Posttraumatic Stress Symptoms Mediate the Effects of Trauma Exposure on Clinical Indicators of Central Sensitization in Patients With Chronic Pain

Abstract

Objective: Evidence supports high rates of co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain disorders involving central sensitization (CS). The nature of this relationship, however, remains relatively unexplored. In this study, we aimed to (1) assess how both trauma exposure and current PTSD symptoms are related to clinical manifestations of CS, and (2) test whether PTSD symptoms explain the relationship between trauma exposure and CS. Because experiential avoidance has been shown to impact the relationship between trauma and health outcomes, we (3) explored experiential avoidance as a possible mediator or moderator of the trauma-CS relationship. Methods: A sample of 202 adult patients (79% female) with chronic pain completed validated self-report measures of trauma exposure, current PTSD symptoms, experiential avoidance, and three manifestations of CS: widespread pain, greater pain severity, and polysomatic symptom reporting. We used path analysis and multivariate regression to assess our study aims. Results: Both trauma exposure and PTSD symptoms were significantly associated with all three clinical indicators of CS. PTSD symptoms partially explained the relationship between trauma exposure and widespread pain, pain intensity, and polysomatic symptoms. Experiential avoidance did not mediate or moderate the trauma-CS relationship.

Degradable polymeric vehicles for postoperative pain management

“…Notably, the incidence of developing chronic pain after major surgeries such as thoracotomy, mastectomy, and amputation is high, and the severity of acute pain is one of the best predictors of chronic pain development 9 . Chronic pain following central sensitization is widespread and associated with emotional stress and posttraumatic stress disorder 140,141 . Given the variety of systems already available, the transformation of current practices for postoperative pain management to safer and more practical and efficacious methods via degradable polymeric vehicles is highly demanded for multiple short-term and longterm benefits.…”

Is there a neuropathic-like component to endometriosis-associated pain? Results from a large cohort questionnaire study

“…To assess a 'centralised' pain component, we included the Fibromyalgia Symptom Scale (FS) 20 (scores are between 0 and 31) which assesses whether pain is widespread or localised and whether patients experience related symptoms. Although originally designed for fibromyalgia patients, the FS questionnaire has additionally been used in patients with postoperative pain following hysterectomy 21 as well as in other pain conditions [22][23][24] .…”

“…33 [27][28][29][30][31][32][33][34][35][36][37][38] Dysmenorrhea Numerical Rating Scale Score (0-10) 8 (0-10) [7][8][9] Dyspareunia Numerical Rating Scale Score (0-10) 7 (0-10) [5][6][7][8] Non-cyclical Pain Numerical Rating Scale Score (0-10) 8 (0-10) [6][7][8][9] Duration of Pain Symptoms (years) 18 (1-47) [13][14][15][16][17][18][19][20][21][22][23][24] Number of surgeries to the abdomen…”

Internet-Administered Emotional Awareness and Expression Therapy for Somatic Symptom Disorder With Centralized Symptoms: A Preliminary Efficacy Trial

“…Although terms such as “medically unexplained,” “functional,” or “psychogenic” are conceptually problematic and are falling from favor, the concept of “central sensitization,” or simply “centralization,” has gained scientific and clinical acceptance ( 5 , 6 ). In this framework, the central nervous system is recognized as being primed by adverse life experiences and sensitized by bodily injury and pain to augment or amplify somatic symptoms or possibly even generate them ( 7 – 12 ). Such ppersistent centralized physical symptoms are both very prevalent and costly, imposing a heavy burden on the individual and society, with over one-third of primary care patients thought to have such symptoms ( 13 ).…”