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The Mediating Effect of Pain Catastrophizing on PTSD Symptoms and Pain Outcome

Gilliam, Wesley P., PhD*; Craner, Julia R., PhD†,‡; Schumann, Matthew E., PhD*; Gascho, Keith, LPCC*

The Clinical Journal of Pain: July 2019 - Volume 35 - Issue 7 - p 583–588
doi: 10.1097/AJP.0000000000000713
Original Articles

Objective: Coprevalence of chronic pain and posttraumatic stress disorder (PTSD) negatively impacts the course of both disorders. Patients diagnosed with both conditions report greater pain, affective distress, and disability when compared with those with either chronic pain or PTSD alone. While the prevalence and complexity of the comorbidity is widely acknowledged, there is a dearth of research examining potential mechanism variables that might account for the relationship between chronic pain and PTSD. The current study utilizes a series of mediation analyses to examine if pain catastrophizing mediates the relationship between PTSD symptomatology and chronic pain outcome.

Materials and Methods: A total of 203 treatment-seeking participants admitted to a 3-week interdisciplinary pain rehabilitation program completed a battery of psychometrically validated measures of pain severity, pain interference, pain catastrophizing, depressive symptoms, and PTSD symptoms at program admission.

Results: A series of multiple parallel mediation analyses revealed that pain catastrophizing fully mediated the relationships between PTSD symptoms and pain outcome (ie, pain severity and pain interference) above and beyond the influence of depressive symptoms.

Discussion: Results suggest that pain catastrophizing may represent an important cognitive mechanism through which PTSD symptoms influence the experience of chronic pain. Psychosocial treatment approaches that directly target tendency to catastrophize in response to pain may hold the potential to have salutary effects on both chronic pain and PTSD.

*Mayo Clinic, Rochester, MN

Mary Free Bed Rehabilitation Hospital

Michigan State University College of Human Medicine, Grand Rapids, MI

The authors declare no conflict of interest.

Reprints: Wesley P. Gilliam, PhD, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905 (e-mail:

Received December 9, 2018

Received in revised form February 18, 2019

Accepted March 21, 2019

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