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NIH study: History of child abuse may amplify symptom severity in fibromyalgia patients
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A history of abuse may amplify some fibromyalgia symptoms, including pain severity and tenderness, according to recently published research by the Divisions of Intramural Research of the National Institute of Nursing Research and the National Institute of Mental Health of the NIH in Bethesda, Maryland and the Georgetown Howard Universities Center for Clinical and Translational Science in Washington, D.C.
Researchers recruited 111 women and 13 men with fibromyalgia (FM). The men, none of whom had a history of child abuse, were excluded from the analysis. Included patients had a mean age of about 47 years, and were diagnosed according to American College of Rheumatology 1990 or 2010 criteria.
Patients were evaluated for FM symptoms in a 90-minute examination that included an interview about abuse (physical, emotional or both) before or after age 18 years. Patients completed the Multidimensional Fatigue Inventory (MFI), Multiple Ability Self-Report Questionnaire (MASQ), Brief Pain Inventory (BPI) Symptom Severity Scale, Hospital Anxiety and Depression Scale, Pain Catastrophization Scale and underwent dolorimetry using an algometer at 18 tender points. All study measurements were completed by 106 participants.
Forty-two women (37.8%) reported abuse as a child, with 14 women reporting physical abuse; 15 women reporting emotional abuse and 14 women reporting both types of abuse. Nine of 24 women who reported abuse as an adult also reported abuse as a child.
Age at inclusion was similar between patients who did and patients who did not experience child abuse, and the mean BMI was around 31 kg/m2 in both groups. Between 72.2% and 79.49% of patients were college graduates among patients who did not report abuse and patients who did, respectively. Employment was reported by 41.67% of participants who reported child abuse compared with 54.84% of patients who reported no abuse.
A history of physical abuse was associated with the language domain of cognitive impairment based on MASQ scores, but in no other MASQ domains. Decreased pain tolerance in both pain threshold below 4 kg/cm2 and the number of pressure points were also observed in participants who reported childhood abuse. The differences persisted after investigators adjusted their findings for patients’ BMI, pain catastrophizing and depression. No association was seen between abuse history and BPI scores. A medium effect size of 0.31 was calculated for women who reported physical abuse compared with a smaller effect size of 0.193 calculated for patients who reported emotional abuse.
Increased general, physical and mental fatigue were higher in patients who reported childhood abuse, but no associations were seen with motivation, activity, WPI or MFI scores.
“Taken together, our findings suggest that different types of child abuse have modest, but predictable, influences on particular FM symptoms later in life,” the researchers wrote, and added, “Given that not all patients with FM have a history of child abuse, the types of abuse appear to shape the contours of symptoms rather than being the etiologic cause of them.” – by Shirley Pulawski
Disclosure s : Ortiz reports research support from the NIH. Please see the full study for a list of all authors’ relevant financial disclosures.
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