Co-Evolution of Pain and PTSD Symptoms in Trauma Survivors with Musculoskeletal Injury: Identifying Early Intervention Targets to Reduce Risk of Chronic Symptoms - PROJECT SUMMARY Many types of traumatic events, such as intimate partner violence, physical assault, combat, and motor vehicle accidents, often result in significant musculoskeletal (MSK) injuries. Individuals who experience trauma with MSK injury are at heightened risk for developing adverse physical and mental health symptoms, including chronic MSK pain and posttraumatic stress disorder (PTSD). Existing research has separately identified diverse trajectories for pain and for PTSD following acute traumatic injury: some individuals recover quickly while others experience chronic symptoms. However, no study to date has examined individual differences in the joint co-evolution of pain and PTSD despite their reciprocal and mutually-exacerbating relationship. Identifying subgroups of individuals at higher risk for developing chronic symptoms of one or both conditions and differences in their treatment interests/needs can inform the development of tailored interventions. The proposed study will leverage Dr. Park’s ongoing Mental and Physical Health Trajectories project to a) identify distinct subgroups with unique joint trajectories of pain and PTSD following trauma with MSK injury using multiple-process growth mixture modeling, b) assess modifiable predictors of those symptom trajectories, and c) understand differences in treatment preferences and needs between subgroups to inform tailored treatments. Participants (N = 411) who experienced trauma with MSK injury within the past 14 days will be recruited via Prolific to complete surveys at five timepoints over three months to assess progression of symptoms from acute to chronic or resolved. Mental and physical health, pain-related factors, and trauma- related factors will be tested as predictors of joint pain and PTSD trajectories. At the final timepoint, participants will answer brief quantitative and open-ended questions about treatment engagement and preferences. This comprehensive approach will provide a deeper understanding of the diverse patterns of pain and PTSD symptom progression post-injury and also examine patient perspectives that can inform optimal treatment for each subgroup's specific needs. NIAMS’ scientific priorities of understanding biopsychosocial factors that make an individual susceptible to the transition from acute to chronic pain and informing person- centered tailored interventions. The fellowship’s training aims are closely linked with the goals for the proposed research project. The individualized training plan will provide the applicant with specialized training in MSK pain, PTSD, non-pharmacologic interventions, biostatistics, and professional development for a research career in examining and treating comorbid pain and PTSD. The training plan will leverage existing resources available at the applicant’s primary institution, the University of Connecticut, with collaboration and mentorship from leading experts across the nation.
