Gender differences in PTSD severity and pain outcomes: baseline results from the LAMP trial

Background Post-traumatic stress disorder (PTSD) and chronic pain are highly prevalent comorbid conditions. Veterans dually burdened by PTSD and chronic pain experience more severe outcomes compared to either disorder alone. Few studies have enrolled enough women Veterans to test gender differences in pain outcomes [catastrophizing, intensity, interference] by the severity of PTSD. Aim Examine gender differences in the association between PTSD symptoms and pain outcomes among Veterans enrolled in a chronic pain clinical trial. Methods Participants were 421 men and 386 women Veterans with chronic pain who provided complete data on PTSD symptoms and pain outcomes. We used hierarchical linear regression models to examine gender differences in pain outcomes by PTSD symptoms. Results Adjusted multivariable models indicated that PTSD symptoms were associated with higher levels of pain catastrophizing (0.57, 95% CI [0.51, 0.63]), pain intensity (0.30, 95% CI [0.24, 0.37]), and pain interference (0.46, 95% CI [0.39, 0.52]). No evidence suggesting differences in this association were found in either the crude or adjusted models (all interaction p-values<0.05). Conclusion These findings may reflect the underlying mutual maintenance of these conditions whereby the sensation of pain could trigger PTSD symptoms, particularly if the trauma and pain are associated with the same event. Clinical implications and opportunities testing relevant treatments that may benefit both chronic pain and PTSD are discussed. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial clinicaltrials.gov. Identifier: [NCT04526158][1] ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: A waiver of documentation of informed consent and the data collection reported herein was approved by the VA Central Institutional Review Board (IRB) (project 18-21). Participants were provided an information sheet about the study which included required consent form language and how to contact study staff with any questions. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes These data are the property of the Veterans Administration and contain potentially identifying information about human subjects who use Veterans Health Administration services for their healthcare. Data requests are subject to case-by-case data use agreements and are routed through the Minneapolis VA Research Privacy and Research Compliance officers, the LAMP study PI, and study coordinator. Information regarding the request process is available here: . [Used for PLOS ONE submission that requires immediate access to data upon publication.] [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04526158&atom=%2Fmedrxiv%2Fearly%2F2023%2F10%2F15%2F2023.10.13.23296998.atom