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Centralized pain and pain catastrophizing mediate the association between lifetime abuse history and self-reported pain medication side effects
  1. Jennifer Pierce1,
  2. Afton L Hassett1,
  3. Jill R Schneiderhan2,
  4. Jude Divers1,
  5. Chad M Brummett1 and
  6. Jenna Goesling1
  1. 1Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jennifer Pierce, Anesthesiology, University of Michigan, Ann Arbor, MI 48108, USA; jmboik{at}


Background Self-reported side effects of pain medication are important determinants of treatment course that can affect patient adherence, medication discontinuation and physician decisions. Yet, few studies have investigated patient-level predictors of self-reported pain medication side effects. The present study sought to fill this gap by exploring the impact of physical or sexual abuse history on self-reported pain medication side effects and considered a mediation model in which those effects are transmitted through a centralized pain phenotype and pain catastrophizing.

Methods We conducted a cross-sectional analysis of 3118 patients presenting to a tertiary-care, outpatient pain clinic.

Results Approximately 15% of the sample (n=479) reported a lifetime history of abuse. Patients with a lifetime history of abuse, particularly abuse that occurred in both childhood and adulthood, reported more pain medication side effects compared with patients reporting no abuse history. Furthermore, path analysis showed that a centralized pain phenotype and pain catastrophizing mediated the association between lifetime abuse history and the sum of pain medication side effects.

Conclusions This suggests that individuals who experience abuse may develop a heightened physiological sensitivity to stimuli, as well as a tendency to interpret stimuli negatively, exaggerate the impact of aversive stimuli and undermine their ability to cope with the stressor. This study highlights the need for physicians to understand patient-level predictors of medication tolerance and to consider a history of abuse and trauma in decisions regarding treatment and medication management.

  • chronic pain
  • psychological aspects of pain
  • pain medicine

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  • Contributors JP: responsible for conception and design of work; data management, analysis, presentation and interpretation; drafting the article; critical revision of the article and final approval of version to be published. AH, CMB and JG: responsible for study design; interpretation of the data; critical revision of the manuscript and final approval of the version to be published. JRS and JD: responsible for critical revision of the manuscript and final approval of version to be published.

  • Funding This research was supported by the Department of Anesthesiology, University of Michigan. JP is supported by a Postdoctoral Translational Scholar Programme training grant from the Michigan Institute for Clinical and Health Research (UL1TR002240; PI: George Mashour).

  • Competing interests ALH is a consultant to Precision Health Economics and AbbVie Pharmaceuticals. CMB is a consultant for Heron Therapeutics.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Review Board (University of Michigan, Ann Arbor, Michigan, USA) approval was obtained and informed consent was waived.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Deidentified participant data are available on reasonable request from the authors.