UroToday - Childhood maltreatment is prevalent and has been associated with a wide range of adult psychiatric and physical disorders. Many studies have focused on the relationship of abuse with depression and anxiety, 2 conditions strongly associated with chronic pain syndromes. The relationship of childhood maltreatment and chronic pain conditions remains a subject of considerable debate.

Dr. Gretchen Tietjen and her American and Canadian colleagues from the Women's Issues Section research consortium of the American Headache Society studied a cross-section of headache clinic patients between February 2006 and June 2008. A total of 1348 patients who received a diagnosis of migraine completed the surveys. The average age was 41 years and 88% of participants were female. Prevalence of current depression was 28% and anxiety was 56%.

The frequency of self-reported physician diagnoses of comorbid pain conditions ranged from 24% for arthritis to 5% for chronic fatigue syndrome. Irritable bowel syndrome was reported in 31%, chronic fatigue syndrome was reported in 16%, and fibromyalgia in 10% of patients. Childhood abuse or neglect was present by history in 58% of the study population. Twenty-five percent of the population noted a sexual abuse history and 21% a physical abuse history.

When looking at other associations in the data, childhood physical abuse was common with arthritis pain, emotional abuse correlated with irritable bowel syndrome and arthritis, and physical neglect paired with irritable bowel syndrome, interstitial cystitis, and arthritis. Fully 61% of this primarily clinic headache population had at least 1 comorbid pain condition, 18% had 2, and 13% had 3 or more. Emotional abuse or physical neglect were key predictors of comorbid pain conditions.

The authors conclude that in specialty migraine headache clinics, comorbid pain conditions and childhood maltreatment history were common, and reported by over half of those surveyed. The possibility that remembrance, perception, and interpretation of persons regarding their abusive experiences may be important with regards to experiencing and reporting chronic pain in adulthood. Hypocortisolism has been described in response to acute stress in healthy adults with a history of childhood maltreatment and in persons with chronic pain. Genetic and epigenetic modifications in the hypothalamic-pituitary-adrenal- system and serotonin system influence the outcome of early life stress.

This is an important article worth looking at by those interested in the epidemiology of bladder pain syndrome. Coming from a different direction, it adds another bit of evidence that the chronic pain syndromes may have much in common and much may be learned from multi-disciplinary experts in this broadening field. The authors conclude that treatment strategies such as cognitive behavioral therapy may be particularly well suited to these cases.

Tietjen GE, Brandes JL, Peterlin BL, Eloff A, Dafer RM, Stein MR, Drexler E, Martin VT, Hutchinson S, Aurora SK, Recober A, Herial NA, Utley C, White L, Khuder SA
Headache. 2009 Oct 21. (Epub ahead of print)
10.1111/j.1526-4610.2009.01558.x

UroToday Contributing Editor Philip M. Hanno, MD, MPH

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