Trauma History and Chronic Pain

This study investigated the relationship between trauma history and emotional functioning in response to chronic pain. The authors broadened the criteria for trauma, having it include crime-related events, disaster or general trauma such as injury or witnessing death, and undesired physical and sexual experiences. Also, the authors expanded the timeframe to include not only traumatic events from childhood, but to give psychological validity to traumatic events if they occurred in adulthood. They sought to find out how these factors were associated with 73 chronic pain patients' adjustment to their condition.

Male chronic pain patients with two or more traumatic events showed poorer adjustment, compared to pain patients without exposure to trauma. General negative affect, pain-related anxiety, and symptoms of depression all correlated to trauma history, while pain severity and activity levels did not. The authors suggest that the anxiety and depression represent the patient's difficulty in handling negative emotional responses to stressful circumstances, such as chronic pain, and that these responses may be exacerbated by previous exposure to trauma. The history of trauma may also play an important role in the success of rehabilitation:

"Reducing the levels of pain experienced may not be enough for those men with a history of trauma who are responding with high levels of emotional distress to their pain. For instance, men who exhibit more anxiety about their pain may have more difficulty participating in the strengthening exercises necessary for their rehabilitation."

Female subjects reported emotional distress levels that were situated between the men with many traumatic experiences and those without. This finding counters the general conception that women experience more emotional tumult than men do. However, the authors admit, "It is possible that we did not examine the emotional responses particularly relevant to women." Previous studies have indicated that women often perceive the world as "dangerous" and themselves as "helpless" following traumatic events. In which case, evaluating anxiety and depression as emotional responses may not correlate to their experience. However, this distinction is significant since it signals differences in how men and women adjust emotionally to trauma. To handle these differences, the authors suggest:

"More specific evaluation of a trauma history and how it currently effects the ability to emotionally manage a pain condition should be included in a comprehensive pain evaluation for both male and female chronic pain patients. Future research that more specifically studies how men and women with a trauma history respond to pain stimuli would provide more insight into these issues."

Spertus IL, Burns J, Glenn B, et al. Gender differences in associations between trauma history and adjustment among chronic pain patients. Pain 1999;82: 97-102.