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Disaggregating the Relationship Between Posttraumatic Stress Disorder Symptom Clusters and Chronic Orofacial Pain: Implications for the Prediction of Health Outcomes with PTSD Symptom Clusters

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Research has established a significant relationship between posttraumatic stress disorder (PTSD) symptoms and pain; however, very little research has examined the differential role of PTSD symptom clusters on pain outcomes.

Purpose

(a) To confirm the most appropriate PTSD symptom factor structure for an orofacial pain population and (b) to test a model of prediction of pain outcomes with PTSD symptom clusters.

Methods

The study was a cross-sectional, retrospective case series of 411 female patients with orofacial pain (mean 41.0 years, SD 13.1). A series of structural equation modeling analyses were conducted to examine five competing models of PTSD symptom clusters.

Results

Two four-factor models of PTSD symptom clusters fit the data reasonably well, and differing PTSD symptom clusters predicted different components of pain.

Conclusions

To increase predictive utility for pain and for a wide range of health disorders, researchers should examine the unique predictive power of PTSD symptom clusters rather than examining a one-factor model of PTSD symptoms.

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References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Publishing; 2000

    Google Scholar 

  2. Taylor S, Kuch K, Koch W, Crockett D, Passey G. The structure of posttraumatic stress symptoms. J Abnorm Psychol. 1998; 107: 154–160

    Article  CAS  PubMed  Google Scholar 

  3. Asmundson G, Wright K, McCreary D, Pedlar D. Post-traumatic stress disorder symptoms in united nations peacekeepers: An examination of factor structure in peace-keepers with and without chronic pain. Cogn Behav Ther. 2003; 32: 26–37

    Article  PubMed  Google Scholar 

  4. Simms L, Watson D, Doebbeling B. Confirmatory factor analyses of posttraumatic stress symptoms in deployed and nondeployed veterans of the Gulf War. J Abnorm Psychol. 2002; 111: 637–647

    Article  PubMed  Google Scholar 

  5. King D, Leskin G, King L, Weathers F. Confirmatory factor analysis of the clinician-administered PTSD scale: Evidence for the dimensionality of posttraumatic stress disorder. Psychol Assess. 1998; 10: 90–96

    Article  Google Scholar 

  6. Foa E, Zinbarg R, Rothbaum B. Uncontrollability and unpredictability in post-traumatic stress disorder: An animal model. Psychol Bull. 1992; 112: 218–38

    Article  CAS  PubMed  Google Scholar 

  7. Palmieri PA, Weathers FW, Difede J, King DW. Confirmatory factor analysis of the PTSD checklist and the clinician-administered PTSD scale in disaster workers exposed to the world trade center ground zero. J Abnorm Psychol. 2007; 116: 329–341

    Article  PubMed  Google Scholar 

  8. Asmundson G, Frombach I, McQuaid J, Pedrelli P, Lenox R, Stein M. Dimensionality of posttraumatic stress symptoms: A confirmatory factor analysis of DSM-IV symptom clusters and other symptom models. Behav Res Ther. 2000; 38: 203–214

    Article  CAS  PubMed  Google Scholar 

  9. McWilliams L, Cox B, Asmundson G. Symptom structure of posttraumatic stress disorder in a nationally representative sample. J Anxiety Disord. 2005; 19: 626–641

    Article  PubMed  Google Scholar 

  10. Geisser ME, Roth RS, Bachman JE, Eckert TA. The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain. Pain. 1996; 66(2–3): 207–214

    Article  CAS  PubMed  Google Scholar 

  11. Roth RS, Geisser ME, Bates R. The relation of post-traumatic stress symptoms to depression and pain in patients with accident-related chronic pain. J Pain. 2008; 9: 588–596

    Article  PubMed  Google Scholar 

  12. Scrivani SJ, Keith DA, Kaban LB. Temporomandibular disorders. N Engl J Med. 2008 Dec 18; 359: 2693–2705

    Article  CAS  PubMed  Google Scholar 

  13. de Leeuw R, Bertoli E, Schmidt J, Carlson C. Prevalence of traumatic stressors in patients with temporomandibular disorders. J Oral Maxillofac Surg. 2005 Jan; 63: 42–50

    PubMed  Google Scholar 

  14. Curran SL, Sherman JJ, Cunningham LL, Okeson JP, Reid KI, Carlson CR. Physical and sexual abuse among orofacial pain patients: Linkages with pain and psychologic distress. J Orofac Pain. 1995; 9: 340–346

    CAS  PubMed  Google Scholar 

  15. Aghabeigi B, Feinmann C, Harris M. Prevalence of post-traumatic stress disorder in patients with chronic idiopathic facial pain. Br J Oral Maxillofac Surg. 1992; 30: 360–364

    Article  CAS  PubMed  Google Scholar 

  16. Burris J, Cyders M, de Leeuw R, Smith G, Carlson C. Posttraumatic stress disorder symptoms and chronic orofacial pain: An empirical examination of the mutual maintenance model. J Orofac Pain. 2009; 23: 243–252

    PubMed  Google Scholar 

  17. Sherman JJ, Carlson CR, Wilson JF, Okeson JP, McCubbin JA. Post-traumatic stress disorder among patients with orofacial pain. J Orofac Pain. 2005; 19: 309–317

    PubMed  Google Scholar 

  18. Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: Mutual maintenance. Clin Psychol Rev. 2001; 21: 857–877

    Article  CAS  PubMed  Google Scholar 

  19. Page GP, Kleiman V, Asmundson GJG, Katz J. Structure of posttraumatic stress symptoms in pain and pain-free patients scheduled for surgery. J Pain. 2009; 10: 984–991

    Article  PubMed  Google Scholar 

  20. Beckham JC, Crawford AL, Feldman ME, Kirby AC, Hertzberg MA, et al. Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. J Psychosom Res. 1997; 43: 379–389

    Article  CAS  PubMed  Google Scholar 

  21. Smith G, Fischer S, Fister S. Incremental validity principles of test construction. Psychol Assessment. 2003; 15: 467–477

    Article  Google Scholar 

  22. Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: Review, criteria, examinations and specifications, critique. J Craniomandib Disord. 1992; 6: 301–355

    CAS  PubMed  Google Scholar 

  23. Okeson J. The clinical management of temporomandibular disorders and occlusion. 6th ed. St. Louis, MO: Mosby; 2007

    Google Scholar 

  24. Weathers F, Huska J, Keane T. PCL-C for DSM-IV. Boston: National Center for PTSD—Behavioral Science Division; 1991

    Google Scholar 

  25. Blanchard E, Jones-Alexander J, Buckley T, Forneris C. Psychometric properties of the PTSD checklist (PCL). Behav Res Ther. 1996; 34: 669–673

    Article  CAS  PubMed  Google Scholar 

  26. Derogatis L. Symptom checklist-90-R. Minneapolis, MN: National Computer Systems; 1979

    Google Scholar 

  27. Derogatis L, Savitz K. The SCL-90-R and brief symptom inventory (BSI) in primary care. In: Maruish M, editor. Handbook of psychological assessment in primary care settings. Mahwah, NJ: Lawrence Erlbaum Associates; 2000. p. 297–334

    Google Scholar 

  28. Kearns R, Turk D, Rudy T. The West-Haven-Yale multidimensional pain inventory (WHYMPI). Pain. 1985; 28: 345–56

    Article  Google Scholar 

  29. Riley JL, 3rd, Zawacki TM, Robinson ME, Geisser ME. Empirical test of the factor structure of the West Haven-Yale multidimensional pain inventory. Clin J Pain. 1999; 15: 24–30

    Article  PubMed  Google Scholar 

  30. Andreu Y, Galdon MJ, Dura E, et al. An examination of the psychometric structure of the multidimensional pain inventory in temporomandibular disorder patients: A confirmatory factor analysis. Head Face Med. 2006; 2: 48

    Article  PubMed  Google Scholar 

  31. Buysse D. The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Res. 1989; 28: 193–213

    Article  CAS  PubMed  Google Scholar 

  32. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equat Model. 1999; 6: 1–55

    Article  Google Scholar 

  33. Bentler PM. Comparative Fit Indexes in Structural Models. Psychol Bull. 1990; 107: 238–246.

    Article  CAS  PubMed  Google Scholar 

  34. Kline R. Principles and practice of structural equation modeling. New York: Guilford Press; 2005.

    Google Scholar 

  35. Browne M, Cudeck R. Alternative ways of assessing model fit. Sociol Methods Res. 1992; 21: 230–258

    Article  Google Scholar 

  36. de Leeuw R, Schmidt J, Carlson C. Traumatic stressors and post-traumatic stress disorder symptoms in headache patients. Headache. 2005; 45: 1365–1374

    Article  PubMed  Google Scholar 

  37. Resnick H, Yehuda R, Acierno R. Acute post-rape plasma cortisol, alcohol use, and PTSD symptom profile among recent rape victims. Ann NY Acad Sci. 1991; 21: 433–436

    Google Scholar 

  38. Schnurr P, Jankowski M. PTSD and physical health: Review and synthesis. Sem Clin Neuropsychiatry. 1999; 4: 295–304

    CAS  Google Scholar 

  39. Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychol Bull. 2006; 132: 959–992

    Article  PubMed  Google Scholar 

  40. Aaron LA, Burke MM, Buchwald D. Overlapping conditions among patients with chronic fatigue syndrome, fibromyalgia, and temporomandibular disorder. Arch Intern Med. 2000; 160: 221–227

    Article  CAS  PubMed  Google Scholar 

  41. de Leeuw R, Bertoli E, Schmidt J, Carlson C. Prevalence of post-traumatic stress disorder symptoms in orofacial pain patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005; 99: 558–568

    Article  PubMed  Google Scholar 

  42. McDonald RP, Ho MHR. Principles and practice in reporting structural equation analyses. Psychol Methods. 2002; 7: 64–82

    Article  PubMed  Google Scholar 

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Conflicts of interest

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Author information

Authors and Affiliations

  1. Department of Psychology, Indiana University-Purdue University Indianapolis, School of Science, Indianapolis, IN, 46202, USA

    Melissa A. Cyders Ph.D.

  2. Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, 40506, USA

    Jessica L. Burris M.A. & Charles R. Carlson Ph.D.

  3. Orofacial Pain Center, College of Dentistry, University of Kentucky, Lexington, KY, 40536, USA

    Jessica L. Burris M.A. & Charles R. Carlson Ph.D.

Authors
  1. Melissa A. Cyders Ph.D.
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  2. Jessica L. Burris M.A.
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  3. Charles R. Carlson Ph.D.
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Correspondence to Melissa A. Cyders Ph.D..

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Cyders, M.A., Burris, J.L. & Carlson, C.R. Disaggregating the Relationship Between Posttraumatic Stress Disorder Symptom Clusters and Chronic Orofacial Pain: Implications for the Prediction of Health Outcomes with PTSD Symptom Clusters. ann. behav. med. 41, 1–12 (2011). https://doi.org/10.1007/s12160-010-9221-5

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  • DOI: https://doi.org/10.1007/s12160-010-9221-5

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