The Indirect Effects of Recalled Trauma Severity on Pain Ratings among People with Fibromyalgia: a Moderated Mediation Model

Abstract

Fibromyalgia syndrome (FM) is a chronic musculoskeletal condition that is accompanied by hypersensitivity to pain. Researchers have examined factors that affect pain ratings among people with FM, such as trauma, depressive symptoms, and coping; however, collectively, the interrelationships among this set of variables, and their relationships to pain, have not been examined. To better understand these relationships, a moderated-mediation model was used to examine how recalled trauma severity, depressive symptoms, relative emotion-focused coping relate to pain ratings. There were 501 participants who were primarily female, White, and ranged in age from 20 to 84 years. All participants had a physician's diagnosis of FM. The results indicated a significant moderated-mediation. Depressive symptoms significantly mediated the relationship between recalled trauma severity and pain ratings, such that greater trauma severity related to more depressive symptoms which in turn were associated with more pain. The mediation chain was moderated by relative emotion-focused coping (i.e., the proportion of emotion-focused coping compared to problem-focused coping), such that when relative emotion-focused coping was used at higher levels, the relationship between recalled trauma severity and depressive symptoms significantly weakened, reducing the indirect association between recalled trauma severity and pain ratings. The findings from the present study indicate that a treatment approach that includes a trauma-focused therapy such as exposure therapy or Emotional Awareness and Expression Therapy should be tested to determine whether these treatments can reduce the impact of past traumas, improve depressive symptoms, decrease pain ratings, and promote more adaptive coping among people with FM.

Keywords: coping; depressive symptoms; fibromyalgia; pain; recalled trauma.

Figure 1.

Conditional indirect effects of trauma severity on pain rating via depressive symptoms, at low (−1 SD) and high (+1 SD) relative emotion-focused coping p < 0.05*, p < 0.001**; index of moderated mediation = −.03 (95% CI = −.057; −.001); Mod denotes the coefficients for the moderation.

Figure 2.

Moderating effect of relative-emotion focused coping on the relationship between trauma severity and depressive symptoms