Exploring the relationship between changes in negative posttrauma cognitions and pain intensity in Veterans undergoing intensive treatment

Abstract: Objective: This study examined whether improvements in posttrauma cognitions during intensive posttraumatic stress disorder (PTSD) treatment were associated with reduced pain intensity in veterans. Method: Participants included 497 veterans with PTSD enrolled in a 2-week intensive PTSD treatment program. Pain intensity and posttrauma cognitions were assessed at baseline, mid-treatment, and posttreatment. Ordinal logistic mixed effects models analyzed the association between changes in posttrauma cognitions and pain intensity, with military sexual trauma (MST) status as a potential moderator. A sensitivity analysis examined whether these associations remained after accounting for PTSD symptom change. Results: Reductions in posttrauma cognitions were significantly associated with decreases in average (b = 1.01, p < .001), current (b = 1.01, p < .001), and worst pain levels (b = 1.01, p < .001), though effect sizes for change in pain intensity were modest (ds between 0.23 and 0.30). This association was no longer significant when adjusting for PTSD symptom changes during the program. MST history did not predict pain outcomes or moderate the association between posttrauma cognition changes and pain. When controlling for PTSD symptom change, the association between posttrauma cognitions and pain was no longer significant. Conclusions: Improvements in posttrauma cognitions were initially linked to reduced pain intensity, suggesting that trauma-focused interventions targeting negative appraisals may support pain relief. However, sensitivity analysis indicated that these effects may be accounted for by overall PTSD symptom improvement. Further studies should clarify the distinct and overlapping contributions of cognitive and symptom change in pain outcomes in veterans with co-occurring PTSD and pain. Our study examined the relationship between posttrauma cognitions and pain intensity in veterans undergoing a 2-week intensive posttraumatic stress disorder treatment program. We discovered that veterans who experienced improvements in negative trauma-related beliefs reported significant reductions in their pain levels, even though pain was not a direct focus of the treatment. This finding underscores the potential of cognitive restructuring in alleviating physical pain alongside psychological distress, suggesting that addressing posttrauma cognitions may provide a dual benefit. By recognizing and targeting these cognitive patterns, practitioners can enhance treatment efficacy and better support veterans in managing both posttraumatic stress disorder symptoms and chronic pain.