The mediating role of posttraumatic stress disorder symptoms in pain cognitions among Veterans with chronic pain.

Symptoms of posttraumatic stress disorder (PTSD) are highly prevalent among Veterans with chronic pain. Considerable research has examined the intersection of chronic pain and PTSD symptoms. However, it remains unclear whether changes in PTSD may potentially serve a mechanistic role in improving unhelpful pain cognitions for individuals with chronic pain. The present research contributes to the foundational knowledge by addressing this question. Baseline data from a randomized controlled trial targeting pain-related disability for Veterans (n = 103; mean age 43.66; SD = 10.17) with musculoskeletal pain and depression and/or PTSD symptoms were used. Cross-sectional mediation analyses showed that PTSD symptoms mediated the relationship between pain severity and pain catastrophizing, and between pain severity and pain acceptance. After controlling for depression, the mediation involving pain catastrophizing remained significant, while the mediation for pain acceptance did not. Although limitations exist, results point to several treatment recommendations, including ensuring that depressive affect, PTSD-specific symptoms, and attention to both body and mind are included in treatment. Results also provide preliminary evidence for examining these associations longitudinally to improve our understanding of this population and corresponding treatment recommendations.

Posttraumatic stress symptoms and substance use among college students: Exploring interactions with sleep quality and assigned sex.

Substance use is widely recognized as a negative outcome following traumatic events and is tied to symptoms of posttraumatic stress (PTS). Sleep quality may influence the PTS and substance use association, particularly among college students who are at risk for poor sleep. The purpose of the present study was to examine the moderating effect of sleep quality on the relationship between PTS and substance use in a cohort of college students, with an exploratory aim of examining potential differences by assigned sex. A screening survey was completed by 2,767 students enrolled in a larger RCT examining various brief college student alcohol reduction strategies. Results found a significant two-way interaction between PTS symptoms and subjective sleep quality on weekly number of drinks and peak drinking occasion, where the significant positive association between PTS symptoms to weekly drinks and peak drinking occasion was only found for those who reported poor sleep quality. A similar pattern emerged for the significant two-way interaction between PTS symptoms and subjective sleep quality on cannabis use frequency. A significant three-way interaction (i.e., PTS Symptoms × Poor Subjective Sleep Quality × Assigned Sex) indicated the two-way interaction between PTS symptoms and sleep quality for both weekly drinks and cannabis use frequency was stronger among male compared to female participants. Study findings suggest sleep quality is an important factor contributing to the relation between PTS symptom severity and substance use among college students. Strategies for assessing and improving sleep quality and PTS symptoms can be incorporated into prevention and intervention efforts targeting substance use related harm for college students.

Effects of Cannabis on PTSD Recovery: Review of the Literature and Clinical Insights.

Purpose of Review: Individuals with posttraumatic stress disorder (PTSD) may use cannabis to reduce symptoms yet are also at risk for developing problematic use. This review outlines theories, summarizes recent empirical studies, and discusses clinical implications of cannabis use and PTSD recovery. Recent Findings: Although naturalistic studies and open trials find a relationship between cannabinoids and PTSD symptom reduction, methodological limitations preclude definitive conclusions. The only randomized controlled trial to date found cannabis had no greater effect on PTSD symptoms than placebo. Summary: Rigorous studies of the long-term impact of cannabis use on PTSD recovery are needed. Clinicians and researchers must weigh the potential therapeutic effect against the costs and risks associated with long-term cannabis use. Clinicians should consider all available PTSD treatment options, along with client level factors such as the function of cannabis use, motivation to change use, and the potential impact of cannabis on treatment engagement when making clinical recommendations.

Posttraumatic cognitions and sexual assault: Understanding the role of cognition type in posttraumatic stress symptoms and problematic alcohol use.

Identifying potential mechanisms underlying the association between posttraumatic stress symptoms (PTSS) and problematic alcohol use is an important target among college women who have experienced sexual assault. This study examined the role of posttraumatic cognitions in this association among college women (N = 530) who experienced either an alcohol-involved assault or non-alcohol-involved assault, using baseline assessment data from a larger study examining cognitive and emotional risk factors for problem drinking. Conditional path analysis was used to examine the indirect effects of posttraumatic cognitions on the association between PTSS and alcohol use consequences, with assault type as a moderator. The findings revealed a significant indirect path from PTSS to alcohol use consequences through posttraumatic cognitions, B = 0.21, SE = 0.04, p < .001, 95% CI [0.13, 0.29], ß = .16, R2 = .32. Exploratory analyses revealed a significant conditional indirect effect through self-blame cognitions, R2 = .31, whereby the indirect effect of self-blame on the association between posttraumatic stress and alcohol consequences was present among participants who experienced alcohol-involved assault, B = 0.10, SE = 0.03, p < .001, 95% CI [0.06, 0.16], ß = .07, but not among those who experienced a non-alcohol-involved assault, B = 0.03, SE = 0.03, p = 0.32, 95% CI [-0.02, 0.08], ß = .02. Posttraumatic cognitions are a potential mechanism underlying the link between posttraumatic stress and alcohol consequences. Addressing posttraumatic cognitions, particularly those related to self-blame, may be an important target for interventions promoting healthy recovery following alcohol-involved assault.

Impact of Chronic Pain and Perceived Opioid Benefit on Value Domains.

Non-pharmacological chronic pain treatments increasingly incorporate values-based approaches as an alternative to opioid therapy. Chronic pain and opioid use may differentially impact value domains such as family or work, and there is little guidance on how to implement values-based treatment to address pain and comorbid opioid use. This study aims to characterize ways in which chronic pain and values interact. Participants (N = 327) 18 or older (M = 46 years) experiencing chronic musculoskeletal pain for > 3 months and actively taking a prescription opioid completed an online, self-report survey assessing the importance of values in six domains (i.e., family, intimate relationships, friendship, work, health, growth). Participants responded to questions about pain interference with and without opioids, and subjective impact of pain within each value domain. There were significant differences between the six value domains in importance ratings. Pain interference also differed among the values with the most reported pain interference occurring in the work and health domains. Pain interference without opioids was significantly greater for work, health, and family than the other values. The subjective impact of pain interference was greatest for family, work, and health as well. Across all value domains, pain interference without opioids was significantly greater than pain interference with the use of opioids. Results highlight that value domains are differentially impacted by chronic pain and opioids are perceived as reducing pain interference across all values. These results provide an initial description from which theory and hypotheses can be developed. Clinical implications and future directions are discussed.

Pain-related disability, PTSD symptoms, and mood among a comorbid chronic pain and PTSD sample prior to and during the COVID-19 pandemic.

There is a knowledge gap when treating comorbid chronic pain and posttraumatic stress disorder (PTSD) during the COVID-19 pandemic. Addressing this gap, 169 individuals (57.4% female), aged 39.8 years were recruited based on levels of pain-related disability and PTSD symptoms. Participants were assessed prior to, and during, the COVID-19 pandemic. Improvements in pain-related disability were marginally attenuated for the comorbid group, compared to the chronic pain group. Results show that some condition-specific symptoms may not have been affected by the COVID-19 pandemic. Cautious interpretation is warranted due to only two time points and the lack of a diverse sample.

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder.

OBJECTIVE: The novel coronavirus (2019; CV-19) is linked to increases in emotional distress and may be particularly problematic for those with pre-existing mental and physical conditions, such as chronic pain and posttraumatic stress disorder (PTSD). However, little empirical research has been published on resilience factors in these individuals. The present study aims to examine authenticity as a resilience factor among those with chronic pain and/or PTSD. METHODS: Prior to the national response to the pandemic (January 10-24, 2020), participants were screened for pain-related disability (Oswestry Disability Index; ODI) and PTSD symptoms (Posttraumatic Checklist for DSM-5; PCL-5), and on the basis of those responses were categorized into one of four groups: healthy, chronic pain only, PTSD only, or comorbid chronic pain and PTSD. During the CV-19 pandemic (May 5-May 13, 2020), participants responded again to the ODI and PCL-5, in addition to the Wood Authenticity Scale, Brief Pain Inventory, and items related to the CV-19 pandemic. RESULTS: A total of 110 participants (54.55% women), aged 42.19 (SD = 13.16), completed the survey during the pandemic. The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Authenticity moderated this relationship relevant to CV-19 Threat among those in the chronic pain only group, and not in any other group. CONCLUSION: The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Importantly, greater authenticity was associated with less CV-19 Threat in the chronic pain only group, and not in any other group. The present study also highlights the importance of engaging authentically for those with chronic pain during the pandemic.

An Examination of Chronic Pain Indices and the Updated Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental-Disorders-Fifth Edition.

INTRODUCTION: Chronic pain and post-traumatic stress disorder (PTSD) comorbidity is prevalent among veterans and is associated with increased levels of pain severity and pain-related disability. An improved understanding of the relationship between these co-occurring disorders, in addition to effective integrated treatments, will develop by considering the changes to the PTSD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The current study examined the relationship between the revised PTSD Checklist for DSM-5 (PCL-5) symptom clusters (i.e., intrusion, avoidance, negative alterations in cognition and mood [NACM], and arousal) and chronic pain measurements (i.e., pain severity, interference, and disability). MATERIALS AND METHODS: Participants included 103 veterans (ages 26-70, mean = 45.33) participating in a randomized clinical trial examining the efficacy of an interdisciplinary pain management program for chronic musculoskeletal pain. The study was approved by a university system Institutional Review Board and affiliated healthcare system. RESULTS: The participants with a provisional PTSD diagnosis based on PCL-5 responses (N = 76) had significantly greater pain severity, interference, and disability than the participants without a provisional diagnosis (N = 23). Correlations between symptom clusters and pain measurements were mostly significant and positive with varying strengths. The avoidance symptom cluster, however, had relatively weaker correlations with pain measurements and was not significantly associated with the numeric rating scale of pain severity. Path analyses revealed that, after controlling for avoidance symptoms, significant associations remained between NACM and all the pain measurements. After controlling for NACM symptoms, however, there were no significant associations between avoidance symptoms and pain measurements. CONCLUSION: The current study highlights a need to re-examine the leading theories about the mutual maintenance of these disorders in order to develop effective integrative treatment approaches. PTSD-related avoidance may have a relatively weaker role in co-occurring chronic pain than the other symptom clusters and may have a qualitatively different role than chronic pain-related avoidance. Future research should explore the relationship between the avoidance in PTSD and the avoidance in chronic pain as well as identify which chronic pain measurements are the most useful when examining the relationship between PTSD and chronic pain. The potential impact of trauma-related cognition and mood on chronic pain indicates that this is an important area for intervention and should be considered in the development of integrated treatments for chronic pain and PTSD among veterans.

The Effectiveness of a School-Based Intervention for Adolescents in Reducing Disparities in the Negative Consequences of Substance Use Among Ethnic Groups.

Ethnic minority youth are disproportionately affected by substance use-related consequences, which may be best understood through a social ecological lens. Differences in psychosocial consequences between ethnic majority and minority groups are likely due to underlying social and environmental factors. The current longitudinal study examined the outcomes of a school-based motivational enhancement treatment intervention in reducing disparities in substance use consequences experienced by some ethnic minority groups with both between and within-subjects differences. Students were referred to the intervention through school personnel and participated in a four-session intervention targeting alcohol and drug use. Participants included 122 youth aged 13-19 years. Participants were grouped by ethnicity and likelihood of disparate negative consequences of substance use. African American/Hispanic/Multiethnic youth formed one group, and youth identifying as White or Asian formed a second group. We hypothesized that (1) there would be significant disparities in psychosocial, serious problem behavior, and school-based consequences of substance use between White/Asian students compared to African American/Hispanic/Multiethnic students at baseline; (2) physical dependence consequences would not be disparate at baseline; and (3) overall disparities would be reduced at post-treatment follow-up. Results indicated that African American/Hispanic/Multiethnic adolescents demonstrated statistically significant disparate consequences at baseline, except for physical dependency consequences. Lastly, significant reductions in disparities were evidenced between groups over time. Our findings highlight the efficacy of utilizing school-based substance use interventions in decreasing ethnic health disparities in substance use consequences.

READY or Not: Findings From a School-Based MI Intervention for Adolescent Substance Use.

We aimed to examine the impact of a school-based Motivational Interviewing (MI) intervention, Project READY, on reducing adolescent substance use. We randomly assigned students (N = 244) to receive the intervention immediately (READY First) or to be in a waitlist control group (WLC). Those in WLC received the intervention once those in READY First had completed the intervention. Our hypotheses were: (1) adolescents in READY First would make greater initial reductions in their alcohol and marijuana use compared to adolescents assigned to WLC, (2) adolescents in READY First would make greater initial reductions in their alcohol and marijuana-related consequences compared to adolescents assigned to WLC, and (3) upon completing treatment, adolescents assigned to WLC would yield substance-related outcomes comparable to their peers in the READY First group. We found that those in READY First made greater initial decreases in their marijuana use and substance-related consequences upon completing treatment than participants in WLC, during the first phase of the study. Once both groups had completed the active intervention, those in the WLC had comparable marijuana use to those in READY First. At enrollment, daily marijuana users were equally represented in both groups. Post-treatment, significantly fewer participants reported daily marijuana use in the READY First group, prior to treatment initiation for WLC. Comparable reductions were observed once WLC began treatment. Those in WLC were observed to make reductions in their alcohol use at the same rate as those in READY First, prior to treatment initiation. Participants were not observed to make differential reductions in alcohol use based on group assignment. The findings from this study support the effectiveness of school-based MI interventions for adolescent marijuana use and provide evidence that MI is a critical and effective component within such interventions.