Highlights
- •Pain patients with a history of lifetime abuse portend a worse clinical phenotype.
- •Fibromyalgianess mediates the relationship between abuse and pain severity.
- •Affective distress also mediates the relationship between abuse and pain severity.
- •56% of patients with a history of abuse met criteria for being fibromyalgia-positive.
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.
Perspective
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.
Key words
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Article info
Publication history
Published online: September 15, 2016
Accepted:
September 7,
2016
Received in revised form:
September 5,
2016
Received:
April 14,
2016
Footnotes
This research was funded by the Department of Anesthesiology, University of Michigan Medical School. Dr. Nicol receives research funding from the Department of Anesthesiology at University of Kansas School of Medicine. Dr. Sieberg receives research funding from a Boston Children's Hospital Career Development Fellowship Award, the Sara Page Mayo Endowment for Pediatric Pain Research and Treatment, and the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children's Hospital. Dr. Hassett receives research funding for investigator-initiated studies from Bristol-Myers Squibb. Dr. Brummett receives research funding from the National Institutes of Health, NIAMS R01 AR060392 and NIDA 1R01DA038261-01A1, the University of Michigan Medical School Dean's Office (Michigan Genomics Initiative), and Neuros Medical Inc (Willoughby Hills, OH).
Dr. Hassett is a consultant for Happify, Inc, and Precision Health Economics. Dr. Brummett discloses that the University of Michigan holds a patent for the use of peripheral perineural dexmedetomidine alone and in combination with local anesthetics (application number 12/791,506; issue date: April 2, 2013; patent number 8410140). Dr. Hassett receives research funding for investigator-initiated studies from Bristol-Myers Squibb. Dr. Brummett receives research funding from Neuros Medical Inc (Willoughby Hills, OH). The remaining authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
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© 2016 by the American Pain Society
