The role of posttraumatic stress disorder symptoms in pain severity, interference, and variability after sexual assault: An ecological momentary assessment study.

Pain is common after sexual assault and may be influenced by posttraumatic stress disorder (PTSD) symptoms. However, little research has tested these associations in the early aftermath of sexual assault. The current study used ecological momentary assessment collected in the context of a randomized clinical trial to test temporal associations between PTSD symptoms and usual pain and highest pain severity, as well as pain variability. Hypotheses were tested among 64 women sexual assault survivors presenting for emergency care who were followed over 6 weeks with 4×/day ecological momentary assessment assessments. Dynamic structural equation modeling analyses indicated that within-person elevations in PTSD symptoms prospectively predicted highest pain severity, while highest pain severity, usual pain severity, and pain interference prospectively predicted PTSD. Heterogeneous variable models revealed that elevated between-persons PTSD was associated with increased variability in all pain outcomes. Findings add to the body of research suggesting that PTSD symptoms may influence the development of persistent pain after sexual assault but add specificity to these models by indicating that PTSD symptoms may uniquely drive spikes in pain and pain variability. Simultaneously, highest pain severity and pain interference may drive PTSD symptoms in the early aftermath of sexual assault. Future research should test whether early interventions after sexual assault could interrupt the vicious cycle of PTSD symptoms and pain. (PsycInfo Database Record (c) 2026 APA, all rights reserved).