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Observational Study
. 2025 Jun;32(3):371-384.
doi: 10.1007/s12529-024-10268-4. Epub 2024 Mar 4.

Associations of Posttraumatic Stress Disorder Symptom Clusters and Pain Interference in Post-9/11 Veterans: Exploring Sleep Impairment and Physical Activity as Underlying Mechanisms

Mariel Emrich  1 , Katherine E Gnall  2 , Camille L Garnsey  2 , Jamilah R George  2 , Crystal L Park  2 , Carolyn M Mazure  3 , Rani A Hoff  4
Affiliations
Observational Study

Associations of Posttraumatic Stress Disorder Symptom Clusters and Pain Interference in Post-9/11 Veterans: Exploring Sleep Impairment and Physical Activity as Underlying Mechanisms

Mariel Emrich et al. Int J Behav Med. 2025 Jun.

Abstract

Background: Posttraumatic stress disorder (PTSD) symptoms and pain are highly prevalent and comorbid, particularly in veterans, but mechanisms explaining their linkage remain unclear. The aims of this study were to determine: (1) whether sleep impairment and physical activity (PA) mediate relations between PTSD symptoms and pain interference (assessed both longitudinally and as residual change) and (2) the unique roles of each PTSD symptom cluster in those relationships.

Methods: The present study is a secondary analysis of a longitudinal observational investigation of 673 post-9/11 veterans (45.8% women). Surveys were administered at baseline and 3-month and 6-month follow-ups.

Results: PTSD symptoms were significantly associated with pain interference longitudinally and worsening pain interference over time. Sleep impairment, but not PA, significantly mediated the relationship between PTSD symptoms and subsequent pain interference. Hyperarousal symptoms were found to be the primary driver of the relationship between PTSD symptoms and pain interference and re-experiencing symptoms were associated with change in pain interference via sleep impairment. Men and women did not differ on any of the study variables with the exception of PA.

Conclusion: Findings underscore the importance of targeting sleep as a key modifiable health factor linking PTSD symptoms to pain interference in post-9/11 veterans.

Keywords: Modifiable health factors; Pain interference; Physical activity; Posttraumatic stress disorder symptoms; Sleep impairment.

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Conflict of interest statement

Declarations. Ethical Approval: Study materials were approved by the Institutional Review Board of the Department of Veterans Affairs (#0010), and written informed consent was obtained from all participants. Statement Regarding Informed Consent: Informed consent was obtained from all individual participants included in the study. Statement Regarding Research Involving Human Participants and/or Animals: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Competing Interests: The authors declare no conflicts of interest.

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