Relationships among childhood trauma, central sensitization, and opioid-related risks in a community sample of adults with chronic pain on opioids.

OBJECTIVES

This study examined the relationships among childhood trauma, central sensitization, and pain-, mood-, and opioid risk-related outcomes among adults with chronic pain (CP) on long-term opioid therapy (LTOT). We hypothesized that Adverse Childhood Experiences (ACEs) would relate to poorer outcomes, and that central sensitization would mediate the relationships between ACEs and outcomes.

METHODS

Adults with CP, actively prescribed opioids, were recruited via ResearchMatch.org and completed a cross-sectional electronic survey. Participants completed the Adverse Childhood Experiences (ACEs) questionnaire, the Central Sensitization Inventory (CSI), the Brief Pain Inventory (BPI), the Center for Epidemiological Studies Depression scale (CES-D-10), the Generalized Anxiety Disorders 7-item questionnaire (GAD-7), the Rapid Opioid Dependence Screen (RODS), and other substance use items. Models were estimated examining main effects of ACEs and potential mediating role of CSI between ACEs and outcome variables.

RESULTS

ACEs positively predicted higher CSI scores (β = 0.434, P<0.001), opioid dependence symptoms (β = 0.199, P<0.05), lifetime polysubstance use (β = 0.367, P<0.001), depressive symptoms (β = 0.262, P<0.001), and anxiety symptoms (β = 0.251, P = 001). As a mediator, CSI symptoms significantly mediated the association between ACEs and pain interference (LCL = 0.124, UCL = 0.303), ACEs and depressive symptoms (LCL = 0.227, UCL = 0.438), and ACEs and anxiety symptoms (LCL = 0.212, UCL = 0.387).

CONCLUSIONS

Among a sample of adults with a variety of CP conditions on LTOT, ACEs emerged as a risk factor for some substance use and mood outcomes, though inconsistent effects suggest other influential factors. CSI mediated the relationship between ACEs and pain interference, depression, and anxiety, indicating childhood trauma may be especially impactful when central sensitization is higher.