Background & Aims

PTSD symptoms are associated with nervous system dysregulation, including greater incidence of chronic pain. However, this relationship is less well understood for acute pain (1-2 months) following orthopedic traumatic injuries. We examined which PTSD symptoms anchored to orthopedic traumatic injury were associated with acute pain and physical dysfunction. In exploratory analyses, we examined factors accounting for the association between PTSD symptoms and physical dysfunction.

Methods

This secondary analysis used baseline data from a multisite trial of an intervention for individuals with heightened pain-related distress following acute orthopedic injury. We examined unique associations between PTSD symptom clusters (re-experiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal) and pain outcomes (pain intensity and physical dysfunction) in hierarchical regressions. In exploratory analyses, we examined the indirect effects of PTSD symptoms on physical dysfunction through catastrophizing, pain intensity, and depression.

Results

Hierarchical linear regressions indicated that hyperarousal was uniquely associated with greater pain intensity (? = .39 , p <.001, ?R2 =.06) and physical dysfunction (? = .22 , p = .04 ?R2 =.02). PTSD symptoms were still associated with pain outcomes even with pain catastrophizing included in the models, and catastrophizing did not have a significant indirect effect on the relationship between PTSD and physical dysfunction (b=.06, SEBoot=.04, 95% CIBoot=[-.003, .14]), whereas the combination of pain intensity and depression did fully account for the association between PTSD symptoms and physical dysfunction.

Conclusions

Catastrophizing alone may not fully explain the relationship between PTSD symptoms and pain outcomes after acute orthopedic injury. Interventions for acute orthopedic pain may benefit from the incorporation of techniques to target PTSD symptoms, especially hyperarousal, and co-occurring depression.

References

Andersen TE, Karstoft KI, Brink O, Elklit A. Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury – A prospective cohort study. Eur J Pain Lond Engl. 2016;20(8):1241-1252. doi:10.1002/ejp.848

Pacella-LaBarbara ML, Plaitano EG, Suffoletto BP, et al. A longitudinal assessment of posttraumatic stress symptoms and pain catastrophizing after injury. Rehabil Psychol. 2023;68(1):32-42. doi:10.1037/rep0000481

Rosenbloom BN, Katz J, Chin KYW, et al. Predicting pain outcomes after traumatic musculoskeletal injury. Pain. 2016;157(8):1733-1743. doi:10.1097/j.pain.0000000000000580

Scott KM, Koenen KC, Aguilar-Gaxiola S, et al. Associations between lifetime traumatic events and subsequent chronic physical conditions: a cross-national, cross-sectional study. PloS One. 2013;8(11):e80573. doi:10.1371/journal.pone.0080573

Presenting Author

Katherine McDermott

Poster Authors

Katherine McDermott

PhD

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

Christina Rush

PhD

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

Tony Pham

MD

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

Julia Hooker

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

Courtney Louis

MS

Massachusetts General Hospital

Lead Author

E-mail

Elizabeth Rochon

BA

Massachusetts General Hospital

Lead Author

E-mail

Ana-Maria Vranceanu

Massachusetts General Hospital/Harvard Medical School

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Post-surgical/Post-traumatic Chronic Pain