Two recent studies have determined the detrimental impact child abuse has on adult disease susceptibility and development, particularly those with pain.
The first study sought to determine if “alleged” childhood abuse causes any changes in the release of daily cortisol, as major stress hormone in women experiencing chronic pain, either fibromyalgia or osteoarthritis.
Women with fibromyalgia or with osteoarthritis only (completed diaries and collected three saliva samples daily for 30 days, with compliance monitored electronically. Childhood abuse and neglect were assessed by self-report using the Childhood Trauma Questionnaire-short form. Analysis determined an association between abuse and cortisol levels, that were confirmed beyond other significant factors including depression, posttraumatic stress disorder (PTSD), and daily experience variables.
The results determined that the women who’d experienced the most severe child abuse had higher cortisol levels throughout the entire day.
Although different forms of maltreatment were interrelated, emotional and sexual abuse were most closely linked to cortisol levels. Fibromyalgia and osteoarthritis groups showed similar patterns of hormone release, and maltreatment was associated with elevated cortisol in both. Although maltreatment was also linked to depression and Post Traumatic Stress Disorder, these factors had no impact on the link between abuse and cortisol.
In women with chronic pain, self-reported childhood maltreatment was associated with higher diurnal cortisol levels. These results add to the evidence that abuse in childhood can induce long-term changes in brain, in particular, hypothalamic-pituitary-adrenocortical activity (an area linked with our response to stress). They also acknowledge the importance of evaluating childhood abuse history in fibromyalgia and other chronic pain conditions.
The second study sought to determine a link between migraine headaches and childhood abuse. To evaluate in a headache clinic population the relationship of childhood maltreatment on the prevalence of pain conditions comorbid with migraine. BACKGROUND: Childhood maltreatment is highly prevalent and has been frequently associated with recurrent headache. The relationship of maltreatment and pain has, however, been a subject of some debate.
Data was collected and reviewed from people with migraine, seeking treatment in headache clinics at 11 centers located in Canada and the United States. These included irritable bowel syndrome (IBS), chronic fatigue syndrome (CFS), fibromyalgia (FM), interstitial cystitis (IC), arthritis, endometriosis, and uterine fibroids. Other information included demographics, migraine characteristics (frequency, headache-related disability), remote and current depression, and remote and current anxiety. Patients also completed the a Childhood Trauma Questionnaire regarding sexual, emotional, and physical abuse, and emotional and physical neglect under the age of 18 years old.
Over 1300 people with migraine headaches, 88% women, 12% men were included in this study, with an average of 41 years. Based on physician diagnosis or validated criteria, 31% had IBS, 16% had CFS, and 10% had FM. Diagnosis of IC was reported by 6.5%, arthritis by 25%, and in women, endometriosis was reported by 15% and uterine fibroids by 14%.
At least one pain condition was reported by 61%, 2 conditions by 18%, and 3 or more by 13%. Childhood abuse was acknowledged by 58% of the patients.
Emotional abuse was associated with increased prevalence of IBS, CFS, arthritis, and physical neglect with arthritis. In women, physical abuse was associated with endometriosis and physical neglect with uterine fibroids.
Emotional abuse, and physical abuse and neglect were also associated with increased total number of other conditions. Adjustments for sociodemographics and current depression that was present in 28% of the participants, and anxiety in 56%, determined emotional abuse and physical neglect were independently associated with an increased number of pain conditions. A comparison group of women, similarly, also had associations of emotional abuse and physical neglect with an increased incidence of pain.
The researchers determined that the relationship between childhood abuse and pain was significantly greater in those reporting multiple pain conditions and multiple maltreatment types. This finding suggests that in people experiencing migraine headaches, childhood abuse may be a risk factor for development of pain disorders.
Headache. 2010 Jan;50(1):42-51. Epub 2009 Oct 21.