A Longitudinal Assessment of Posttraumatic Stress Symptoms and Pain Catastrophizing After Injury

• Published in: Rehabilitation psychology 2023-02, Vol.68 (1), p.32-42
• Main Authors: Pacella-LaBarbara, Maria L., Plaitano, Enzo G., Suffoletto, Brian P., Kuhn, Eric, Germain, Anne, Jaramillo, Stephany, Repine, Melissa, Callaway, Clifton W.
• Format: Article
• Language: English
• Subjects: Accidents, Traffic - psychology; Adult; Catastrophization; Catastrophizing; Chronic Pain; Emergency Services; Female; Human; Humans; Injuries; Male; Motor Traffic Accidents; Pain; Pain Measurement; Posttraumatic Stress; Rumination (Cognitive Process); Stress Disorders, Post-Traumatic - psychology; Symptoms
• ISSN: 0090-5550; 1939-1544
• DOI: 10.1037/rep0000481

Purpose/Objective: Identifying individuals with high levels of pain catastrophizing (PC) may inform early psychological interventions to prevent the transition from acute to chronic post-injury pain. We examined whether pre-and post-injury posttraumatic stress symptoms (PTSS) predict post-injury PC among emergency department (ED) patients following acute motor vehicle crash (MVC). Research Method/Design: This study represents secondary data analysis of a randomized clinical trial (NCT03247179) examining the efficacy of the PTSD Coach app on post-injury PTSS (PTSSpost). Among 63 injured ED patients (63% female; 57% non-White; average age = 37) with moderate pain (≥4 of 10), we assessed recall of pre-injury PTSS (PTSSrecall: stemming from preexisting exposures) and baseline PC within 24 hr post-MVC; PTSSpost stemming from the MVC was assessed 30-days later, and the outcome of PC was assessed at 90-days post-injury. We controlled for group assignment (intervention vs. control) in all analyses. Results: Results revealed that at baseline and 90-days, PC was higher among non-White versus White participants. After adjusting for relevant covariates, PTSSrecall uniquely predicted post-injury PC and each subscale of PC (helplessness, magnification, and rumination). Similarly, after controlling for PTSSrecall and relevant covariates, PTSSpost uniquely predicted total and subscale post-injury PC. Intervention group participants reported less rumination than control group participants. Conclusions/Implications: These novel findings highlight that injured Black patients may be vulnerable to post-injury PC, and that both PTSSrecall and PTSSpost significantly predict post-injury PC. Brief PTSS assessment in the ED can identify high-risk patients who may benefit from early intervention. Impact and Implications These novel findings among recently injured motor vehicle crash victims highlight the contribution of both preexisting and post-injury posttraumatic stress symptoms to the development of pain catastrophizing at 3-months post-injury, above and beyond relevant demographic (e.g., race and sex) and injury-related (initial pain score) factors, psychological characteristics (initial pain catastrophizing score, preexisting posttraumatic stress symptoms), and group assignment; these findings can inform early intervention given that posttraumatic stress symptoms are malleable to change. Individuals with high levels of posttraumatic stress symptoms may be ideal candidates for