Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)

Graduate Group


First Advisor

Rosemary C. Polomano


Improvements in military trauma care during the wars in Afghanistan and Iraq have contributed to increased survival rates for combat-injured American military personnel. Yet, little is understood about the short- and long-term physical and mental health symptoms resulting from these injuries. Understanding clinical presentations and symptom trajectories in survivors of complex combat injuries is paramount to the future development and implementation of interventions that are capable of reducing the disabling effects of symptoms and, subsequently, improving health outcomes across the continuum of trauma care. This dissertation addresses the key question: in an era of unprecedented survival after complex and life-threatening injuries, what are the short- and long-term symptom trajectories of post-traumatic stress disorder (PTSD) and pain, even after exposure to pain management interventions, specifically regional anesthesia (RA)? Furthermore, this investigation evaluates the effectiveness of RA on reducing pain intensity after injury. To address these inquiries, this dissertation used the longitudinal data from one of the largest and most comprehensive datasets of patient-reported outcomes from American military personnel and veterans wounded in action during Operation Enduring Freedom and Operation Iraqi Freedom. Principle findings were: 1) There is an established association between pain and mental health symptom presentations in combat-injured military personnel and veteran populations that exists throughout care settings where nurses are practicing; 2) PTSD symptom severity, and pain intensity and interference are significantly correlated up to twenty-one months after injury; 3) Worsening PTSD symptom trajectories are associated with higher pain intensity after injury compared to improving or stable PTSD symptom trajectories; 4) Early receipt of RA for pain management following combat injury is associated with improved patient-reported pain outcomes; 5) Markov chains are a practical method for characterizing probabilistic pain trajectories after combat injury, and can be beneficial in future work to examine the benefits of analgesic interventions. Results inform future directions for advancing nursing science research and directing practice, in the context of implementing interventions to manage pain after serious injury in order to maximize recovery across military, veteran, and civilian populations.

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