandt MS, Sonne C, Mortensen EL, Carlsson J. Trauma-affected refugees treated with basic body awareness therapy or mixed physical activity as augmentation to treatment as usual-A pragmatic randomised controlled trial. PLoS One 2020; 15:e0230300. [PMID: 32163509 PMCID: PMC7067472 DOI: 10.1371/journal.pone.0230300] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 02/25/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of post-traumatic stress disorder (PTSD) is estimated to be as high as 30% among refugees. The coexistence of prevalent chronic pain is believed to maintain symptoms of PTSD and add complexity to the condition. Despite this, little evidence exists on how to treat PTSD and comorbid conditions best in trauma-affected refugees. AIM The aim of the present study was to investigate if adding either BBAT or mixed physical activity to the treatment as usual (TAU) for trauma-affected refugees with PTSD would increase the treatment effect compared to TAU alone. METHOD Randomised controlled trial, 3-armed parallel group superiority study, conducted at Competence Centre for Transcultural Psychiatry, Denmark. Participants were adult trauma-affected refugees with PTSD. Allocation ratio was 1:1:1, stratified for PTSD severity and gender. An open-label design was applied due to the nature of the intervention. Participants were randomised to receive either individual basic body awareness therapy (group B) or individual mixed physical activity (group M) one hour/week for 20 weeks plus TAU, or TAU only (group C). The primary outcome was PTSD severity measured by Harvard Trauma Questionnaire (HTQ). Trial registration: ClinicalTrials.gov, NCT01955538. RESULTS Of the 338 patients included (C/B/M = 110/114/114), 318 patients were eligible for intention-to-treat analysis (C/B/M = 104/105/109). On the primary outcome, intention-to-treat as well as per-protocol analyses showed small but significant improvement on scores from pre- to post-treatment in all three groups but with no significant difference in improvement between groups. CONCLUSIONS The findings do not provide evidence that either BBAT or mixed physical activity as add-on treatment bring significantly larger improvement on symptoms of PTSD compared to TAU alone for adult, trauma-affected refugees. There is a need for studies on potential subpopulations of trauma-affected refugees who could benefit from physical activity as a part of their treatment.
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Affiliation(s)
- Maja Sticker Nordbrandt
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Sonne
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Mental Health Services of the Capital Region, Ballerup, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
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29
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Lee SY, Finkelstein-Fox L, Park CL, Mazure CM, Huedo-Medina TB, Hoff R. Bidirectionality of Pain Interference and PTSD Symptoms in Military Veterans: Does Injury Status Moderate Effects? PAIN MEDICINE 2020; 20:934-943. [PMID: 30016463 DOI: 10.1093/pm/pny133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Pain and post-traumatic stress disorder (PTSD) symptoms are strongly correlated in veteran populations. Arguments for which one condition predicts or worsens the other condition have gone in both directions. However, research addressing this issue has been primarily limited to cross-sectional studies rather than examinations of a potential bidirectional relationship between pain interference and PTSD symptoms over time. In addition, no studies have examined deployment injury status as potentially moderating this bidirectional effect in veterans. To address these gaps in the literature, the present longitudinal study examined whether there is a bidirectional relationship between pain interference and PTSD symptoms in a sample of male and female veterans returning from Operation Iraqi Freedom, Operation Enduring Freedom, or Operation New Dawn (N = 729) and whether deployment injury status moderates this relationship. METHODS Participants completed phone interviews regarding pain interference and PTSD symptoms at three time points, each three months apart. RESULTS Pain interference at Time 1 predicted worse PTSD symptoms at Time 2 for the subset of veterans who sustained injuries during deployment (n = 381) but not for veterans with pain interference who did not sustain injuries (n = 338). From Time 1 to Time 3, elevations in PTSD symptoms were mediated by pain interference for injured veterans; in contrast, PTSD symptoms did not appear to drive changes in pain interference in either group. CONCLUSIONS These results indicate that physical symptom management should be a crucial target of psychological intervention for returning veterans with PTSD symptoms and deployment-related injuries.
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Affiliation(s)
- Sharon Y Lee
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Lucy Finkelstein-Fox
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Carolyn M Mazure
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Women's Health Research at Yale, New Haven, CT, USA
| | | | - Rani Hoff
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Women's Health Research at Yale, New Haven, CT, USA.,VISN1 MIRECC, VA Connecticut Healthcare System, New Haven, CT, USA
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30
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Hansen C, McFarlane A, Iannos M, Sadler N, Benassi H, Lawrence-Wood E, Hodson S, Searle A, Van Hooff M. Psychosocial factors associated with psychological distress and functional difficulties in recently transitioned and current serving regular Australian Defence Force members. Psychiatry Res 2020; 286:112860. [PMID: 32065981 DOI: 10.1016/j.psychres.2020.112860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 02/07/2020] [Accepted: 02/08/2020] [Indexed: 11/19/2022]
Abstract
The transition period from military-to-civilian life can be one of the most significant and stressful periods in the military life cycle. We explore the psychosocial factors associated with psychological distress and functional impairment among those who recently transitioned from the Australian Defence Force (ADF) and those currently serving in 2015. Using data from the Transition and Wellbeing Research Programme, multinomial logistic regression models were used to analyze the associations between a combined measure of psychological distress and functional impairment (K10/SDS) with various psychosocial, lifestyle, and physical health factors. There were 10,210 in the final analytic cohort (Transitioned=3,254; Regular 2015 ADF=6,956). Overall, the odds of belonging to the highly distressed/impaired group were greatest among those with insomnia (Odds Ratio 18.53), low resilience (OR 7.67), physical health symptoms (OR 7.16), and alcohol risk (OR 4.67). Other factors included pain (OR 3.36), financial issues (OR 2.38), and social strain (OR 1.98). The associations with insomnia and physical health symptoms were stronger among the Transitioned compared to the Regular 2015 ADF. Results of this research highlights the importance of taking a multi-dimensional perspective of symptoms in military populations, particularly in those recently transitioned from permanent service, as predictors of future risk of disorder.
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Affiliation(s)
- Craig Hansen
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia.
| | - Alexander McFarlane
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Marie Iannos
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Nicole Sadler
- Department of Defence, Canberra, Australia; Phoenix Australia, Centre for Posttraumatic Mental Health, Melbourne, Australia
| | - Helen Benassi
- Department of Defence, Canberra, Australia; Australian National University, Canberra, Australia
| | - Ellie Lawrence-Wood
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | | | - Amelia Searle
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
| | - Miranda Van Hooff
- Centre for Traumatic Stress Studies, University of Adelaide, South Australia, Australia
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The Association Between Pain Trajectories With Posttraumatic Stress Disorder, Depression, and Disability During the Acute Posttrauma Period. Psychosom Med 2020; 82:862-868. [PMID: 33156263 PMCID: PMC7665839 DOI: 10.1097/psy.0000000000000866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Exposure to a traumatic event is common among US adults, yet only a small fraction develops posttraumatic stress disorder (PTSD). Higher pain after a traumatic injury has been associated with higher PTSD symptoms and thus may be a risk factor. However, few studies have examined how pain during the period immediately after a trauma, referred to as the acute posttrauma period, relates later to PTSD outcomes. METHODS A sample of (n = 87) individuals who had experienced a traumatic injury assessed their pain through daily mobile assessments for the first month after injury. PTSD, depression, and functional impairment were assessed at the time of trauma and 1 and 3 months later. RESULTS Using latent class growth analysis, three trajectories of pain were identified: low pain (41.3%), decreasing pain (43.7%), and high pain (14.9%). At baseline, the high-pain class reported higher levels of depression and functional impairment than did the low-pain group. From baseline to 3 months, the low-pain class experienced a reduction in PTSD, depression, and functional impairment, whereas the high-pain class experienced an increase in PTSD symptoms, persistent depression, and functional impairment. CONCLUSIONS These results demonstrate that there are distinct trajectories of pain after a traumatic injury. Persistent elevated pain is associated with more severe psychopathology in the period immediately after a traumatic injury.
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32
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Attentional bias and its temporal dynamics among war veterans suffering from chronic pain: Investigating the contribution of post-traumatic stress symptoms. J Anxiety Disord 2019; 66:102115. [PMID: 31394483 DOI: 10.1016/j.janxdis.2019.102115] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 07/01/2019] [Accepted: 07/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cognitive models propose that attentional dysregulation, including an attentional bias towards threat, is one of the factors through which chronic pain and post-traumatic stress symptoms (PTSS) maintain and exacerbate one another. The current investigation assessed the attentional bias for painful facial expressions and its relationship with PTSS, using both traditional and variability-based attentional bias measures, among veterans with chronic pain and PTSS and controls. METHOD Fifty-four veterans with chronic pain and 30 age/education-matched controls participated in this investigation. Participants completed a self-report measure of PTSS and a modified version of the dot-probe task with painful, happy, and neutral facial expressions. Attention was assessed using both traditional and variability-based reaction time measures of attentional bias. RESULTS Veterans directed attention away from painful facial expressions (i.e., avoidance) relative to both the control group (between-subject effect) and relative to neutral faces (within-subject effect). Veterans also showed significantly elevated attentional bias variability for both happy and painful facial expressions compared to controls. Attentional bias variability for happy and painful facial expressions was correlated with PTSS among all participants. CONCLUSION Veterans with chronic pain and PTSS avoided pain-related stimuli and displayed an overall attentional dysregulation for emotional facial expressions. Avoidance of pain cues may be a coping strategy that these individuals develop under stressful conditions. Implications, limitations, and directions for future research are discussed.
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33
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Morris MC, Bailey B, Ruiz E. Pain in the Acute Aftermath of Stalking: Associations With Posttraumatic Stress Symptoms, Depressive Symptoms, and Posttraumatic Cognitions. Violence Against Women 2019; 26:1343-1361. [PMID: 31359841 DOI: 10.1177/1077801219857829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This longitudinal study examined whether posttraumatic stress and depressive symptoms, posttraumatic cognitions, and ongoing cyberstalking exposures were independently associated with changes in pain outcomes among 82 young adult women with recent exposure to stalking. Multilevel models indicated that higher sensory pain intensity and pain-related interference were associated with more negative cognitions about the self. Higher affective pain intensity was associated with higher posttraumatic stress and depressive symptoms. Cyberstalking exposures were not associated with pain intensity or pain-related interference. Results reveal persistent pain complaints in recent stalking victims and highlight distinct psychological risk factors for pain intensity and pain-related interference.
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34
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Bakker GM. A new conception and subsequent taxonomy of clinical psychological problems. BMC Psychol 2019; 7:46. [PMID: 31291999 PMCID: PMC6617608 DOI: 10.1186/s40359-019-0318-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A taxonomy of the objects of study, theory, assessment, and intervention is critical to the development of all clinical sciences. Clinical psychology has been conceptually and administratively dominated by the taxonomy of an adjacent discipline - psychiatry's Diagnostic and statistical manual of mental disorders (DSM). Many have called for a 'paradigm shift' away from a medical nosology of diseases toward clinical psychology's own taxonomy of clinical psychological problems (CPPs), without being able to specify what is to be listed and classified. MAIN TEXT An examination of DSM's problems for clinical psychology, especially its lack of clinical utility, and a search for the essence of CPPs in what clinical psychologists actually do, leads to the proposal that: The critical psychological-level phenomenon underlying CPPs is the occurrence of 'problem-maintaining circles' (PMCs) of causally related cognitions, emotions, behaviours, and/or stimuli. This concept provides an empirically-derived, theory-based, treatment-relevant, categorical, essentialist, parsimonious, and nonstigmatizing definition of CPPs. It distinguishes psychological problems in which PMCs have not (yet?) formed, and which may respond to 'counseling', clinical psychological problems in which active PMCs require clinical intervention, and psychopathological problems which are unlikely to be 'cured' by PMC-breaking alone. CONCLUSION A subsequent classification and coding system of PMCs is proposed, and expected benefits to research, communication, and the quality of case formulation in clinical psychology are described, reliant upon a development effort of some meaningful fraction of that which has been devoted to the DSM.
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Affiliation(s)
- Gary M Bakker
- School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tasmania, 7250, Australia.
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35
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36
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Curry I, Malaktaris AL, Lyons R, Herbert MS, Norman SB. The Association Between Negative Trauma-Related Cognitions and Pain-Related Functional Status Among Veterans With Posttraumatic Stress Disorder and Alcohol Use Disorder. J Trauma Stress 2019; 32:317-322. [PMID: 30913347 PMCID: PMC6476639 DOI: 10.1002/jts.22394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/06/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022]
Abstract
Among veterans with posttraumatic stress disorder (PTSD), alcohol use disorders (AUDs) are highly prevalent. Furthermore, PTSD frequently co-occurs with chronic pain (CP), and CP is associated with an increased risk of AUD. Pain-related beliefs and appraisals are significantly associated with poorer pain-related functional status, yet few studies have examined negative trauma-related cognitions and their impact on pain-related functional disability in veterans with co-occurring PTSD and AUD. Accordingly, we examined the association between negative trauma-related cognitions and pain severity and pain disability in 137 veterans seeking treatment for PTSD and AUD. Using hierarchical multiple linear regression, we found that higher levels of negative trauma-related cognitions (e.g., "I am completely incompetent") were associated with a higher level of pain severity, after controlling for PTSD symptom severity and frequency of alcohol use, total R2 = .07, ΔR2 = .06. Additionally, as hypothesized, we found that higher levels of negative trauma-related cognitions were associated with higher levels of pain disability, after controlling for PTSD symptom severity, frequency of alcohol use, and pain severity, total R2 = .46, ΔR2 = .03. Given that negative trauma-related cognitions contributed to pain severity and pain disability, even when controlling for PTSD severity and frequency of alcohol use, future studies should explore the potential impact of interventions that address negative trauma-related cognitions (e.g., prolonged exposure or cognitive processing therapy) on pain severity and disability.
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Affiliation(s)
- Inga Curry
- VA San Diego Healthcare System, La Jolla, California, USA
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Anne L Malaktaris
- VA San Diego Healthcare System, La Jolla, California, USA
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
- Center of Excellence for Stress and Mental Health/VA San Diego Healthcare System, San Diego, California, USA
| | - Robert Lyons
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, La Jolla, California, USA
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
- Center of Excellence for Stress and Mental Health/VA San Diego Healthcare System, San Diego, California, USA
| | - Sonya B Norman
- VA San Diego Healthcare System, La Jolla, California, USA
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
- Center of Excellence for Stress and Mental Health/VA San Diego Healthcare System, San Diego, California, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
- National Center for PTSD, White River Junction, Vermont, USA
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Do post-traumatic pain and post-traumatic stress symptomatology mutually maintain each other? A systematic review of cross-lagged studies. Pain 2019; 159:2159-2169. [PMID: 29994992 DOI: 10.1097/j.pain.0000000000001331] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
After traumatic exposure, individuals are at risk of developing symptoms of both pain and post-traumatic stress disorder (PTSD). Theory and research suggest a complex and potentially mutually maintaining relationship between these symptomatologies. However, findings are inconsistent and the applied methods are not always well suited for testing mutual maintenance. Cross-lagged designs can provide valuable insights into such temporal associations, but there is a need for a systematic review to assist clinicians and researchers in understanding the nature of the relationship. Thus, the aim of this systematic review was to identify, critically appraise, and synthesize results from cross-lagged studies on pain and PTSD symptomatology to assess the evidence for longitudinal reciprocity and potential mediators. Systematic searches resulted in 7 eligible studies that were deemed of acceptable quality with moderate risk of bias using the cohort study checklist from Scottish Intercollegiate Guidelines Network. Furthermore, synthesis of significant pathways in the cross-lagged models showed inconsistent evidence of both bidirectional and unidirectional interaction patterns between pain and PTSD symptomatology across time, hence not uniformly supporting the theoretical framework of mutual maintenance. In addition, the synthesis suggested that hyperarousal and intrusion symptoms may be of particular importance in these cross-lagged relationships, while there was inconclusive evidence of catastrophizing as a mediator. In conclusion, the findings suggest an entangled, but not necessarily mutually maintaining relationship between pain and PTSD symptomatology. However, major variations in findings and methodologies complicated synthesis, prompting careful interpretation and heightening the likelihood that future high-quality studies will change these conclusions.
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Pedras S, Preto I, Carvalho R, Graça Pereira M. Traumatic stress symptoms following a lower limb amputation in diabetic patients: a longitudinal study. Psychol Health 2019; 34:535-549. [PMID: 30632805 DOI: 10.1080/08870446.2018.1545907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Limited research has focussed on the development of traumatic stress symptoms following an amputation due to a chronic disease such as Diabetes. This study analysed whether coping strategies, anxiety and depression symptoms, sociodemographic and clinical variables were related to traumatic stress symptoms in a sample of patients who had undergone a lower limb amputation. DESIGN A longitudinal design with three assessments, one month (T1), six (T2) and ten months after an amputation surgery (T3), included 144 patients. MAIN OUTCOME MEASURES IES-R, WOC and HADS. RESULTS Traumatic stress symptoms were prevalent at T1 (M = 15.65, SD = 15.40) and probable PTSD was observed in 13.9% patients. Presence of pain, high level of anxiety symptoms and emotion-focused strategies contributed to traumatic stress symptoms, and the period between T1 and T2, was critical. Six to ten months (Λ = 0.871, F (2,84) =6.245, p=. 003), after surgery, symptoms tended to decrease 0.122 units (SE = 0.032, p = 0.002) per assessment. CONCLUSIONS Findings raise awareness to the need of urgent identification of traumatic stress symptoms in medically ill patients who underwent a lower limb amputation, given the prevalence of traumatic stress symptoms right after surgery and in the following six months.
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Affiliation(s)
- Susana Pedras
- a School of Psychology , University of Minho , Braga , Portugal
| | - Isabel Preto
- b Faculty of Engineering , University of Porto , Porto , Portugal
| | | | - M Graça Pereira
- a School of Psychology , University of Minho , Braga , Portugal
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Morina N, Kuenburg A, Schnyder U, Bryant RA, Nickerson A, Schick M. The Association of Post-traumatic and Postmigration Stress with Pain and Other Somatic Symptoms: An Explorative Analysis in Traumatized Refugees and Asylum Seekers. PAIN MEDICINE 2019; 19:50-59. [PMID: 28340069 DOI: 10.1093/pm/pnx005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objective Post-traumatic stress disorder (PTSD) and somatic symptoms, such as pain, are frequently seen in refugees. Their relationship is poorly understood, and the treatment of these comorbid conditions can be very challenging. The current cross-sectional study examined pain and other somatic symptoms and their relationship with trauma history, PTSD symptom clusters, and current living difficulties among treatment-seeking refugees. Methods One hundred thirty-four treatment-seeking traumatized refugees (78% male, mean age = 42 years) were assessed regarding lifetime traumatic experiences, symptoms of post-traumatic stress, overall pain and somatic symptoms, and postmigration living difficulties. Results An exploratory factor analysis of the 12 somatic symptoms revealed two distinct factors: somatic symptoms related to bodily dysfunction ("weakness") and somatic symptoms related to increased sympathetic activity ("arousal"). DSM-5 PTSD Criteria D "alterations in cognitions and mood" and E "alterations in arousal and reactivity" were primarily related to "weakness," while PTSD Criterion E "alterations in arousal and reactivity" and postmigration living difficulties were associated with "arousal." Overall pain was associated primarily with living difficulties and PTSD Criterion D and Criterion E. Conclusions Results indicate that somatic symptoms are of considerable concern among traumatized refugees and that different patterns of somatic symptoms are associated with different clusters of PTSD symptoms. The findings contribute to the better understanding of the symptom presentation of traumatized people who are experiencing somatization and potentially inform treatment directions and highlight the importance of screening for PTSD in refugees presenting with pain and somatic symptoms.
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Affiliation(s)
- Naser Morina
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alexa Kuenburg
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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40
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Elman I, Upadhyay J, Langleben DD, Albanese M, Becerra L, Borsook D. Reward and aversion processing in patients with post-traumatic stress disorder: functional neuroimaging with visual and thermal stimuli. Transl Psychiatry 2018; 8:240. [PMID: 30389908 PMCID: PMC6214971 DOI: 10.1038/s41398-018-0292-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/27/2018] [Accepted: 09/26/2018] [Indexed: 12/12/2022] Open
Abstract
In patients with post-traumatic stress disorder (PTSD), a decrease in the brain reward function was reported in behavioral- and in neuroimaging studies. While pathophysiological mechanisms underlying this response are unclear, there are several lines of evidence suggesting over-recruitment of the brain reward regions by aversive stimuli rendering them unavailable to respond to reward-related content. The purpose of this study was to juxtapose brain responses to functional neuroimaging probes that reliably produce rewarding and aversive experiences in PTSD subjects and in healthy controls. The stimuli used were pleasant, aversive and neutral images selected from the International Affective Picture System (IAPS) along with pain-inducing heat applied to the dorsum of the left hand; all were administered during 3 T functional magnetic resonance imaging. Analyses of IAPS responses for the pleasant images revealed significantly decreased subjective ratings and brain activations in PTSD subjects that included striatum and medial prefrontal-, parietal- and temporal cortices. For the aversive images, decreased activations were observed in the amygdala and in the thalamus. PTSD and healthy subjects provided similar subjective ratings of thermal sensory thresholds and each of the temperatures. When 46 °C (hot) and 42 °C (neutral) temperatures were contrasted, voxelwise between-group comparison revealed greater activations in the striatum, amygdala, hippocampus and medial prefrontal cortex in the PTSD subjects. These latter findings were for the most part mirrored by the 44 vs. 42 °C contrast. Our data suggest different brain alterations patterns in PTSD, namely relatively diminished corticolimbic response to pleasant and aversive psychosocial stimuli in the face of exaggerated response to heat-related pain. The present findings support the hypothesis that brain sensitization to pain in PTSD may interfere with the processing of psychosocial stimuli whether they are of rewarding or aversive valence.
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Affiliation(s)
- Igor Elman
- Department of Psychiatry, Cooper Medical School, Rowan University, Glassboro, NJ, USA.
| | - Jaymin Upadhyay
- 000000041936754Xgrid.38142.3cCenter for Pain and the Brain, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Daniel D. Langleben
- 0000 0004 1936 8972grid.25879.31Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Mark Albanese
- 000000041936754Xgrid.38142.3cCambridge Health Alliance, Harvard Medical School, Boston, MA USA
| | - Lino Becerra
- 000000041936754Xgrid.38142.3cCenter for Pain and the Brain, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - David Borsook
- 000000041936754Xgrid.38142.3cCenter for Pain and the Brain, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
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Hass-Cohen N, Bokoch R, Clyde Findlay J, Banford Witting A. A four-drawing art therapy trauma and resiliency protocol study. ARTS IN PSYCHOTHERAPY 2018. [DOI: 10.1016/j.aip.2018.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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42
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Nelson S, Conroy C, Logan D. The biopsychosocial model of pain in the context of pediatric burn injuries. Eur J Pain 2018; 23:421-434. [PMID: 30288844 DOI: 10.1002/ejp.1319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Burns are a common and traumatic source of childhood injury in the United States. The treatment and recovery from burn injuries can be significantly painful and may lead to chronic or persistent pain for years following the initial incident. Further, burn injuries in youth have been found to increase the potential for significant psychosocial (e.g., anxiety, depression, PTSD) and physical (e.g., decreased mobility) impairment. Relatedly, the general experience and processing of pain in youth can also be associated with greater psychosocial (e.g., anxiety, depression) impairment and functional disability over time. However, the phenomenology and associated characteristics of the pain experience following burn injury and, in particular, the potential for combined impact on physical and psychosocial outcomes in youth with severe and/or prolonged pain and a history of burn injury is poorly understood. METHODS A review of the literature was performed in the areas of burn injuries and outcomes associated with both acute and chronic pain with youth and adult populations. RESULTS The current review highlights current gaps in the literature in important areas of function in youth with a history of burn injuries using the biopsychosocial model of pain. Future research and considerations for practice are also outlined. CONCLUSIONS Gaining a greater understanding of the relationship between pain, physical impairment, and psychosocial functioning in these youth is significantly important in order to provide greater preventative and treatment-related intervention going forward. SIGNIFICANCE Using a biopsychosocial framework, this review highlights the need for a greater understanding of pain processing and the long-term potential for persistent pain and pain-related impairment (e.g., functional disability) in youth with a history of burn injuries.
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Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Conroy
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Mayo Clinic Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, Massachusetts
| | - Deirdre Logan
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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43
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Garfin DR, Thompson RR, Holman EA. Acute stress and subsequent health outcomes: A systematic review. J Psychosom Res 2018; 112:107-113. [PMID: 30097129 DOI: 10.1016/j.jpsychores.2018.05.017] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 05/13/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To systematically review the relationship between acute posttraumatic stress symptoms (<1 month) and subsequent physical and mental health outcomes other than posttraumatic stress disorder (PTSD). METHODS A systematic search of electronic databases (PubMed, PsycINFO, CINAHL, and Web of Science) was conducted to identify longitudinal studies examining the link between acute posttraumatic stress and physical and mental health. Inclusion criteria required assessment of acute posttraumatic stress (<1 month post-event) and at least one follow-up assessment of a physical or mental health outcome (not PTSD). RESULTS 1,051 articles were screened; 22 met inclusion criteria. Fourteen studies examined physical health outcomes and 12 examined non-PTSD mental health outcomes. Early psychological responses to trauma were associated with a variety of short- (<1 year) and long- (≥1 year) term physical and mental health outcomes. Physical health outcomes included poor general physical health, increased pain and disability, lower quality of life, and higher risk of all-cause mortality. Significant psychological outcomes included more cumulative psychiatric disorders, depression, and anxiety. Significant psychosocial outcomes included increased family conflict. CONCLUSIONS Methodologically rigorous longitudinal studies support the utility of measuring acute psychological responses to traumatic events as they may be an important marker of preventable trauma-related morbidity and mortality that warrants long-term monitoring and/or early intervention.
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44
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Akhtar E, Ballew AT, Orr WN, Mayorga A, Khan TW. The Prevalence of Post-Traumatic Stress Disorder Symptoms in Chronic Pain Patients in a Tertiary Care Setting: A Cross-Sectional Study. PSYCHOSOMATICS 2018; 60:255-262. [PMID: 30143327 DOI: 10.1016/j.psym.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/20/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is limited research regarding the prevalence of post-traumatic stress disorder (PTSD) in civilian multidisciplinary pain clinics. Controlled studies have only examined specific patient populations, such as those with motor vehicle accidents, war veterans, work-related injuries, back pain, and headache. OBJECTIVE The purpose of this study was to estimate the prevalence of PTSD symptoms in patients with chronic pain at a large multidisciplinary pain clinic. METHODS Three hundred consecutive new or newly referred patients with a self-reported history of chronic pain were recruited to complete an in-person screen for PTSD symptoms, which included the Brief Trauma Questionnaire and the PTSD Symptom-Scale Self-Report. Two hundred and sixty-five were eligible for the study. RESULTS Seventy-four (28%) screened positive for PTSD symptoms, a value higher than the lifetime prevalence of PTSD in the general population (6.8%). Those who screened positive for PTSD symptoms were significantly younger (p = 0.007) and had higher levels of pain intensity (p = 0.0005) compared to those who screened negative for PTSD symptoms. CONCLUSIONS The prevalence of PTSD symptoms in our chronic pain population (28%) exceeded the prevalence of PTSD in the general population (7%). Patients with chronic pain who screened positive for PTSD reported higher pain severity and were younger. This emphasizes the need for PTSD screening in the chronic pain population, as early identification and treatment may be effective in reducing the mounting health care costs and disease burden of comorbid chronic pain and PTSD.
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Affiliation(s)
- Eeman Akhtar
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS
| | - Angela T Ballew
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS.
| | - Walter N Orr
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
| | - Angela Mayorga
- Department of Psychiatry and Behavioral Sciences, University of Kansas Medical Center, Kansas City, KS
| | - Talal W Khan
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS
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45
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Price M, van Stolk-Cooke K, Brier ZMF, Legrand AC. mHealth solutions for early interventions after trauma: improvements and considerations for assessment and intervention throughout the acute post-trauma period. Mhealth 2018; 4:22. [PMID: 30148137 PMCID: PMC6087875 DOI: 10.21037/mhealth.2018.06.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/08/2018] [Indexed: 12/14/2022] Open
Abstract
Interventions administered shortly after a traumatic event have the potential to prevent posttraumatic stress disorder (PTSD) and related mental health conditions. A key challenge in delivering such interventions is understanding how PTSD symptoms develop in the acute post-trauma period, defined as the first 30 days after a trauma. Mobile devices have the potential to transform the way symptoms are assessed and how treatment is delivered in that they can capture the dynamic and nuanced nature of symptom progression after trauma. Symptoms can be assessed through active strategies that require user input, such as self-report, or through passive strategies, such as location information. Adaptive mobile interventions can be tailored to target PTSD symptoms as they appear and ultimately prevent more chronic courses of illness. Considerations for how such mobile strategies should be implemented are discussed.
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Affiliation(s)
- Matthew Price
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Katherine van Stolk-Cooke
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Zoe M F Brier
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Alison C Legrand
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, Burlington, VT, USA
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46
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Early psychological interventions for posttraumatic stress, depression and anxiety after traumatic injury: A systematic review and meta-analysis. Clin Psychol Rev 2018; 62:11-36. [DOI: 10.1016/j.cpr.2018.05.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 02/27/2018] [Accepted: 05/03/2018] [Indexed: 12/22/2022]
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47
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Kao GS, Bhandari RP, Huestis SE, Golianu B. Traumatic Stress and Pediatric Pain: Towards a Neurobiological Stress-Health Perspective. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:249-255. [PMID: 32318154 PMCID: PMC7163901 DOI: 10.1007/s40653-017-0145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This theoretical review aims to present the limited findings on traumatic stress and pain in children and adolescents, highlight recent discoveries regarding neurobiological processes, and suggest an alternative stress-health perspective in the future study and conceptualization of pediatric pain and traumatic stress based on results. Current literature highlights a positive correlation between pain and trauma symptoms in youth and suggests a complex relationship that may have mutually maintaining dynamics and intertwined physiological processes. Developmentally sensitive, longitudinal, process-oriented designs assessing neurobiological alterations and stress responses should be utilized in the examination of the trauma-pain relationship. Such investigations may provide a more unified explanation of the relationship between chronic pain and traumatic stress.
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Affiliation(s)
- Grace S. Kao
- Stanford Children’s Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
- Departments of Pediatrics and Anesthesiology, Perioperative and Pain Medicine, Baylor College of Medicine, Houston, TX USA
- Texas Children’s Hospital, 6621 Fannin St., #A3300, Houston, TX 77030 USA
| | - Rashmi Parekh Bhandari
- Stanford Children’s Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Samantha E. Huestis
- Stanford Children’s Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
| | - Brenda Golianu
- Stanford Children’s Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA USA
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48
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Morina N, Schnyder U, Klaghofer R, Müller J, Martin-Soelch C. Trauma exposure and the mediating role of posttraumatic stress on somatic symptoms in civilian war victims. BMC Psychiatry 2018; 18:92. [PMID: 29631551 PMCID: PMC5891991 DOI: 10.1186/s12888-018-1680-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 03/27/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It has been well documented that the exposure to war has a negative effect on the psychological health of civilian. However, little is known on the impact of war exposure on the physical health of the civilian population. In addition, the link between trauma exposure and somatic symptoms remain poorly understood. This cross-sectional study examined levels of somatic symptoms in the aftermath of war, and the mediating role of posttraumatic stress symptoms in the relationship between trauma exposure and somatic symptoms. METHODS Civilian war survivors (N = 142) from Kosovo were assessed for potentially traumatic events, posttraumatic stress symptoms, and somatic symptoms. Data were analyzed using mediation analyses. Posttraumatic stress disorder (PTSD) symptoms were categorized based on King's four factor model (Psychol Assessment. 10: 90-96, 1998). RESULTS Participants reported on average more than 5 types of traumatic exposure. The cut-off indicative for PTSD was exceeded by 26.1% of participants. Symptom levels of PTSD were associated with somatic symptoms. The relationship between trauma exposure and somatic symptoms was partly mediated by the active avoidance and hyperarousal symptom clusters of PTSD. CONCLUSION Active avoidance and hyperarousal symptoms seem to play a key role in traumatized people suffering from somatic symptoms.
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Affiliation(s)
- Naser Morina
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland.
| | - Ulrich Schnyder
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Culmannstrasse 8, 8091 Zurich, Switzerland
| | - Richard Klaghofer
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Culmannstrasse 8, 8091 Zurich, Switzerland
| | - Julia Müller
- Psychiatric Services Thurgau, 8596 Münsterlingen, Switzerland ,0000 0004 0523 5263grid.21604.31Paracelsus Medical University, Salzburg, Austria
| | - Chantal Martin-Soelch
- 0000 0004 0478 1713grid.8534.aDivision of Clinical and Health Psychology, Department of Psychology, University of Fribourg, 1700 Fribourg, Switzerland
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49
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Berghoff CR, McDermott MJ, Dixon-Gordon KL. Psychological flexibility moderates the relation between PTSD symptoms and daily pain interference. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Fishbain DA, Pulikal A, Lewis JE, Gao J. Chronic Pain Types Differ in Their Reported Prevalence of Post -Traumatic Stress Disorder (PTSD) and There Is Consistent Evidence That Chronic Pain Is Associated with PTSD: An Evidence-Based Structured Systematic Review. PAIN MEDICINE 2018; 18:711-735. [PMID: 27188666 DOI: 10.1093/pm/pnw065] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objectives The hypotheses of this systematic review were the following: 1) Prevalence of post-traumatic stress disorder (PTSD) will differ between various types of chronic pain (CP), and 2) there will be consistent evidence that CP is associated with PTSD. Methods Of 477 studies, 40 fulfilled the inclusion/exclusion criteria of this review and were grouped according to the type of CP. The reported prevalence of PTSD for each grouping was determined by aggregating all the patients in all the studies in that group. Additionally all patients in all groupings were combined. Percentage of studies that had found an association between CP and PTSD was determined. The consistency of the evidence represented by the percentage of studies finding an association was rated according to the Agency for Health Care Policy and Research guidelines. Results Grouping PTSD prevalence differed ranging from a low of 0.69% for chronic low back pain to a high of 50.1% in veterans. Prevalence in the general population with CP was 9.8%. Of 19 studies, 16 had found an association between CP and PTSD (84.2%) generating an A consistency rating (consistent multiple studies). Three of the groupings had an A or B (generally consistent) rating. The veterans grouping received a C (finding inconsistent) rating. Conclusion The results of this systematic review confirmed the hypotheses of this review.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine at the University of Miami, Florida, USA.,Neurological Surgery, Miller School of Medicine at the University of Miami, Florida, USA,Anesthesiology, Miller School of Medicine at the University of Miami, Florida, USA.,Department of Psychiatry, Miami VA Medical Center, Miami, Florida, USA.,State Farm Insurance Bloomington, Illinois, USA
| | - Aditya Pulikal
- Department of Psychiatry, Miller School of Medicine at the University of Miami, Florida, USA
| | - John E Lewis
- Department of Psychiatry, Miller School of Medicine at the University of Miami, Florida, USA
| | - Jinrun Gao
- State Farm Insurance Bloomington, Illinois, USA
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