Elevated Levels of Childhood Adversity in Patients with Fibromyalgia and Chronic Widespread Pain

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Post-traumatic stress disorder was associated with higher perceived pain intensity in FM/CWP patients.
Post-traumatic stress disorder was associated with higher perceived pain intensity in FM/CWP patients.

A recent study published in the European Journal of Pain found elevated levels of childhood adversity (CA) in female patients with fibromyalgia (FM) and chronic widespread pain (CWP).1 The impact of CA on reports of pain severity was most pronounced in women who developed the symptoms of post-traumatic stress disorder (PTSD).

“Results of this study suggest that the impact of childhood adversity (ie, whether such events have led to the development of PTSD symptoms), rather than the mere presence of such adversity, is of crucial importance in FM/CWP patients,” said Eline Coppens, MS, psychologist-psychotherapist at The Leuven Centre for Algology & Pain Management, University Hospitals Leuven, Belgium, and corresponding study investigator, in an email interview with Psychiatry Advisor.

The prevalence of childhood adversities was investigated in 3 groups of female patients — 154 patients with either FM or CWP, 83 patients with functional dyspepsia (FD), and 53 patients with achalasia. Coppens and colleagues recruited study participants from a tertiary care center for chronic pain at the University Hospitals Leuven, Belgium, between 2011 and 2014. In the FM/CWP group, the investigators also analyzed the association between childhood adversities, PTSD, and pain severity. CA, PTSD symptoms, and pain severity were assessed using self-report questionnaires.

Ms Coppens emphasized that “CA has been associated with increased vulnerability to medical symptoms in adulthood.”2

In the present study, “we found elevated levels of CA in FM/CWP patients (prevalence around 50%) compared to both healthy controls and patients with a chronic organic disease,” said Ms Coppens. She added, “In FM/CWP, we found no direct relationship between CA and pain severity. However, PTSD mediated the relationship between CA and pain severity in FM/CWP and FM/CWP patients were about 6 times more likely to report PTSD.”

At least one type of CA was reported in 49% of patients with FM/CWP, 39.7% of patients with FD, and 23.4% of patients with achalasia (P <.01). Sexual abuse, emotional abuse, and emotional neglect were more frequently reported by patients with FM/CWP than patients with achalasia. PTSD was associated with higher pain intensity in patients with FM/CWP.

“These results suggest that screening for PTSD symptoms should be an essential part of the assessment process in patients suffering from FM/CWP, so that patients can be referred for evidence-based treatment to mental health care specialists when appropriate,”3,4 emphasized Ms Coppens. She added that “semi-structured interviews such as the MINI [Mini International Neuropsychiatric Interview,5 or well-validated self-report questionnaires such as PTSD-ZIL,6 may be used for this purpose.”

“In the context of multidisciplinary treatment of FM/CWP, psychotherapeutic strategies need to focus on treatment of PTSD symptoms and on the possible impact of these symptoms on pain severity,” she concluded.

Study limitations

  • Comparable demographic characteristics were limited in all 3 study groups due to retrospective study design
  • Study results were potentially influenced by selection bias since all patients were recruited from a tertiary care center and more than 5% of missing data was provided by 19% of study participants
  • Self-report questionnaires were used instead of interviews
  • Under-reporting was possible in the study since the prevalence of CA was lower compared with other studies
  • Achalasia, which is not characterized by chronic pain symptoms, was used as a chronic organic disease control group
  • Cross-sectional study design, which prevents conclusions from being drawn about the directionality of observed associations

References

  1. Coppens E, Van Wambeke P, Morlion B, et al. Prevalence and impact of childhood adversities and post-traumatic stress disorder in women with fibromyalgia and chronic widespread pain [published online May 24, 2017]. Eur J Pain. doi:10.1002/ejp.1059
  2. Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits. Ann Intern Med. 2001;134:917-925.
  3. Bisson JI, Ehlers A, Matthews R, et al. Psychological treatments for chronic post-traumatic stress disorder. Br J Psychiatry. 2007;190:97-104.
  4. Stein DJ, Ipser J, McAnda N. Pharmacotherapy of posttraumatic stress disorder: A review of meta-analyses and treatment guidelines. CNS Spectr. 2009;14:25-31.
  5. Lecrubier Y, Sheehan D, Weiller E, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. Eur Psychiatry. 1997;12:224-231.
  6. Hovens J, Bramsen I, Van Der Ploeg HM. Manual for the Self-Rating Inventory for Posttraumatic Stress Disorder (SRIP). Lisse, Netherlands:Swets Test Publishers, 2000. 
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