Prevalence and impact of childhood adversities and post‐traumatic stress disorder in women with fibromyalgia and chronic widespread pain

Abstract

Objective: This study investigates the prevalence of different types of childhood adversities (CA) and posttraumatic stress disorder (PTSD) in female patients with Fibromyalgia or Chronic Widespread Pain (FM/ CWP) compared to patients with Functional Dyspepsia (FD) and achalasia. In FM/CWP, we also investigated the association between CA and PTSD on the one hand and pain severity on the other. Methods: Patient samples consisted of 154 female FM/CWP, 83 female FD and 53 female achalasia patients consecutively recruited from a tertiary care hospital. Well-validated self-report questionnaires were used to investigate CA and PTSD. Results: Forty-nine per cent of FM/CWP patients reported at least 1 type of CA, compared to 39.7% of FD patients and 23.4% of achalasia patients (p < 0.01). The prevalence of CA did not differ significantly between FM/CWP and FD, but both groups had a higher prevalence of CA compared to both achalasia and healthy controls (p < 0.01). FM/ CWP patients were six times more likely to report PTSD than both FD (p < 0.001) and achalasia (p < 0.001) patients. Conclusion: In FM/CWP, PTSD comorbidity, but not CA, was associated with self-reported pain severity and PTSD severity mediated the relationship between CA and pain severity. In summary, the prevalence of CA is higher in FM/CWP compared to achalasia, but similar to FD. However, PTSD is more prevalent in FM/CWP compared to FD and associated with higher pain intensity in FM/CWP. Significance: As expected and has been shown in other functional disorders, we found elevated levels of childhood adversity in FM/CWP patients. Results of this study however suggest that the impact of childhood adversity (i.e. whether such events have led to the development of PTSD symptoms), rather than the mere presence of such adversity, is of crucial importance in FM/CWP patients. Screening for PTSD symptoms should be an essential part of the assessment process in patients suffering from FM/CWP, and both prevention and intervention

Evaluation of Candidate Items for Severe PTSD Screening for Patients With Chronic Pain: Pilot Data Analysis With the IRT Approach

“…Additionally, theta scores were positively associated with PROMIS‐Depression T scores ( r = 0.43, P = 0.001), as well as Pain interference, Pain behaviors, Fatigue, Sleep disturbance, Sleep impairment, and Social isolation T scores ( r s = 0.38 to −0.51, P s < 0.01). These results demonstrate that more severe PTSD was associated with greater pain, severe depressive symptoms, worse physical health status, and greater pain‐related interference, as expected from other study findings …”

“…The current study found that higher PTSD symptom severity (theta) was associated with poorer health status across multiple domains, specifically in sleep ( r s = 0.38 and 0.51), social ( r s = −0.45, −0.44, and 0.51), depression ( r = 0.43), and fatigue or other health issues ( r s = 0.33 to −0.41), which are consistent with previous findings . Additionally, theta scores were positively associated with ratings for worst pain.…”

“…These results demonstrate that more severe PTSD was associated with greater pain, severe depressive symptoms, worse physical health status, and greater pain-related interference, as expected from other study findings. [12][13][14][15]…”

“…The overlap between PTSD and chronic pain is not fully accounted for by traumatic etiology of chronic pain . Greater PTSD symptoms are associated with greater pain severity, emotional distress, and disability . Therefore, it is recommended that trauma history and PTSD symptoms be routinely assessed among patients with chronic pain .…”

“…1,10,11 Greater PTSD symptoms are associated with greater pain severity, emotional distress, and disability. [12][13][14][15] Therefore, it is recommended that trauma history and PTSD symptoms be routinely assessed among patients with chronic pain. 9 However, patients are increasingly burdened with completing forms and surveys, so efficient assessment tools are needed.…”