College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, Alabama.
Department of Anesthesiology, Washington University Pain Center, Washington University, St. Louis, Missouri.
J Pain. 2024 Sep;25(9):104551. doi: 10.1016/j.jpain.2024.104551. Epub 2024 Apr 29.
Chronic low back pain (cLBP) is characterized by biopsychosocial determinants that collectively result in a substantial burden at the individual, community, and health care system levels. A growing body of literature suggests that childhood adversity is longitudinally associated with the development and maintenance of various chronic pain conditions in adulthood. Little research has investigated the psychological processes that might underlie the association between adverse childhood experiences (ACEs) and cLBP. Emotion regulation comprises a substantive part of the subjective experience of pain and may be a potential mechanism through which ACEs contribute to cLBP etiology and maintenance. Thus, the current study examined the extent to which emotion dysregulation mediated the relationship between ACEs and pain severity (pain at rest and movement-evoked pain) in adults with cLBP. Participants included 183 adults (53.0% female, 62.5% non-Hispanic Black) between the ages of 18 and 85 with cLBP. Participants self-reported on ACEs, pain, difficulties in emotion regulation (DER), depression, and completed brief physical function tasks. In data analytic models, sociodemographic variables were included as covariates. Analyses revealed that emotion regulation mediated the relationship between ACEs and cLBP severity at rest (indirect effect = .15 [95% CI {.06-.25}]) and with movement (indirect effect = 1.50 [95% CI {.69-2.57}]). Findings suggest ACEs are linked to cLBP severity in adulthood through DER. This aligns with research demonstrating that childhood maltreatment can lead to DER, which perpetuate over the lifespan to impact adult health outcomes. PERSPECTIVE: This study presents emotion dysregulation as a psychological pathway through which childhood adversity may contribute to cLBP in adulthood. This work may bolster our understanding of social experiences as risk factors for chronic pain, while identifying targets for clinical intervention. TRIAL REGISTRATION: This study utilized baseline data collected as part of a parent trial titled "Examining Racial and SocioEconomic Disparities in Chronic Low Back Pain" (ClinicalTrials.gov ID: NCT03338192).
慢性下背痛（cLBP）的特征是生物心理社会决定因素，这些因素共同导致个人、社区和医疗保健系统层面的巨大负担。越来越多的文献表明，童年逆境与成年后各种慢性疼痛状况的发展和维持呈纵向相关。很少有研究调查可能潜在地解释童年逆境经历（ACEs）与 cLBP 之间关联的心理过程。情绪调节构成了疼痛主观体验的重要部分，并且可能是 ACEs 促进 cLBP 病因学和维持的潜在机制。因此，目前的研究调查了情绪调节在多大程度上调节了 ACEs 与 cLBP 患者疼痛严重程度（休息时疼痛和运动诱发疼痛）之间的关系。参与者包括 183 名年龄在 18 至 85 岁之间的 cLBP 成年人（53.0%为女性，62.5%为非西班牙裔黑人）。参与者报告了 ACEs、疼痛、情绪调节困难（DER）、抑郁，并完成了简短的身体功能任务。在数据分析模型中，将社会人口统计学变量作为协变量。分析显示，情绪调节调节了 ACEs 与休息时 cLBP 严重程度（间接效应 =.15 [95%CI {.06-.25}])和运动时的关系（间接效应=1.50 [95%CI {.69-2.57}])。研究结果表明，ACEs 通过 DER 与成年人的 cLBP 严重程度相关。这与研究结果一致，该研究表明，儿童期虐待会导致 DER，这种情况会持续一生，从而影响成年后的健康结果。观点：本研究提出情绪失调是童年逆境可能导致成年人慢性下背痛的心理途径。这项工作可以增进我们对社会经历作为慢性疼痛风险因素的理解，同时确定临床干预的目标。试验注册：本研究利用了作为一项名为“慢性下背痛的种族和社会经济差异研究”（ClinicalTrials.gov ID：NCT03338192）的母试验的一部分收集的基线数据。
