Figure 2.

Proposed model on the potential effects of trauma and/or posttraumatic stress symptoms (PTSS) on coping and pain-related outcomes in pediatric pain populations.

^aA traumatic event (“trauma”), defined in the DSM 5, is an “actual or threatened death, serious injury, or sexual violence.” Following a trauma, some experience post-traumatic symptoms (PTSS). We have a bidirectional arrow between these factors as they can exacerbate the effect on the other (e.g., those who experience PTSS may be vulnerable to re-traumatization). Our model focuses those with pain and either exposure to traumatic event and/or PTSS, which is also represented by a bidirectional arrow as the factors of pain and trauma can co-occur and influence one another.