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Posttraumatic stress symptoms and the diathesis-stress model of chronic pain and disability in patients undergoing major surgery

Posttraumatic stress symptoms and the diathesis-stress model of chronic pain and disability in patients undergoing major surgery

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Title: Posttraumatic stress symptoms and the diathesis-stress model of chronic pain and disability in patients undergoing major surgery
Author: Martin, Andrea L
Halket, Eileen
Asmundson, Gordon J.G.
Flora, David B.
Katz, Joel
Abstract: Objectives: 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 diathesisstress model, with PTSS accounting for a significant proportion of the variance in pain disability.
Discussion: 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.
Sponsor: Supported by a CIHR Canada Research Chair in Health Psychology (J.K.); a CIHR Investigator Award and NET Grant (G.J.G.A.); as well as a CIHR Doctoral Award and a CIHR Strategic Training Fellowship in Pain: Molecules to Community (A.L.M.).
Subject: diathesis-stress, fear-avoidance, PTSS, chronic pain
Type: Article
Rights: http://journals.lww.com/clinicalpain/pages/articleviewer.aspx?year=2010&issue=07000&article=00008&type=abstract
http://journals.lww.com/clinicalpain/pages/default.aspx
http://www.lww.com
URI: http://hdl.handle.net/10315/26493
Published: Lippincott, Williams & Wilkins
Citation: Clin J Pain. 2010 Jul-Aug;26(6):518-27.
ISSN: ISSN: 0749-8047 (print), 1536-5409 (online)
Date: 2010-07

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