Bidirectionality of Pain Interference and PTSD Symptoms in Military Veterans: Does Injury Status Moderate Effects?

Lee, Sharon Y.; Finkelstein‐Fox, Lucy; Park, Crystal L.; Mazure, Carolyn M.; Huedo‐Medina, Tania B.; Hoff, Rani A.

doi:10.1093/pm/pny133

Cited by 14 publications

(13 citation statements)

References 30 publications

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“…After, there was a unidirectional relationship where increases in physical symptoms predicted further increases in subsequent PTSD symptoms, but not vice versa. These findings are consistent with most previous research that showed a bidirectional relationship at first and a unidirectional relationship over time (Carty et al, 2011;Jenewein et al, 2009;Lee et al, 2018;Ravn et al, 2018;Stratton et al, 2014). The extant research is evenly split between whether the unidirectional relationship is between increases in PTSD predicting later increases in physical symptoms or increases in physical symptoms predicting later increases in PTSD symptoms.…”

Section: Discussionsupporting

confidence: 90%

“…The extant research finds consistent support that baseline levels of PTSD symptoms predict subsequent increases in physical symptoms and baseline levels of physical symptoms predict subsequent increases in PTSD symptoms with study baseline assessments ranging from 24 hours to 3 years after the traumatic event (Carty, O'Donnell, Evans, Kazantzis, & Creamer, 2011;Feinberg et al, 2017;Jenewein, Wittmann, Moergeli, Creutzig, & Schnyder, 2009;Lee et al, 2018;Liedl & Knaevelsrud, 2008;Ravn, Sterling, Lahav, & Andersen, 2018;Stratton et al, 2014). These same studies find inconsistent support that increases in PTSD (from baseline to a second time point) predict further increases in physical symptoms (from a second to a third time point) and vice versa.…”

mentioning

confidence: 90%

“…Three studies found that increases in PTSD symptoms (from baseline to the second time point) predicted increases in physical symptoms (from the second to third time point), but not vice versa (Jenewein et al, 2009;Ravn et al, 2018;Stratton et al, 2014). Two additional studies found that increases in physical symptoms (from baseline levels to the second time point) predicted increases in PTSD symptoms (from the second to third time point), but not vice versa (Carty et al, 2011;Lee et al, 2018). Only one study found support for a bidirectional model where increases in PTSD and physical symptoms predicted subsequent increases in physical symptoms and PTSD symptoms, respectively (Feinberg et al, 2017).…”

mentioning

confidence: 99%

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Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

McAndrew

Phillips

et al. 2019

European Journal of Psychotraumatology

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Background : The mutual maintenance model proposes that post-traumatic stress disorder (PTSD) symptoms and chronic physical symptoms have a bi-directional temporal relationship. Despite widespread support for this model, there are relatively few empirical tests of the model and these have primarily examined patients with a traumatic physical injury. Objective : To extend the assessment of this model, we examined the temporal relationship between PTSD and physical symptoms for military personnel deployed to combat (i.e., facing the risk of death) who were not evacuated for traumatic injury. Methods : The current study used a prospective, longitudinal design to understand the cross-lagged relationships between PTSD and physical symptoms before, immediately after, 3 months after, and 1 year after combat deployment. Results : The cross-lagged results showed physical symptoms at every time point were consistently related to greater PTSD symptoms at the subsequent time point. PTSD symptoms were related to subsequent physical symptoms, but only at one time-point with immediate post-deployment PTSD symptoms related to physical symptoms at three months after deployment. Conclusion : The findings extend prior work by providing evidence that PTSD and physical symptoms may be mutually maintaining even when there is not a severe traumatic physical injury.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 90%

mentioning

confidence: 99%

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Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

McAndrew

Phillips

et al. 2019

European Journal of Psychotraumatology

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“…A substantial amount of research has demonstrated a significant association between PTSR and higher levels of various adverse physical health outcomes after trauma including traumatic injury (Afari et al, 2014;Pacella et al, 2013;Zatzick et al, 2003). Such outcomes may include both defined medical illnesses and subjectively reported somatic health complaints related to multiple bodily organs (Green & Kimerling, 2004;Koenen et al, 2017;Lee et al, 2018). PTSD was early on hypothesized to mediate the relationship between trauma exposure and physical health (Schnurr & Jankowski, 1999), and biological, psychological, and behavioral mechanisms have been proposed to be involved (Koenen et al, 2017;Schnurr & Green, 2004).…”

Section: The Role Of Posttraumatic Stress Reactionsmentioning

confidence: 99%

Psychosocial care for hospitalized young survivors after the terror attack on Utøya Island: A qualitative study of the survivors’ experiences

Bugge

Jensen

Nilsen

et al. 2019

Injury

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The origin of the project One peaceful summer day in 2011, Friday the 22nd of July, Norway was hit by two devastating terrorist attacks. A man, dressed as a police officer, detonated a bomb outside the Oslo government building and then entered a political summer camp for adolescents and young adults at Utøya Island one hour's drive outside Oslo. Heavily armed, he hunted down and targeted the camp participants. The perpetrator killed 77 people, eight in the bomb attack and 69 in the Utøya shooting attack. In total, more than 150 victims sustained physical injuries. Ten survivors from the bomb attack and 33 survivors from the Utøya attack were hospitalized due to physical injuries at Oslo University Hospital (OUS) and at local hospitals situated near Utøya Island (Vestre Viken Hospital Trust). Since 2008, I had been working as a child and adolescent psychiatrist at OUS, Department of Child and Adolescent Mental Health in Hospital (S-BUP). Through my daily work, I had met medically ill or injured children and adolescents struggling with how to live with their compromised bodies. Being at work during the critical days in July 2011, I became part of the psychosocial crisis team that was mobilized to handle the extraordinary situation. The psychiatrists, psychologists, nurses, and social workers in the team contributed to providing psychosocial care for the hospitalized youths and their families. We sought to offer empathetic and practical support with a focus on rebuilding the feeling of safety and stabilization of affects and arousal. The team also provided support and supervision to the regular health care personnel. For me, many questions arose subsequently: Was our support helpful? What was important for the youths in this profoundly stressful situation? Would they cope with their challenges of distress and grief, and how would the psychological and physical trauma affect their health over time? Trond H. Diseth, who took part in organizing the psychosocial support in the hospital, and I applied for funding of this doctoral dissertation focusing on the physically injured survivors of the Utøya shooting attack. The project was developed as a part of the Utøya study led by principal investigator Grete Dyb at the Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS). From August 2013, I started my PhD project and took part in the Utøya project group at NKVTS contributing to the conduction of the study. The Faculty of

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“…Chronic pain and PTSD occur together in veterans more frequently than either condition alone, 3,4 and this comorbidity can have worse implications for well-being than either condition individually. 5,6 Veterans with both conditions report greater psychological distress and functional interference compared with those with chronic pain but without PTSD, and those with chronic pain often report more severe PTSD. 7 The aim of this article is to summarise what is known about why chronic pain and PTSD frequently co-occur, what is known about treatment options, current service provision for UK veterans with both conditions and to provide research recommendations.…”

Section: Introductionmentioning

confidence: 98%

Comorbid chronic pain and post-traumatic stress disorder in UK veterans: a lot of theory but not enough evidence

Morgan

Aldington

2019

British Journal of Pain

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Introduction: Chronic pain and post-traumatic stress disorder (PTSD) are strongly correlated in military veteran populations. The aim of this article is to review what is known about the comorbidity of the two conditions. Methods: A literature search was carried out to establish evidence for current explanatory models of why the two conditions frequently co-occur, the most appropriate treatments and current UK service provision for veterans and to identify gaps in research. Results: Chronic pain and PTSD share a number of features, yet the mechanisms behind their comorbidity are not well understood, and while each condition alone has extensive literature, there is limited evidence to support specific care and treatment for the two conditions simultaneously. In addition, there is currently no UK data for veterans with comorbid chronic pain and PTSD so it is not possible to gauge the numbers affected or to predict the numbers who will be affected in the future, and there appear to be no co-located services within the United Kingdom for the management of the two conditions simultaneously in this population. Conclusion: This review highlights a paucity of evidence in all areas of comorbid chronic pain and PTSD. Further work needs to consider fully the nature of the event that led to the development of the two conditions and examine further the possible mechanisms involved, and clinics need to establish routine and systematic evaluations of how any interventions work in practice.

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Bidirectionality of Pain Interference and PTSD Symptoms in Military Veterans: Does Injury Status Moderate Effects?

Abstract: These results indicate that physical symptom management should be a crucial target of psychological intervention for returning veterans with PTSD symptoms and deployment-related injuries.

Cited by 14 publications

References 30 publications

Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

Mutual maintenance of PTSD and physical symptoms for Veterans returning from deployment

Psychosocial care for hospitalized young survivors after the terror attack on Utøya Island: A qualitative study of the survivors’ experiences

Comorbid chronic pain and post-traumatic stress disorder in UK veterans: a lot of theory but not enough evidence

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