The Association Between Acute Pain and Posttraumatic Stress Symptoms in Children and Adolescents 3\xa0Months After Accidental Injury

Martha A. Grootenhuis,Maj R. Gigengack,Frits Boer,Eva Verlinden,Ramón J. L. Lindauer,Els P. M. van Meijel,J. Carel Goslings,Alida F. W. van der Steeg,Frank W. Bloemers,Jan S. K. Luitse

doi:10.1007/s10880-018-9567-6

Abstract

Previous research suggests that acute pain is a risk factor for later posttraumatic stress symptoms (PTSS). In a prospective cohort study, we examined the association between acute pain from accidental injury and PTSS in children and adolescents, taking into account factors potentially related to pain or posttraumatic stress. Participants were 135 children and adolescents, 8–18 years old. We measured the worst experienced pain since the accident took place with a visual analogue scale. Three months after the accident, posttraumatic stress was assessed with a self-report measure. We found a positive association between acute pain and posttraumatic stress. The amount of pain was negatively associated with injury severity in girls and positively associated with the presence of an extremity fracture in boys. In children who reported severe pain, this pain was significantly associated with PTSS and may account for around 10% of the variance in the severity of PTSS. Although the experience of pain is subjective, our study indicates that severe pain is associated with the severity of later PTSS. Timely management of pain according to acute pain protocols in all phases and disciplines after accidental injury is therefore recommended.

Highlights

Every year, many children and adolescents are injured in accidents and they are often treated in the trauma resuscitation room of the Emergency Department
We found no significant differences between boys and girls, except on the severity of posttraumatic stress: girls had a higher Children’s Revised Impact of Event Scale (CRIES) score than boys
Girls generally have a greater risk for posttraumatic stress disorder (PTSD) than boys (Alisic et al, 2014; Stallard et al, 2004; Winston et al, 2003), our results suggest that the risk for PTSD in injured children might be influenced by injury severity, pain, and pain management

Summary

Introduction

Patients are referred to the trauma room in cases with a high-energy trauma mechanism involving a risk of severe and/or potentially life-threatening injuries. These symptoms disappear spontaneously in the majority of the children in the weeks following traumatic events, but 8–14% develop posttraumatic stress disorder (PTSD) following unintentional injury (Alisic et al, 2014; van Meijel et al, 2015) and up to 18% develop severe posttraumatic stress symptoms (PTSS; Landolt, Vollrath, Timm, Gnehm, & Sennhauser, 2005). Since ASD or PTSD at a subsyndromal level can result in substantial impairment in functioning, it is appropriate to evaluate and treat children reporting clinically significant persistent PTSS (Gold, Kant, & Kim, 2008)

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