Els van Meijel

50 Chapter 3 | Acute pain and posttraumatic stress symptoms Discussion In this study, we found an association between acute pain after accidental injury and PTSS 3 months later. The findings of our study confirm the findings of other studies, in that pain after accidental injury contributes to or is a risk factor for later PTSD or PTSS in children and adolescents (Hildenbrand et al., 2016; Saxe et al., 2005). However, the difference in outcome related to gender had not been specified previously. Furthermore, the association between acute pain and severity of posttraumatic stress was strongest in the group of children that reported severe pain. This result supports the finding of Hildenbrand et al. (2016) that themost severe pain predicted subsequent PTSS. In the group of children with severe pain, pain may account for around 10% of the variance in the severity of the PTSS after 3 months. In our study, girls reported more severe PTSS than boys. This finding is consistent with a previous study which found that girls have a greater risk for PTSD then boys (Alisic et al., 2014). Injury severity and the presence of an extremity fracture were moderately associated and influenced the amount of acute pain. In boys, we found an association between the presence of an extremity fracture and pain. A possible explanation is that an extremity fracture causes more pain than other injuries. This is in line with the findings of Baxt et al. (2004) in which extremity fracture was associated with greater “worst pain” ratings. Pain management may not always fit the need for pain medication that accompanies the presence of an extremity fracture, at least not immediately. Except for the gender difference that emerged fromour study, our results are in line with previous findings (Winston et al., 2003), i.e., that the presence of one or more extremity fractures is considered to be a risk factor for persistent posttraumatic stress. Although previous research has shown that injury severity is not a predictor of PTSD (Brosbe et al., 2011), we found a negative association between injury severity and pain. A possible explanation might be that more severely injured children are likely to receive more adequate pain medication. The negative association was only found in girls. Research on gender differences in pain suggests a difference between genders in their response to pain. Gender has been reported as a critical factor in the perception of pain; males and females experience pain differently (Paller, Campbell, Edwards, & Dobs, 2009). In that study, increased pain sensitivity and risk for clinical pain were