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EVIDENCE IN ACTION
A quarterly research brief from the
Center on Trauma and Children
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Trauma Exposure and Women's Experiences of Pain
This
Evidence in Action highlights findings from the following study conducted by Center on Trauma and Children faculty and other colleagues from the University of Kentucky:
Sprang, G., Bush, H. M., Coker, A. L., & Brancato, C. J. (2017). Types of trauma and self-reported pain that limits functioning in different-aged cohorts. Journal of Interpersonal Violence, 0886260517723144.
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Background
Over half of the U.S. population reports experiencing at least one form of trauma with an increasing likelihood of exposure with age. Children who are exposed to trauma are more likely to experience additional trauma in adulthood. However, there is a need to understand how trauma exposure during various life stages impacts overall health and functioning to better recognize risk among clients. Children exposed to physical and/or sexual abuse likely experience violations of trust within their family units that can lead to long-term distress and poor health outcomes. Specifically, childhood trauma exposure has been found to impact experiences with chronic pain through altering neurological development, regulation, and functioning. Research demonstrating that chronic pain is associated with substance abuse, smoking, and higher numbers of sexual partners highlights the importance of this public health concern. Existing research also shows that women have different experiences with both trauma and pain in comparison to men and therefore, further study is warranted on this topic targeting women.
Study Aim
This study aimed to examine the following questions in a sample of women:
- How rates of pain (resulting in health limitations) are linked to one or more forms of the following traumatic experiences: childhood sexual abuse, childhood physical abuse, adult violence or stalking, sexual or physical partner violence, or forced sex by someone other than a partner
- How pain that limits functioning is related to trauma exposure
Participants
This study includes reports from 16,093 non-help seeking women from the Kentucky Women's Health Registry survey. Of these women,
- 25% had either childhood physical or sexual abuse
- 42% disclosed adult sexual violence
- 51% experienced either childhood abuse or adult violence
- Of these, 56% disclosed physical Intimate Partner Violence (IPV), 27% sexual IPV, 52% stalking by an intimate partner, and 26% forced sex by someone other than an intimate partner
Results
Personal Characteristics
.
Characteristics linked to trauma exposure include: age group (40-54), non-White race, relationship divorce or separation, less than a college education, unemployed status, receiving Medicaid, and not being exclusively heterosexual. Similar characteristics were linked to pain including: age, being widowed, less than a college education, unemployed status (retired or disabled), receiving Medicaid or Medicare, not being exclusively heterosexual, living in Appalachian or rural counties.
Childhood Abuse Alone.
Exposure to either childhood physical or sexual abuse was linked to a 56% increase in rate of pain that limited functioning. Specifically, nearly 40% of women disclosing childhood abuse reported pain compared to 24% of women who did not disclose childhood abuse.
Adult Abuse Alone.
Exposure to adult violence was linked to a 47% increase in rate of pain that limited functioning. Specifically, 34% of women disclosing adult violence reported pain compared to 23% of women never disclosing adult violence.
Combinations of Trauma Exposure
.
Pain rates were higher when women disclosed experiencing more than one form of violence and were highest (43%) when disclosing all three forms of violence (childhood physical abuse, childhood sexual abuse, and adult violence).
Impact of Age on Outcomes of Trauma Exposure.
Experiencing more than one form of trauma was associated with a 3 to 4-fold increase in rate of pain for younger women reporting symptoms before their 40th birthday, compared to those with no history of violence exposure.
Main Findings
- One exposure to trauma has a strong connection to pain that limits functioning. However more than one trauma exposure makes this connection stronger.
- Repeated trauma exposure across different developmental stages is a signature risk of developing pain in adulthood.
- Women reporting multiple trauma exposures were 3 to 4 times more likely than those with no violence exposure to begin having pain that limits functioning at a young age. This is an important finding because it points to trauma as the reason for pain instead of as a natural sign of aging.
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Translational Tips
To adequately address the needs of women who have been exposed to trauma and are experiencing chronic pain, professionals should consider the following:
- Assessing for trauma exposure across the lifespan may help inform treatment of chronic pain among women.
- Dose of exposure to trauma matters, not only for the development of mental health symptoms but physical pain. However, dose alone does not sufficiently explain the link between exposure and pain. Type of trauma, certain combinations of trauma types and its occurrence at different stages of development influence the potency of the impact. Assessment strategies that are sensitive enough to detect dose of exposure are needed.
- This link between trauma and pain can provide practitioners with helpful insight into why victims of violence report experiencing debilitating pain at a time in their lives when pain associated with aging would not be expected.
This project was supported by the NIH National Center for Advancing Translational Sciences through grant number UL1TR001998 (Kern, PI).
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