Physiological and Emotional Reactivity to Pain after Physical and Sexual Abuse

Westlund-High, Karin

Abstract

This proposal details a short-term career enhancement plan for a seasoned pain research scientist paired with experienced clinical behavioral scientists in the College of Dentistry at the University of Kentucky, as mentors. The proposed training opportunity for the faculty level candidate includes: (1) formal Certificate training in Clinical and Translational Science (CTS) and (2) mentored training in a clinical orofacial pain study. Chronic pain is a long lasting but less well documented outcome associated with post-traumatic stress disorder (PTSD) after exposure to interpersonal violence. The mentored pilot study will be performed in women with a history of physical and/or sexual abuse from local community shelters. Laboratory findings of mentor, Dr. Charles Carlson, and his colleagues have established a link between PTSD and chronic orofacial pain for women. Coincident physiological response changes in these chronic pain sufferers include decreased heart rate variability (HRV). Alterations in responsivity of this physiological biomarker suggest it as an appropriate target for interventional strategies. Recent evidence suggests controlling rate and pattern of respiration can restore an increase in HRV. Dr. Carlson has developed a method of individual skills training in self-regulation of respiration that may help offset enduring physiological changes precipitated by exposure to traumatic events. Hypothesis: Improved self-regulation of autonomic nervous system function with controlled breathing can offset altered physiological responses to a painful heat stress precipitated by exposure to traumatic events.
AIM 1 : To evaluate differences in physiological activity and emotional reactivity in participants with/without PTSD symptoms who have experience physical or sexual abuse. Physiological activation and emotional reactivity will be assessed in 60 participants who have experienced interpersonal violence. Participants will fill out questionnaires: Emotion Assessment Scale (EAS), Pittsburgh Sleep Quality Index (PSQI), Post Traumatic Stress Disorder Checklist (PCL-C), Self Report Depression Scale (CES-D), and Current Stage of Menstrual Cycle. Baseline physiologic measures will include heart rate, end- tidal CO2 (ETCO2), and respiration rate.
AIM 2 : To study responses to a physical stressor (heat stimulation) and the effects of a brief physical self-regulation breathing intervention on the physiological variables. A physical stressor consisting of application of unilateral intermittent painfully hot stimulation will be applied to the orofacial area while physiological recordings (heart rate, ETCO2, respiration rate) continue. The procedure will be repeated after instruction in a slow diaphragmatic breathing intervention that is introduced to one-half of the participants selected at random using a table of random numbers. The long-term goal of this training is to prepare the candidate to design, perform and analyze clinical translational studies in patients with chronic orofacial pain after formal CTS training and participation in a mentored pilot study to understand adverse physiological outcomes of PTSD after physical/sexual abuse.

Public Health Relevance

Severe psychological trauma produced by abuse can produce well characterized chronic physiological and psychological responses, including decreased heart rate variability and increased responsivity to pain. Individual skills training in self-regulation of respiration will be used to offset persisting physiological changes and increased reactivity to noxious heat-induced orofacial pain precipitated by exposure to traumatic physical or sexual abuse.