美国军人的慢性疼痛与童年逆境经历。

Department of Family Medicine, Womack Army Medical Center, Fort Liberty, NC 28310, USA.

Department of Family Medicine, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA.

Mil Med. 2023 Nov 8;188(Suppl 6):561-566. doi: 10.1093/milmed/usad244.

INTRODUCTION

Chronic pain in a military population is prevalent, is costly, and can limit daily activities and affect soldier readiness. It has been associated with childhood adversity (CA) within the veteran, adult, and pediatric populations. Given the need to maximize soldier resiliency, an examination of the link between CA and chronic pain in an active duty population for a better understanding that informs treatment options is warranted.

MATERIALS AND METHODS

The analytic sample comprised 32 men and 8 women drawn from a retrospective review of 203 intake assessments at an interdisciplinary pain management center. We identified a group (CA) of 20 patients who reported a history of pre-adolescent sexual abuse or living in an "abusive" childhood home and compared it with a control group (no-CA) of 20 patients, matched for age, gender, pain history duration, and pain problem. Validated measures were used to assess pain intensity, interference in functioning and well-being, emotional sequelae of pain as reflected in symptoms of depression and anxiety, and pain-related catastrophic thinking. Data were analyzed using descriptive statistics and independent samples t-test analyses.

RESULTS

Differences in current, worst, and average pain ratings were non-significant between groups. The CA group reported significantly greater effect of pain on mood (mean: 6.20 versus 4.25, P < .02) and showed a trend toward higher pain interference in functioning (mean: 17.70 versus 15.05, P = .053). The CA patients had significantly more serious depression (mean: 12.65 versus 4.50, P < .001) and anxiety symptoms (mean: 10.60 versus 2.35, P < .001) and significantly higher pain catastrophizing tendency (mean: 30.05 versus 20.50, P < .03).

CONCLUSIONS

Overall, the findings suggest that childhood trauma should be considered by providers when treating depression and anxiety in soldiers with chronic pain. Being mindful of trauma-informed care may have implications, perhaps, for cases perceived as treatment resistant.

简介

在军人中，慢性疼痛很常见，代价高昂，会限制日常活动并影响士兵的战备状态。在退伍军人、成人和儿科人群中，它与童年逆境（CA）有关。鉴于需要最大限度地提高士兵的适应力，因此有必要在现役人群中检查 CA 与慢性疼痛之间的联系，以便更好地了解情况并为治疗方案提供信息。

材料和方法

分析样本由 32 名男性和 8 名女性组成，他们是从一个跨学科疼痛管理中心的 203 份入组评估中回顾性抽取的。我们确定了一组（CA）20 名患者，他们报告有青春期前性虐待或生活在“虐待”家庭的经历，并将其与 20 名年龄、性别、疼痛史持续时间和疼痛问题相匹配的对照组（无-CA）进行比较。使用经过验证的措施评估疼痛强度、对功能和幸福感的干扰、疼痛的情绪后果，如抑郁和焦虑症状、以及与疼痛相关的灾难性思维。使用描述性统计和独立样本 t 检验分析数据。

结果

两组患者当前、最严重和平均疼痛评分无显著差异。CA 组报告疼痛对情绪的影响明显更大（均值：6.20 与 4.25，P<.02），且在功能障碍方面的疼痛干扰呈趋势更高（均值：17.70 与 15.05，P=.053）。CA 患者的抑郁症状（均值：12.65 与 4.50，P<.001）和焦虑症状（均值：10.60 与 2.35，P<.001）更严重，疼痛灾难化倾向也更高（均值：30.05 与 20.50，P<.03）。