Mediators of the association between childhood trauma and pain sensitivity in adulthood: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network analysis : PAIN

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Mediators of the association between childhood trauma and pain sensitivity in adulthood: a Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network analysis

Pierce, Jennifera,*; Harte, Steven E.a; Afari, Niloofarb; Bradley, Catherine S.c; Griffith, James W.d; Kim, Jayounge; Lutgendorf, Susanf; Naliboff, Bruce D.g; Rodriguez, Larissa V.h; Taple, Bayley J.i; Williams, Davida; Harris, Richard E.a; Schrepf, Andrewa;  on behalf of the MAPP Research Network

Author Information

aDepartment of Anesthesiology, University of Michigan, Ann Arbor, MI, United States

bVA Center for Excellence for Stress & Mental Health and Department of Psychiatry, University of California San Diego, San Diego, CA, United States

cDepartments of Obstetrics and Gynecology and Urology, Carver College of Medicine, and Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States

dDepartment of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

eDepartments of Surgery and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States

fDepartment of Psychological and Brain Sciences, Department of Urology, and Department of Obstetrics and Gynecology, University of Iowa, Iowa City, IA, United States

gDepartment of Medicine, Oppenheimer Center for Neurobiology of Stress and Resilience and Division of Digestive Diseases, David Geffen School of Medicine, University of California—Los Angeles, Los Angeles, CA, United States

hInstitute of Urology, University of Southern California, Beverly Hills, CA, United States

iDepartment of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States

*Corresponding author. Address: Department of Anesthesiology, University of Michigan, Back & Pain Center, 325 E. Eisenhower Parkway, Burlington Building 1, Suite 310, Ann Arbor, MI 48108, United States. Tel.: 734-998-0454; fax: 734-936-6585. E-mail address: [email protected] (J. Pierce).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.painjournalonline.com).

On Behalf of the MAPP Research Network, see MAPPII Masthead (available online as supplemental digital content at https://links.lww.com/PAIN/B810).

PAIN 164(9):p 1995-2008, September 2023. | DOI: 10.1097/j.pain.0000000000002895

Urologic chronic pelvic pain syndrome (UCPPS) is a complex, debilitating condition in which patients often report nonpelvic pain in addition to localized pelvic pain. Understanding differential predictors of pelvic pain only vs widespread pain may provide novel pathways for intervention. This study leveraged baseline data from the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network's Symptom Pattern Study to investigate the impact of childhood sexual and nonsexual violent trauma on pelvic and nonpelvic pain sensitivity among adult patients with UCPPS, as well as potential mediators of this association. Study participants who met inclusion criteria for UCPPS completed questionnaires assessing childhood and recent trauma, affective distress, cognitive dysfunction, and generalized sensory sensitivity. Experimental pain sensitivity was also evaluated using standardized pressure pain applied to the pubic region and the arm. Bivariate analyses showed that childhood violent trauma was associated with more nonviolent childhood trauma, more recent trauma, poorer adult functioning, and greater pain sensitivity at the pubic region, but not pain sensitivity at the arm. Path analysis suggested that childhood violent trauma was indirectly associated with pain sensitivity at both sites and that this indirect association was primarily mediated by generalized sensory sensitivity. More experiences of recent trauma also contributed to these indirect effects. The findings suggest that, among participants with UCPPS, childhood violent trauma may be associated with heightened pain sensitivity to the extent that trauma history is associated with a subsequent increase in generalized sensory sensitivity.

© 2023 International Association for the Study of Pain

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