Psychological stress and musculoskeletal pain: the moderating effect of childhood and adulthood trauma

Doctoral thesis English OPEN
Woodward, April (2015)
  • Subject: R1

The aetiology of widespread musculoskeletal pain is complex. Psychological stress is a robust predictor of symptom onset and persistence but not everyone who experiences stress goes on to develop widespread pain. The aim of the studies presented in this thesis was to ascertain whether individuals with a history of trauma have an increased susceptibility to widespread pain when they experience psychological stress; to identify psychosocial mediators of the stress pain relationship, and ascertain whether these mediators differ, i.e. are moderated by, the experience of prior trauma and by sex.\ud \ud The trauma diathesis stress model of widespread pain, developed by the author, was assessed using structural equation modelling on data collected by two population-based prospective studies. In the General Practice Symptom Survey (GPSS), 1,443 adults aged 25–65 years provided data on the number of pain sites, psychological stress and childhood abuse. In the North Staffordshire Osteoarthritis Project (NorStOP), 6,678 adults aged 50–90 years provided data on the number of pain sites and psychological stress, whilst the occurrence of surgeries, fractures, RTAs and burns was obtained from their medical records.\ud \ud Higher levels of psychological stress were associated with a higher number of pain sites. The stress pain relationship was moderated by childhood abuse but not by adult physical trauma. The relationship between stress and pain was mediated by attachment style (GPSS) and by social support (NorStOP).\ud \ud This research explored the moderators (in whom) and mediators (how) of the stress pain relationship. Childhood abuse was identified as a susceptibility factor and adult attachment style and social support as the processes by which stress leads to pain. These findings have implications for both primary and secondary prevention; suggesting that a stratified treatment approach may be most appropriate.
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    2.2 Trauma and widespread pain .............................................................................18 2.2.1 Trauma: Definition and history........................................................................18 2.2.2 Childhood interpersonal trauma .....................................................................21 2.2.3 Adult physical trauma.....................................................................................32

    2.3 Psychological stress and widespread pain .........................................................38 2.3.1 Defining and assessing psychological stress..................................................38 2.3.2 The relationship between widespread pain and life events, anxiety, depression, somatisation and sleep problems .............................................40

    2.4 Theoretical models of trauma and widespread pain ...........................................45 2.4.1 Diathesis stress models .................................................................................45 2.4.2 A model of trauma exposure and physical health ...........................................47

    2.5 Trauma diathesis stress model of widespread pain ............................................50 2.5.1 Direct relationship: Psychological stress and widespread pain .......................51 2.5.2 Mediators of the stress pain relationship ........................................................54 a) Biological mediators of the stress pain relationship ...........................................54

    2.5.3 Moderators of the stress pain relationship......................................................65

    2.5.4 Summary of the trauma diathesis stress model of widespread pain ...............71

    5.4 GPSS study questionnaire .................................................................................96 5.4.1 Demographic details ......................................................................................97 5.4.2 Assessment of pain........................................................................................97 5.4.3 Assessment of childhood abuse.....................................................................98 5.4.4 Assessment of psychological stress.............................................................100 5.4.5 Potential mediators ......................................................................................102

    4.6 Structural equation modelling (SEM) ..................................................................81 4.6.1 Latent variables..............................................................................................84 4.6.2 Basic predictor outcome models ....................................................................87 4.6.3 Moderation models.........................................................................................88 4.6.4 Mediation models...........................................................................................89 4.6.5 Moderated Mediation models .........................................................................90 4.6.6 The influence of baseline pain in prospective modelling .................................90

    7.2 Participant characteristics and association with baseline number of pain sites.118 7.2.1 Number of pain sites ....................................................................................118 7.2.2 Association between number of pain sites at baseline and covariates..........119

    7.3 Participant characteristics and association with follow up number of pain sites 123 7.3.1 Number of pain sites at follow up .................................................................123 7.3.2 Association between number of pain sites at follow up and covariates.........123

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