title: The Association Between a History of Lifetime Traumatic Events and Pain Severity, Physical Function, and Affective Distress in Patients With Chronic Pain.
abstract: Evidence suggests that pain patients who report lifetime abuse experience greater psychological distress, have more severe pain and other physical symptoms, and greater functional disability. The aim of the present study was to determine the associations between a history of lifetime abuse and affective distress, fibromyalgianess (measured using the 2011 Fibromyalgia Survey), pain severity and interference, and physical functioning. A cross-sectional analysis of 3,081 individuals presenting with chronic pain was performed using validated measures and a history of abuse was assessed via patient self-report. Multivariate logistic regression showed that individuals with a history of abuse (n = 470; 15.25%) had greater depression, greater anxiety, worse physical functioning, greater pain severity, worse pain interference, higher catastrophizing, and higher scores on the Fibromyalgia Survey criteria (P < .001 for all comparisons). Mediation models showed that the Fibromyalgia Survey score and affective distress independently mediate the relationship between abuse and pain severity and physical functioning (Ps < .001). Our mediation models support a novel biopsychosocial paradigm wherein affective distress and fibromyalgianess interact to play significant roles in the association between abuse and pain. We posit that having a centralized pain phenotype underlies the mediation of increased pain morbidity in individuals with a history of abuse.
  
  
  
  This article examines the associations between a history of lifetime abuse and affective distress, fibromyalgianess, pain severity and interference, and physical functioning in chronic pain patients. Our findings support a novel biopsychosocial paradigm in which affective distress and fibromyalgianess interact to play roles in the association between abuse and pain.
authors.affiliation: Department of Anesthesiology, University of Kansas School of Medicine, Kansas City, Kansas. Electronic address: anicol@kumc.edu.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Nicol
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Biobehavioral Pediatric Pain Lab, Boston Children's Hospital; and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Sieberg
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Clauw
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Afton L
authors.initials: AL
authors.lastname: Hassett
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Moser
authors.affiliation: Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Chad M
authors.initials: CM
authors.lastname: Brummett
mesh_terms: D000328:Adult; D000368:Aged; D058443:Catastrophization / Q000503:physiopathology / Q000523:psychology; D059350:Chronic Pain / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology*; D003430:Cross-Sectional Studies; D064891:Disaster Victims / Q000523:psychology*; D015444:Exercise / Q000502:physiology*; D005260:Female; D005356:Fibromyalgia / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology / Q000209:etiology*; D010147:Pain Measurement; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Chronic pain; affective distress; fibromyalgia; pain severity; traumatic events