Everyone experiences pain. How you experience pain, however, is likely different from how your friends or family experience pain. In other words, many factors may come into play when it comes to the individual pain experience. Researchers have been particularly interested in understanding how psychological factors may influence the experience of chronic pain and how we function with pain.
Chronic pain is defined as pain that lasts longer than six months. With chronic pain, signals of pain to the nervous system persist despite a clear reason for their presence; this may be long after an acute injury has healed or may be related to other medical issues such as headaches or arthritis. The experience of chronic pain is a frustrating one that can take both a physical and emotional toll on the sufferer. While many treatments are available that can help reduce pain levels – medications, acupuncture, surgery – there is not a cure for chronic pain and part of treatment often includes finding new ways to better manage or cope with the pain that exists. This can be very difficult for individuals to accept and understand, and improvements are more likely to be impaired when psychological problems, like depression or anxiety, co-occur with the pain.
The Link Between Trauma, Abuse, and Chronic Pain
There appears to be a particular connection between trauma and chronic pain. Past studies show that childhood abuse is a risk factor for the development of pain conditions in adulthood. Why this is true remains unclear, although one possibility is that being in a perpetually dangerous environment leads to a heightened stress response. When chronically activated, that stress response can become dysregulated and lead to many negative physical and psychological outcomes later on. Post-traumatic Stress Disorder (PTSD) is also linked to pain conditions and higher levels of reported disability from pain. This relationship is present regardless of what type of traumatic event (and whether an injury) occurred. With PTSD and chronic pain, many suggest that there may be a shared vulnerability to both conditions or a mutual maintenance of symptoms that is driven by common factors. Emotion dysregulation, or the inability to regulate or manage intense negative emotions, is a common element of PTSD and is often found in children exposed to abuse. This may be one factor that helps to explain the relationship between trauma, PTSD and chronic pain, since difficulties with emotion regulation can lead to maladaptive coping strategies for both psychological and physical health problems.
Assessing Pain From a Public Hospital in Atlanta
To better understand the complex relationships between childhood abuse exposure, PTSD symptoms, emotion dysregulation, and the experience of pain, we studied these associations in a sample of highly traumatized, economically disadvantaged, minority subjects. This research was done as part of the Grady Trauma Project, a large scale study of genetic and environmental risk and resilience to PTSD. Our sample included 814 individuals found in the medical waiting rooms of an urban public hospital in downtown Atlanta, GA. These participants were assessed using the Childhood Trauma Questionnaire (CTQ), the Modified PTSD Symptom Scale (mPSS), the Emotion Dysregulation Scale (EDS), the Positive and Negative Affect Schedule (PANAS), and the Short Form Health Survey (SF-36). The SF-36 asks subjects to rate their bodily pain in the past month and how much bodily pain interfered with functioning in the past month.
Our study revealed that PTSD mediated the effect of childhood abuse on both pain level and pain-related limitations in subjects. Emotion dysregulation also had a significant effect on individuals’ level of pain-related limitations—that is, higher levels of emotion dysregulation were related to higher levels of reported impairment related to pain within the previous month. Our findings suggest that PTSD symptoms contribute to the connection between exposure to childhood abuse and current reported pain and pain-related limitations within this sample of highly traumatized adults. Adult symptoms of PTSD may serve as a pathway through which the relationship between childhood abuse and adult pain manifests. Greater difficulty with emotion regulation also contributes to the relationship between pain and impaired ability to manage daily tasks. There are many negative long-term effects of pain-related conditions, and our findings suggest that emotion regulation difficulties may be in part driving the effect of PTSD on worse pain-related functioning.
Many hospitals and pain clinics are now taking a more comprehensive approach to treating chronic pain conditions. It is clear that treating the psychological side of pain conditions is critical. These results provide further evidence that there needs to be increased awareness of how trauma and trauma-related conditions may affect pain in medical and veteran populations. A focus on emotion regulation strategies in the treatment of PTSD within medical settings may improve management of pain conditions through addressing issues related to pain-related functional limitations.
Abigail Powers Lott is a clinical psychologist and Assistant Professor at Emory University. She completed her education in Psychology and Anthropology at Emory and received her doctoral degree from Washington University in St. Louis. Dr. Lott's research focuses on trauma-related psychopathology, particularly emotion dysregulation in PTSD. She is involved in the Grady Trauma Project and is a member of the Anxiety and Depression Association of America.