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Posttraumatic Stress Disorder and Pain in Veterans: Indirect Association Through Anxiety Sensitivity

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Abstract

Background

Despite high rates of comorbidity between pain and posttraumatic stress disorder (PTSD), little is known about factors that may account for this association. Previous research demonstrates that anxiety sensitivity (AS), the tendency to fear bodily sensations associated with anxious arousal, is elevated among patients with these conditions. However, no research to date has examined whether AS explains the association between pain and PTSD symptom severity.

Methods

The current sample included 115 veterans with a trauma- and stressor-related disorder (i.e., PTSD or subthreshold PTSD) presenting for psychological services to an outpatient PTSD clinic at a Veterans Affairs hospital.

Results

Findings revealed a significant association between self-reported pain and PTSD symptom severity that was indirect via AS and in particular, AS cognitive concerns.

Conclusions

These findings, though limited by their cross-sectional nature, provide support for AS as a risk factor for perceived pain and PTSD symptoms, particularly among veteran samples.

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Notes

  1. Given the high rates of comorbidity between depression and pain (Bair et al., 2003) as well as depression and PTSD (Rytwinski et al., 2013), both models were re-run using depression diagnosis as a covariate. The inclusion of this variable did not change the direction or statistical significance of findings.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Daniel Paulus was supported by a Postdoctoral Fellowship by the National Institute of Alcohol Abuse and Alcoholism (T32AA007453).

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Authors and Affiliations

  1. Southeast Louisiana Veterans Health Care System, 2400 Canal St, New Orleans, LA, 70119, USA

    Amanda M. Raines, Sunni J. Primeaux, Chelsea R. Ennis, Jessica L. Walton, Karen D. Slaton, Joseph O. Vigil & C. Laurel Franklin

  2. South Central Mental Illness Research Education and Clinical Center, New Orleans, LA, 70119, USA

    Amanda M. Raines, Chelsea R. Ennis, Jessica L. Walton & C. Laurel Franklin

  3. School of Medicine, Louisiana State University, New Orleans, LA, 70112, USA

    Amanda M. Raines

  4. Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, LA, 70112, USA

    Chelsea R. Ennis, Jessica L. Walton, Karen D. Slaton & C. Laurel Franklin

  5. Department of Clinical Rehabilitation and Counseling, Louisiana State University, New Orleans, LA, 70112, USA

    Joseph O. Vigil

  6. Department of Psychology, Ohio University, Athens, OH, 45701, USA

    Nicholas P. Allan

  7. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Daniel J. Paulus

  8. Department of Psychology, University of Houston, Houston, TX, 77204, USA

    Michael J. Zvolensky

  9. Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA

    Michael J. Zvolensky

  10. Department of Psychology, Florida State University, Tallahassee, FL, 32306, USA

    Norman B. Schmidt

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  1. Amanda M. Raines
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  2. Sunni J. Primeaux
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Contributions

All authors contributed to the conceptualization, overall design, data collection, manuscript preparation, and/or editing of the manuscript. Manuscript conceptualization was performed by AMR with input from NPA. Data collection was performed by AMR and JLW. Data analysis was performed by AMR with statistical consultation from DJP and NPA. Manuscript preparation was performed by AMR, SJP, and CRE. Manuscript review and editing was performed by KDS, JOV, MJZ, NBS, and CLF. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Amanda M. Raines.

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Conflict of Interest

Amanda M. Raines, Sunni J. Primeaux, Chelsea R. Ennis, Jessica L. Walton, Karen D. Slaton, Joseph O. Vigil, Nicholas P. Allan, Daniel J. Paulus, Michael J. Zvolensky, Norman B. Schmidt, and C. Laurel Franklin declare that they have no conflict of interest.

Ethical Approval

Approval was obtained from the VA IRB. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Informed Consent

Given that the data were collected as part of routine clinical care, informed consent was not obtained. However, the VA IRB approved use of these data for research purposes.

Animal Rights

No animal studies were carried out by the authors for this article.

Disclaimer

This material is the result of work supported with resources and the use of facilities at the Southeast Louisiana Veterans Health Care System in New Orleans, LA. The contents of this article do not represent the views of the Department of Veterans Affairs (VA) or the United States Government.

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Raines, A.M., Primeaux, S.J., Ennis, C.R. et al. Posttraumatic Stress Disorder and Pain in Veterans: Indirect Association Through Anxiety Sensitivity. Cogn Ther Res 46, 209–216 (2022). https://doi.org/10.1007/s10608-021-10230-8

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