Heightened Temporal Summation of Pain in Patients with Functional Gastrointestinal Disorders and History of Trauma
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ORIGINAL ARTICLE
Heightened Temporal Summation of Pain in Patients with Functional Gastrointestinal Disorders and History of Trauma Amanda L. Sherman, MS 1 & Matthew C. Morris, PhD 2 & Stephen Bruehl, PhD 3 & Travis D. Westbrook, BA 4 & Lynn S. Walker, PhD 5,6
# The Society of Behavioral Medicine 2015
Abstract Background Individuals with functional gastrointestinal disorders (FGIDs) report experiencing trauma more often than healthy controls, but little is known regarding psychophysical correlates. Purpose The purpose of this study was to test the hypothesis that adolescents and young adults with FGIDs since childhood and a trauma history (n=38) would exhibit heightened temporal summation to thermal pain stimuli, an index of central sensitization, and greater clinical symptoms compared to patients with FGIDs and no trauma history (n=95) and healthy controls (n=135). Methods Participants completed self-report measures, an experimental pain protocol, and psychiatric diagnostic interview as part of a larger longitudinal study. Results FGID+Trauma patients exhibited greater temporal summation than FGID +No Trauma patients and healthy
* Lynn S. Walker, PhD [email protected] 1
Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
2
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, USA
3
Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA
4
Department of Psychology, The Ohio State University, Columbus, OH, USA
5
Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
6
Division of Adolescent and Young Adult Health, Monroe Carell Jr. Children’s Hospital at Vanderbilt, 2146 Belcourt Ave., Nashville, TN 37212, USA
controls. Additionally, FGID +Trauma patients exhibited greater gastrointestinal and non-gastrointestinal symptom severity, number of chronic pain sites, and disability. Conclusions Assessing for trauma history in patients with FGIDs could identify a subset at risk for greater central sensitization and pain-related symptoms. Keywords Central sensitization . Functional abdominal pain . Chronic pain . Trauma . Temporal summation Individuals with functional gastrointestinal disorders (FGIDs) report having experienced a psychological trauma (e.g., sexual and/or physical abuse or assault) more often than patients with organic gastrointestinal diseases or healthy individuals [1–3]. A variety of psychosocial and biological mechanisms have been proposed to account for high rates of FGIDs in individuals exposed to interpersonal trauma. Traumatic events may increase risk for FGIDs by altering appraisals of bodily symptoms (e.g., catastrophizing), by enhancing reliance on maladaptive coping styles (e.g., avoidance), or by triggering the onset of psychiatric conditions known to impact pain sensitivity, such as posttraumatic stress disorder (PTSD) or major depressive disorder [4]. Individuals exposed to trauma also tend to exhibit heightened autonomic and hypothala
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