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.