Childhood Trauma and Posttraumatic Stress in Pediatric Amplified Musculoskeletal Pain Syndromes
Authors:   , Hildenbrand Aimee K. , Daly Brian P. 
Published: July 2021

Background: Potentially traumatic events (PTEs) are unfortunately common experiences among children and adolescents. Approximately one quarter of US children are exposed to a PTE before the age of four, with rates increasing to 60% by 16 years of age (Briggs-Gowan, Ford, Fraleigh, McCarthy, & Carter, 2010; Copeland, Keeler, Angold, & Costello, 2007). Exposure to PTEs during childhood is associated with a wide range of negative emotional, behavioral, and physical health consequences over the life course (Anda et al., 2006; Felitti et al., 1998; Gilbert et al., 2009; Shonkoff et al., 2012). Emerging research suggests that childhood trauma may also increase susceptibility to the development of chronic pain in adolescence and adulthood (Boey & Goh, 2001; Davis, Luecken, & Zautra, 2005; Larsson & Sund, 2007; Liakopoulou-Kairis et al., 2002; Mulvaney, Lambert, Garber, & Walker, 2006). However, most investigations of the link between childhood trauma and chronic pain have focused on adults with history of maltreatment. As a result, the contribution of other PTEs to the development of chronic pain among children and adolescents is poorly understood. Additionally, prior research has largely emphasized the prevalence of comorbid chronic pain and posttraumatic stress disorder (PTSD) diagnoses, rather than closely examining the associations between specific posttraumatic stress symptoms (PTSS), pain severity, and functional impairment. As such, much remains unknown regarding the interplay between exposure to PTEs, PTSS, and chronic pain in youth. Aims: The current study aimed to investigate the relationships between quantity and timing of PTEs, pain severity, and pain-related functional impairment among children with amplified musculoskeletal pain syndromes (AMPS). Additionally, this investigation examined the relationships between indices of PTSD symptomatology (i.e., overall symptom severity and symptom clusters) and pain. Finally, this study explored whether potential associations between childhood trauma and pain outcomes were moderated by anxiety, depression, PTSS, and family functioning. Methods: This study employed a cross-sectional design. Participants included 76 children ages 8-17 years (M = 14.08, SD = 2.14) diagnosed with AMPS and their caregivers presenting to the CHOP Center for Amplified Musculoskeletal Pain Syndromes. Participants completed assessments of childhood trauma history, family functioning, and child anxiety, depression, and PTSS online within two weeks before or after their initial consultation appointment. Medical records were reviewed to obtain information about demographic characteristics, pain severity, and pain-related functional disability from measures administered as part of routine clinical care. Results: While total quantity of PTEs was not associated with pain, PTEs reported during the first five years of life significantly predicted pain-related disability. This relationship varied as a function of both child depression and perceptions of family functioning, such that children who endorsed higher current depression and family functioning exhibited the strongest relationship between early trauma and disability. Total PTSS severity and specific symptom clusters were not associated with pain outcomes and did not moderate the relationship between early childhood PTEs and pain-related disability. Conclusions: Early childhood may be a sensitive period for the effects of PTEs on risk for functional disability in youth with AMPS. Additional research utilizing prospective and longitudinal designs is needed to better understand the biopsychosocial mechanisms underlying the relationship between early childhood trauma and pediatric chronic pain.