Childhood maltreatment, trauma, and pain: trauma-related symptoms as mediators in a high-risk group

Abstract Introduction: A history of childhood maltreatment (CM) and trauma-related symptoms has been associated with the development of pain conditions. Individuals raised in Residential Youth Care (RYC) often report significant exposure to CM, high rates of posttraumatic stress disorder (PTSD), and an increased risk for various adverse health outcomes, making them a high-risk group for pain symptoms. Objectives: This study examines the role of CM, trauma, and symptoms of PTSD and dissociation for pain indicators. Methods: As part of the 10-year follow-up project, N = 157 individuals (68.15% women) with a history of RYC were recruited. Pain symptoms were assessed using standardized questions from a large-scale population-based study in Norway, recording headache, pain lasting at least 3 months, pain intensity, as well as continuous muscle and joint pain. Childhood maltreatment was measured using the Maltreatment and Abuse Chronology of Exposure scale, and dissociative symptoms through self-report online survey. Trauma load and symptoms of PTSD were evaluated using clinician-administered interviews based on the PTSD Checklist, aligned with Diagnostic and Statistical Manual of Mental Disorders-5 criteria. Results: We confirmed associations between CM, trauma load and pain intensity, and body pain distribution in a high-risk group, while we did not find associations for headache. Symptoms of PTSD and dissociation predominantly mediated the relationship between CM/trauma load and pain symptoms. Conclusion: A history of CM and trauma-related symptoms are crucial for understanding pain symptoms in individuals transitioning to adulthood after RYC. Posttraumatic stress disorder and dissociation symptoms may contribute to development and exacerbation of pain symptoms and may be a target for intervention.