Pain experience and traumatic events in childhood and recent adulthood in chronic pelvic pain

Background & Aims

The development and maintenance of chronic pain conditions involves complex, and not yet fully understood, interactions between a range of biological, psychological and social factors [1]. Experiences of abuse, and particularly sexual abuse, have been suggested to play a significant role in distress associated with chronic pelvic pain (CPP) [2]. However, there is increasing recognition that a wide range of stressful life events (such as death of someone close or upheaval) in both childhood and adulthood may also be important [3, 4, 5].

Understanding the relationship between CPP and traumatic events may provide valuable insights into the underlying mechanisms of chronic pain and inform assessment and treatments [4, 5]. The present study explored differences in experiences of traumatic events in childhood and recent adulthood between women with and without CPP. We hypothesise that those with CPP will have experienced more traumatic events and higher trauma burden compared to controls.

Methods

This study was completed as part of the Translational Research in Pelvic Pain (TRiPP) Project which comprises women from three study sites (Oxford, Boston, Porto). Participants were women of reproductive age (18-50 years) with one of four CPP conditions (Endometriosis Associated Pain, Interstitial Cystitis/Bladder Pain Syndrome, Comorbid Endometriosis and Bladder Pain, Pelvic Pain with no endometriosis or bladder symptoms). All participants scored >4/10 on at least one pelvic pain numerical rating scale (NRS). Diagnostic groups were combined for the purpose of this analysis. The control group were women scoring <4 on all pelvic pain numerical rating scales. All eligible participants were invited to complete a set of questionnaires. Traumatic life events were assessed using the Childhood Traumatic Events Scale (CTES) and Recent Traumatic Events Scale (RTES) (trauma in the past 3 years). Statistical analyses to explore effect associations were conducted on SPSS software.

Results

There were 105 women in the CPP group (20-50 years, mean=34.3) and 50 women in the control group.

Childhood trauma: Women with CPP were significantly more likely to have experienced a traumatic event in childhood (74.5 %, N=73) compared to controls (CON 53.3%, N=21) (?2 (1, N = 137) = 5.5, p = 0.02). They also reported a significantly higher average number of traumatic childhood experiences (CPP mean=1.35, SD=1.19; CON mean=0.69, SD=0.77; t=-3.17, P=0.01). There were no significant differences between the control and CPP groups in the types of traumas experienced.

Recent (adult) trauma: Traumatic events in adulthood were common for both groups (CON 78.6%, N=33/52; CPP 82.3%, N=79/96; ?2 (1, N = 138) = 0.26, p = 0.61). Compared to controls, women with CPP reported a significantly higher average number of recent traumatic experiences (CPP mean=1.59, SD=1.21; CON mean=1.21, SD=0.90; t=1.82, P=0.03). The CPP group experienced more illness but less work change than the control group.

Conclusions

Compared to controls, women living with CPP were more likely to have experienced a traumatic event in childhood. They were also more likely to have experienced multiple different types of traumatic events and experienced these as burdensome. There were no differences between the CPP and control groups in the types of traumatic events experienced. Traumatic events in adulthood are common irrespective of CPP. However, the number of different type of events and the extent to which these were experienced as traumatic did differ between the CPP and control groups. These results suggest that the type of trauma may not be as important as the cumulative load of multiple traumatic events which are experienced as burdensome. Unsurprisingly the CPP group experienced more illness in adulthood than controls. The control group experienced more work-related change, but this was not experienced negatively whereas work-related change was a negative experience for the CPP group.

References

[1] Nicholas, M. K. (2022). The biopsychosocial model of pain 40 years on: time for a reappraisal?. Pain, 10-1097.

[2] Poleshuck, E. L., Dworkin, R. H., Howard, F. M., Foster, D. C., Shields, C. G., Giles, D. E., & Tu, X. (2005). Contributions of physical and sexual abuse to women’s experiences with chronic pelvic pain. The Journal of reproductive medicine, 50(2), 91.

[3] Goldberg, R. T., Pachasoe, W. N., & Keith, D. (1999). Relationship between traumatic events in childhood and chronic pain. Disability and rehabilitation, 21(1), 23-30.

[4] Nicol, A. L., Sieberg, C. B., Clauw, D. J., Hassett, A. L., Moser, S. E., & Brummett, C. M. (2016). The association between a history of lifetime traumatic events and pain severity, physical function, and affective distress in patients with chronic pain. The Journal of Pain, 17(12), 1334-1348.

[5] Lamvu, G., Carrillo, J., Ouyang, C., & Rapkin, A. (2021). Chronic pelvic pain in women: a review. Jama, 325(23), 2381-2391.

Presenting Author

Emma Evans

Poster Authors

Emma Evans

BSc(Hons)

Oxford University Hospitals NHS Foundation Trust

Lead Author

Pain experience and traumatic events in childhood and recent adulthood in chronic pelvic pain

Background & Aims

Methods

Results

Conclusions

References

Presenting Author

Emma Evans

Poster Authors

Emma Evans

Katy Vincent DPhil BSc MBBS MRCOG

Lysia Demetriou

Claire Lunde

Lydia Coxon

Pedro Abreus Mendes

Kurtis Garbutt

Michal Krassowski

Allison Vitonis

Lars Arendt-Nielsen

Qasim Aziz

Judy Birch

Andrew Horne

Anja Hoffman

Jane Meijlink

Danielle Perro

Esther Pogatzki-Zahn

Rolf-Detlef Treede

Christian Becker

Francisco Cruz

Stacey Missmer

Krina Zondervan

Jens Nagel

Christine Sieberg

Topics

IASP 2024 World Congress on Pain