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.
Highlights
A burn injury is associated with substantial pain and patients with burns are at risk of developing posttraumatic stress disorder (PTSD) as a result of being exposed to a traumatic event (Richardson and Mustard, 2009; Hobbs, 2015)
This study investigated the relationship between PTSD symptom clusters and pain in a sample of patients with burns
The level of acute pain was a predictor of later chronic pain
Summary
A burn injury is associated with substantial pain and patients with burns are at risk of developing posttraumatic stress disorder (PTSD) as a result of being exposed to a traumatic event (Richardson and Mustard, 2009; Hobbs, 2015). PTSD is prevalent in ∼10% of patients who were admitted to a burn center and an additional 15% of burn survivors experience subclinical PTSD symptoms 1–4 years later (Dyster-Aas et al, 2008; Van Loey et al, 2008). Both pain and PTSD affect functioning up to 2 years post-burn (Corry et al, 2010). While the exact nature of the relationship between pain and PTSD symptoms is still largely unknown, there are several theories on how the concepts might be associated. Sharp and Harvey (2001) proposed the Mutual Maintenance Model of PTSD and pain
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