Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Posttraumatic Stress Symptoms Mediate the Effects of Trauma Exposure on Clinical Indicators of Central Sensitization in Patients With Chronic Pain

McKernan, Lindsey C., PhD*,†; Johnson, Benjamin N., MS; Crofford, Leslie J., MD§; Lumley, Mark A., PhD; Bruehl, Stephen, PhD; Cheavens, Jennifer S., PhD#

The Clinical Journal of Pain: May 2019 - Volume 35 - Issue 5 - p 385–393
doi: 10.1097/AJP.0000000000000689
Original Articles

Objective: Evidence supports high rates of co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain disorders involving central sensitization (CS). The nature of this relationship, however, remains relatively unexplored. In this study, we aimed to (1) assess how both trauma exposure and current PTSD symptoms are related to clinical manifestations of CS, and (2) test whether PTSD symptoms explain the relationship between trauma exposure and CS. Because experiential avoidance has been shown to impact the relationship between trauma and health outcomes, we (3) explored experiential avoidance as a possible mediator or moderator of the trauma-CS relationship.

Methods: A sample of 202 adult patients (79% female) with chronic pain completed validated self-report measures of trauma exposure, current PTSD symptoms, experiential avoidance, and 3 manifestations of CS: widespread pain, greater pain severity, and polysomatic symptom reporting. We used path analysis and multivariate regression to assess our study aims.

Results: Both trauma exposure and PTSD symptoms were significantly associated with all 3 clinical indicators of CS. PTSD symptoms partially explained the relationship between trauma exposure and widespread pain, pain intensity, and polysomatic symptoms. Experiential avoidance did not mediate or moderate the trauma-CS relationship.

Conclusions: Our findings suggest that trauma exposure is linked to elevated clinical markers of CS but a critical factor in this relationship is the mediating effect of current PTSD symptoms.

Departments of *Psychiatry and Behavioral Sciences

Physical Medicine and Rehabilitation


Anesthesiology, Vanderbilt University Medical Center, Nashville, TN

Department of Psychology, The Pennsylvania State University, University Park, PA

Department of Psychology, Wayne State University, Detroit, MI

#Department of Psychology, The Ohio State University, Columbus, OH

Supported by the Vanderbilt Patient Centered Outcomes Research Education and Training Initiative and the Agency for Healthcare Research and Quality (AHRQ 6K12HS022990-05), Nashville, TN, NIH grant R01-DA037891, Nashville, TN, and by Vanderbilt University Medical Center CTSA award No. UL1TR002243 from the National Center for Advancing Translational Sciences, Nashville, TN. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. The authors declare no conflict of interest.

Reprints: Lindsey C. McKernan, PhD, Departments of Psychiatry and Behavioral Sciences, Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Osher Center for Integrative Medicine, 3401 West End Avenue, Suite 380, Nashville, TN 37203 (e-mail:

Received August 13, 2018

Received in revised form January 11, 2019

Accepted January 22, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.