title: Longitudinal interactions of pain and posttraumatic stress disorder symptoms in U.S. Military service members following blast exposure.
abstract: Military personnel returning from conflicts in Iraq and Afghanistan often endorse pain and posttraumatic stress disorder (PTSD) symptoms, either separately or concurrently. Associations between pain and PTSD symptoms may be further complicated by blast exposure from explosive munitions. Although many studies have reported on the prevalence and disability associated with polytraumatic injuries following combat, less is known about symptom maintenance over time. Accordingly, this study examined longitudinal interactive models of co-occurring pain and PTSD symptoms in a sample of 209 military personnel (mean age = 27.4 years, standard deviation = 7.6) who experienced combat-related blast exposure. Autoregressive cross-lagged analysis examined longitudinal associations between self-reported pain and PTSD symptoms over a 1-year period. The best-fitting covariate model indicated that pain and PTSD were significantly associated with one another across all assessment periods, χ² (3) = 3.66, P = .30, Tucker-Lewis index = .98, comparative fit index = 1.00, root mean squared error of approximation = .03. PTSD symptoms had a particularly strong influence on subsequent pain symptoms. The relationship between pain and PTSD symptoms is related to older age, race, and traumatic brain injury characteristics. Results further the understanding of complex injuries among military personnel and highlight the need for comprehensive assessment and rehabilitation efforts addressing the interdependence of pain and co-occurring mental health conditions.
  
  
  CONCLUSIONS
  This longitudinal study demonstrates that pain and PTSD symptoms strongly influence one another and interact across time. These findings have the potential to inform the integrative assessment and treatment of military personnel with polytrauma injuries and who are at risk for persistent deployment-related disorders.
authors.affiliation: Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Department of Psychology, Virginia Commonwealth University, Richmond, Virginia; Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia. Electronic address: Kelcey.Stratton@va.gov.
authors.forename: Kelcey J
authors.initials: KJ
authors.lastname: Stratton
authors.affiliation: Center for Biomarker Research and Personalized Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Shaunna L
authors.initials: SL
authors.lastname: Clark
authors.affiliation: Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Sage E
authors.initials: SE
authors.lastname: Hawn
authors.affiliation: Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Ananda B
authors.initials: AB
authors.lastname: Amstadter
authors.affiliation: Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: David X
authors.initials: DX
authors.lastname: Cifu
authors.affiliation: Hunter Holmes McGuire VA Medical Center, Richmond, Virginia; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: William C
authors.initials: WC
authors.lastname: Walker
mesh_terms: D000328:Adult; D000367:Age Factors; D001753:Blast Injuries / Q000150:complications* / Q000453:epidemiology*; D001930:Brain Injuries / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008889:Military Personnel; D008954:Models, Biological; D015233:Models, Statistical; D010146:Pain / Q000453:epidemiology* / Q000209:etiology*; D057566:Self Report; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
keywords: Chronic pain; blast injuries; longitudinal studies; military personnel; posttraumatic; stress disorders