Trauma History Associated With Psychological Comorbidities in Patients With Juvenile-Onset Fibromyalgia

According to a study published in Arthritis Care & Research, young adults with juvenile-onset fibromyalgia (JFM) and a history of trauma are more likely than patients with JFM and no trauma history to have psychological comorbidities.¹

Contrary to the researchers’ hypothesis, a trauma history was not associated with worse pain or physical functioning in patients with JFM. However, patients with JFM had poorer psychological and health-related outcomes than healthy control patients. The study was the first of its kind to assess the differential effect of trauma exposure in childhood or early adulthood on psychological and health-related outcomes in JFM.

Incidence of childhood trauma was shown to be significantly higher in adult patients with fibromyalgia than in the general population or in individuals with chronic pain.^2,3

Lead study investigator Sarah Nelson, PhD, told Clinical Pain Advisor, “Although compelling, this research has been limited through the use of retrospective reporting of trauma several decades after the initial incident, which increases potential for recall bias.”

Dr Nelson continued, “The current study, although still using retrospective reporting, utilizes a much younger population, which likely increases the validity of trauma reports. Further, the use of younger populations also gives us a much clearer picture of how the association between trauma and chronic pain conditions may develop over time.”

The study involved 110 participants (86 patients with JFM and 24 healthy control patients with an average age of 23.4 years). Each participated in structured clinical interviews aiming to assess psychological symptoms and history of trauma. In addition, study participants completed self-report questionnaires for the assessment of pain, physical functioning, and healthcare use. Participants were part of a cohort consisting of patients diagnosed with JFM in adolescence and age- and sex-matched healthy control subjects that have been followed over the course of 8 years.

Summary and Clinical Applicability

This study highlights the need for referrals for psychotherapy or psychiatry in patients with symptoms suggestive of psychological impairment (eg, anxiety or depression), according to Dr Nelson. “This is particularly important, because if young adult patients with JFM are exhibiting psychological impairment without increased physical impairment, they may have a history of trauma, and thus, timely psychological intervention may actually be preventive for further impairment in physical functioning.” 

Limitations and Disclosures

• Dr Nelson and colleagues noted several potential limitations of the study:
• Data relied on self-reports, thus introducing the potential for recall bias.
• Because the cohort studied was predominantly white and female, results may not be representative of more diverse populations.

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References

1. Nelson S, Cunningham N, Peugh J, et al. Clinical profiles of young adults with juvenile-onset fibromyalgia with and without a history of trauma [published online January 13, 2017]. Arthritis Care Res. doi: 10.1002/acr.23192
2. Dell’osso L, Carmassi C, Consoli G, et al. Lifetime post-traumatic stress symptoms are related to the health-related quality of life and severity of pain/fatigue in patients with fibromyalgia. Clin Exp Rheumatol. 2011;29(6 Suppl 69):S73-S78.
3. Schilling EA, Aseltine RH, Gore S. Adverse childhood experiences and mental health in young adults: a longitudinal survey. BMC Public Health. 2007;7:30. doi: 10.1186/1471-2458-7-30