Post-traumatic stress disorder moderates the relation between documented childhood victimization and pain 30 years later

Karen G. Raphael, Cathy Spatz Widom

Research output: Contribution to journalArticlepeer-review


Cross-sectional designs and self-reports of maltreatment characterize nearly all the literature on childhood abuse or neglect and pain in adulthood, limiting potential for causal inference. The current study describes a prospective follow up of a large cohort of individuals with court-documented early childhood abuse or neglect (n = 458) and a demographically matched control sample (n = 349) into middle adulthood (mean age 41), nearly 30 years later, comparing the groups for risk of adult pain complaints. We examine whether Post-Traumatic Stress Disorder (PTSD) mediates or moderates risk of pain. Assessed prospectively across multiple pain measures, physically and sexually abused and neglected individuals generally showed a significant (p < .05) but notably small (η2 = .01) increased risk of pain symptoms in middle adulthood. Although PTSD was associated with both childhood victimization (p < .01) and risk of middle adulthood pain (p < .001), it did not appear to mediate the relationship between victimization and pain. However, across all pain outcomes other than medically unexplained pain, PTSD robustly interacted with documented childhood victimization to predict adult pain risk: Individuals with both childhood abuse/neglect and PTSD were at significantly increased risk (p < .001, η2 generally = .05-.06) of pain. After accounting for the combined effect of the two factors, neither childhood victimization nor PTSD alone predicted pain risk. Findings support a view that clinical pain assessments should focus on PTSD rather than make broad inquiries into past history of childhood abuse or neglect.

Original languageEnglish (US)
Pages (from-to)163-169
Number of pages7
Issue number1
StatePublished - Jan 2011


  • Childhood abuse
  • Childhood neglect
  • Childhood trauma
  • Post-traumatic stress disorder
  • Unexplained pain symptoms

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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