PTSD Perpetuates Pain in Children With Traumatic Brain Injury

OBJECTIVE: This study tested theoretical models of the relationship between pain and posttraumatic stress disorder (PTSD) in children with traumatic brain injury (TBI). METHODS: Participants consisted of 195 children aged 6-15 years presenting to 1 of 3 Australian hospitals following a mild-severe TBI. Children were assessed at 3, 6, and 18 months after their accident for PTSD (via the Clinician-Administered PTSD Scale for Children and Adolescents [CAPS-CA] clinical interview) as well as physical pain (via the Child Health Questionnaire, 50-item version [CHQ-PF50]). Trained clinicians administered the CAPS-CA at home visits, and the CHQ-PF50 was collected through questionnaires. RESULTS: Structural equation modeling found the data supported the mutual maintenance model and also the nested perpetual avoidance model. CONCLUSIONS: Both models indicate PTSD is driving the presence of pain, and not vice versa. A fourth model stating this was proposed. Therefore, it may be useful to address PTSD symptoms in treating child pain for expediting recovery.