All ETDs from UAB

Advisory Committee Chair

Robert Sorge

Advisory Committee Members

Casey Azuero

Burel Goodin

Document Type


Date of Award


Degree Name by School

Master of Arts (MA) College of Arts and Sciences


Adverse childhood experiences (ACEs) can have profound deleterious effects on physical health and psychological functioning in adulthood. ACEs may be a social determinant of chronic pain development and severity in adulthood; however, little research to date has investigated the psychological processes that might underlie this association. Emotion regulation, an established transdiagnostic risk factor underlying psychopathological conditions, may be a potential mediator of the relationship between ACEs and pain. Lower socioeconomic status is associated with greater risk of ACEs and poor chronic pain outcomes, yet research has not clarified the role of subjective versus objective determinants of socioeconomic factors within these associations. Finally, pain research has prioritized the assessment of pain-at-rest, yet there is a need for research which examines pain with movement and endogenous pain modulation. The primary objective of this study was to examine the relationships among ACEs, emotion regulation, and adult cLBP, as well as to determine whether associations vary by SES. Study participants included 183 adults (53% female, 62.8% non-Hispanic Black) with chronic low back pain (cLBP). Participants reported on ACEs, emotion regulation, pain-at-rest, movement-evoked pain, area deprivation, and subjective social status. All participants completed experimental assessment of endogenous pain modulation using quantitative sensory testing. Sociodemographic data were also collected. iii No significant bivariate associations were observed between ACEs and cLBP severity measures. Greater ACEs were significantly associated with less efficient pain inhibition, but only for those living in less socioeconomic disadvantage. Greater ACEs were associated with greater difficulties in emotion regulation; though this association was not moderated by indicators of SES. Emotion dysregulation and pain severity measures were significantly associated, however the same was not found for endogenous pain modulation responses. The data revealed that the relationship between ACEs and movement-evoked pain was significantly mediated by emotional dysregulation. Unexpectedly, this mediation effect did not differ in strength or magnitude according to indicators of SES. The present study reinforces the link between ACEs and chronic pain, underscoring the importance of childhood maltreatment, impaired emotional regulation, and socioeconomic disadvantage as a risk factors cLBP. Implications of these findings are discussed.



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