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Licensed Unlicensed Requires Authentication Published by De Gruyter March 19, 2020

Self-reported traumatic etiology of pain and psychological function in tertiary care pain clinic patients: a collaborative health outcomes information registry (CHOIR) study

Chloe J. Taub, John A. Sturgeon, Mandeep K. Chahal, Ming-Chih Kao, Sean C. Mackey and Beth D. Darnall


Background and aims

A sizable body of research has elucidated the significant role of psychological reactions to trauma on pain coping and outcomes. In order to best inform intervention development and clinical care for patients with both trauma and pain at the tertiary care level, greater clarity is needed regarding the magnitude of these effects and the specific pathways through which they may or may not function at the time of first presentation to such a treatment setting. To achieve this, the current study examined the cross-sectional relationships between traumatic etiology of pain, psychological distress (anger, depressive symptoms, and PTSD symptoms), and pain outcomes (pain catastrophizing, physical function, disability status).


Using a structural path modeling approach, analyses were conducted using a large sample of individuals with chronic pain (n = 637) seeking new medical evaluation at a tertiary pain management center, using the Collaborative Health Outcomes Information Registry (CHOIR). We hypothesized that the relationships between traumatic etiology of pain and poorer pain outcomes would be mediated by higher levels of psychological distress.


Our analyses revealed modest relationships between self-reported traumatic etiology of pain and pain catastrophizing, physical function, and disability status. In comparison, there were stronger relationships between indices of psychological distress and pain catastrophizing, but a weaker pattern of associations between psychological distress and physical function and disability measures.


To the relatively small extent that self-reported traumatic etiology of pain correlates with pain-related outcomes, these relationships appear to be due primarily to the presence of psychiatric symptoms and manifest most notably in the context of psychological responses to pain (i.e. catastrophizing about pain).


Findings from this study highlight the need for early intervention for patients with traumatic onset of pain and for clinicians at tertiary pain centers to include more detailed assessments of psychological distress and trauma as a component of comprehensive chronic pain treatment.

Corresponding author: Chloe J. Taub, MA, University of Miami, Department of Psychology, Coral Gables, FL, USA, Phone: +(207)610-0534, Fax: +(650)320-9443, E-mail:

  1. Authors’ statements

  2. Research funding: Authors acknowledge funding support from National Institutes of Health (NIH) National Center for Complementary and Integrative Health (NCCIH) R01AT008561 (BDD and SCM), P01AT006651 (SCM) and P01AT006651S1 (SCM and BDD); NIH National Institute on Drug Abuse (NIDA) K24DA029262 (SCM); NIH Pain Consortium HHSN271201200728P (SCM); and from the Chris Redlich Pain Research Endowment (SCM).

  3. Conflict of interest: Authors state no conflict of interest.

  4. Informed consent: Informed consent has been obtained from all individuals included in this study.

  5. Ethical approval: The research related to human use complies with all the relevant national regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.


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Received: 2019-11-01
Revised: 2020-01-31
Accepted: 2020-02-13
Published Online: 2020-03-19
Published in Print: 2020-07-28

©2020 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved.

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