Associations between Childhood Adversity and Pain in Breast Cancer Survivors

OBJECTIVE: Pain is a prominent symptom in breast cancer survivors, but associated factors are still under investigation. Childhood adversity has been linked to pain in adulthood through emotional and biological pathways but has been relatively unexplored in the context of breast cancer. The current study examines the association between childhood adversity and pain in breast cancer survivors and meditation by ambivalence over emotional expression (hereinafter referred to as emotional ambivalence) and inflammation. We hypothesize a positive association between childhood adversity and pain, mediated by greater emotional ambivalence and higher levels of inflammation. METHODS: Women diagnosed with stage 0-IIIA breast cancer completed assessments one year after the completion of primary treatment, including questionnaires assessing childhood adversity (Risky Families), emotional ambivalence (Ambivalence Towards Emotional Expressivity), and pain (SF-36). Blood samples were collected to measure plasma markers of inflammation (IL-1ra, IL-6, CRP, and sTNF-RII). RESULTS: Childhood adversity was significantly associated with greater pain, B=0.36, P=.008, which was significantly mediated by emotional ambivalence, B=0.09, 95%CI [0.02, 0.18]. There were no significant indirect effects through any of the inflammatory markers. We also explored the associations between dimensions of childhood adversity and pain. Similar linear regression and mediation results were found for threat and neglect while there were no significant findings in models examining household chaos. CONCLUSIONS: Findings highlight the relevance of childhood adversity as a contributor to persistent pain in breast cancer survivors and identify emotional ambivalence as a key pathway and potential target for intervention.