Childhood Trauma Raises Risk of Chronic Pain in Adults by 45%

By Pat Anson, PNN Editor

People who experienced neglect or physical, sexual or emotional abuse as children are significantly more likely to have chronic pain as adults, according to a large new analysis. Individuals who had adverse childhood experiences (ACEs) were 45% more likely to report chronic pain in adulthood than those who did not have childhood trauma.

“These results are extremely concerning, particularly as over 1 billion children – half of the global child population – are exposed to ACEs each year, putting them at increased risk of chronic pain and disability later in life,” says lead author André Bussières, PhD, an Assistant Professor at the School of Physical & Occupational Therapy at McGill University. 
 
“There is an urgent need to develop targeted interventions and support systems to break the cycle of adversity and improve long-term health outcomes for those individuals who have been exposed to childhood trauma.”  

Bussières and his colleagues reviewed 75 years of research involving over 826,000 people. Their findings, published in the peer-reviewed journal European Journal of Psychotraumatology, adds to the growing body of evidence showing an association between ACEs and chronic pain.

ACEs may affect a child directly through physical, sexual or emotional abuse, or neglect – or indirectly through exposure to environmental factors like domestic violence, living with substance abuse, or parental loss.

Physical abuse during childhood had the strongest association with chronic pain and pain-related disability. The odds of having chronic pain were also higher if a person experienced multiple ACEs, either alone or combination with indirect ACEs. The research does not prove that ACEs cause chronic pain, only that there’s an association.

“Our findings suggest ACE exposure is associated with the most common and costly chronic pain conditions, including back and neck pain and other MSDs (musculoskeletal disorders), which account for the highest total health care spending compared to other health conditions,” researchers said.

“People with ACEs tend to have a higher chronic disease burden, barriers to treatment engagement, and greater health care utilization in adulthood. Adult patients exposed to ACEs may not be achieving optimal health outcomes due to the physiological and psychological effects of toxic stress. While the relative contributions of these mechanisms are not yet well understood, emerging evidence links ACEs to changes in genetic expressions that affect structural and functional changes in the brain and clinical phenomena in adulthood.”

Still unclear is the role that ACEs play in specific pain-related conditions. Previous studies have linked childhood trauma to an increased risk of headache disorders, fibromyalgia and lupus, as well as mood and sleep problems.

The Trauma-Pain Connection Explored at For Grace’s Women In Pain Conference

By Cynthia Toussaint, PNN Columnist

Four years ago, I was wheeled into my pain management doctor’s office, not to talk about Complex Regional Pain Syndrome, but rather my newest and most dire diagnosis: Triple Negative Breast Cancer (TNBC). I knew I didn’t have a good chance at survival, but didn’t know why I had the most rare and aggressive form of the disease.

I asked Dr. Richeimer why this cancer would appear now, as my oncologist and genetic counselor were baffled. Without pause, he answered, “Cynthia, you’ve been trying to fix your dysfunctional family your entire life. The toll that’s taken on your body is why you have TNBC.”     

Thus began my trauma-informed journey.

I was already aware and intrigued that many researchers were identifying trauma as the main driver for chronic pain. Despite this, I passed on having trauma release treatment because I’d heard it could be triggering. But now that I was fighting for my very existence, I was all in.

In the midst of full-dose chemotherapy, no less, I took to reading and researching everything I could get my hands on about childhood trauma and how it leads to adult on-set chronic illness. On the trauma release front, I jumped into talk therapy and EMDR (Eye Movement Desensitization and Reprocessing), complimenting those treatments with big doses of music, writing, meditation, inner child work and ancestral healing.

I also started focusing my “For Grace” work on the trauma-pain connection. This included interviewing a boatload of experts and survivors as well as collecting and spotlighting lived experiences, all culminating in Friday’s 11th Annual Women In Pain Conference – “The Trauma-Pain Connection: A Path to Recovery and Growth.”

Radene Marie Cook

You see, I now understand that my 40+ years of pain and chronic illness are the result of serious and sustained trauma, suffered primarily during my early development. In short, trauma is not a piece of my chronic pain puzzle. It’s the whole puzzle.

I want to share all that I’ve learned with women in pain, during a day that I hope will launch your own trauma-informed journey, one that I promise will bring you healing and growth.

To start you on your way, our five-hour online seminar, beginning at 10am PT on November 17, will be broken into three sessions led by world-class speakers, panelists and breakout leaders, all who have survived trauma and volunteered their time.

• Session One will examine what trauma is, how it can be passed down generationally, and how it’s a driver for chronic pain.

• Session Two will highlight trauma release and the myriad of effective techniques, methods and strategies used to achieve that end, both practitioner-led and solo.

• Session Three will celebrate what I call the silver-lining of trauma, Post-Traumatic Growth, a process that paves the way for recovery, deeper meaning, new-found strength, and helping others.            

Themed throughout the conference will be the beauty, struggle and resilience of the Native American people. Because I’ve read time and again that this community suffers greatly from generational trauma, the day will be infused with stunning music and photography, compliments of one of our main speakers, Dr. Noshene Ranjbar, a leader of indigenous studies at the University of Arizona. It touched my heart that two of her students put in hours to gift us these sacred elements.

Perhaps the most poignant part of our event will be the extraordinary gift of intensely personal video vignettes sprinkled in from people who’ve traveled the dimly-lit trauma-pain tunnel, found healing through release, and moved on to the light of growth. The courage of these generous souls is a triumph of the spirit.      

This conference was For Grace’s heaviest lift to date. Coming from a chronic pain background, I didn’t know anyone in trauma and it took several years to build a critical mass of relationships. Also, because this conference is the first of its kind, our planning committee had to build it from whole cloth. Perhaps most difficult and most satisfying, was getting people to talk publicly about their deepest, darkest experiences. I know the challenge well because when I recorded my story, I was brought to tears more than once.

It was worth the sweat and tears because we struck gold.

This is the most important topic For Grace has covered. I’m certain that if you do the work, it will be a catalyst for healing and renewed wholeness. Remembering, facing and addressing our past traumas is our best hope to overcome the scourge of chronic pain.

Don’t wait to get a deadly disease to learn, to explore, to discover trauma’s place in your life. You’re braver than you think - and when you use that courage, you’ll be on the path to finding the last piece to your pain puzzle.

You can watch the conference for free at this link.

Cynthia Toussaint is the founder and spokesperson at For Grace, a non-profit dedicated to bettering the lives of women in pain. She has lived with Complex Regional Pain Syndrome (CRPS) and 19 co-morbidities for four decades, and has been battling cancer since 2020. Cynthia is the author of “Battle for Grace: A Memoir of Pain, Redemption and Impossible Love.”

Childhood Trauma and Neglect Increase Risk of Headache Disorders

By Pat Anson, PNN Editor

People who experience traumatic events during childhood, such as physical abuse, sexual abuse or neglect, are more likely to have headache disorders as adults, according to a large new study. The research adds to a growing body of evidence linking adverse childhood experiences (ACEs) to headaches and migraines in adults.

“Traumatic events in childhood can have serious health implications later in life,” says lead author Catherine Kreatsoulas, PhD, of Harvard T.H. Chan School of Public Health. “Our meta-analysis confirms that childhood traumatic events are important risk factors for headache disorders in adulthood, including migraine, tension headaches, cluster headaches, and chronic or severe headaches. This is a risk factor that we cannot ignore.”

Kreatsoulas and her colleagues reviewed 28 studies that examined the childhood histories of nearly 155,000 people in 19 countries. Their findings are published Neurology, the medical journal of the American Academy of Neurology.

About a third of the participants (31%) reported at least one traumatic childhood event. Of those, 26% were diagnosed with a primary headache disorder, compared to 12% of participants who said they experienced no childhood trauma. People who had four or more traumatic events during childhood were more than twice as likely to have a headache disorder than those who had one ACE.

Researchers also examined different types of childhood trauma. Events categorized as “threat” traumas included physical abuse, sexual abuse, emotional abuse, witnessing or being threatened with violence, and serious family conflicts.

Events categorized as “deprivation” traumas included childhood neglect, economic adversity, divorce or separation, parental death, alcohol or substance abuse, and living in a household where someone has a mental illness, chronic illness, disability or is incarcerated.

Threat traumas were linked to a 46% increase in headache disorders, while deprivation traumas were linked to a 35% increase in headaches. Among threat traumas, physical and sexual abuse were associated with a 60% increased risk for headaches. Among deprivation traumas, neglect was linked to a nearly three-fold increased risk for headache disorders.

“Threat or deprivation traumas are important and independent risk factors for headache disorders in adulthood,” said Kreatsoulas. “Identifying the specific types of childhood experiences may help guide prevention and treatment strategies for one of the leading disabling disorders worldwide. A comprehensive public health plan and clinical intervention strategies are needed to address these underlying traumatic childhood events.”

Due to the stigma and sensitive nature of childhood trauma, researchers say it’s likely the number of ACE cases is under-reported by adults.

 “Despite this, the robustness of these findings cannot be underappreciated as the studies composing this meta-analysis represent diverse global regions and the findings supersede cultural contexts,” they said.

The research does not prove that ACEs cause headaches -- it only shows an association.

Previous studies have also linked childhood trauma to an increased risk of chronic pain conditions such as fibromyalgia and lupus, as well as mood and sleep problems.

Learning How to Cope With Childhood Trauma

By Cynthia Toussaint, PNN Columnist

My world became unreal and terrifying when I was 18. Literally, everything looked, sounded and felt distorted. While I’ve long known this experience is called “derealization,” I only recently discovered it’s a form of dissociative coping that sprung from childhood trauma – trauma that also seeded a lifetime of chronic pain, including my Complex Regional Pain Syndrome.

During my trauma-release work last year, I learned that dissociation protects us from experiencing what is too overwhelming: perceived annihilation, if you will. My childhood years were so traumatizing, I now see that my mind made everything unreal to escape the horror of my world, which included domestic violence, mental illness, addiction and suicide.

There are five different forms of dissociation (depersonalization, derealization, amnesia, identity confusion and identity alteration), and my trauma therapist explained that, unfortunately, derealization is the least common variety, with scant research behind it. Also, it’s near-impossible to manage.

When my reality imploded a lifetime ago, my derealization felt anything but protective. It invaded me so dark and destructively, I feared I’d gone insane and that my next stop was an asylum.

It all started by eating too many pot-filled brownies while I was on an anxiety-ridden outing with my abusive brother and his posse. To get home, I was named designated driver because I’d partaken less than the others. I was terrified because I felt like I was on a bad trip. Also, I’m awful with directions and knew my brother would mercilessly belittle me for my wrong turns.               

Still, I took the wheel. Soon, out of nowhere, or so it seemed, I blew through a stoplight and missed a speeding Mack truck by a hair, my spatial abilities incapacitated. There must have been an angel on my shoulder that day as we all should have died. In a way, I did.

After being relieved of my driving duties, the people around me, the cars outside, even my own body became terrifyingly unreal and distorted, like being in a funhouse hall of mirrors. I also had such severe paranoia that when my brother’s girlfriend took a turnoff I wasn’t familiar with, I was certain she was driving me to hell. And when I say hell, I mean fire, brimstone and the guy with the pitchfork and tail.  

The horror didn’t let up for the next couple of weeks as I felt I was looking through a veil of fog. Perhaps the freakiest part was that everyone acted as though they weren’t on the same drug trip. I felt alone, always holding the tears and screams inside. I tried to play along with everyone else’s normal, reminding myself that if I let out my terror, they’d likely have me committed.

Panic Attack

Soon after, when my family took a long-anticipated trip to New York City, I lost my marbles. It was too much of a load of sensory input that I was unable to process in my vulnerable state. One night in our hotel room, I released my panic with a gut-wrenching scream that didn’t let up for hours. Horrified, my family got me to an ER, and I was diagnosed with an anxiety attack. I only wish.

After that, my derealization became my new normal. Good god, it didn’t let up for an entire year. During college and my first professional dancing job, I learned to cope by using distraction and reminding myself that the bad times were temporary, that some days were better than others.

After developing CRPS and seeing my life and dreams crumble a few years later, I had to give in to the spreading, fiery pain by moving back into my mother’s home. Anxiety, fear and despondency took over and my derealization roared back worse than ever. I was debilitated to the point that I could only lie on a bed and stare at cracks in the wall. It was a single crack that looked real to me.

Out of desperation, I saw a compassionate psychiatrist who mercifully blew open my world. I was stunned as he asked questions that lead me to understand that, not only did he believe me to be sane, he actually knew what plagued me. Stunned, I asked him if my symptoms were familiar.

“Let’s just say that if I had a nickel for every patient that came to me with what you’ve got, I could buy something expensive,” he told me. With that, a ton of weight lifted from my shoulders.

This healer put me on a benzodiazepine, Klonopin, and gave me a book that detailed my dissociative disorder. I was no longer alone and, at last, knew I was sane. Regarding the Klonopin, the good doctor added, “I wouldn’t be surprised if your pain lets up as well.” 

Within a few days, my derealization miraculously eased by about 80% and, as a bonus, I went into my first CRPS remission. The word “hope” re-entered my vocabulary, and I was again among the living.           

44 years after eating that brownie, I still wrangle with derealization. If stressed or triggered, the fog closes in, but it no longer runs me. I’m fortunate the clonazepam (generic for Klonopin) is still effective, as I have a brother who isn’t as lucky. He’s suffered most of his life with derealization, and nothing has ever provided respite.

Trauma brings on so much bad in so many ways, and our minds and bodies go to astounding extremes to persevere. Since my trauma-release work, I’ve arrived at surprising new understandings and feelings. I’ve come to a place of acceptance, even a bit of gratitude, for my derealization. It’s gifted a lifetime of protection by shielding me from what I likely wouldn’t have survived. It was simply trying to do right by me. Still is.              

For real.           

Cynthia Toussaint is the founder and spokesperson at For Grace, a non-profit dedicated to bettering the lives of women in pain. She has lived with Complex Regional Pain Syndrome (CRPS) and 19 co-morbidities for four decades, and has been battling cancer since 2020. Cynthia is the author of “Battle for Grace: A Memoir of Pain, Redemption and Impossible Love.”

Does Childhood Trauma Increase Risk for Opioid Misuse?

By Pat Anson, PNN Editor

Did a parent humiliate or swear at you as a child? Were you ever molested? Did you live with a problem drinker or someone who went to prison? Were your parents ever separated or divorced?

Those are some of the questions posed to over 1,400 college students in a study by researchers at the University of Georgia, who wanted to assess the relationship between childhood trauma and the misuse of prescription opioids later in life.

Their research, recently published in the Journal of American College Health, found that most students had at least one adverse childhood experience (ACE). But those who reported four or more ACEs were almost three times more likely to misuse opioid medication.

Based on that finding, the researchers say healthcare providers should consider a patient’s experience with childhood trauma before prescribing them opioids.

“Our findings suggest need to include assessment of ACEs as a screening criterion for opioid prescription and administration among college-aged individuals,” wrote lead author Janani Thapa, PhD, an associate professor in UGA’s College of Public Health.

Many doctors already use screening tools to assess whether a patient is at risk for opioid misuse. They look up their prescription drug history, or ask patients if they’ve been sexually abused or have family members with a substance use disorder.

But Thapa and her colleagues think that assessment should go further, incorporating a wider range of childhood trauma, such as whether a patient didn’t have enough to eat or had to wear dirty clothes as a child.  

“Prevention of opioid misuse demands careful consideration of the traumatic exposure of the patient,” they said. “Current opioid assessment measures, including patient or family interviews, and prescription monitoring, may need to incorporate patients’ traumatic history for proper chronic pain management and integrated care.”

Penalizing Patients

The use of opioid screening tools is controversial. Some patients resent being asked about their childhood trauma – which they see as irrelevant to their health problems and pain management as adults.   

“I overcame my early life abuse until an ignorant doctor used that childhood abuse without psychiatric consultation to put labels on me and refuse medicine for pain,” one patient told us.

“Just because a patient may have been sexually abused or has family members who are addicts/alcoholics, does not mean the patient will be,” said another. “To penalize a person who is in excruciating pain due to no choice of their own, is cruel and inhumane.”

But a pain management expert says opioid screening tools have their place, because childhood trauma can have a lasting impact. 

“Most studies have shown that 4 in 5 people with an Opioid Use Disorder have at least one ACE,” says Lynn Webster, MD, past president of the American Academy of Pain Management and a PNN contributor. “I consider ACEs a form of post-traumatic stress disorder. It affects emotion regulation, causing an inability to modulate distressing emotions in a healthy and adaptive way. ACEs create a maladaptive response to stress. The earlier in life the ACEs occur, the more effect they will have later in life.” 

Over 20 years ago, Webster developed one of the first opioid screening tools for doctors, a short survey that asked patients if they had a history of substance abuse, sexual abuse, or any mental health issues. In his own practice, Webster found the survey helpful in identifying patients at risk of abusing opioids, but he later came to regret how the screening tool was “weaponized” against patients, particularly women, and used by other doctors as an excuse to deny patients opioids. 

“The Opioid Risk Tool (ORT) incorporates pre-adolescent trauma to help identify females who were at greater risk of OUD from what I believe is a form of PTSD. If I were to develop the tool today, I would probably make it gender neutral, but the increased risks for females would remain,” Webster said in an email. 

Webster agrees with the University of Georgia researchers that ACEs should be used to help assess whether a patient is at risk of abusing medication. But he says a high number of ACEs should not be used to avoid prescribing opioids to someone who has a medical need for them.  

Study Finds Childhood Trauma Increases Risk of Opioid Addiction

By Pat Anson, PNN Editor

Several studies have found that if you experienced physical or emotional trauma as a child you are more likely to have migraines, fibromyalgia and other painful conditions as an adult.

Australian researchers have taken that theory a step further, with a small study that found adults with a history of childhood abuse or neglect are more likely to feel the pleasurable effects of opioids, putting them at greater risk of addiction.

That finding, recently published in the journal Addiction Biology, is based on a double-blind, placebo-controlled study that compared the effects of morphine on 52 healthy people – 27 with a history of severe childhood trauma and a control group of 25 who had no such experiences as children.

Participants in both groups were given an injection of morphine or a placebo dose, and then asked how it made them feel. People in the trauma group reported more euphoria or feeling high and more “liking” of morphine. They also felt less nauseous and dizzy after taking the drug compared to the non-trauma control group.

“Those with childhood trauma preferred the opioid drug morphine and they felt more euphoric and had a stronger desire for another dose,” lead author Molly Carlyle, PhD, a research fellow at The University of Queensland, said in a statement. “Those with no childhood trauma were more likely to dislike the effects and feel dizzy or nauseous.

“This is the first study to link childhood trauma with the effects of opioids in people without histories of addiction, suggesting that childhood trauma may lead to a greater sensitivity to the positive and pleasurable effects of opioids.”

Researchers say people in the trauma group were significantly more likely to have a history of anxiety or depression, and to use over-the-counter pain relievers regularly.  They were also more likely to report stress, loneliness and less social support and self-compassion than the control group.

“One possible explanation for the differing responses to morphine is that childhood trauma affects the development of the endogenous opioid system – a pain-relieving system that is sensitive to chemicals including endorphins, our natural opioids,” Carlyle explained. "It's possible that childhood trauma dampens that system.

“When a baby cries and is comforted, endorphins are released, so if loving interactions like this don't happen, this system may develop differently and could become more sensitive to the rewarding effects of opioid drugs."

Pain was also measured during the study, with participants immersing a hand in cold water both before and after receiving morphine. Researchers measured how long it took for them to find the cold water painful and how long it took before they pulled their hand out. Morphine was found to increase pain threshold and tolerance in both groups, regardless of whether they experienced childhood trauma.

“The findings of this study are a stepping stone in highlighting the role of childhood trauma in OUD (opioid use disorder), emphasising the need to address trauma symptoms in this vulnerable group, and targeting early interventions at traumatised young people,” researchers concluded. “These findings have many clinical and social implications including reducing the guilt and shame common amongst those with OUD about the reasons behind the development of this damaging addiction.”

What ‘Rocketman’ Tells Us About Pain and Addiction

By Lynn Webster, MD, PNN Columnist

“Rocketman” is a new biopic about the legendary singer Elton John. The emotionally-driven musical fantasy takes some liberties with certain details of John's life, but it illuminates an essential truth: childhood trauma can lead to pain, addiction and other severe health problems.

The movie is generating some Oscar buzz, but it offers more to viewers who want to see how painful childhood experiences can adversely affect people when they become adults.

The film begins with the flamboyantly wealthy and gifted Elton John strutting down a hallway -- in full costume complete with a colorful headpiece from a recent stage show -- to his first Alcoholics Anonymous meeting.

He becomes the center of attention at the AA meeting when he begins to describe -- through flashbacks told, in part, through song and dance -- his childhood, which was devoid of love and acceptance.

“rocketman” Paramount pictures

Elton John is a musical prodigy, but his talent couldn't save him from the harm caused by a father who rejected him and a mother who didn't protect him. As John told The Guardian, "My dad was strict and remote and had a terrible temper; my mum was argumentative and prone to dark moods. When they were together, all I can remember are icy silences or screaming rows."

As John remembers it, "The rows were usually about me, how I was being brought up."

How Childhood Trauma Affects Health

In her TED Talk, Dr. Nadine Burke Harris describes how childhood trauma can affect health over a lifetime — laying the foundation for seven out of 10 leading causes of death in the United States, including addiction and even suicide.

As Dr. Harris points out, our healthcare system treats childhood trauma as a social or mental health problem rather than as a medical issue. Doctors are trained to refer traumatized children to specialists rather than providing intervention and treatment themselves. But childhood trauma may lead to serious medical problems and can even reduce life expectancy by 20 years, according to a study published in the American Journal of Preventive Medicine.

The CDC’s Adverse Childhood Experiences Study (also known as the ACE Study) defined and examined this problem. The study acknowledged 10 types of childhood trauma, including verbal, physical, and sexual abuse; parental rejection and neglect; mental illness or incarceration of a family member; divorce; and substance dependence.

Of the 17,000 adults who participated in the study, two-thirds had experienced at least one of these childhood traumas. Eighty-seven percent had lived through more than one. The consequences of this can be staggering. People who experienced four childhood traumas were 2.5 times more likely to have pulmonary disease and hepatitis. And they were four times more prone to depression and had 12 times the risk for suicidality.

“Adverse childhood experiences are the single greatest unaddressed public health threat facing our nation today,” says Dr. Robert Block, President of the Academy of Pediatrics.

Trauma Rewires the Brain

Adverse childhood experiences rewire the brain. The heightened response to stress that some children develop can affect the reward center of the brain and the executive functioning of the prefrontal cortex. It can also result in maladaptive behaviors associated with pain and addiction.

About a decade ago, Dr. Norman Doidge provided an understanding of how our brains have the capacity to change in his book, “The Brain that Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.”  His highly acclaimed research offers scientific hope that there is treatment for the adverse effects of childhood trauma and chronic pain.

Dr. Doidge describes neuroplasticity as the process through which an injured brain can heal itself. An example of this healing process was reported by National Public Radio's Patti Neighmond. It is called emotional awareness and expression therapy (EAET).

Developed in 2011 by psychologist Mark Lumley and Dr. Howard Schubiner, EAET combines talk therapy with cognitive behavioral therapy to change brains that have been structurally altered by trauma. The NIH’s Pain Management Best Practices Inter-Agency Task Force has recognized EAET as potentially beneficial to some people in chronic pain.

Preventing the Need for Drugs

“Rocketman” reflects more than the consequences of a single individual's traumatic childhood. It illuminates a broader social problem that sows the seeds for substance use disorders in adults. 

The approach we take to solving substance use disorders today is focused on treatment and law enforcement. Neither approach seems to be curbing the problem, which suggests the need for a better strategy. Long-term solutions to substance use disorders must include prevention. This means we need to understand what creates the demand for drugs.

Elton John’s story poignantly illustrates two of the causes of addictive behavior:

1. Memories of pleasurable experiences are the reason drugs are repeatedly abused

2. Memories of painful life experiences are commonly the genesis of drug initiation

There is compelling evidence that the trajectory of our mental and physical health begins with how we are treated as children. It may seem Pollyannish to say this, but our first line of defense is to love and accept our children, regardless of their gender identity, abilities or individual traits.

As “Rocketman” testifies, anything else can set children on the path to developing a substance use disorder and, in some cases, chronic pain. 

Lynn R. Webster, MD, is a vice president of scientific affairs for PRA Health Sciences and consults with the pharmaceutical industry. Lynn is a former president of the American Academy of Pain Medicine, author of the award-winning book “The Painful Truth” and co-producer of the documentary “It Hurts Until You Die.”

You can find him on Twitter: @LynnRWebsterMD.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Childhood Abuse Raises Lupus Risk for Adult Women

By Pat Anson, PNN Editor

Women who experienced physical or emotional abuse as children have a significantly higher risk of developing lupus as adults, according to new research presented at the annual meeting of the American College of Rheumatology.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that causes inflammation in multiple organs. Most patients have times when the disease is active, followed by times when the disease is mostly quiet and in remission. Lupus is far more common in women than men.

“In prior work, exposure to stress and stress-related disorders, notably post-traumatic stress disorder, has been associated with increased risk of subsequently developing autoimmune diseases, including lupus,” said lead author Candace Feldman, MD, an Assistant Professor at Brigham and Women’s Hospital/Harvard Medical School.

“Exposure to adverse childhood experiences has specifically been associated with higher levels of inflammation, as well as with changes in immune function.”

To identify what kind of childhood trauma raises the risk of lupus, Feldman and her colleagues looked at health data for over 67,000 women participating in the Nurses’ Health Study II, an ongoing study of female nurses that began in 1989. There were 93 diagnosed cases of lupus among the women.

In detailed questionnaires, the women were asked whether and how often as children they experienced physical abuse from a family member, or yelling, screaming or insulting remarks from a family member. The women were also asked to recall incidents of sexual abuse by either adults or older children.

Researchers found that physical and emotional abuse were associated with a more than twofold greater risk of developing lupus. But the data did not reveal a statistically significant association between sexual abuse and lupus risk.

“The study’s findings suggest that the effects of exposure to physical and emotional abuse during childhood may be more far-reaching than previously appreciated,” said Feldman. “The strong association observed between childhood abuse and lupus risk suggests the need for further research to understand biological and behavioral changes triggered by stress combined with other environmental exposures. In addition, physicians should consider screening their patients for experiences of childhood abuse and trauma.”

This is not the first study to find an association between childhood trauma and chronic illness in adults. A recent study of 265 adults in New York City found that those who experienced more adversity or trauma as children were more likely to have mood or sleep problems as adults -- which in turn made them more likely to have physical pain.

Another study found that children who witness domestic violence between their parents are significantly more likely to experience migraine headaches as adults. A large survey also found that nearly two-thirds of adults who suffer from migraines experienced emotional abuse as children.

Childhood Trauma Linked to Adult Pain

By Pat Anson, Editor

If you experienced physical or emotional trauma as a child – like a major illness, abuse or your parents’ divorce – you are more likely to experience pain as an adult, according to researchers at Penn State.

Their findings -- published in the Journal of Behavioral Medicine – add to previous research suggesting there’s a link between adult physical pain and childhood trauma or adversity.

"Pain is the number one reason people seek health care in the United States," said co-author Jennifer Graham-Engeland, PhD, a professor of biobehavioral health at Penn State. “We need more insight into pain and the phenomenon that can make pain both better or worse."

The researchers surveyed a diverse group of 265 adults who lived in a housing cooperative in the Bronx, New York.  All reported at least one form of trauma or adversity as children or adolescents. Some reported as many as seven.

A traumatizing event that left a person scared for years was the most common adversity (44%), followed by parental divorce (31%), a major illness or accident requiring hospitalization (24%), parental substance abuse (24%), sexual abuse (23%), parental unemployment (21%), a child’s removal from the home (10%) and physical abuse (10%).

Participants were also asked about their current mood, sleep patterns, optimism, how in control of their lives they felt, and if they recently felt pain.

Those who experienced more adversity or trauma as children were more likely to have mood or sleep problems as adults -- which in turn made them more likely to have physical pain. But the connection to pain was weaker in those who felt more optimistic and resilient.

"The participants who felt more optimistic or in control of their lives may have been better at waking up with pain but somehow managing not to let it ruin their day," said Ambika Mathur, a graduate student in biobehavioral health. "They may be feeling the same amount or intensity of pain, but they've taken control of and are optimistic about not letting the pain interfere with their day. They're still performing their work or daily activities while doing their best to ignore the pain."

The researchers found that childhood or adolescent adversity was strongly associated with more physical pain in adulthood, which could be partially explained by feelings of anger, depression or anxiety -- as well as poor sleep.

"Basically what's happening is mood and sleep disturbances are explaining the link between early life adversity and pain in adulthood," Mathur said. "The findings suggest that early life trauma is leading to adults having more problems with mood and sleep, which in turn lead to them feeling more pain and feeling like pain is interfering with their day."

The researchers also found that people who felt more optimistic or resilient didn't have as strong of a connection between trouble sleeping and pain interfering with their day. This suggests that childhood adversity can be overcome and doesn't necessarily sentence anyone to a lifetime of pain.

"This study does build on a body of research showing a connection between early life adversity and pain, but also that some people can achieve resilience," said Graham-Engeland. “Some people can be relatively resilient to adverse effects in the longer term, while others have a harder time."

Recent studies have also linked childhood trauma to adult migraine and fibromyalgia.

Major Depression Increasing

Pain sufferers aren't the only ones dealing with anxiety or depression. According to a new report from Blue Cross Blue Shield, major depression affects more than 9 million Americans who are commercially insured.

Diagnoses of major depression have risen by 33 percent since 2013. The rate is rising even faster in millennials (up 47%) and adolescents (47% for boys and 65% for girls).

In most cases, major depression coincides with a chronic or behavioral health condition. People diagnosed with depression are three times more likely to suffer from pain related disorders and injuries, and seven times more likely to have a substance use disorder.

It's worth noting that a recent study by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that medications used to treat depression, anxiety and other mental health disorders are now involved in more overdoses than opioid pain medication.

Over 25,000 overdoses in 2016 were linked to "psychotherapeutic" medications such as antidepressants, benzodiazepines, anti-psychotics, barbiturates and attention deficit hyperactive disorder (ADHD) drugs such as Adderall. Deaths linked to psychotherapeutic drugs have risen by 45 percent since 2010.

Over 17,000 Americans died in 2016 from overdoses involving prescription opioids.

Is Fibromyalgia Caused by Childhood Trauma?

By Pat Anson, Editor

An article in a peer-reviewed medical journal that promotes a “new way of thinking” about chronic pain – and its possible ties to childhood trauma -- is stirring some controversy in the fibromyalgia community.

In the article, published in The Journal of Family Practice, co-authors Bennet Davis, MD, and Todd Vanderah, PhD,  say there may be “psychological reasons” for chronic pain that is not caused by tissue injuries or damage to the nervous system – what they call a “third type of pain.”

“We hypothesize that this pain may be the consequence of changes in nervous system function that arise from developmental trauma, other traumatic experiences in a patient’s life, or mental health disorders. It is this third type of pain that may offer us insights into conditions such as fibromyalgia,” they wrote

Davis and Vanderah say the third type of pain can be recognized when a patient makes an “emotionally charged presentation” that they are in severe pain when there is no physical evidence of tissue injury or pathology.

Where then does the pain come from? Davis and Vanderah say childhood accidents, trauma and abuse are so emotionally upsetting that they can lead to long-term changes in the central nervous system that amplify pain.

“We believe that these changes lead to a bias toward hyperactivation of emotional pain circuits, which leads to the emotionally laden pain behaviors that often seem out of proportion to tissue pathology,” they said.

“Perhaps this will explain what is happening with some of our patients who complain of pain ‘all over’ and who are often classified as having fibromyalgia.”

Fibromyalgia is a poorly understood disorder that is characterized by deep tissue pain, fatigue, depression, mood swings and insomnia. The exact cause of fibromyalgia is unknown.

Article Called "Dangerous"

Are Davis and Vanderah onto something? Or is their theory simply a new variation of the “it’s all in your head” explanation that many patients get from doctors?

“This article is dangerous,” says Jan Chambers, President of the National Fibromyalgia and Chronic Pain Association. “The slippery slope created by this article for a quick shove-off of patients with fibromyalgia generally to a psychiatrist or psychologist for talk therapy is very concerning.

“Singling out childhood psychological trauma without rigorous research as a ‘third type of pain’ and potential cause of fibromyalgia is dangerous because this could become an easy reason for medical doctors to further dismiss pain patients with challenging treatments from their care or withhold needed medical treatments or prescriptions. Additionally, other medical conditions could go undiagnosed with their symptoms attributed to being a psychological aspect of childhood trauma.”

Chambers says research has found that about 70 percent of people with fibromyalgia have neck pain – and many also have a history of whiplash-type injuries – indicating there is a physical explanation for fibromyalgia.

“When people receive appropriate care and spinal rehabilitation for their cervical spine, their fibromyalgia symptoms significantly reduce,” Chambers said in an email to PNN. “Several prominent fibromyalgia researchers have known this for years but have not convinced medical doctors to recruit chiropractors to help alleviate the suffering of their patients with fibromyalgia who have significant neck or low back pain.”

Another patient advocate disputes the notion that chronic pain is linked to childhood trauma and abuse.

“We would be hard pressed to find anyone who hasn't experienced psychological trauma at some point in their life,” says Celeste Cooper, a retired nurse and fibromyalgia sufferer.

“So, are we to assume they will all have multiple sclerosis, nerve impingement, Ehler's Danlos, CRPS, fibromyalgia, myofascial pain syndrome, Crohn's disease, chronic fatigue, cancer, etc.? Childhood trauma is a horse of a different color and should be left to those who specialize in this type of care. I cannot connect the dots on that one. Mental illness should be addressed by a trained psychiatrist and psychologist, not someone treating adult chronic pain.” 

Davis is a pain management specialist at the Integrative Pain Center of Arizona in Tucson, while Vanderah is a Professor of Pharmacology at the University of Arizona.

Davis said he developed his theory about the connection between childhood trauma and fibromyalgia after listening to thousands of patients’ stories. He believes there is a connection between emotional and physical pain that every doctor needs to understand.

“The nervous system is the connector between tissues and mind/consciousness, and every health provider needs to understand the nervous system to do their job, especially primary care providers,” Davis wrote in an email to PNN. “The artificial separation of mind and body represents a paradigm that has led the American health care system to multiple dead ends (including a dead end in understanding fibromyalgia), to misdiagnoses, to unnecessary surgeries and tests, to accusing patients that ‘it’s in your head’ when it most definitely is not, and has contributed to nearly bankrupting our health care system.”

How would Davis and Vanderah evaluate and treat fibromyalgia? If a physical cause of the pain cannot be found, they recommend doctors look for signs of “psychologically traumatic experiences” in patients, and assess them for anxiety and depression.

Recommended treatments include counseling, cognitive behavioral therapy, hypnotherapy, post-traumatic stress disorder therapies and anti-depressant medications such as Cymbalta (duloxetine) and Effexor (venlafaxine). Interestingly, they do not recommend any type of pain medication – either opioids or over-the-counter pain relievers.

“Above all, when you are caring for someone who has pain without clear tissue pathology or who has recognized intensified emotional pain processing, reassure the person that the pain experience is not in his or her head, but rather in his or her nervous system,” they said. “Such discussions go a long way toward helping patients understand their experience, as well as feel validated. And that can lead to improved compliance with therapy going forward.”

The Journal of Family Practice is delivered to nearly 100,000 family physicians, general practitioners and osteopaths in primary care.

Childhood Emotional Abuse Raises Risk of Migraine

By Pat Anson, Editor

New research is adding to the growing body of evidence linking child abuse with migraines. In a large survey of young adults, nearly two-thirds who suffer from migraines said they experienced emotional abuse as children.

"Emotional abuse showed the strongest link to increased risk of migraine," said Gretchen Tietjen, MD, University of Toledo. “Childhood abuse can have long-lasting effects on health and well-being."

In the study, nearly 14,500 people aged 24 to 32 were asked the question: "How often did a parent or other adult caregiver say things that really hurt your feelings or made you feel like you were not wanted or loved?"

Of those diagnosed with migraines, 61% said they had been abused as a child. Of those who never had a migraine, 49% said they were abused.

The participants were then asked whether they had experienced emotional, physical or sexual abuse as children. Physical abuse was defined as being hit with a fist, kicked, or thrown down on the floor, into a wall, or down stairs. Sexual abuse included forced sexual touching or sexual relations.

Nearly half of the participants answered yes to emotional abuse, 18% said they were physically abused, and 5% sexually abused.

Those who were emotionally abused were 52% more likely to have migraine than those who were not abused. But those who were sexually or physically abused were not significantly more likely to have migraine.

“Multiple studies have shown a strong link between childhood trauma and subsequent risk for developing chronic pain in adulthood, for instance, fibromyalgia. This study appears to be showing a similar association in migraine,” said Beth Darnall, PhD, Clinical Associate Professor at Stanford University and co-chair of the Pain Psychology Task Force at the American Academy of Pain Medicine. 

“The collective findings suggest that childhood emotional trauma has a lasting impact on emotional and sensory experience throughout life, and underscore trauma as an important therapeutic target to reduce chronic pain and its impact, and to possibly prevent chronic pain.”

A similar study published last year found that children who witnessed domestic violence between their parents were significantly more likely to experience migraine headaches as adults.

Researchers at the University of Toronto surveyed over 12,000 women and 10,000 men who participated in the 2012 Canadian Community Health Survey-Mental Health. Participants were asked if they experienced physical abuse, sexual abuse or if they witnessed parental domestic violence as children.

"We found the more types of violence the individual had been exposed to during their childhood, the greater the odds of migraine. For those who reported all three types of adversities -- parental domestic violence, childhood physical and sexual abuse -- the odds of migraine were a little over three times higher for men and just under three times higher for women" said Sarah Brennenstuhl, PhD, first author of the study.

Previous research has also shown the risk of depression and suicide ideation is about twice as high for migraine sufferers. People with migraine under the age of 30 have six times the odds of depression compared to migraineurs aged 65 and over.

Migraine is thought to affect a billion people worldwide and 36 million adults in the United States, according to the American Migraine Foundation. It affects three times as many women as men. In addition to headache pain and nausea, migraine can also cause vomiting, blurriness or visual disturbances, and sensitivity to light and sound.

A Pained Life: Does Child Abuse Cause Chronic Pain?

By Carol Levy, Columnist

The idea of childhood trauma or abuse leading to chronic pain in adulthood has always bothered me.

The idea that trauma/abuse can change the neural system sounds intriguing, but has yet to be proven. The studies I have seen do not prove a connection, only a link.

I was abused as a child.  I have almost no memory of my childhood, but I fit the profile. Two siblings also circumstantially validated it.

My trigeminal neuralgia is a symptom of a neurovascular birth defect that I was unaware of until the pain was diagnosed. My pain started as typical trigeminal neuralgia; out of the blue a horrendous, excruciating, world bending pain. It lasted only a few seconds then disappeared.

I have a birthmark in the exact area of the pain which anatomically corresponds to the pained area and trigeminal nerve distribution in the face. It's presence, as well as the fact that it is 'vascularized' (can change color), is a sign of the birth defect.

Growing up my sister would sometimes say, “You're upset.” I’d deny it and she'd smile knowingly, “Yes you are. Your birthmark's out.”

I am lucky in that this birth defect often comes with other terrible consequences; paralysis, blindness, intellectual deficit, and psychiatric disorders. That may be the only time the words “luck” and “trigeminal neuralgia” have gone hand in hand. I could have had some or all of those awful things. Instead it was only trigeminal neuralgia.

My signs and symptoms of abuse are many, among them that I do not like to be touched unexpectedly. I often flinch when it happens. Trigeminal neuralgia can be triggered when something touches the pained area, even something as benign as the slight wisp of a strand of hair.

Circumstantially, one could put those two together; I don't like to be touched and I developed disorder that makes touch horrendously painful.

The negative to that is twofold. I did not know I had the defect, and trigeminal neuralgia in my case has very specific neurosurgical attributes. Although the cause has been theorized, no one is completely sure of what causes trigeminal neuralgiait. In my case though, there is no doubt: dozens and dozens of tiny vessels throughout the affected side of my brain.

I moved to New York City six months before the pain started. I shared a two- room apartment with someone I knew slightly. We never developed chemistry and one day I came home to find a note on the table saying, “I'm going back to Washington.”

I now had the unexpected responsibility of full rent, which I could barely afford. To top it off, I had just been fired. I hated my job but was not aware my employer also knew it until 3 days before Christmas, when he said, without preamble, “You're fired.”

Not surprisingly, I became very depressed. Now, did the depression change my neurochemistry so that the birth defect suddenly became active? I can see that as a possibility. Is there a way to prove it? None of which I am aware.

I think it is too easy to make a connection between two disconnected things, like chronic pain and childhood trauma/abuse, and turn it into an explanation.

Many articles and studies conclude that there is a high prevalence of childhood abuse among those with chronic pain. Often the studies rely on self-reporting, so there is also a question of reliability and constancy as to what constitutes abuse. Too often the authors go on to postulate that there is a connection.

But the presence of one does not mean it causes the other.

Without true studies, such as MRI imaging or other forms of measurement, to compare and contrast the brains of those with chronic pain and childhood abuse histories to those who have chronic pain but suffered no abuse -- we are left with a theory in search of a proof.

Carol Jay Levy has lived with trigeminal neuralgia, a chronic facial pain disorder, for over 30 years. She is the author of “A Pained Life, A Chronic Pain Journey.”  Carol is the moderator of the Facebook support group “Women in Pain Awareness.” Her blog “The Pained Life” can be found here.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Childhood Trauma Linked to Adult Migraine

By Pat Anson, Editor

Children who witness domestic violence between their parents are significantly more likely to experience migraine headaches as adults, according to a large new study published in the journal Headache.

Researchers at the University of Toronto examined a nationally representative sample of over 12,000 women and 10,000 men who participated in the 2012 Canadian Community Health Survey-Mental Health. About 6.5% of the men and 14.2% of the women experienced migraine, which is consistent with prior research.

Participants were asked if they had experienced three types of childhood trauma: physical abuse, sexual abuse or if they witnessed parental domestic violence.

"We found the more types of violence the individual had been exposed to during their childhood, the greater the odds of migraine. For those who reported all three types of adversities -- parental domestic violence, childhood physical and sexual abuse -- the odds of migraine were a little over three times higher for men and just under three times higher for women" said Sarah Brennenstuhl, PhD, first author of the study.

Researchers said the most surprising finding was the link between migraines and parental domestic violence. Even after accounting for variables such as age, race, and socioeconomic status, men and women who had witnessed parental domestic violence had 52% and 64% higher odds of migraine compared to those who did not see their parents fighting.

"The cross-sectional design of our study does not allow us to determine if the association between early adversities and migraines is causative, but our findings do underline the importance of future prospective studies investigating the long-term physical health of children exposed to parental domestic violence,” said co-author Esme Fuller-Thomson, professor and Sandra Rotman Endowed Chair at University of Toronto's Factor-Inwentash Faculty of Social Work.

Previous research by Fuller-Thomson has found that depression and thoughts of suicide are more likely among individuals with migraine.

The risk of depression and suicide ideation is about twice as high for those who experience migraine. Individuals with migraine who are under the age of 30 had six times the odds of depression compared to migraineurs aged 65 and over.

Migraine is thought to affect a billion people and about 36 million adults in the United States, according to the American Migraine Foundation. It affects three times as many women as men. In addition to headache pain and nausea, migraine can also cause vomiting, blurriness or visual disturbances, and sensitivity to light and sound. About half of people living with migraine are undiagnosed.

The month of June is Migraine Awareness Month.