A Conceptual Framework for Understanding the Role of Adverse Childhood Experiences in Pediatric Chronic Pain

Nelson, Sarah Milledge; Cunningham, N.; Kashikar‐Zuck, Susmita

doi:10.1097/ajp.0000000000000397

Cited by 78 publications

(59 citation statements)

References 85 publications

(106 reference statements)

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“…Consistent with this, results of this study indicated that youth with juvenile‐onset FM continue to experience increased pain and disability and decreased physical functioning, compared to healthy controls in young adulthood, years after the initial diagnosis . However, the influence that trauma may have on physical outcomes in young adults with chronic pain remains poorly understood . Contrary to previous studies on adults with FM , findings from this study indicate that trauma did not appear to impact current physical functioning in juvenile‐onset FM participants, as no differences were found on any physical or disease‐related outcomes between juvenile‐onset FM participants with and without a history of trauma as young adults.…”

Section: Discussionsupporting

confidence: 73%

Clinical Profiles of Young Adults With Juvenile‐Onset Fibromyalgia With and Without a History of Trauma

Nelson

Cunningham

Peugh

et al. 2017

Arthritis Care & Research

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Objective The primary objectives of this study were to examine the differential presentation(s) in young adults with Juvenile-onset Fibromyalgia (JFM) with and without a history of trauma as compared to healthy controls across psychological and health-related outcomes. Methods 110 participants (86 with JFM and 24 healthy controls; Mage=23.4 years) completed a structured clinical interview to assess for trauma and psychological comorbidities and self-report questionnaires on pain, physical functioning, and healthcare utilization. Results 37% (n=32) of JFM participants reported a trauma history. Three group comparisons (i.e., JFMTrauma vs. JFMNo Trauma vs. Healthy Controls) revealed that JFM participants significantly differed on all psychological and health-related outcomes from healthy controls. Further, although JFM participants with and without a trauma history did not significantly differ on pain and physical functioning, JFM participants with a trauma history were significantly more likely to have psychological comorbidities. Conclusion The current study is the first controlled study to examine the differential outcomes between JFM participants with and without a history of trauma. Two group comparisons between JFM participants and healthy controls were consistent with previous research. Further, our findings indicate that JFM participants with a trauma history experience greater psychological but not physical impairment than JFM participants without a trauma history.

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Section: Discussionsupporting

confidence: 73%

Clinical Profiles of Young Adults With Juvenile‐Onset Fibromyalgia With and Without a History of Trauma

Nelson

Cunningham

Peugh

et al. 2017

Arthritis Care & Research

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“…Although the link between childhood trauma and positive symptoms of somatoform dissociation (e.g. medically unexplained pain) was tenuous in the current study, there is evidence that childhood trauma is associated with physical as well as emotional pain (Nelson, Cunningham, & Kashikar-Zuck, 2017; Sachs-Ericsson, Sheffler, Stanley, Piazza, & Preacher, 2017) and that perceived control over pain is associated with reduced anxiety and enhanced emotion regulation (Salomons, Nusslock, Detloff, Johnstone, & Davidson, 2015). Therefore, assessment of somatoform dissociation appears warranted as a precaution when clinically treating adults with CPTSD/DESNOS.…”

Section: Discussioncontrasting

confidence: 54%

Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder

Dijke

Hopman

Ford

2018

European Journal of Psychotraumatology

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Objective: Complex posttraumatic stress disorder (CPTSD) as defined by the Disorders of Extreme Stress Not Otherwise Specified (DESNOS) formulation is associated with childhood relational trauma and involves relational impairment, affect dysregulation, and identity alterations. However, the distinct contributions of relational impairment (operationalized in the form fears of closeness or abandonment), affect dysregulation (operationalized in the form of overregulation and under-regulation of affect), and identity alterations (operationalized in the form of positive or negative psychoform or somatoform dissociation) to the relationship between childhood trauma and CPTSD/DESNOS have not been systematically tested. Method and Results: In a clinical sample of adults diagnosed with severe and chronic psychiatric and personality disorders (n = 472; M = 34.7 years, SD = 10.1), structural equation modelling with bootstrap 95% confidence intervals demonstrated that the association between childhood trauma and CPTSD/DESNOS symptoms in adulthood was partially mediated by under-regulation of affect, negative psychoform dissociation, and adult relational fears of closeness and of abandonment. These results also were independent of the effects of borderline personality disorder (BPD) symptoms. Conclusions: Some, but not all, hypothesized components of the DESNOS formulation of CPTSD statistically mediate the relationship between childhood trauma and adult CPTSD/DESNOS. These relationships appear specific to CPTSD/DESNOS and not to the effects of another potential sequelae of childhood trauma BPD. Replication with prospective longitudinal studies is needed.

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“…For example, a conceptual framework was recently proposed which drew parallels between the biopsychosocial processes involved in the experience of acute traumatic or significantly stressful events (e.g., HPA axis involvement, allostatic load, etc.) and the experience of pain (Danese & McEwen, ; McEwen & Kalia, ) and posited that the combination of these experiences could potentially amplify or maintain pain sensations over time (Nelson, Cunningham, & Kashikar‐Zuck, ). The stress model of chronic pain also asserts that, following repeated experiences of stress, increased hormonal responses to general stress (i.e., cortisol secretion) and reduced volume of the hippocampus may lead to persistent pain (Vachon‐Presseau et al., ).Evidence gathered across these theoretical models indicates that there may be significant overlap between neurological processes involved with stress/trauma and pain processing.…”

Section: Resultsmentioning

confidence: 99%

The biopsychosocial model of pain in the context of pediatric burn injuries

Nelson

Conroy

Logan

2018

European Journal of Pain

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Background Burns are a common and traumatic source of childhood injury in the United States. The treatment and recovery from burn injuries can be significantly painful and may lead to chronic or persistent pain for years following the initial incident. Further, burn injuries in youth have been found to increase the potential for significant psychosocial (e.g., anxiety, depression, PTSD) and physical (e.g., decreased mobility) impairment. Relatedly, the general experience and processing of pain in youth can also be associated with greater psychosocial (e.g., anxiety, depression) impairment and functional disability over time. However, the phenomenology and associated characteristics of the pain experience following burn injury and, in particular, the potential for combined impact on physical and psychosocial outcomes in youth with severe and/or prolonged pain and a history of burn injury is poorly understood. Methods A review of the literature was performed in the areas of burn injuries and outcomes associated with both acute and chronic pain with youth and adult populations. Results The current review highlights current gaps in the literature in important areas of function in youth with a history of burn injuries using the biopsychosocial model of pain. Future research and considerations for practice are also outlined. Conclusions Gaining a greater understanding of the relationship between pain, physical impairment, and psychosocial functioning in these youth is significantly important in order to provide greater preventative and treatment‐related intervention going forward. Significance Using a biopsychosocial framework, this review highlights the need for a greater understanding of pain processing and the long‐term potential for persistent pain and pain‐related impairment (e.g., functional disability) in youth with a history of burn injuries.

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A Conceptual Framework for Understanding the Role of Adverse Childhood Experiences in Pediatric Chronic Pain

Cited by 78 publications

References 85 publications

Clinical Profiles of Young Adults With Juvenile‐Onset Fibromyalgia With and Without a History of Trauma

Clinical Profiles of Young Adults With Juvenile‐Onset Fibromyalgia With and Without a History of Trauma

Affect dysregulation, psychoform dissociation, and adult relational fears mediate the relationship between childhood trauma and complex posttraumatic stress disorder independent of the symptoms of borderline personality disorder

The biopsychosocial model of pain in the context of pediatric burn injuries

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