Child Abuse Dials Up the Volume on Pain

April 4, 2008 — -- About one in 50 infants in the United States experience abuse or neglect in the first year of life, according to a government report published this week. And experts say this maltreatment can also have serious health consequences later in life.

"Kids unfortunately who are being maltreated show problems in brain development," said Ileana Arias, director of the CDC National Center for Injury Prevention and Control, who, along with the Administration for Children and Families, created the report. Maltreatment can begin "a trajectory of a number of negative outcomes, including health outcomes," according to Arias.

Now, the mechanism behind those problems may have been pinned down.

A recent study revealed a physiological connection between child abuse and feelings of intense pain. Researchers at UCLA and the University of North Carolina compared pain responses in a group of women with and without irritable bowel syndrome (IBS), with surprising results.

In a test group of 20 women, 10 suffered from IBS and 10 did not. Both groups had people with a history of abuse, both physical and sexual. When subjected to mildly painful stimuli, the subjects with both IBS and a history of abuse reported feeling more intense pain than their counterparts.

In addition to self-reported data from the test subjects, the authors were able to document the pain experience using fMRI brain imaging. This data showed that the women who reported the most pain had heightened activity in the sensation and emotion regions of the brain. In addition, the brain areas that normally help to dampen negative sensations and emotions were inhibited.

"It's the first time we are able to show a mechanistic explanation for a clinical observation," said Dr. Yehuda Ringel, an assistant professor of medicine at the University of North Carolina at Chapel Hill. "It provides patients reassurance. They are not crazy, but there is a physiological explanation for why they experience more sensation."

A Painful Past

Based on their study, Ringel and Dr. Doug Drossman, a professor of medicine and psychiatry at UNC, reported that the link between abuse and IBS-related pain can apply to other physical conditions.

That link is well-known among clinicians, therapists, counselors and pain specialists.

"It's something that we've seen for some time in victims of [abuse]," said Thomas Miller, emeritus professor of psychology at the University of Connecticut. "Individuals who complain of pain-related symptoms may have experienced other forms of pain."

Though the stigma associated with abuse, in which survivors are brushed off or their claims are minimized, is one of the strongest deterrents to reporting, survivors feel the need to voice that something is wrong.

Nissa Howard, 30, was sexually abused by her mother's boyfriend between the ages of 5 and 8. Around that time, she developed stomach aches, extreme nausea and trouble eating food.

"When I felt the pain in [my] abdomen, it reminded me of being assaulted. It's the same feeling," Howard said. "I was emotionally overwhelmed and it manifested physically. … I didn't want [food], I didn't want anything. I just wanted help."

This may be one of the reasons why people with a history of abuse frequently seek out treatment for physical ailments as adults. It is much easier to go to a doctor and get treated for a headache than to face the stigma of having been abused.

Gina Scaramella, executive director of the Boston Area Rape Crisis Center, said she once knew a young woman who was in so much emotional pain that she put a false cast on her arm so that people would ask her what was wrong.

The Pain in the Brain

Survivors who do seek treatment can search in vain if their ailments are difficult to diagnose, and they often are. Such patients often suffer from nonspecific chronic pain conditions such as endometriosis, fibromyalgia, gastrointestinal problems, frequent headaches and joint pain.

Howard, a dancer/choreographer from Vancouver, was diagnosed with IBS, a notoriously indeterminate gastrointestinal problem, during her senior year of college after years of stomach pains, nausea and acid reflux.

She continues to experience pain sometimes because of her abuse history, which included forced oral sex.

"That was the most traumatic of the abuse that I experienced," Howard said. "That's why I responded with such a strong sense of nausea."

Ringel pointed out that the study did not show that a history of abuse leads to IBS, or any other chronic pain problem. Nor did they suggest that people with IBS necessarily have a history of abuse.

Rather, Ringel and Drossman were able to provide quantifiable data on how trauma can have long-term effects on the brain, amplifying pain sensations.

During a traumatic experience, the prefrontal cortex, the rational part of the brain, shuts down. Anything the body experiences after that time -- including fear, confusion, feeling out of control and physical pain -- is relayed directly to the emotion processing centers in the brain, creating areas of hypersensitivity. Later, pain can parallel those feelings.

"When triggered… they can't reason themselves out of it," Drossman said. "You get this very primitive emotional reaction that you can't control. And that's exactly what patients tell you: 'I can't control it.'"

And survivors of child abuse are less able to control their pain than other people. Children cannot protect themselves mentally, the way an adult might during a traumatic experience, by trying to calm and distract themselves. In addition, since the abuser is often a relative or friend, a child is more likely to have conflicted feelings toward their abuser and take the guilt and responsibility for the abuse upon themselves. Thus, the effects of abuse or other trauma are stronger and more lasting.

Coping With the Past

Though their sample size was small, Ringel and Drossman believe their study is representative and could help tip off doctors and therapists that a person who reports unusually intense amounts of pain for chronic problems may have a history of abuse. If so, including therapy in the treatment options could be an effective way to ease both the mental and physical pain the person experiences.

"We looked at the brain response before and after treatment," Ringel said. "These alterations in brain function are reversible with treatment. … This is where research needs to go."

Howard never told anyone close to her about her abuse until she told her husband one year after they were married. She also began therapy for her abuse history.

"I think [the pain] did get a bit better, it stopped being this constant thing," said Howard, who will now share in cupcakes and goldfish crackers with her two daughters. "I really enjoy eating now, taking it to a place of being really healthy. I feel good about that."