San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA; University of California - San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA; Sierra Pacific Mental Illness Research Education, and Clinical Center, 4150 Clement St, San Francisco, CA, 94121, USA.
San Francisco VA Health Care System, 4150 Clement St, San Francisco, CA, 94121, USA; University of California - San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, USA.
J Psychiatr Res. 2022 Nov;155:104-111. doi: 10.1016/j.jpsychires.2022.08.009. Epub 2022 Aug 19.
Posttraumatic stress disorder (PTSD) and chronic pain are highly prevalent and co-morbid among veterans. Moral injury (MI), which results from traumatic experiences that conflict with deeply held moral beliefs, is also associated with pain. However, relationships between different types of exposures to potentially morally injurious events (PMIEs) and pain have not yet been investigated. In the current study, we investigated these relationships between exposure to PMIEs (betrayal, witnessing, and perpetration) and different types of pain (joint pain, muscle pain, and overall pain intensity), while controlling for other relevant variables (including PTSD symptoms, combat exposure, adverse childhood experiences, age, gender, and race/ethnicity). We also examined gender differences in these associations. Participants were 11,871 veterans drawn from a nationwide, population-based survey who self-reported exposure to PMIEs, PTSD symptoms, frequency of adverse childhood experiences, combat exposure, sociodemographic information, past six-month joint pain, past six-month muscle pain, and past week overall pain intensity. Population weighted regression models demonstrated that PMIEs were not significantly associated with joint or muscle pain, but that betrayal was associated with past week overall pain intensity, even when controlling for all other variables. Models investigating men and women separately found that for women, betrayal was associated with joint pain and pain intensity, but for men, betrayal was not associated with any pain outcome. These findings suggest that it may be especially important to assess betrayal when treating patients with a history of trauma and chronic pain.
创伤后应激障碍（PTSD）和慢性疼痛在退伍军人中普遍存在且常并发。道德伤害（MI）是由与个人深层道德信仰冲突的创伤经历引起的，它也与疼痛有关。然而，不同类型的潜在道德伤害事件（PMIEs）暴露与疼痛之间的关系尚未得到研究。在当前研究中，我们调查了 PMIEs（背叛、目睹和实施）暴露与不同类型疼痛（关节痛、肌肉痛和整体疼痛强度）之间的关系，同时控制了其他相关变量（包括 PTSD 症状、战斗暴露、不良童年经历、年龄、性别和种族/民族）。我们还检查了这些关联中的性别差异。参与者是从全国性的基于人群的调查中抽取的 11871 名退伍军人，他们自我报告了 PMIEs、PTSD 症状、不良童年经历的频率、战斗暴露、社会人口统计学信息、过去六个月的关节痛、过去六个月的肌肉痛和过去一周的整体疼痛强度。人口加权回归模型表明，PMIEs 与关节或肌肉疼痛没有显著关联，但背叛与过去一周的整体疼痛强度有关，即使在控制了所有其他变量的情况下也是如此。分别对男性和女性进行的模型研究发现，对于女性，背叛与关节痛和疼痛强度有关，但对于男性，背叛与任何疼痛结果均无关。这些发现表明，在治疗有创伤和慢性疼痛病史的患者时，评估背叛可能尤为重要。
