Abigail Powers1, Negar Fani2, Andrew Pallos2, Jennifer Stevens2, Kerry J Ressler3, Bekh Bradley4. 1. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. Electronic address: adpower@emory.edu. 2. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA. 3. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; Howard Hughes Medical Institute, Chevy Chase, MD. 4. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA; Atlanta VA Medical Center, Atlanta, GA.
Abstract
BACKGROUND: Previous findings suggest a relationship between childhood abuse and pain-related conditions. It is yet to be determined whether adult posttraumatic stress disorder (PTSD) symptoms may mediate the association between the experience of childhood abuse and reported pain in adulthood. OBJECTIVE: We sought to determine if emotion dysregulation may also play a role in mediating PTSD and pain levels. METHODS: We examined subjects (N = 814) recruited from the primary care clinics of an urban public hospital as part of an National Institute of Mental Health-funded study of trauma-related risk and resilience. We evaluated childhood abuse with the Childhood Trauma Questionnaire, PTSD symptoms with the PTSD Symptom Severity scale, and emotional dysregulation with the Emotion Dysregulation Scale. Pain and functional limitations of pain were assessed through self-report. RESULTS: We found that both childhood abuse and current PTSD symptoms predicted higher levels of reported pain. Childhood abuse, PTSD symptoms, and emotion dysregulation all predicted higher levels of functional impairment related to pain. Using the Sobel method and bootstrapping techniques and controlling for current level of negative affect, we found that PTSD fully mediated the effect of childhood abuse on pain level and pain-related limitations; emotion dysregulation partially mediated the effect of PTSD symptoms in predicting higher levels of pain-related limitations. CONCLUSIONS: Although causality cannot be determined in the present study, these findings suggest that PTSD may serve as the pathway between exposure to childhood abuse and the development of pain-related conditions in adulthood, and that emotion dysregulation is a significant factor in understanding how PTSD relates to specific pain-related functional impairment.
BACKGROUND: Previous findings suggest a relationship between childhood abuse and pain-related conditions. It is yet to be determined whether adult posttraumatic stress disorder (PTSD) symptoms may mediate the association between the experience of childhood abuse and reported pain in adulthood. OBJECTIVE: We sought to determine if emotion dysregulation may also play a role in mediating PTSD and pain levels. METHODS: We examined subjects (N = 814) recruited from the primary care clinics of an urban public hospital as part of an National Institute of Mental Health-funded study of trauma-related risk and resilience. We evaluated childhood abuse with the Childhood Trauma Questionnaire, PTSD symptoms with the PTSD Symptom Severity scale, and emotional dysregulation with the Emotion Dysregulation Scale. Pain and functional limitations of pain were assessed through self-report. RESULTS: We found that both childhood abuse and current PTSD symptoms predicted higher levels of reported pain. Childhood abuse, PTSD symptoms, and emotion dysregulation all predicted higher levels of functional impairment related to pain. Using the Sobel method and bootstrapping techniques and controlling for current level of negative affect, we found that PTSD fully mediated the effect of childhood abuse on pain level and pain-related limitations; emotion dysregulation partially mediated the effect of PTSD symptoms in predicting higher levels of pain-related limitations. CONCLUSIONS: Although causality cannot be determined in the present study, these findings suggest that PTSD may serve as the pathway between exposure to childhood abuse and the development of pain-related conditions in adulthood, and that emotion dysregulation is a significant factor in understanding how PTSD relates to specific pain-related functional impairment.
Authors: J E Ware; M Kosinski; B Gandek; N K Aaronson; G Apolone; P Bech; J Brazier; M Bullinger; S Kaasa; A Leplège; L Prieto; M Sullivan Journal: J Clin Epidemiol Date: 1998-11 Impact factor: 6.437