Do MD/SH explain the link between child trauma and adult chronic pain?
Research type
Research Study
Full title
To what extent do mental defeat (MD) and somatic hypervigilance (SH) mediate the relationship between childhood maltreatment and chronic pain symptomology in adults with fibromyalgia?
IRAS ID
321725
Contact name
Rosie Powell Davies
Contact email
Sponsor organisation
Oxford Health NHS Foundation Trust
Duration of Study in the UK
0 years, 8 months, 19 days
Research summary
Research Summary
People who experienced abuse or neglect in their childhood are more likely to live with widespread long-term pain as adults. They are also more likely to report more intense pain and feel more pain-related distress. It is not yet known why this is.
We know that the experience of childhood abuse or neglect can influence the way an adult thinks. Research has also shown that certain thinking patterns are more common among people living with long-term pain. This study will investigate whether two thinking patterns – ‘mental defeat’ and ‘somatic hypervigilance’ – can help to explain the relationship between child abuse or neglect and widespread long-term pain in adults. If we understand more about what can make long-term pain worse, it might enable the development of better treatments.
‘Mental defeat’ is the name of a thinking patten through which a person views themselves as less of a human being and feels they have little control over their life. The term ‘somatic hypervigilance’ describes a thinking style whereby a person pays very close attention to their bodily sensations.
This study will recruit adults who have a diagnosis of fibromyalgia from anywhere in the UK. They do not need to have ever used NHS pain services or to have experienced any childhood abuse or neglect.
Each person will be asked to fill in a set of questionnaires online, which would take up to one hour to complete. The surveys will gather information on:
- the person’s experience of long-term pain (including how intense and distressing the pain is).
- Any experiences of abuse or neglect that the person might have experienced in childhood.
- Whether the person has a tendency to thinking using either of the styles or patterns being studied here (mental defeat or somatic hypervigilance).Summary of Results
Fibromyalgia is a syndrome as part of which people can experience chronic (long-term) pain. People who experienced abuse or neglect in their childhood are more likely to live with fibromyalgia and chronic pain as adults. They are also more likely to describe their chronic pain as being more intense and feel more distressed by it. Some researchers have suggested that this is because the experience of childhood abuse or neglect can influence the way a person thinks and responds to threat. Certain thinking patterns are more common among people living with chronic pain, including ‘mental defeat’ (when a person does not view themselves as a human being who can cope with threat) and ‘somatic hypervigilance’ (when a person pays extra attention to the sensations in their body which feel threatening). This study wanted to find out whether either of these thinking patterns play a role in the relationship between child abuse or neglect and chronic pain.
What did we do?
We asked adults with a diagnosis of fibromyalgia to fill in a survey online, which included questions to find out:
- if they had experienced different types of child abuse and neglect;
- how defeated they felt by their pain;
- how much they paid attention to sensations of pain;
- how intense they would describe their pain, how distressed they felt by their pain, and how much their pain stopped them from doing activities.What did we find?
We found that ‘mental defeat’ did play a role in the relationship between childhood abuse or neglect and adult chronic pain severity. More specifically, ‘mental defeat’ was a significant mediator, meaning that it formed an indirect pathway which helped to explain the link between the two. However, ‘somatic hypervigilance’ was not a mediator, meaning it did not help to explain the relationship between child abuse or neglect and adult chronic pain severity.What does this mean?
Now that we have learned that mental defeat plays a role in the relationship between child abuse or neglect and adult chronic pain, we can recommend treatment approaches for therapists in chronic pain services who are working with adults with histories of child abuse or neglect. It could be useful, for example, for therapists to explore with people whether ‘mental defeat’ was a strategy they developed in childhood which helped them to survive abusive or neglectful environments, and whether this strategy is still beneficial in the context of chronic pain. Therapists could also help people to identify current thoughts and beliefs relating to ‘mental defeat’, and to develop confidence in their abilities to cope with chronic pain.We want to see researchers in future develop these findings by testing whether ‘mental defeat’ has a particularly strong effect on the relationships between child abuse or neglect and different parts of the pain experience (such as pain intensity, pain-related distress, and pain-related disability). They should also explore whether different types of child abuse or neglect have different influences on thinking styles which can make the experience of chronic pain worse.
REC name
Wales REC 1
REC reference
23/WA/0316
Date of REC Opinion
11 Dec 2023
REC opinion
Further Information Favourable Opinion