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Author Notes:

Nicholas A. Giordano, PhD, RN, Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, Georgia 30322, USA. Tel: (404) 727-7980; E-mail: ngiorda@emory.edu

The authors thank the entire Regional Anesthesia Military Battlefield Pain Outcome Study team including Drs. Wensheng Guo and Lynne Taylor. The authors appreciate the insightful feedback provided by Drs. Amy Sawyer, Peggy Compton, and Sydney Axson. Additionally, the authors would like to thank the service members who participated in the study for both their contributions to this research and their military service.

Dr. Giordano received a grant from the National Institutes of Health (1F31NR017151-01A1) and The Rita & Alex Hillman Foundation’s Hillman Scholars in Nursing Innovation program. Dr. Gallagher received funding for the original study from the U.S. Department of Veterans Affairs (VA RRD D45064-1). For the remaining authors, no conflicts were declared. The views expressed in this manuscript are those of the authors and do not reflect the official policy of the Department of Veterans Affairs, Uniformed Services University, the Department of the Army/Navy/Air Force, the Department of Defense, or the United States Government.


Research Funding:

Dr. Giordano received a grant from the National Institutes of Health (1F31NR017151-01A1) and The Rita & Alex Hillman Foundation’s Hillman Scholars in Nursing Innovation program.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Anesthesiology
  • Medicine, General & Internal
  • General & Internal Medicine
  • Injury
  • Pain
  • PTSD
  • Regional Anesthesia
  • Patient-Reported Outcomes

Differential Pain Presentations Observed across Post-Traumatic Stress Disorder Symptom Trajectories after Combat Injury


Journal Title:



Volume 22, Number 11


, Pages 2638-2647

Type of Work:

Article | Final Publisher PDF


Objective: This study evaluated the association between pain outcomes and post-traumatic stress disorder (PTSD) symptom trajectories after combat-related injury, while adjusting for receipt of regional anesthesia (RA) soon after injury. Methods: The PTSD symptom trajectories of N = 288 combat-injured service members were examined from within a month of injury up to two-years after. Linear mixed-effects models evaluated the association between PTSD symptom trajectories and average pain and pain interference outcomes while adjusting for receipt of RA during combat casualty care. Results: Four PTSD trajectories were characterized: Resilient, recovering, worsening, and chronic. Differential pain presentations were associated with PTSD symptom trajectories, even after adjusting for receipt of RA. Compared to those with a resilient PTSD symptom trajectory, individuals presenting with chronic PTSD trajectories were estimated to experience average pain scores 2.61 points higher (95% CI: 1.71, 3.14). Participants presenting with worsening (β = 1.42; 95% CI: 0.77, 1.78) and recovering PTSD trajectories (β = 0.65; 95% CI: 0.09, 1.08) were estimated to experience higher average pain scores than participants with resilient PTSD trajectories. Significant differences in pain interference scores were observed across PTSD trajectories. Receiving RA was associated with improved pain up to two years after injury (β =-0.31; 95% CI:-0.90,-0.04), however no statistically significant association was detected between RA and PTSD trajectories. Conclusions: Chronic and worsening PTSD trajectories were associated with greater pain intensity and interference following combat injury even when accounting for receipt of early RA for pain management. These findings underscore the need to jointly assess pain and PTSD symptoms across the trauma care continuum.
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