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Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms

Published online by Cambridge University Press:  08 October 2009

A. Liedl ,
M. O'Donnell ,
M. Creamer ,
D. Silove ,
A. McFarlane ,
C. Knaevelsrud  and
R. A. Bryant
A. Liedl*
Affiliation:
Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany Treatment Centre for Torture Victims, Berlin, Germany
M. O'Donnell
Affiliation:
Australian Centre for Posttraumatic Mental Health, Melbourne, Australia Department of Psychiatry, University of Melbourne, Australia National Trauma Research Institute, Melbourne, Australia
M. Creamer
Affiliation:
Australian Centre for Posttraumatic Mental Health, Melbourne, Australia Department of Psychiatry, University of Melbourne, Australia
D. Silove
Affiliation:
University of New South Wales, Sydney, Australia
A. McFarlane
Affiliation:
The Centre of Military and Veterans' Health, Adelaide, Australia
C. Knaevelsrud
Affiliation:
Treatment Centre for Torture Victims, Berlin, Germany Free University of Berlin, Germany
R. A. Bryant
Affiliation:
University of New South Wales, Sydney, Australia
*
*Address for correspondence: A. Liedl, Treatment Centre for Torture Victims Berlin (bzfo), Research Department, Turmstrasse 21, 10559Berlin, Germany. (Email: a.liedl@bzfo.de)
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Abstract

Background

Pain and post-traumatic stress disorder (PTSD) are frequently co-morbid in the aftermath of a traumatic event. Although several models attempt to explain the relationship between these two disorders, the mechanisms underlying the relationship remain unclear. The aim of this study was to investigate the relationship between each PTSD symptom cluster and pain over the course of post-traumatic adjustment.

Method

In a longitudinal study, injury patients (n=824) were assessed within 1 week post-injury, and then at 3 and 12 months. Pain was measured using a 100-mm Visual Analogue Scale (VAS). PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS). Structural equation modelling (SEM) was used to identify causal relationships between pain and PTSD.

Results

In a saturated model we found that the relationship between acute pain and 12-month pain was mediated by arousal symptoms at 3 months. We also found that the relationship between baseline arousal and re-experiencing symptoms, and later 12-month arousal and re-experiencing symptoms, was mediated by 3-month pain levels. The final model showed a good fit [χ2=16.97, df=12, p>0.05, Comparative Fit Index (CFI)=0.999, root mean square error of approximation (RMSEA)=0.022].

Conclusions

These findings provide evidence of mutual maintenance between pain and PTSD.

Keywords

Mediatormutual maintenancepainpost-traumatic stress disorderstructural equation modelling
Type
Original Articles
Information
Psychological Medicine , Volume 40 , Issue 7 , July 2010 , pp. 1215 - 1223
Copyright
Copyright © Cambridge University Press 2009

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