Skip to main content

Is childhood abuse a risk factor for chronic pain in adulthood?

Current Pain and Headache Reports volume 8, pages 99–110 (2004)Cite this article

Abstract

Childhood sexual and physical abuse often are viewed as important factors in the development and persistence of chronic pain syndromes in adulthood. Nevertheless, earlier reviews on this issue have reached conflicting conclusions regarding the veracity of the relationship. In this critical review of existing research on childhood abuse and pain in adulthood, surprisingly mixed evidence is found, with significant effects found most consistently in very large crosssectional studies that rely on self-reported abuse status. The few prospective studies that are available do not support the relationship. When examining the literature from the perspective of epidemiological standards for inferring causation, the authors conclude that the evidence does not demonstrate a causal relationship. It appears that any overall relationship between childhood abuse and pain in adulthood probably is modest in magnitude, if it exists at all. Clinical implications and suggestions for future research directions are discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References and Recommended Reading

  1. Engel GL: “Psychogenic” pain and the pain-prone patient. Am J Med 1959, 26:899–918.

    PubMed  Article  CAS  Google Scholar 

  2. Adler RH, Zlot S, Hurny C, Minder C: Engel’s “Psychogenic Pain and the Pain-Prone Patient:” a retrospective, controlled clinical study. Psychosom Med 1989, 51:87–101.

    PubMed  CAS  Google Scholar 

  3. Grzesiak RC: “Psychogenic pain” and pain-proneness: comments on “Childhood victimization and pain in adulthood” Raphael KG et al. Pain 2001, 92:283-293. Pain 2002, 98:231–233.

    PubMed  Article  Google Scholar 

  4. Turk DC, Okifuji A: Assessment of patients’ reporting of pain: an integrated perspective. Lancet 1999, 353:1784–1788.

    PubMed  Article  CAS  Google Scholar 

  5. Drossman DA: Presidential address: gastrointestinal illness and the biopsychosocial model. Psychosom Med 1998, 60:258–267.

    PubMed  CAS  Google Scholar 

  6. Turk DC, Okifuji A: Psychologicalal factors in chronic pain: evolution and revolution. J Consult Clin Psychol 2002, 70:678–690.

    PubMed  Article  Google Scholar 

  7. Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977, 196:129–136.

    PubMed  Article  CAS  Google Scholar 

  8. Drossman DA: Physical and sexual abuse and gastrointestinal illness: What is the link? Am J Med 1994, 97:105–107.

    PubMed  Article  CAS  Google Scholar 

  9. Drossman DA, Talley NJ, Leserman J, et al.: Sexual and physical abuse and gastrointestinal illness: review and recommendations. Ann Intern Med 1995, 123:782–794.

    PubMed  CAS  Google Scholar 

  10. Walker EA, Stenchever MA: Sexual victimization and chronic pelvic pain. Obstet Gynecol Clin North Am 1993, 20:795–807.

    PubMed  CAS  Google Scholar 

  11. Fry RP, Crisp AH, Beard RW: Sociopsychologicalal factors in chronic pelvic pain: a review. J Psychosom Res 1997, 42:1–15.

    PubMed  Article  CAS  Google Scholar 

  12. Fry R: Adult physical illness and childhood sexual abuse. J Psychosom Res 1993, 37:89–103.

    PubMed  Article  CAS  Google Scholar 

  13. Linton SJ: A review of psychologicalal risk factors in back and neck pain. Spine 2000, 25:1148–1156.

    PubMed  Article  CAS  Google Scholar 

  14. Springer KW, Sheridan J, Kuo D, Carnes M: The long-term health outcomes of childhood abuse: an overview and a call to action. J Gen Intern Med 2003, 18:864–870.

    PubMed  Article  Google Scholar 

  15. Penza KM, Heim C, Nemeroff CB: Neurobiologicalal effects of childhood abuse: implications for the pathophysiology of depression and anxiety. Arch Women Ment Health 2003, 6:15–22.

    Article  CAS  Google Scholar 

  16. Van Houdenhove B, Egle UT: Comment on Raphael KG, Widom CS, Lange G: Childhood victimization and pain in adulthood: a prospective investigation, Pain 2001, 92:283–293. Pain 2002, 96:215–216.

    Article  Google Scholar 

  17. Green CR, Flowe-Valencia H, Rosenblum L, Tait AR: The role of childhood and adulthood abuse among women presenting for chronic pain management. Clin J Pain 2001, 17:359–364.

    PubMed  Article  CAS  Google Scholar 

  18. Yunus MB: A comprehensive medical evaluation of patients with fibromyalgia syndrome. Rheum Dis Clin North Am 2002, 28:201–217, v–vi.

    PubMed  Article  Google Scholar 

  19. Ciccone DS, Elliot DK, Chandler HK, et al.: Sexual and physical abuse in women with fibromyalgia: a test of the trauma hypothesis. Clin J Pain, in press. Unique among case-control studies through its recruitment of community women rather than care-seeking women with a pain disorder and because of its control for depression.

  20. Drossman DA, Leserman J, Nachman G, et al.: Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med 1990, 113:828–833.

    PubMed  CAS  Google Scholar 

  21. Newman MG, Clayton L, Zuellig A, et al.: The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization. Psychol Med 2000, 30:1063–1077.

    PubMed  Article  CAS  Google Scholar 

  22. Arnow BA, Hart S, Scott C, et al.: Childhood sexual abuse, psychologicalal distress, and medical use among women. Psychosom Med 1999, 61:762–770.

    PubMed  CAS  Google Scholar 

  23. Galbaud du Fort G, Newman SC, Bland RC: Psychiatric comorbidity and treatment seeking: sources of selection bias in the study of clinical populations. J Nerv Ment Dis 1993, 181:467–474.

    PubMed  Article  CAS  Google Scholar 

  24. Finkelhor D: The international epidemiology of child sexual abuse. Child Abuse Negl 1994, 18:409–417.

    PubMed  Article  CAS  Google Scholar 

  25. Gavranidou M, Rosner R: The weaker sex? Gender and posttraumatic stress disorder. Depress Anxiety 2003, 17:130–139.

    PubMed  Article  Google Scholar 

  26. Rollman GB, Lautenbacher S: Sex differences in musculoskeletal pain. Clin J Pain 2001, 17:20–24.

    PubMed  Article  CAS  Google Scholar 

  27. Desai S, Arias I, Thompson MP, Basile KC: Childhood victimization and subsequent adult revictimization assessed in a nationally representative sample of women and men. Violence Vict 2002, 17:639–653.

    PubMed  Article  Google Scholar 

  28. Day SX, Schneider PL: Psychotherapy using distance technology: a comparison of face-to-face, video, and audio treatment. J Couns Psychol 2002, 49:499–503.

    Article  Google Scholar 

  29. Jumper SA: A meta-analysis of the relationship of child sexual abuse to adult psychologicalal adjustment. Child Abuse Negl 1995, 19:715–728.

    PubMed  Article  CAS  Google Scholar 

  30. Boisset-Pioro MH, Esdaile JM, Fitzcharles MA: Sexual and physical abuse in women with fibromyalgia syndrome. Arthritis Rheum 1995, 38:235–241.

    PubMed  Article  CAS  Google Scholar 

  31. Walker EA, Katon WJ, Keegan D, et al.: Predictors of physician frustration in the care of patients with rheumatological complaints. Gen Hosp Psychiatry 1997, 19:315–323.

    PubMed  Article  CAS  Google Scholar 

  32. Imbierowicz K, Egle UT: Childhood adversities in patients with fibromyalgia and somatoform pain disorder. Eur J Pain 2003, 7:113–119.

    PubMed  Article  Google Scholar 

  33. Ehlert U, Heim C, Hellhammer DH: Chronic pelvic pain as a somatoform disorder. Psychother Psychosom 1999, 68:87–94.

    PubMed  Article  CAS  Google Scholar 

  34. Lampe A, Doering S, Rumpold G, et al.: Chronic pain syndromes and their relation to childhood abuse and stressful life events. J Psychosom Res 2003, 54:361–367.

    PubMed  Article  Google Scholar 

  35. Rapkin AJ, Kames LD, Darke LL, et al.: History of physical and sexual abuse in women with chronic pelvic pain. Obstet Gynecol 1990, 76:92–96.

    PubMed  CAS  Google Scholar 

  36. Walker EA, Gelfand AN, Gelfand MD, et al.: Chronic pelvic pain and gynecological symptoms in women with irritable bowel syndrome. J Psychosom Obstet Gynecol 1996, 17:39–46.

    CAS  Google Scholar 

  37. Walker E, Katon W, Harrop-Griffiths J, et al.: Relationship of chronic pelvic pain to psychiatric diagnoses and childhood sexual abuse. Am J Psychiatry 1988, 145:75–80.

    PubMed  CAS  Google Scholar 

  38. Walling MK, Reiter RC, O’Hara MW, et al.: Abuse history and chronic pain in women. I: prevalences of sexual abuse and physical abuse. Obstet Gynecol 1994, 84:193–199.

    PubMed  CAS  Google Scholar 

  39. Ciccone DS, Bandilla EB, Wu W: Psychologicalal dysfunction in patients with reflex sympathetic dystrophy. Pain 1997, 71:323–333.

    PubMed  Article  CAS  Google Scholar 

  40. Nickel R, Egle UT, Hardt J: Are childhood adversities relevant in patients with chronic low back pain? Obstet Gynecol 2002, 6:221–228.

    CAS  Google Scholar 

  41. Goldberg RT, Goldstein R: A comparison of chronic pain patients and controls on traumatic events in childhood. Disabil Rehabil 2000, 22:756–763.

    PubMed  Article  CAS  Google Scholar 

  42. Lampe A, Solder E, Ennemoser A, et al.: Chronic pelvic pain and previous sexual abuse. Obstet Gynecol 2000, 96:929–933.

    PubMed  Article  CAS  Google Scholar 

  43. Marbach JJ, Schwartz S, Link BG: The control group conundrum in chronic pain case/control studies. Clin J Pain 1992, 8:39–43.

    PubMed  CAS  Article  Google Scholar 

  44. Walker EA, Keegan D, Gardner G, et al.: Psychosocial factors in fibromyalgia compared with rheumatoid arthritis. II: sexual, physical, and emotional abuse and neglect. Psychosom Med 1997, 59:572–577.

    PubMed  CAS  Google Scholar 

  45. Bodden-Heidrich R, Kuppers V, Beckmann MW, et al.: Chronic pelvic pain syndrome (CPPS) and chronic vulvar pain syndrome (CVPS): evaluation of psychosomatic aspects. J Psychosom Obstet Gynecol 1999, 20:145–151.

    CAS  Google Scholar 

  46. Walker EA, Keegan D, Gardner G, et al.: Psychosocial factors in fibromyalgia compared with rheumatoid arthritis. I: psychiatric diagnoses and functional disability. Psychosom Med 1997, 59:565–571.

    PubMed  CAS  Google Scholar 

  47. Finestone HM, Stenn P, Davies F, et al.: Chronic pain and health care utilization in women with a history of childhood sexual abuse. Child Abuse Negl 2000, 24:547–556.

    PubMed  Article  CAS  Google Scholar 

  48. Romans S, Belaise C, Martin J, et al.: Childhood abuse and later medical disorders in women: an epidemiologicalal study. Psychother Psychosom 2002, 71:141–150.

    PubMed  Article  Google Scholar 

  49. Bendixen M, Muus KM, Schei B: The impact of child sexual abuse: a study of a random sample of Norwegian students. Child Abuse Negl 1994, 18:837–847.

    PubMed  Article  CAS  Google Scholar 

  50. Linton SJ: A population-based study of the relationship between sexual abuse and back pain: establishing a link. Pain 1997, 73:47–53.

    PubMed  Article  CAS  Google Scholar 

  51. Jamieson DJ, Steege JF: The association of sexual abuse with pelvic pain complaints in a primary care population. Am J Obstet Gynecol 1997, 177:1408–1412.

    PubMed  Article  CAS  Google Scholar 

  52. Springs FE, Friedrich WN: Health risk behaviors and medical sequelae of childhood sexual abuse. Mayo Clin Proc 1992, 67:527–532.

    PubMed  CAS  Google Scholar 

  53. Goodwin RD, Hoven CW, Murison R, Hotopf M: Association between childhood physical abuse and gastrointestinal disorders and migraine in adulthood. Am J Public Health 2003, 93:1065–1067.

    PubMed  Article  Google Scholar 

  54. McBeth J, Macfarlane GJ, Benjamin S, et al.: The association between tender points, psychologicalal distress, and adverse childhood experiences: a community-based study. Arthritis Rheum 1999, 42:1397–1404.

    PubMed  Article  CAS  Google Scholar 

  55. McBeth J, Morris S, Benjamin S, et al.: Associations between adverse events in childhood and chronic widespread pain in adulthood: Are they explained by differential recall? J Rheumatol 2001, 28:2305–2309.

    PubMed  CAS  Google Scholar 

  56. McCauley J, Kern DE, Kolodner K, et al.: Clinical characteristics of women with a history of childhood abuse: unhealed wounds. JAMA 1997, 277:1362–1368.

    PubMed  Article  CAS  Google Scholar 

  57. Moeller TP, Bachmann GA, Moeller JR: The combined effects of physical, sexual, and emotional abuse during childhood: long-term health consequences for women. Child Abuse Negl 1993, 17:623–640.

    PubMed  Article  CAS  Google Scholar 

  58. Linton SJ: A prospective study of the effects of sexual or physical abuse on back pain. Pain 2002, 96:347–351. Notable as one of two prospective studies on childhood abuse and pain in adulthood, but somewhat limited by reliance on self-reported abuse and its sole focus on back pain.

    PubMed  Article  Google Scholar 

  59. Raphael KG, Widom CS, Lange G: Childhood victimization and pain in adulthood: a prospective investigation. Pain 2001, 92:283–293. The only prospective cohort study that relies on court-documented experience of childhood abuse when studying pain in adulthood.

    PubMed  Article  CAS  Google Scholar 

  60. Raphael KG, Widom CS, Lange G: Reply to Dr. Grzesiak: “Psychogenic pain” and “pain-proneness” (comments on Raphael et al. Childhood victimization and pain in adulthood. Pain 2001, 92:283-293). Pain 2002, 98:233–234.

    Article  Google Scholar 

  61. Raphael KG, Widom CS, Lange G: Response by Raphael et al. to letter from Van Houdenhove and Egle. Childhood victimization and pain in adulthood: a prospective investigation, Pain 2001, 92:283-293. Pain 2002, 96:216–217.

    Article  Google Scholar 

  62. Luntz BK, Widom CS: Antisocial personality disorder in abused and neglected children grown up. Am J Psychiatry 1994, 151:670–674.

    PubMed  CAS  Google Scholar 

  63. Perez CM, Widom CS: Childhood victimization and longterm intellectual and academic outcomes. Child Abuse Negl 1994, 18:617–633.

    PubMed  Article  CAS  Google Scholar 

  64. Widom CS: Post-traumatic stress disorder in abused and neglected children grown up. Am J Psychiatry 1999, 156:1223–1229.

    PubMed  CAS  Google Scholar 

  65. Widom CS, Ireland T, Glynn PJ: Alcohol abuse in abused and neglected children followed-up: Are they at increased risk? J Stud Alcohol 1995, 56:207–217.

    PubMed  CAS  Google Scholar 

  66. Susser M: Judgment and causal inference: criteria in epidemiological studies. Am J Epidemiol 1977, 105:1–15.

    PubMed  CAS  Google Scholar 

  67. Weed DL: On the use of causal criteria. Int J Epidemiol 1997, 26:1137–1141.

    PubMed  Article  CAS  Google Scholar 

  68. Susser M: What is a cause and how do we know one? A grammar for pragmatic epidemiology. Am J Epidemiol 1991, 133:635–648.

    PubMed  CAS  Google Scholar 

  69. Weed DL: Interpreting epidemiologicalal evidence: how meta-analysis and causal inference methods are related. Int J Epidemiol 2000, 29:387–390.

    PubMed  Article  CAS  Google Scholar 

  70. Fergusson DM, Horwood LJ, Woodward LJ: The stability of child abuse reports: a longitudinal study of the reporting behavior of young adults. Psychol Med 2000, 30:529–544.

    PubMed  Article  CAS  Google Scholar 

  71. Krinsley KE, Gallagher JG, Weathers FW, et al.: Consistency of retrospective reporting about exposure to traumatic events. J Trauma Stress 2003, 16:399–409.

    PubMed  Article  Google Scholar 

  72. Widom CS, Morris S: Accuracy of adult recollections of childhood victimization, Part 2: childhood sexual abuse. Psychol Assess 1997, 9:34–46.

    Article  Google Scholar 

  73. Widom CS, Shepard RL: Accuracy of adult recollections of childhood victimization. Part 1: childhood physical abuse. Psychol Assess 1996, 8:412–421.

    Article  Google Scholar 

  74. Raphael K: Recall bias: a proposal for assessment and control. Int J Epidemiol 1987, 16:167–170.

    PubMed  Article  CAS  Google Scholar 

  75. Raphael KG, Cloitre M: Does mood-congruence or causal search govern recall bias? A test of life event recall. J Clin Epidemiol 1994, 47:555–564.

    PubMed  Article  CAS  Google Scholar 

  76. Heim C, Newport DJ, Bonsall R, et al.: Altered pituitary-adrenal axis responses to provocative challenge tests in adult survivors of childhood abuse. Am J Psychiatry 2001, 158:575–581.

    PubMed  Article  CAS  Google Scholar 

  77. Crofford LJ: The hypothalamic-pituitary-adrenal stress axis in fibromyalgia and chronic fatigue syndrome. Z Rheumatol 1998, 57(suppl 2):67–71.

    PubMed  Article  Google Scholar 

  78. Briere J: Methodological issues in the study of sexual abuse effects. J Consult Clin Psychol 1992, 60:196–203.

    PubMed  Article  CAS  Google Scholar 

  79. Dong M, Anda RF, Dube SR, et al.: The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood. Child Abuse Negl 2003, 27:625–639.

    PubMed  Article  Google Scholar 

  80. Van Houdenhove B, Neerinckx E, Lysens R, et al.: Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics. Psychosomatics 2001, 42:21–28.

    PubMed  Article  Google Scholar 

  81. Banks SM, Kerns RD: Explaining high rates of depression in chronic pain: a diathesis-stress framework. Psychol Bull 1996, 119:95–110.

    Article  Google Scholar 

  82. Caspi A, Sugden K, Moffitt TE, et al.: Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science 2003, 301:386–389.

    PubMed  Article  CAS  Google Scholar 

Download references

Author information

Affiliations

  1. Department of Psychiatry, UMDNJ New Jersey Medical School, 183 South Orange Avenue, BHSB F-1512, 07103, Newark, NJ, USA

    Karen G. Raphael PhD

Authors
  1. Karen G. Raphael PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helena K. Chandler PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Donald S. Ciccone PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Raphael, K.G., Chandler, H.K. & Ciccone, D.S. Is childhood abuse a risk factor for chronic pain in adulthood?. Current Science Inc 8, 99–110 (2004). https://doi.org/10.1007/s11916-004-0023-y

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-004-0023-y

Keywords

  • Sexual Abuse
  • Childhood Abuse
  • Fibromyalgia
  • Chronic Fatigue Syndrome
  • Childhood Sexual Abuse