Childhood stressors linked to future symptoms of pain, fatigue in MS

Experiencing certain stressors during childhood may predict the future presence and severity of fatigue, pain, and psychiatric conditions associated with multiple sclerosis (MS), according to a new U.S. study.

Childhood physical and emotional stressors were each significantly linked to a higher likelihood of MS patients experiencing each of the three symptoms. Also, stressors in a child’s environment were significantly associated with a greater chance of having a new mental health symptom, diagnosis, or event.

The researchers say their findings emphasize the importance of considering the backgrounds of MS patients when developing personalized care plans. These findings also should inform the development of strategies to prevent the negative consequences of early-life stress altogether, the team suggested.

“From a preventative perspective, teasing out which stressors are potentially most impactful during childhood is important to help inform intervention and policy efforts to decrease the stress experience and promote healthy trajectories from childhood into adulthood,” Carri Polick, PhD, the study’s first author and a clinical associate at Duke University’s School of Nursing, in North Carolina, said in a university press release.

The study, “Fatigue, pain interference, and psychiatric morbidity in multiple sclerosis: The role of childhood stress,” was published in PLOS One.

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In recent decades, numerous studies have emerged across multiple fields of medicine indicating that adverse childhood experiences can significantly influence the risk of negative health outcomes in adulthood.

Such experiences may include emotional stressors (i.e. emotional abuse) and physical stressors (e.g. physical or sexual abuse and harsh disciple), as well as environmental stressors such as parental divorce, parental mental illness and/or substance use, discrimination or social isolation, and housing instability.

“Since the original Adverse Childhood Experiences (ACEs) study in the late 90’s, childhood stress and adversity has been linked to numerous adult health outcomes, including many of the leading causes of mortality in the U.S.,” Polick said.

“This is, in part, due to the physiological stress response and how it sets the tone for how people experience stress and cope over their lifetime,” Polick added.

In MS, an increasing number of studies have suggested that various forms of childhood trauma may be risk factors for developing the disorder in adulthood — though not all studies have observed such a relationship. Research into how adversity in early life influences the expression of MS clinical features later on also is lacking.

Now, Polick and colleagues aimed to better understand how different types of childhood adversity might contribute to common, but often difficult to treat, MS symptoms. Their focus was on fatigue, pain, and psychiatric conditions.

The team analyzed data from 719 adult MS patients in the U.S. who completed a national, web-based survey deployed through the National MS Society. Most respondents were women (84%) and white people (88%), who had a diagnosis of relapsing-remitting MS (79%). Nearly three-quarters (71%) had a bachelor’s degree or higher education.

The participants were asked about whether they had experienced a certain stressor — including physical, emotional, and environmental ones — starting before age 18, and if so, when it started, how severe it was, and how long it lasted.

The results showed that the most prevalent type of childhood stressor was harsh discipline, reported by 50.9% of participants, followed by emotional abuse (33.4%), physical abuse (16.7%), and sexual abuse (12.8%). These stressors were experienced for a mean of 60-190 months, or overall, about 5-15 years.

Childhood emotional and physical stressors were found to be significant contributors to the presence and severity of MS fatigue and pain interference, or disruptions to daily life due to pain. Also, harsh discipline duration was significantly and independently linked to the severity of both fatigue and pain interference.

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All three stressor types were significantly associated with psychiatric problems, including depression, anxiety, and post-traumatic stress disorder.

In particular, patients who rated their emotional abuse experiences as extremely severe were at a 30% higher risk of accumulating a new mental health symptom, diagnosis, or event relative to those who were not exposed to emotional abuse.

Further, each additional childhood environmental stressor patients experienced was associated with a 4.8% increase in risk of accumulating mental health-related outcomes. This meant that “those who experienced eight environmental stressors during childhood had 40% more risk of [psychiatric-related outcomes] compared to those who had no exposure to environmental stressors,” the researchers wrote.

”These study findings expand upon the many known detrimental health outcomes stemming from adverse childhood experiences to include negative impacts on three chronic debilitating symptoms in MS.

Other demographic factors also were found to significantly influence symptoms. For example, higher education levels were linked to better outcomes across all three symptoms.

Given that most participants had higher education, “the relationships found could be even stronger for other [patient samples] who may have experienced additional adversity and barriers to education,” the team wrote.

Moreover, older age increased the risk of experiencing any pain interference, but was associated with decreased fatigue and pain severity as well as lower odds of psychiatric issues.

“This may represent better disease management, better coping skills, and perhaps engaging in mental health support happening over time since their diagnosis,” the researchers wrote.

Overall, the team wrote, “these study findings expand upon the many known detrimental health outcomes stemming from adverse childhood experiences to include negative impacts on three chronic debilitating symptoms in MS.”

The scientists believe the data support a movement for so-called trauma-informed care, wherein a person’s past experiences with stressors are screened and considered when formulating a treatment plan.

“Screening could enable neurologists to be more informed about patient backgrounds and risk factors that predict disease trajectories, thereby contributing to personalized approaches to MS care,” the researchers wrote.

Noted study limitations included a low participant response rate (about 0.01%), and the inclusion of mostly female and white patients with high education levels. Recall of past trauma also could have been inaccurately remembered or reported, the team noted.

“More studies are needed to add to the scarce literature in this area, replicate results, and expand to unexplored clinical features such as sleep, cognitive function, and response to treatments to better support trauma informed precision medicine,” the team concluded.