title: Posttraumatic stress symptoms and the diathesis-stress model of chronic pain and disability in patients undergoing major surgery.
abstract: OBJECTIVE
  To (1) use structural equation modeling (SEM) to examine relationships proposed in Turk's diathesis-stress model of chronic pain and disability as well as (2) investigate what role, if any, posttraumatic stress symptoms (PTSS) play in predicting pain disability, relative to some of the other factors in the model.
  
  
  METHODS
  The study sample consisted of 208 patients scheduled for general surgery, 21 to 60 years of age (mean age=47.18 y, SD=9.72 y), who reported experiencing persistent pain for an average of 5.56 years (SD=7.90 y). At their preadmission hospital visit, patients completed the Anxiety Sensitivity Index, Pain Catastrophizing Scale, Pain Anxiety Symptoms Scale-20, Pain Disability Index, posttraumatic stress disorder Checklist, and rated the average intensity of their pain (0 to 10 numeric rating scale). SEM was used to test a model of chronic pain disability and to explore potential relationships between PTSS and factors in the diathesis-stress model.
  
  
  RESULTS
  SEM results provided support for a model in which anxiety sensitivity predicted fear of pain and catastrophizing, fear of pain predicted escape/avoidance, and escape/avoidance predicted pain disability. Results also provided support for a feedback loop between disability and fear of pain. SEM analyses provided preliminary support for the inclusion of PTSS in the diathesis-stress model, with PTSS accounting for a significant proportion of the variance in pain disability.
  
  
  CONCLUSIONS
  Results provide empirical support for aspects of Turk's diathesis-stress model in a sample of patients with persistent pain. Findings also offer preliminary support for the role of PTSS in fear-avoidance models of chronic pain.
authors.affiliation: Department of Psychology, York University, Toronto, Ontario, Canada. jkatz@yorku.ca
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Martin
authors.forename: Eileen
authors.initials: E
authors.lastname: Halket
authors.forename: Gordon J G
authors.initials: GJ
authors.lastname: Asmundson
authors.forename: David B
authors.initials: DB
authors.lastname: Flora
authors.forename: Joel
authors.initials: J
authors.lastname: Katz
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010146:Pain / Q000523:psychology*; D010147:Pain Measurement / Q000379:methods; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013514:Surgical Procedures, Operative / Q000523:psychology*; D055815:Young Adult