Psychological Medicine

Original Articles

Pain in the aftermath of trauma is a risk factor for post-traumatic stress disorder

S. B. Normana1 c1, M. B. Steina1, J. E. Dimsdalea1 and D. B. Hoyta1

a1 Departments of Psychiatry and Surgery (Division of Trauma Surgery), University of California, San Diego, CA, USA


Background Identifying risk factors for the development of post-traumatic stress disorder (PTSD) is important for understanding and ultimately preventing the disorder. This study assessed pain shortly after traumatic injury (i.e. peritraumatic pain) as a risk factor for PTSD.

Method Participants (n=115) were patients admitted to a Level 1 Surgical Trauma Center. Admission to this service reflected a severe physical injury requiring specialized, emergent trauma care. Participants completed a pain questionnaire within 48 h of traumatic injury and a PTSD diagnostic module 4 and 8 months later.

Results Peritraumatic pain was associated with an increased risk of PTSD, even after controlling for a number of other significant risk factors other than acute stress disorder symptoms. An increase of 0.5 s.d. from the mean in a 0–10 pain rating scale 24–48 h after injury was associated with an increased odds of PTSD at 4 months by more than fivefold, and at 8 months by almost sevenfold. A single item regarding amount of pain at the time of hospital admission correctly classified 65% of participants.

Conclusions If these findings are replicated in other samples, high levels of peritraumatic pain could be used to identify individuals at elevated risk for PTSD following traumatic injury.

(Received January 16 2007)

(Revised June 21 2007)

(Accepted June 26 2007)

(Online publication September 10 2007)


c1 Address for correspondence: S. B. Norman, Ph.D., University of California, San Diego, 140 Arbor Drive (0851), San Diego, CA 92103, USA. (Email: