The relationship between pain and posttraumatic stress symptoms in palliative care

The palliative care literature suggests that pain and psychological distress are considerable concerns, and recent research has demonstrated that PTSD is prevalent among oncology and palliative care patients. Furthermore, research emanating from the chronic pain literature suggests that pain and PTSD co-occur and are mutually maintained by proposed psychological variables. This study was conducted in order to investigate the relationship between pain and posttraumatic stress symptoms (PTSS) in palliative care. The first objective was to examine psychosocial predictors of PTSS after controlling for pain intensity, pain interference, and symptom distress. The second objective was to assess whether proposed psychosocial mutual maintenance variables mediate the relationship between pain interference and PTSS. The study findings suggest that pain anxiety is the strongest predictor of PTSS in this cohort after controlling for pain intensity, pain interference, and symptom distress among palliative care patients. The results of the present study also suggest that pain interference and PTSS co-occur in palliative care, and that pain catastrophizing and pain anxiety significantly mediate the relationship between pain interference and PTSS in this cohort. More specifically, when examined together pain anxiety emerged as the stronger mediator of pain interference and PTSS. Taken together, these results are a significant contribution to the palliative care literature. This is the first study to examine predictors of PTSS in palliative care, as well as the relationship between pain interference and PTSS in this cohort. Second, these results replicate known associations in the chronic pain literature and extend them to a palliative care milieu.