Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study

Abstract

Childhood maltreatment (CM) has been associated with an increased risk of nonspecific chronic low back pain (nsCLBP). However, the mechanisms underlying this association are unclear. Therefore, this study considered whether distinct types of CM are accompanied by specific alterations in somatosensory function. A total of 176 subjects with nsCLBP and 27 pain-free controls (PCs) were included. The Childhood Trauma Questionnaire (CTQ) was used to categorize patients into 2 groups (abused/neglected vs nonabused/nonneglected) for 5 types of CM (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). The standardized quantitative sensory testing protocol of the "German Research Network on Neuropathic Pain" was performed to obtain comprehensive profiles on somatosensory function, including detection and pain thresholds, pain sensitivity, and assessments of temporal summation (wind-up). Between 17.7% and 51.4% of subjects with nsCLBP reported CM, depending on the type of CM. Childhood Trauma Questionnaire subscores for emotional and sexual abuse were significantly higher in subjects with nsCLBP than in PCs. Compared with PCs, subjects with CM showed reduced pressure pain thresholds (PPTs), irrespective of the type of CM. Regarding distinct types of CM, subjects with nsCLBP with emotional abuse reported significantly higher wind-up than those without, and sexual abuse was accompanied by enhanced touch sensitivity. Our findings suggest that CM is nonspecifically associated with a decreased PPT in nsCLBP. Emotional abuse apparently leads to enhanced spinal pain summation, and sexual abuse leads to enhanced touch sensitivity. These results emphasize the importance of emotional abuse in nsCLBP and suggest that CM can induce long-term changes in adult somatosensory function.

Phenotypic features of central sensitization

“…A WUR > 1 indicates temporal summation (Rolke et al, 2006). The presence of wind-up has long been proposed as a feature of central sensitization (Nijs et al, 2014;Woolf, 2011) and has been identified in many COPCs (e.g., FM (Price et al, 2002), including TMD (Maixner, Fillingim, Sigurdsson, Kincaid, & Silva, 1998), LBP (Tesarz, Eich, Treede, & Gerhardt, 2016), endometriosis (Napadow et al, 2012), and IBS (Zhou, Price, Callam, Woodruff, & Verne, 2011)).…”

Assessment and manifestation of central sensitisation across different chronic pain conditions

“…When different QST modalities have been used to discriminate chronic LPB patients from healthy controls, the temporal summation showed good discriminability (fitted area under the receiver operating characteristic (ROC), 0.80) (Neziri et al, 2012) with a significant association with clinical pain severity and disability (Owens et al, 2016). Of note, the temporal summation was elevated in chronic LBP patients who had experienced emotional abuse during their childhood (Tesarz et al, 2016).…”

“…In many chronic pain conditions, such as neuropathic (Nikolajsen et al, 1996;Maier et al, 2010), musculoskeletal (Staud et al, 2014;Tesarz et al, 2016), joint (Arendt-Nielsen, 2017), and visceral pain (Arendt- Nielsen, 1997;Dimcevski et al, 2007;Sherman et al, 2015), the temporal summation is significantly facilitated.…”

Eye Movement Desensitization and Reprocessing vs. Treatment-as-Usual for Non-Specific Chronic Back Pain Patients with Psychological Trauma: A Randomized Controlled Pilot Study

“…One explanation might be that psychotherapeutic attention paid to patients affected by pain had long focused mainly on cognitive-behavioral factors such as dysfunctional coping strategies and maladaptive behavioral patterns (14). This neglected the fact that emotional distress, e.g., caused by psychological trauma, can also have a central impact on the sensation and processing of pain (15–17). It is well known that physical pain alongside the purely sensory experience of pain generally also comes with a significant emotional dimension (17, 18).…”