Posttraumatic Stress in Children after Injury: The Role of Acute Pain and Opioid Medication Use

Aimee K. Hildenbrand, Nancy Kassam-Adams, Lamia P. Barakat, Kristen L. Kohser, Jeffrey A. Ciesla, Douglas L. Delahanty, Joel A. Fein, Lindsay B. Ragsdale, Meghan L. Marsac

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Objectives After injury, many children experience posttraumatic stress symptoms (PTSS) that negatively impact recovery. Acute pain and PTSS share neurobiological pathways, and acute dosage of morphine has been linked to reduced PTSS in naturalistic studies. However, the complex interactions between pain, morphine and other opioid use, and PTSS have yet to be investigated in robust pediatric samples. This prospective, longitudinal study examined relationships between acute pain, opioid medications, and PTSS after pediatric injury. Methods Ninety-six children aged 8 to 13 years (mean = 10.60, SD = 1.71), hospitalized for unintentional injury, completed assessments at baseline (T1) and 12 weeks (T2) later. Pain ratings and opioid administration data were obtained via chart review. Results Structural equation modeling revealed that worst pain endorsed during hospitalization was positively associated with concurrent and later PTSS when controlling for evidence-based risk factors (ie, age, sex, prior trauma history, traumatic appraisals of injury event, heart rate). Neither opioid medications overall nor morphine specifically (milligram/kilogram/day) administered during hospitalization mediated the relationship between pain and T2 PTSS. Conclusions Pain during hospitalization may increase susceptibility for persistent PTSS above and beyond the influence of other empirical risk factors. Findings suggest that pain assessment may be a useful addition to pediatric PTSS screening tools and highlight the need for additional research on pharmacological secondary prevention approaches. Given that inadequate pain control and persistent PTSS each hinder recovery and long-Term functioning, better understanding of interactions between acute pain and PTSS after injury is essential for improving screening, prevention, and early intervention efforts.

Original languageEnglish
Pages (from-to)E549-E557
JournalPediatric Emergency Care
Issue number10
StatePublished - Oct 1 2020

Bibliographical note

Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.


  • injury
  • opioid
  • pain
  • posttraumatic stress
  • posttraumatic stress disorder

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine


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