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Depression Partially Mediates the Association of Adverse Childhood Experiences with Pain Intensity in Patients with Chronic Pelvic Pain Syndrome: Results from a Cross-Sectional Patient Survey.

Authors
  • Piontek, Katharina1
  • Apfelbacher, Christian1
  • Ketels, Gesche2
  • Brünahl, Christian3
  • Löwe, Bernd3
  • 1 Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto von Guericke University Magdeburg, Magdeburg, Germany. , (Germany)
  • 2 Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. , (Germany)
  • 3 Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. , (Germany)
Type
Published Article
Journal
Pain medicine (Malden, Mass.)
Publication Date
May 21, 2021
Volume
22
Issue
5
Pages
1174–1184
Identifiers
DOI: 10.1093/pm/pnaa325
PMID: 33155025
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Adverse childhood experiences (ACEs), such as emotional and physical maltreatment, are linked to chronic pelvic pain syndrome (CPPS) in adults. Psychological factors are important in understanding CPPS. We aimed to determine the nature and frequency of ACEs in male and female patients with CPPS and to investigate whether somatic symptoms and psychological comorbidities mediate the relationship of ACE severity with pain intensity. Cross-sectional study. Interdisciplinary outpatient clinic for CPPS in Hamburg, Germany. Individuals with CPPS (n = 234) who were 18 to 84 years of age. Using a self-administered questionnaire, we assessed the history of ACEs (ACE Scale), pain intensity (McGill Pain Questionnaire), somatic symptoms (Patient Health Questionnaire-15]), depression (Patient Health Questionnaire-9), and anxiety (Generalized Anxiety Disorder Scale). Parallel mediation analysis was conducted to examine whether the association of ACE severity with pain intensity is mediated by somatic symptoms, depression, and anxiety. Emotional abuse and neglect were reported more than twice as often as physical abuse and neglect (37.2% vs 17.1%). Depression partially mediated the association of ACE severity with pain intensity in the whole study population. In sex-stratified analyses, different patterns of associations were observed, but somatic symptoms predicted pain intensity in both sexes. Emotional maltreatment was highly prevalent, supporting an increased consideration of psychological factors in CPPS and indicating the need to screen for ACEs in patients with CPPS. Findings further suggest that depression and somatic symptoms may be important targets for therapeutic interventions in patients with CPPS who have a history of childhood adversity. © The Author(s) 2020. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: [email protected]

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