Background & Aims
Childhood trauma and post-traumatic stress disorder (PTSD) are discussed as risk factors for the development of chronic pain. Both, childhood trauma and PTSD, appear to be associated with increased pain-related burden in patients with chronic pain. Most studies on this relationship have focused on a limited number of pain syndromes, primarily musculoskeletal pain, fibromyalgia, and migraine (MIG). Other pain syndromes such as neuropathic pain and small fiber neuropathy (SFN) in particular, have been neglected. Our transdiagnostic cross-sectional study investigates the relevance of childhood trauma as well as PTSD-symptoms for pain-related burden (e.g. disability, depression) in a sample of patients suffering either from SFN or from MIG, i.e. from one of two neurological, yet, pathophysiologically distinct pain-related disorders. We hypothesize that severity of childhood trauma and PTSD-symptoms is associated with a higher pain-related burden, regardless of the underlining condition.
Methods
So far 25 SFN patients and 21 MIG patients (mean age 54.8 vs 39.1) have participated in this ongoing study. Only patients receiving outpatient care at the Department of Neurology at the University Hospital Würzburg are included to ascertain standardized clinical assessment. Inclusion criteria require a confirmed diagnosis of SFN (according to Egenolf et al., 2021) or MIG (according to ICHD-3) by a Neurologist. Patients with additional neurological disorders are excluded. All patients are interviewed concerning traumatic life events and PTSD-symptoms following traumatic events using a structured clinical interview. In a subsequent online survey, patients answer questionnaires to assess childhood trauma (CTQ), pain intensity, pain-related disability (PDI), pain-related self-efficacy (FESS), Depression and Anxiety (DASS-21), perceived stress (PSS) and sleep quality (PSQI).
Results
Patient groups do not differ regarding pain-related burden. Interestingly, SFN patients endorse higher pain-related self-efficacy compared to MIG patients, t(44) = 3.08, p = 004. Furthermore, there were no differences between patient groups in severity of childhood trauma and severity of PTSD-symptoms. 20% of SFN patients and 43% of MIG patients reported clinically relevant PTSD-symptoms. Only 4% of SFN patients and none of MIG patients met diagnostic criteria for PTSD (DSM-5). We found no correlation between severity of childhood trauma and pain-related burden, and low to moderate correlations (r = .14 – .38) between severity of PTSD-symptoms and pain-related burden in SFN patients, which did not reach significance. We found similar, but not yet significant, correlations for both childhood trauma (r = .17 – .45) and PTSD-symptoms (r = .12 – .36) with pain-related burden. In MIG patients, severity of childhood trauma was significantly associated with depression, r = .45.
Conclusions
No differences were found between the two patient groups for pain-related burden except for SFN patients’ higher pain-related self-efficacy. In previous studies, patients with neuropathic pain compared to non-neuropathic pain reported higher pain-related burden (e.g. higher disability). In these studies, however, patients with SFN were not specifically considered. There was no difference in severity of childhood trauma or PTSD-symptoms reported by both groups. Consistent with literature, we observed low to moderate correlations between PTSD symptoms and pain-related burden in both groups. In MIG patients only, we found low to moderate-size correlations between childhood trauma and pain-related burden. Higher age, self-efficacy and retirement rate in SFN patients may account for this pattern. The low frequency of traumatic events in our sample may partially explain these findings and underlines the importance of the setting when studying the role of trauma in pain patients.
References
Beala, S. J., Kashikar-Zuck, S., King, C., Black, W., Barnesb, J., & Noll, J. G. (2020). Heightened risk for pain in young adult women with a history of childhood maltreatment: A prospective longitudinal study. Pain, 161(1), 156–165.
Davis, D. A., Luecken, L. J., & Zautra, A. J. (2005). Are reports of childhood abuse related to the experience of chronic pain in adulthood? A meta-analytic review of the literature. Clinical Journal of Pain, 21(5), 398–405.
Egenolf, N., Altenschildesche, C. M. zu, Kreß, L., Eggermann, K., Namer, B., Gross, F., … Üçeyler, N. (2021). Diagnosing small fiber neuropathy in clinical practice: A deep phenotyping study. Therapeutic Advances in Neurological Disorders, 14, 1–13.
Langley, P. C., Van Litsenburg, C., Cappelleri, J. C., & Carroll, D. (2013). The burden associated with neuropathic pain in Western Europe. Journal of Medical Economics, 16(1), 85–95.
Ohayon, M. M., & Stingl, J. C. (2012). Prevalence and comorbidity of chronic pain in the German general population. Journal of Psychiatric Research, 46(4), 444–450.
Raphael, K. G., & Widom, C. S. (2011). Post-traumatic stress disorder moderates the relation between documented childhood victimization and pain 30 years later. Pain, 152(1), 163–169.
Siqveland, J., Hussain, A., Lindstrøm, J. C., Ruud, T., & Hauff, E. (2017). Prevalence of posttraumatic stress disorder in persons with chronic pain: A meta-analysis. Frontiers in Psychiatry, 8, 164.
Presenting Author
Silas Pfeiffer
Poster Authors
Silas Pfeiffer
MSc
University Giessen
Lead Author
Judith Kappesser
Justus Liebig University
Lead Author
Luisa Kreß
Dr. med.
University Hospital Würzburg
Lead Author
Nurcan Üçeyler
MD
Department of Neurology, University of Würzburg, Germany
Lead Author
Christiane Hermann
Justus-Liebig-Univerversity Giessen
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Migraine
- Specific Pain Conditions/Pain in Specific Populations: Neuropathic Pain - Peripheral