Posttraumatic stress disorder and pain impact functioning and disability after major burn injury

This study sought to clarify the prospective and concurrent associations of posttraumatic stress disorder (PTSD) and pain with functioning and disability after burn injury. The sample was composed of consecutive patients admitted to a regional burn center with major burn injuries (N = 171) who were followed at 1, 6, 12, and 24 months postdischarge. The predictor measures were the McGill Pain Questionnaire and Davidson Trauma Scale, and the outcome measures were Short Form-36 Health Survey subscales administered at 6, 12, and 24 months after discharge. Linear mixed-effects analyses were conducted to evaluate pain and PTSD as predictors of functional outcomes. Higher PTSD symptom severity soon after hospital discharge was prospectively related to poorer physical and social functioning and greater psychosocial disability (P < .001). However, significant PTSD-by-time interactions also predicted future physical functioning and disability, indicating that the deleterious effects of early PTSD were ameliorated by time. In addition, at each follow-up, PTSD symptoms were concurrently related to greater physical and psychosocial disability, poorer social functioning, and less vitality (P < .001). More severe pain at each follow-up, but not PTSD, was correlated with poorer concurrent physical functioning (P < .002). Significant interaction terms indicated that the concurrent effect of PTSD on psychosocial disability, social functioning, and vitality attenuated during the 24-month recovery period. These findings suggest that assessing PTSD and pain following burn injury may aid in predicting future functioning. Future work should confirm this and evaluate whether aggressively treating both PTSD and pain helps improve functioning after major burn injury.