Abstract
Previous research has demonstrated an association between lifetime exposure to adverse events and chronic back pain (CBP), but the nature of this relationship has not been fully specified. Adversity exposure typically predicts undesirable outcomes, suggesting that lack of all adversity is optimal. However, we hypothesized that among individuals faced with CBP, a history of a low level of lifetime adversity would yield protective effects, manifested as lower impairment and healthcare utilization. Adult members of a national panel ( N = 396) endorsed a history of CBP when reporting their physical health status in an online survey; they further reported their functional impairment and healthcare utilization. Respondents had previously completed a survey of lifetime exposure to adverse events. Significant U-shaped quadratic relationships emerged between adversity and self-rated functional impairment ( p < 0.001), disabled employment status ( p < 0.001), frequency of physician/clinic visits for CBP ( p < 0.01), prescription (but not over-the-counter) analgesic use ( p < 0.01), and comorbid depression treatment seeking ( p < 0.01). Specifically, people with some lifetime adversity reported less impairment and healthcare utilization than people who had experienced either no adversity or a high level of adversity. Additional analyses failed to support alternative explanations of the findings. Implications for understanding and promoting resilience in the context of CBP are discussed.
Highlights
Complaints of back pain are among the most common reasons for patient presentations to ambulatory medical settings in industrialized countries [3]
To test the extent to which our results for functional impairment and other healthcare utilization varied as a function of respondents’ anxiety and depression status, we separately examined the interactions between anxiety/depression status and adversity
Previous research has suggested that a graded relationship exists between adversity exposure and subsequent development of chronic back pain (CBP) [23] and that exposure to adverse life events correlates with greater CBP severity [4,13,27]
Summary
Complaints of back pain are among the most common reasons for patient presentations to ambulatory medical settings in industrialized countries [3]. Most of these remit spontaneously or respond to simple treatment interventions; for a subset of patients, these symptoms remain chronic [33]. Research has examined the relationship between exposure to adverse events and CBP. CBP patients report an increased rate of traumatic events in childhood, including sexual or physical abuse [27,28,41]. Childhood physical and sexual abuse rendered CBP patients refractory to surgical interventions [41,42]
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