Central Sensitization Syndromes and Trauma: Mediating Role of Sleep Quality, Pain Catastrophizing, and Emotional Dysregulation Between Post-Traumatic Stress Disorder and Pain

Abstract

Background: Central sensitization syndromes (CSSs) are associated with a high incidence of traumatic events; however, few studies have examined the potential mechanisms linking post-traumatic stress disorder (PTSD) and pain. Objectives: The present research aims to clarify this association by exploring the presence of trauma, PTSD, and related clinical variables in participants with CSSs compared to healthy controls and those with medical problems. Methods: A large sample of both sexes of the Spanish general population (n = 1542; aged 18–84 years) completed an online survey assessing the presence of traumatic experiences (psychological trauma, physical trauma, physical and sexual abuse), PTSD, and other clinical measures (central sensitization, pain, sleep quality, anxiety, depression, perceived stress, and emotional regulation). Results: The CSS group (n = 467) showed a higher incidence of repeated trauma, PTSD, and dissociative symptoms compared to the medical pathologies (n = 214) and healthy (n = 861) groups. The CSS group also showed greater clinical impairment than the other groups, especially the CSS subgroup with PTSD. In this subgroup, PTSD symptoms were significantly correlated with the remaining clinical measures, and sleep dysfunction, pain catastrophizing, and emotional dysregulation mediated the relationship between PTSD and pain, accounting for 55.3% of the variance. Conclusions: CSS represents a major therapeutic challenge. An integrated treatment addressing both trauma and pain, with an emphasis on sleep quality, pain catastrophizing, and emotional regulation, could improve the effectiveness of the current therapeutic approaches.