Friedman J K, Taylor B C, Hagel Campbell E, Allen K, Bangerter A, Branson M, Bronfort G, Calvert C, Cross Ljs, Driscoll M, Evans R, Ferguson J E, Haley A, Hennessy S, Meis L A, Burgess D J
Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Healthcare System (MVAHCS), Minneapolis, MN.
University of Minnesota Medical School, Minneapolis, MN.
medRxiv. 2023 Oct 15:2023.10.13.23296998. doi: 10.1101/2023.10.13.23296998.
Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD.
Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial.
Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms.
Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05).
These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed.
创伤后应激障碍(PTSD)和慢性疼痛是高度普遍的共病情况。与仅患其中一种疾病相比,同时受到PTSD和慢性疼痛双重困扰的退伍军人会经历更严重的后果。很少有研究纳入足够数量的女性退伍军人来测试PTSD严重程度对疼痛结果[灾难化、强度、干扰]的性别差异。
研究参加慢性疼痛临床试验的退伍军人中,PTSD症状与疼痛结果之间关联的性别差异。
参与者为421名患有慢性疼痛的男性退伍军人和386名患有慢性疼痛的女性退伍军人,他们提供了关于PTSD症状和疼痛结果的完整数据。我们使用分层线性回归模型来研究PTSD症状对疼痛结果的性别差异。
调整后的多变量模型表明,PTSD症状与更高水平的疼痛灾难化(0.57,95%置信区间[0.51,0.63])、疼痛强度(0.30,95%置信区间[0.24,0.37])和疼痛干扰(0.46,95%置信区间[0.39,0.52])相关。在粗模型或调整模型中均未发现该关联存在差异的证据(所有交互作用p值<0.05)。
这些发现可能反映了这些情况之间潜在的相互维持关系,即疼痛感觉可能触发PTSD症状,特别是如果创伤和疼痛与同一事件相关。讨论了相关的临床意义以及测试可能对慢性疼痛和PTSD都有益的相关治疗方法的机会。