Posttraumatic Stress Symptoms Mediate the Effects of Trauma Exposure on Clinical Indicators of Central Sensitization in Patients With Chronic Pain
Open accessAbstract
Objective: Evidence supports high rates of co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain disorders involving central sensitization (CS). The nature of this relationship, however, remains relatively unexplored. In this study, we aimed to (1) assess how both trauma exposure and current PTSD symptoms are related to clinical manifestations of CS, and (2) test whether PTSD symptoms explain the relationship between trauma exposure and CS. Because experiential avoidance has been shown to impact the relationship between trauma and health outcomes, we (3) explored experiential avoidance as a possible mediator or moderator of the trauma-CS relationship. Methods: A sample of 202 adult patients (79% female) with chronic pain completed validated self-report measures of trauma exposure, current PTSD symptoms, experiential avoidance, and 3 manifestations of CS: widespread pain, greater pain severity, and polysomatic symptom reporting. We used path analysis and multivariate regression to assess our study aims. Results: Both trauma exposure and PTSD symptoms were significantly associated with all 3 clinical indicators of CS. PTSD symptoms partially explained the relationship between trauma exposure and widespread pain, pain intensity, and polysomatic symptoms. Experiential avoidance did not mediate or moderate the trauma-CS relationship. Conclusions: Our findings suggest that trauma exposure is linked to elevated clinical markers of CS but a critical factor in this relationship is the mediating effect of current PTSD symptoms.
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The centralized pain phenotype in BPS/IC is associated with increased emotional distress, psychiatric comorbidity, catastrophizing and poorer quality of life.
“There is building evidence of the association with this phenotype with increased emotional distress, psychiatric comorbidity, catastrophizing and poorer QoL [32, 33, 35].”
From Cognition, Emotion, and the Bladder: Psychosocial Factors in Bladder Pain Syndrome and Interstitial Cystitis (BPS/IC) (2020) · cites this paper as [32]
The Results report an association between PTSD symptoms and clinical indicators of central sensitization, supporting the psychiatric-symptom aspect of the claim in a mixed chronic-pain sample. The Results list BPS/IC among participants’ diagnoses but do not analyze that subgroup separately. Catastrophizing was not an outcome, and the Discussion’s mention of quality of life is a proposed treatment implication, not a measured association (page numbers unavailable). (LLM, conf=0.86)
Experimental — accuracy not yet measuredA 'centralized pain' phenotype in BPS/IC is characterised by widespread pain and high somatic symptom comorbidity.
“A ‘centralized pain’ phenotype in BPS/IC is characterised by widespread pain and high somatic symptom comorbidity [32, 33, 34].”
From Cognition, Emotion, and the Bladder: Psychosocial Factors in Bladder Pain Syndrome and Interstitial Cystitis (BPS/IC) (2020) · cites this paper as [32]
The Introduction and Methods (page not provided) describe widespread pain and polysomatic complaints as indicators of central sensitization in chronic pain. The Results list interstitial cystitis/bladder pain syndrome among participants’ diagnoses, but do not establish this phenotype specifically in BPS/IC patients. (LLM, conf=0.86)
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References 70 · Cited by 77
Research works printed but not linked: 4
- [45]Merskey H, Bogduk N. Classification of chronic pain. 2nd edition ed Seattle, WA: IASP Press; 1994.
- [46]Green BL. Psychometric review of Trauma History Questionnaire (Self-Report). Lutherville, MD: Sidran Press; 1996.
- [51]Brummett CM, Hassett AL, Brummett KA, Clauw DJ, Williams DA. The Michigan Body Map and its use in assessing the American College of Rheumatology survey criteria for Fibromyalgia. Arthritis & Rheumatism. 2011; 62: 744.
- [69]Foa EB, Hembree E, Rothbaum B. Prolonged exposure therapy for PTSD. New York: Oxford University Press; 2007.
- Authors
- McKernan, L. C., Johnson, B. N., Crofford, L. J., Lumley, M. A., Bruehl, S., & Cheavens, J. S.
- Affiliations
- Psychiatry and Behavioral Sciences
- Pennsylvania State University (US)
- Medicine
- Wayne State University (US)
- Vanderbilt University Medical Center (US)
- The Ohio State University (US)
- Corresponding author
- McKernan, Lindsey C.
- ORCID
- Venue
- The Clinical Journal of Pain
- Published
- 2019-05
- Volume
- 35
- Issue
- 5
- Pages
- 385-393
- ISSN
- 0749-8047 (ISSN-L)
- PMC
- PMC6450707
- OpenAlex
- W2913342148
- Cited by
- 77
- References
- 70
- Citations by year
- 2026: 9 · 2025: 13 · 2024: 12 · 2023: 10 · 2022: 11 · 2021: 11 · 2020: 9 · 2019: 1
- FWCI
- 9.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR002243)
- Agency for Healthcare Research and Quality (K12HS022990)
- National Institute on Drug Abuse (R01DA037891)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Keywords
- post-traumatic stress disorder, posttraumatic stress symptoms, trauma exposure, central sensitization, chronic pain, experiential avoidance, widespread pain, pain intensity, mediation
- MeSH terms
- Adult, Female, Humans, Male, Middle Aged, Surveys and Questionnaires, Stress Disorders, Post-Traumatic, Self Report, Central Nervous System Sensitization, Chronic Pain
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