Recalled protective childhood experiences are associated with positive emotional expression in active-duty firefighters.

There is a wealth of research linking adverse childhood experiences (ACEs) with negative outcomes later in life, but less research has focused on the effects of protective childhood experiences (PCEs). PCEs have been shown broadly to promote resilience, but the precise nature of this association is not clear, particularly in studies of at-risk adults. The current investigation explored the association between recollection of early life experiences and in vivo emotional responses in at-risk adults. In 2018, 56 active-duty firefighters reported childhood experiences via a questionnaire. Using a semistructured interview, firefighters then responded to questions about recent emotionally evocative experiences (positive and negative) as a firefighter. Emotion was measured in vivo via sympathetic arousal and recorded facial expressions of emotion. Individuals who reported more PCEs expressed significantly more facial expressions of positive emotion across contexts, sr2 = .11-.14. Early childhood experiences were not significantly associated with negative facial expressions or changes in sympathetic reactivity, but ACEs were associated with tonic levels of arousal in a negative context, r = -.36. Given the adaptive role of positive emotions in adjustment to adverse events, the current investigation suggests a potential protective association between PCEs and the expression of emotion even within a high-risk context, which could help explain the resilience promoting role of PCEs.

Relationship of Morphometrics and Symptom Severity in Female Type I Chiari Malformation Patients with Biological Resilience.

In the present study we report the relationship among MRI-based skull and cervical spine morphometric measures as well as symptom severity (disability-as measured by Oswestry Head and Neck Pain Scale and social isolation-as measured by the UCLA Loneliness scale) on biomarkers of allostatic load using estrogen, interleukin-6, C-reactive protein, and cortisol in a sample of 46 CMI patients. Correlational analyses showed that McRae line length was negatively associated with interleukin-6 and C-reactive protein levels, and Analysis of Variance (ANOVA) showed joint effects of morphometric measures (McRae line length, anterior CSF space) and symptom severity (disability and loneliness) on estrogen and intereukin-6 levels. These results are consistent with allostatic load. That is, when the combination of CSF crowding and self-report symptom (disability and loneliness) severity exceed the capacity of biological resilience factors, then biomarkers such as neuroprotective estrogen levels drop, rather than rise, with increasing symptom severity.

Rare copy number variation in posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is a heritable (h2 = 24-71%) psychiatric illness. Copy number variation (CNV) is a form of rare genetic variation that has been implicated in the etiology of psychiatric disorders, but no large-scale investigation of CNV in PTSD has been performed. We present an association study of CNV burden and PTSD symptoms in a sample of 114,383 participants (13,036 cases and 101,347 controls) of European ancestry. CNVs were called using two calling algorithms and intersected to a consensus set. Quality control was performed to remove strong outlier samples. CNVs were examined for association with PTSD within each cohort using linear or logistic regression analysis adjusted for population structure and CNV quality metrics, then inverse variance weighted meta-analyzed across cohorts. We examined the genome-wide total span of CNVs, enrichment of CNVs within specified gene-sets, and CNVs overlapping individual genes and implicated neurodevelopmental regions. The total distance covered by deletions crossing over known neurodevelopmental CNV regions was significant (beta = 0.029, SE = 0.005, P = 6.3 × 10-8). The genome-wide neurodevelopmental CNV burden identified explains 0.034% of the variation in PTSD symptoms. The 15q11.2 BP1-BP2 microdeletion region was significantly associated with PTSD (beta = 0.0206, SE = 0.0056, P = 0.0002). No individual significant genes interrupted by CNV were identified. 22 gene pathways related to the function of the nervous system and brain were significant in pathway analysis (FDR q < 0.05), but these associations were not significant once NDD regions were removed. A larger sample size, better detection methods, and annotated resources of CNV are needed to explore this relationship further.

Resilience and recovery from total knee arthroplasty (TKA): a pathway for optimizing patient outcomes.

Identifying and promoting resilience factors may offer novel strategies for optimizing the recovery of patients following orthopedic surgery. Prior research has suggested that self-efficacy, positive affect, vigor, and vitality may function as resilience factors in the face of chronic pain. The present study examines these resilience factors in a prospective, cognitive-affective-behavioral pathway to recovery. Patients (n = 110) undergoing unilateral, total knee replacement surgery completed self-report assessments of study variables. Self-efficacy was assessed 2 ½ weeks prior to surgery, positive affect the day after surgery, vitality and vigor one-month following surgery, and post-operative pain at one- and three-months following surgery. Control variables included gender, pain, and depressive symptoms prior to surgery. Path analysis revealed significant coefficients from pre-operative self-efficacy to positive affect during hospitalization (ß = .246, p = .017), as well as to vitality (ß = .323, p = .001) and vigor (ß = .387, p < .001) at one-month following surgery. Both indicators of energy predicted better post-operative recovery (one-month: vitality ß = -.254, p = .016; vigor ß = -.329, p = .002); three-months: vitality ß = -.192, p = .047, vigor ß = -.201, p = .044). Findings support a cognitive-affective-behavioral pathway to recovery.

Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD.

BACKGROUND: Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. METHODS: This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. RESULTS: Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. CONCLUSIONS: The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.

Impact of Surgical Status, Loneliness, and Disability on Interleukin 6, C-Reactive Protein, Cortisol, and Estrogen in Females with Symptomatic Type I Chiari Malformation.

Chiari malformation type I (CMI) provides an opportunity for examining possible moderators of allostatic load. CMI patients who had (n = 43) and had not (n = 19) undergone decompression surgery completed questionnaires regarding pain, disability, and loneliness, and provided serum samples for IL-6, CRP, estrogen, and free estradiol assays, and saliva samples to assess diurnal cortisol curves. ANOVAs examining surgical status (decompressed versus non-decompressed), loneliness (high vs. low), and disability (high vs. low) as independent variables and biomarker variables as dependent factors found that loneliness was associated with higher levels of cortisol, F(1, 37) = 4.91, p = .04, η2P = .11, and lower levels of estrogen, F(1, 36) = 7.29, p = .01, η2P = .17, but only in decompressed patients. Results highlight the possible impact of loneliness on biological stress responses and the need to intervene to reduce loneliness in patients with symptomatic CMI.

Boosting positive mood in medical and emergency personnel during the COVID-19 pandemic: preliminary evidence of efficacy, feasibility and acceptability of a novel online ambulatory intervention.

OBJECTIVES: The aim of this project was to test the efficacy of a brief and novel online ambulatory intervention aimed at supporting psychological health and well-being for medical personnel and first responders during the COVID-19 pandemic. METHODS: Interested participants, n=28, actively employed as medical personnel, support staff and emergency responders, in the Midwestern USA in May-June of 2020, provided informed consent and were randomised to complete either low-dose or high-dose intervention, one time daily for 1 week via smartphone application. Each daily intervention included expressive writing, adaptive emotion regulation activity and (one vs two) positive emotion-generation activities, lasting 3-6 min a day. Ratings of negative and positive emotion were provided before and after each activity daily. Analyses tested compliance, acceptability, as well as efficacy at increasing positive emotion and decreasing negative emotion with each use and across time. RESULTS: The results indicated a 13% increase in positive emotion, t(25)=2.01, p=0.056; and decrease in negative emotion by 44%, t(25)=-4.00, p=0.001 across both doses. However, there was a clear advantage for individuals in the high-dose condition as daily boosts in positive emotion were significantly greater (an additional 9.4%) B=0.47, p=0.018. Overall, compliance was good. Acceptability ratings were good for those who completed the follow-up assessment. CONCLUSION: Front-line personnel, including medical staff and emergency responders, are experiencing unprecedented psychological stress during the COVID-19 pandemic. This investigation suggests both feasibility and efficacy for a brief, daily, ambulatory intervention which could provide essential psychological support to individuals at risk in the workplace.

Posttraumatic Stress in Children After Injury: The Role of Acute Pain and Opioid Medication Use.

OBJECTIVES: After injury, many children experience posttraumatic stress symptoms (PTSS) that negatively impact recovery. Acute pain and PTSS share neurobiological pathways, and acute dosage of morphine has been linked to reduced PTSS in naturalistic studies. However, the complex interactions between pain, morphine and other opioid use, and PTSS have yet to be investigated in robust pediatric samples.This prospective, longitudinal study examined relationships between acute pain, opioid medications, and PTSS after pediatric injury. METHODS: Ninety-six children aged 8 to 13 years (mean = 10.60, SD = 1.71), hospitalized for unintentional injury, completed assessments at baseline (T1) and 12 weeks (T2) later. Pain ratings and opioid administration data were obtained via chart review. RESULTS: Structural equation modeling revealed that worst pain endorsed during hospitalization was positively associated with concurrent and later PTSS when controlling for evidence-based risk factors (ie, age, sex, prior trauma history, traumatic appraisals of injury event, heart rate). Neither opioid medications overall nor morphine specifically (milligram/kilogram/day) administered during hospitalization mediated the relationship between pain and T2 PTSS. CONCLUSIONS: Pain during hospitalization may increase susceptibility for persistent PTSS above and beyond the influence of other empirical risk factors. Findings suggest that pain assessment may be a useful addition to pediatric PTSS screening tools and highlight the need for additional research on pharmacological secondary prevention approaches. Given that inadequate pain control and persistent PTSS each hinder recovery and long-term functioning, better understanding of interactions between acute pain and PTSS after injury is essential for improving screening, prevention, and early intervention efforts.

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study.

BACKGROUND: Previous work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator. METHODS: We used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities. RESULTS: Twenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided. CONCLUSION: Peritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation. TRIAL REGISTRATION: Jerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.

Correction to: Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study.

An amendment to this paper has been published and can be accessed via the original article.

Effect of smoke exposure on young adults' sleep quality.

In this study, we aimed to examine the relationship between active smoking and environmental tobacco smoke exposure on sleep-quality complaints. In total, 1023 young adult participants completed online surveys. Based on these surveys, participants were classified into three groups according to their level of smoke exposure (low, moderate, high). An analysis of covariance revealed that, after controlling for sex, participants with high and moderate smoke exposure reported more sleep complaints than those with low exposure. Among non-smokers, hierarchical linear regression indicated that environmental tobacco smoke exposure was positively associated with sleep complaints. Improved understanding of modifiable risk factors for young adults' poor sleep quality, such as smoke exposure, could enable lifestyle changes that might lay the foundation for improved health at later life stages.

Clinical implications of the proposed ICD-11 PTSD diagnostic criteria.

BACKGROUND: Projected changes to post-traumatic stress disorder (PTSD) diagnostic criteria in the upcoming International Classification of Diseases (ICD)-11 may affect the prevalence and severity of identified cases. This study examined differences in rates, severity, and overlap of diagnoses using ICD-10 and ICD-11 PTSD diagnostic criteria during consecutive assessments of recent survivors of traumatic events. METHODS: The study sample comprised 3863 survivors of traumatic events, evaluated in 11 longitudinal studies of PTSD. ICD-10 and ICD-11 diagnostic rules were applied to the Clinician-Administered PTSD Scale (CAPS) to derive ICD-10 and ICD-11 diagnoses at different time intervals between trauma occurrence and 15 months. RESULTS: The ICD-11 criteria identified fewer cases than the ICD-10 across assessment intervals (range -47.09% to -57.14%). Over 97% of ICD-11 PTSD cases met concurrent ICD-10 PTSD criteria. PTSD symptom severity of individuals identified by the ICD-11 criteria (CAPS total scores) was 31.38-36.49% higher than those identified by ICD-10 criteria alone. The latter, however, had CAPS scores indicative of moderate PTSD. ICD-11 was associated with similar or higher rates of comorbid mood and anxiety disorders. Individuals identified by either ICD-10 or ICD-11 shortly after traumatic events had similar longitudinal course. CONCLUSIONS: This study indicates that significantly fewer individuals would be diagnosed with PTSD using the proposed ICD-11 criteria. Though ICD-11 criteria identify more severe cases, those meeting ICD-10 but not ICD-11 criteria remain in the moderate range of PTSD symptoms. Use of ICD-11 criteria will have critical implications for case identification in clinical practice, national reporting, and research.

Are There Age Differences in Consolidated Episodic Memory?

Background/Study Context: While most aging research on memory uses a retention interval of one hour or less, episodic consolidation takes longer (e.g., 6-24 hours for synaptic consolidation). In three experiments, we examined age differences in recall followed by recognition in which the retention interval was varied in younger and older adults. METHODS: In Experiment 1 (n = 24 for both age groups), zero-, 1- and 24-hour retention intervals were used for recall for all participants, and a 24-hour retention interval was used for recognition. In Experiment 2 (n = 24 for both age groups), just a 24-hour retention interval was used. In Experiment 3 (n = 20 for both age groups), a within-subjects design was used in which participants recalled one word list after one hour and again after 24 hours, and recalled another word list just after 24 hours (with recognition for both conditions after the 24-hour recall). RESULTS: In Experiment 1, older adults recalled fewer words at both the 1- and 24-hour retention intervals, but the magnitude of the age difference did not differ. In Experiment 2 (just 24-hour retention interval), there were no age differences in recall. In Experiment 3, in the two-recall condition, older adults showed lower recall at both 1-hour and 24-hour retention intervals (but the magnitude of the age difference remained constant across retention interval). In the single-recall just 24-hour retention condition, there were no age differences. There were no age differences in recognition in any of the three experiments. CONCLUSION: These results suggest that recall declines for a 24-hour retention interval relative to a zero or one-hour retention interval (Experiments 1 and 3) for both age groups. However, when the first recall attempt occurs after a 24-hour retention interval, there are no age differences. These replicated results suggest that older adults do not benefit as much as younger adults from pre-consolidated rehearsal, but that rehearsal-based age differences do not increase in magnitude from the last rehearsal to memory consolidation. Furthermore, (along with), the present results indicate that there are no age differences in recall when the first recall attempt occurs after a long retention interval - when memory consolidation is likely to have occurred before the first retrieval attempt.

Improving our understanding of the relationship between emotional abuse and substance use disorders: the mediating roles of negative urgency and posttraumatic stress disorder.

Background: Emotional abuse is associated with an increased risk for substance use disorders (SUDs) as well as with negative urgency and posttraumatic stress disorder (PTSD) following a subsequent trauma. Both negative urgency and PTSD are key contributors to the relationship between emotional abuse and SUDs when examined separately. A comprehensive model including both factors can inform models of PTSD-SUD comorbidity. Furthermore, the comparison of these mechanistic roles in emotional versus other types of abuse can shed light on the specificity of these effects. Objectives: The present study tested whether negative urgency and PTSD symptom severity serially mediated the relationship between emotional abuse and substance use across two separate samples. Method: Participants were recruited from a detoxification center and completed a battery of surveys examining abuse history, PTSD symptom severity, and impulsivity measures including negative urgency and substance use history during the last 3 months. The samples consisted of predominantly (59% and 62%) males with an average age of 35 (age range: 18-65). The majority of participants (90% and 93%) were Caucasian. Results: Study 1 (N = 368) and Study 2 (N = 274) both found that negative urgency and PTSD symptom severity serially mediated the relationship between emotional abuse and substance use. When comparing indirect effects, both contributed equally. Conclusion: These findings suggest that negative urgency and PTSD symptom severity together account more for the link between emotional abuse and SUDs than either alone and argue for the inclusion of negative urgency in models of PTSD-SUD comorbidity.

The Role of Negative Affect on Headache-Related Disability Following Traumatic Physical Injury.

OBJECTIVE: Acute postinjury negative affect (NA) may contribute to headache pain following physical injury. Early psychiatric-headache comorbidity conveys increased vulnerability to chronic headache-related disability and impairment. Yet, it is unknown whether NA is involved in the transition to chronic headache related-disability after injury. This prospective observational study examined the role of acute postinjury NA on subacute and chronic headache-related disability above and beyond nonpsychiatric factors. METHODS: Eighty adult survivors of single-incident traumatic physical injury were assessed for negative affect (NA): a composite of depression and anxiety symptoms, and symptoms of posttraumatic stress disorder (PTSS) during the acute 2-week postinjury phase. NA was examined as the primary predictor of subacute (6-week) and chronic (3-month) headache-related disability; secondary analyses examined whether the individual NA components differentially impacted the outcomes. RESULTS: Hierarchical linear regression confirmed NA as a unique predictor of subacute (Cohen's f 2 = 0.130; P = .005) and chronic headache related-disability (Cohen's f 2 = 0.160; P = .004) beyond demographic and injury-related factors (sex, prior headaches, and closed head injury). Upon further analysis, PTSS uniquely predicted greater subacute (Cohen's f 2 = 0.105; P = .012) and chronic headache-related disability (Cohen's f 2 = 0.103; P = .022) above and beyond demographic and injury-related factors, depression, and anxiety. Avoidance was a robust predictor of subacute headache impairment (explaining 15% of the variance) and hyperarousal was a robust predictor of chronic headache impairment (10% of the variance). CONCLUSION: Although NA consistently predicted headache-related disability, PTSS alone was a unique predictor above and beyond nonpsychiatric factors, depression, and anxiety. These results are suggestive that early treatment of acute postinjury PTSS may correlate with reductions in disability and negative physical health sequelae associated with PTSS and chronic headache.

A multi-level modeling approach examining PTSD symptom reduction during prolonged exposure therapy: moderating effects of number of trauma types experienced, having an HIV-related index trauma, and years since HIV diagnosis among HIV-positive adults.

People living with HIV (PLWH) have extensive interpersonal trauma histories and higher rates of posttraumatic stress disorder (PTSD) than the general population. Prolonged exposure (PE) therapy is efficacious in reducing PTSD across a variety of trauma samples; however, research has not examined factors that influence how PTSD symptoms change during PE for PLWH. Using multi-level modeling, we examined the potential moderating effect of number of previous trauma types experienced, whether the index trauma was HIV-related or not, and years since HIV diagnosis on PTSD symptom reduction during a 10-session PE protocol in a sample of 51 PLWH. In general, PTSD symptoms decreased linearly throughout the PE sessions. Experiencing more previous types of traumatic events was associated with a slower rate of PTSD symptom change. In addition, LOCF analyses found that participants with a non-HIV-related versus HIV-related index trauma had a slower rate of change for PTSD symptoms over the course of PE. However, analyses of raw data decreased this finding to marginal. Years since HIV diagnosis did not impact PTSD symptom change. These results provide a better understanding of how to tailor PE to individual clients and aid clinicians in approximating the rate of symptom alleviation. Specifically, these findings underscore the importance of accounting for trauma history and index trauma type when implementing a treatment plan for PTSD in PLWH.

Self-Regulation Shift Theory: A Dynamic Systems Approach to Traumatic Stress.

Self-regulation shift theory (SRST) is a threshold theory explaining self-regulation following trauma that utilizes nonlinear dynamics to capture systemic shifts in trauma adaptation. Cusp catastrophe modeling tests nonlinear changes in an outcome (e.g., posttraumatic distress) based on an identified bifurcation factor under specific conditions (i.e., asymmetry variables). We evaluated two cusp models in a motor vehicle accident (MVA) database and then confirmed findings within a similar dataset. Based on SRST, we tested coping self-efficacy (CSE) as the bifurcation factor and a set of asymmetry controlling variables. Results demonstrated significant cusp models with CSE as a consistent bifurcation factor in all models. When participants reported lower peritraumatic dissociation, early lower CSE was a significant bifurcation factor for 3-month trauma symptoms in Sample 1, R2 = .18. The cusp model for changes in symptoms from 30 days to 3 months showed CSE as a significant bifurcation variable with higher levels of avoidant coping (R2 = .27). In a separate sample, early lower CSE was again a significant bifurcation variable with lower injury severity (R2 = .52). Results support the importance of self-regulatory appraisals in nonlinear shifts in posttraumatic stress symptoms 3 months post-MVA. Theoretical and practical implications are discussed.

Perceptions of Harm and Reasons for Misuse of Prescription Opioid Drugs and Reasons for Not Seeking Treatment for Physical or Emotional Pain Among a Sample of College Students.

BACKGROUND: Since the early 1990s, the United States has seen a significant increase in the prevalence of prescription opioid misuse. Despite benefits prescription opioids provide, misuse can be fatal. OBJECTIVES: The current study was designed to investigate the prevalence of prescription opioid misuse, perceived harm of misuse, and reasons for misuse for physical or emotional pain instead of seeking professional medical or mental health treatment. METHODS: Survey data were collected in the fall of 2013 via an online survey to a random sample of 668 students from a public Midwestern university. RESULTS: Lifetime prevalence of prescription opioid misuse was 9.5%. Misusers of prescription opioid drugs generally reported lower ratings of perceived harm as compared to individuals not reporting misuse of prescription opioid drugs. Primary reasons for misuse of prescription opioid drugs was to relieve pain (33.9%), "to feel good/get high" (23.2%) and experimentation (21.4%). Lifetime misuse of a prescription opioid drug for physical or emotional pain was reported by 8.1% and 2.2% of respondents, respectively. Primary reasons for misuse for physical pain included because pain was temporary, immediate relief was needed, and no health insurance/financial resources. Primary reasons for misuse for emotional pain included not wanting others to find out, embarrassment and fear. Conclusions/Importance: Reasons for misuse of prescription opioid drugs vary by type of prescription opioid drug. Reasons for not seeking treatment that ultimately lead to misuse, vary by type of pain being treated and may be important considerations in the effort to stem the misuse of prescription opioid drugs among college students.

Physiological Indices of Stress Prior to and Following Total Knee Arthroplasty Predict the Occurrence of Severe Post-Operative Pain.

OBJECTIVE: The severe pain and disability associated with osteoarthritis often motivate individuals to undergo arthroplastic surgery. However, a significant number of surgical patients continue to experience pain following surgery. Prior research has implicated both the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) in the sensitization of pain receptors and chronic pain conditions. This study uses a prospective, observational, cohort design to examine whether physiological stress responses before and after surgery could predict post-operative pain severity. SUBJECTS: Participants included 110 patients undergoing total knee arthroplasty. METHODS: Physiological indices of stress included the measurement of catecholamine and cortisol levels in 15-hour urine samples collected prior to and 1 month following surgery, as well as in-hospital heart rate and blood pressure (before and after surgery), which were abstracted from medical records. Patients completed the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) [Bellamy et al., J Orthop Rheumatol 1: , 95 (1988)] 2.5 weeks prior to surgery and at a 3-month follow-up. RESULTS: Contrary to expectations, lower stress hormone levels at baseline were related to more severe post-operative pain. Data at later time points, however, supported our hypothesis: cardiovascular tone shortly before surgery and urinary levels of epinephrine 1 month following surgery were positively related to pain severity 3 months later. CONCLUSION: Results suggest that the occurrence of post-operative pain can be predicted on the basis of stress physiology prior to and following arthroplastic surgery.

Pharmacological modulation of acute trauma memories to prevent PTSD: considerations from a developmental perspective.

Estimates of the lifetime prevalence of posttraumatic stress disorder (PTSD) in American adults range from 6.4% to 6.8%. PTSD is associated with increased risk for comorbid major depression, substance use disorder, suicide, and a variety of other mental and physical health conditions. Given the negative sequelae of trauma/PTSD, research has focused on identifying efficacious interventions that could be administered soon after a traumatic event to prevent or reduce the subsequent incidence of PTSD. While early psychosocial interventions have been shown to be relatively ineffective, early (secondary) pharmacological interventions have shown promise. These pharmacological approaches are largely based on the hypothesis that disruption of altered stress hormone levels and the consequent formation of trauma memories could protect against the development of PTSD. The present manuscript reviews the literature regarding the role of peri-traumatic stress hormones as risk factors for the development of PTSD and reviews evidence for the efficacy of exogenously modulating stress hormone levels to prevent/buffer the development of PTSD symptoms. Whereas prior literature has focused primarily on either child or adult studies, the present review incorporates both child and adult studies in a developmental approach to understanding risk for PTSD and how pharmacological modulation of acute memories may buffer the development of PTSD symptoms.