Associations of chronic pain and PTSD factors among military personnel: An exploration of the mutual maintenance model

Abstract: Introduction: Chronic pain is common among Canadian Armed Forces (CAF) service members and Veterans. This has prompted investigators to develop theoretical models that identify the factors contributing to chronic pain. The mutual maintenance model (MMM) posits that when chronic pain co-occurs with posttraumatic stress disorder (PTSD), seven cognitive, behavioural, and affective features of both disorders work to maintain PTSD and chronic pain. This study examined the MMM by investigating which model factors predicted the presence of chronic pain and PTSD and which PTSD symptom clusters predicted chronic pain severity and pain interference in a sample of 233 CAF service members and Veterans. Methods: Participants completed an online survey assessing PTSD and chronic pain symptoms and proxies for MMM factors. Two binary logistic regression analyses determined which MMM factors predicted the presence of chronic pain and PTSD. Two multiple linear regressions determined which PTSD symptom clusters predicted chronic pain severity and interference. Results: Intrusion symptoms were associated with the presence of chronic pain, and anxiety symptoms were associated with the presence of PTSD. The hyper-arousal symptom cluster was positively related to pain severity and interference. Discussion: Contrary to the predictions of the MMM, only intrusion and anxiety symptoms were associated with chronic pain and PTSD presence, respectively. Only hyper-arousal was associated with pain severity and interference. Although cross-sectional analyses cannot demonstrate causation, results of the study suggest that three of the seven MMM factors (i.e., intrusion and anxiety symptoms and hyper-arousal) maintain or exacerbate chronic pain when it co-occurs with PTSD.

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