Relationship Between Pain/Pain-Related Characteristics and Posttraumatic Stress Symptoms in Children After Accidental Injury
Anna Monica Agoston, John C. Bleacher, Maia Routly
Children's Healthcare of Atlanta, Atlanta, GA
Background (issue):Around 20% of children demonstrate persistent posttraumatic stress symptoms (PTSS) after accidental injury, with more severe pain intensity predicting concurrent and later PTSS (Hildebrand et al., 2018). PTSS also facilitated maintenance of pain in a study with TBI patients (Brown et al., 2014), suggesting a bidirectional relationship between pain and PTSS. These studies have relied on pain ratings, specifically intensity and frequency of pain. However, additional pain-related characteristics like pain behaviors, impairment related to pain, and subjective experience of pain might provide additional insight into the mechanisms that reinforce relationships between PTSS and pain. Methods:
During an outpatient appointment one month after accidental injury, 41 children (mean age: 12.41, SD: 2.52, 26 boys, 15 girls) were administered the Child PTSD Symptom Scale (CPSS-5; Foa et al., 2018) to assess PTSS, as well as four PROMIS questionnaires designed to assess pain and pain-related characteristics (e.g., interference, quality, behaviors, and intensity). Findings:
Correlations between CPSS-5 and total for PROMIS questionnaires were significant (r=.58, p < .001), as well as for each characteristic individually (pain interference, r=.62, p < .001; quality, r=.57, p < .001, behaviors r=.45, p = .003; intensity, r=.42, p = .007). Conclusions (implications for practice):
This study adds to the literature by investigating relationships between PTSS and pain-related characteristics. The degree of pain behaviors, impairment related to pain, and subjective experiences of pain may reflect cognitive biases (e.g., catastrophizing) and perceptions that may mutually reinforce PTSS and pain. Psychological interventions to address these cognitive biases may result in improved outcomes for children with accidental injury.
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