title: [Childhood abuse experiences and chronic low back pain. Direct and mediated effects of childhood abuse in different pain dimensions of nonspecific chronic low back pain].
abstract: BACKGROUND
  Physical, sexual and emotional abuse in childhood and adolescence is considered to play a role in the etiology and generalization of chronic pain in adulthood. However, it remains unclear whether abuse is specifically associated with different dimensions of nonspecific chronic low back pain (CLBP) and if these associations are mediated by psychological symptoms.
  
  
  METHODS
  A total of 103 patients with validated CLBP were assessed by pain drawing, the multidimensional pain questionnaire and the pain experience scale. The childhood trauma questionnaire was used to retrospectively screen for physical, sexual and emotional abuse in childhood and adolescence. Patients were also screened for symptoms of depression, anxiety and dissociation in order to look for possible mediators.
  
  
  RESULTS
  Patients with CLBP who reported childhood abuse showed higher pain intensity, higher spatial extent of pain, higher affective and sensory pain sensation and more pain disability compared to CLBP patients who had not experienced abuse. However, multivariate analyses revealed that only the spatial extent of pain was directly associated with childhood abuse. Furthermore, a significant association between childhood abuse and sensory pain sensation was found to be mediated by symptoms of anxiety and dissociation.
  
  
  CONCLUSIONS
  The influence of childhood abuse on CLBP is different for specific pain dimensions; therefore, CLBP should be faced as a complex construct that comprises different dimensions. Childhood abuse is suggested as a risk factor for spreading pain in CLBP persons; therefore, CLBP patients reporting additional pain locations might benefit from diagnostic and therapeutic interventions specific for childhood abuse experiences.
authors.affiliation: Sektion Integrierte Psychosomatik, Klinik für Allgemeine Innere Medizin und Psychosomatik, Universitätsklinikum Heidelberg, Thibautstr. 2, 69115, Heidelberg, Deutschland, sabine.leisner@med.uni-heidelberg.de.
authors.forename: S
authors.initials: S
authors.lastname: Leisner
authors.forename: A
authors.initials: A
authors.lastname: Gerhardt
authors.forename: J
authors.initials: J
authors.lastname: Tesarz
authors.forename: S
authors.initials: S
authors.lastname: Janke
authors.forename: G H
authors.initials: GH
authors.lastname: Seidler
authors.forename: W
authors.initials: W
authors.lastname: Eich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology; D015984:Causality; D002648:Child; D002649:Child Abuse / Q000175:diagnosis / Q000523:psychology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D004213:Dissociative Disorders / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D012189:Retrospective Studies; D011795:Surveys and Questionnaires