McDermott Katherine, Rush Christina, Pham Tony, Hooker Julia, Louis Courtney, Rochon Elizabeth A, Vranceanu Ana-Maria
Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
Harvard Medical School, Boston, MA, Massachusetts General Hospital, Boston, MA.
Pain Med. 2024 Jul 30;25(12):758-67. doi: 10.1093/pm/pnae068.
PTSD is associated with greater incidence of chronic pain. Pain catastrophizing often accounts for this association. Less is known about these relationships during the acute phase (1-2 months) following orthopedic traumatic injuries. We sought to understand which orthopedic traumatic injury-related PTSD symptoms were associated with acute pain and physical dysfunction and whether pain catastrophizing accounted for these associations.
This secondary analysis uses baseline data from a multisite randomized controlled trial of an intervention for individuals with heightened pain catastrophizing or pain anxiety following acute orthopedic injury. We used partial correlations to examine associations between PTSD symptom clusters (re-experiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal) and pain outcomes (pain intensity and physical dysfunction) controlling for pain catastrophizing. We used hierarchical regressions to evaluate unique associations between PTSD clusters and pain outcomes. In exploratory analysis, we examined the indirect effects of PTSD symptoms on pain outcomes through catastrophizing.
Hierarchical linear regressions indicated that hyperarousal was uniquely associated with greater pain intensity with activity (β = 0.39, p < 0.001, ΔR2 =0.06) and physical dysfunction (β = 0.22, p = 0.04 ΔR2 =0.02). PTSD symptoms were still associated with pain with activity even with pain catastrophizing included in the models, and catastrophizing did not have a significant indirect effect on the relationship between PTSD and physical dysfunction (b=0.06, SEBoot=0.04, 95% CIBoot = [-0.003, 0.14]). Pain catastrophizing did largely account for the association between re-experiencing, avoidance, and negative alterations in cognitions and mood symptoms and pain at rest.
Pain catastrophizing interventions may be best suited for limiting the impact of PTSD symptoms on pain at rest, but catastrophizing alone may not fully explain the relationship between PTSD symptoms and physical dysfunction after acute orthopedic injury. To prevent the negative association of PTSD symptoms, especially hyperarousal, on physical outcomes in acute pain populations, interventions may require more than solely targeting pain catastrophizing.
创伤后应激障碍（PTSD）与慢性疼痛的发生率较高有关。疼痛灾难化往往是造成这种关联的原因。对于骨科创伤性损伤急性期（1 - 2个月）期间的这些关系，人们了解较少。我们试图了解哪些与骨科创伤性损伤相关的PTSD症状与急性疼痛和身体功能障碍有关，以及疼痛灾难化是否能解释这些关联。
这项二次分析使用了一项多中心随机对照试验的基线数据，该试验针对急性骨科损伤后疼痛灾难化或疼痛焦虑加剧的个体进行干预。我们使用偏相关分析来检验PTSD症状群（重新体验、回避、认知和情绪的消极改变以及过度警觉）与疼痛结果（疼痛强度和身体功能障碍）之间的关联，并控制疼痛灾难化因素。我们使用层次回归来评估PTSD症状群与疼痛结果之间的独特关联。在探索性分析中，我们研究了PTSD症状通过灾难化对疼痛结果的间接影响。
层次线性回归表明，过度警觉与活动时更大的疼痛强度（β = 0.39，p < 0.001，ΔR2 = 0.06）和身体功能障碍（β = 0.22，p = 0.04，ΔR2 = 0.02）存在独特关联。即使模型中纳入了疼痛灾难化因素，PTSD症状仍与活动时的疼痛有关，并且灾难化对PTSD与身体功能障碍之间的关系没有显著的间接影响（b = 0.06，SEBoot = 0.04，95% CIBoot = [-0.003, 0.14]）。疼痛灾难化在很大程度上解释了重新体验、回避以及认知和情绪消极改变症状与静息痛之间的关联。
疼痛灾难化干预可能最适合限制PTSD症状对静息痛的影响，但仅靠灾难化可能无法完全解释急性骨科损伤后PTSD症状与身体功能障碍之间的关系。为了预防PTSD症状，尤其是过度警觉，对急性疼痛人群身体状况的负面影响，干预措施可能需要不仅仅针对疼痛灾难化。
