Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia.
University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
Pain Med. 2021 Nov 26;22(11):2638-2647. doi: 10.1093/pm/pnab204.
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.
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.
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.
Chronic and worsening 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.
本研究评估了与战斗相关损伤后疼痛结果和创伤后应激障碍（PTSD）症状轨迹之间的关联，同时调整了损伤后即刻接受区域麻醉（RA）的情况。
从损伤后一个月内到两年内，对 288 名战斗受伤的现役军人的 PTSD 症状轨迹进行了检查。线性混合效应模型评估了 PTSD 症状轨迹与平均疼痛和疼痛干扰结果之间的关联，同时调整了在战斗伤员救治期间接受 RA 的情况。
确定了四种 PTSD 轨迹：恢复良好、恢复中、恶化和慢性。即使在调整了接受 RA 的情况后，不同的疼痛表现与 PTSD 症状轨迹相关。与 PTSD 症状轨迹恢复良好的个体相比，患有慢性 PTSD 轨迹的个体估计会经历高 2.61 分的平均疼痛评分（95%CI：1.71，3.14）。与 PTSD 轨迹恢复良好的个体相比，表现出恶化（β=1.42；95%CI：0.77，1.78）和恢复（β=0.65；95%CI：0.09，1.08）的个体预计会经历更高的平均疼痛评分。在 PTSD 轨迹中观察到疼痛干扰评分的显著差异。接受 RA 与损伤后两年内的疼痛改善相关（β=-0.31；95%CI：-0.90，-0.04），但是在 RA 和 PTSD 轨迹之间未检测到统计学上的显著关联。
即使考虑到早期接受 RA 进行疼痛管理，慢性和恶化的 PTSD 轨迹与战斗损伤后更大的疼痛强度和干扰相关。这些发现强调了在整个创伤护理过程中共同评估疼痛和 PTSD 症状的必要性。
