Depression Partially Mediates the Association of Adverse Childhood Experiences with Pain Intensity in Patients with Chronic Pelvic Pain Syndrome: Results from a Cross-Sectional Patient Survey

Abstract

Objective Adverse childhood experiences (ACEs), such as emotional and physical maltreatment, are linked to chronic pelvic pain syndrome (CPPS) in adults. Psychological factors are important in understanding CPPS. We aimed to determine the nature and frequency of ACEs in male and female patients with CPPS and to investigate whether somatic symptoms and psychological comorbidities mediate the relationship of ACE severity with pain intensity. Design Cross-sectional study. Setting Interdisciplinary outpatient clinic for CPPS in Hamburg, Germany. Subjects Individuals with CPPS (n = 234) who were 18 to 84 years of age. Methods Using a self-administered questionnaire, we assessed the history of ACEs (ACE Scale), pain intensity (McGill Pain Questionnaire), somatic symptoms (Patient Health Questionnaire–15]), depression (Patient Health Questionnaire–9), and anxiety (Generalized Anxiety Disorder Scale). Parallel mediation analysis was conducted to examine whether the association of ACE severity with pain intensity is mediated by somatic symptoms, depression, and anxiety. Results Emotional abuse and neglect were reported more than twice as often as physical abuse and neglect (37.2% vs 17.1%). Depression partially mediated the association of ACE severity with pain intensity in the whole study population. In sex-stratified analyses, different patterns of associations were observed, but somatic symptoms predicted pain intensity in both sexes. Conclusions Emotional maltreatment was highly prevalent, supporting an increased consideration of psychological factors in CPPS and indicating the need to screen for ACEs in patients with CPPS. Findings further suggest that depression and somatic symptoms may be important targets for therapeutic interventions in patients with CPPS who have a history of childhood adversity.

Childhood Adversity Among Adults With Chronic Pain

“…Therefore, the research examining the relationship between ACEs and pain intensity, without assessing other relevant variables (eg, emotional distress and maladaptive cognitions about pain), may not capture the impact of ACEs on pain-related outcomes. This is supported by prior research indicating that ACE exposure may not lead to the development of chronic pain per se, but seems to lead to mental health problems and other psychosocial difficulties that negatively impact the adjustment to chronic pain 17–20…”

“…For example, 1 study found that ACE severity predicted depression among males but not females with chronic pelvic pain. 18 Another study indicated that history of trauma (not specific to ACEs) was associated with poorer affective adjustment among male but not female patients. 21 Therefore, research examining sex differences in the prevalence and impact of ACEs in a clinical chronic pain sample would add to the literature in this area.…”

“…This is supported by prior research indicating that ACE exposure may not lead to the development of chronic pain per se, but seems to lead to mental health problems and other psychosocial difficulties that negatively impact the adjustment to chronic pain. [17][18][19][20] There may also be sex differences in the relationship between ACEs and pain-related outcomes. For example, 1 study found that ACE severity predicted depression among males but not females with chronic pelvic pain.…”

Adverse childhood events and substance use history or recent opioid use among women with chronic pelvic pain

“…[10][11][12] ACEs are associated with a wide range of health consequences, [13][14][15] and emerging evidence links high ACEs to CPP in adult women. [16][17][18] Adverse childhood events and substance use history or recent opioid use among women with chronic pelvic pain Unfortunately, many women with CPP turn to opioids for pain relief, with up to 42% of this population reporting recent opioid use. 16,19 As there is an ongoing crisis of opioid misuse in this country, 20 addressing risk factors for opioid use in CPP patients is vital.…”

“…10 –12 ACEs are associated with a wide range of health consequences, 13 –15 and emerging evidence links high ACEs to CPP in adult women. 16 –18…”