Longitudinal Interactions of Pain and Posttraumatic Stress Disorder Symptoms in U.S. Military Service Members Following Blast Exposure

  • Kelcey J. Stratton
    Address reprint requests to Kelcey J. Stratton, PhD, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Blvd (116-B), Richmond, VA 23249.
    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
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  • Shaunna L. Clark
    Center for Biomarker Research and Personalized Medicine, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
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  • Sage E. Hawn
    Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
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  • Ananda B. Amstadter
    Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, Virginia
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  • David X. Cifu
    Hunter Holmes McGuire VA Medical Center, Richmond, Virginia

    Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
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  • William C. Walker
    Hunter Holmes McGuire VA Medical Center, Richmond, Virginia

    Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
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      • We examine longitudinal models of pain and PTSD symptoms among military personnel.
      • Pain and PTSD symptoms are strongly associated with one another across time.
      • PTSD symptoms show a particularly strong influence on subsequent pain symptoms.


      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.


      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.

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