Lifetime exposure to adversity predicts functional impairment and healthcare utilization among individuals with chronic back pain

Pain. 2010 Sep;150(3):507-515. doi: 10.1016/j.pain.2010.06.007. Epub 2010 Jul 1.


Previous research has demonstrated an association between lifetime exposure to adverse events and chronic back pain (CBP), but the nature of this relationship has not been fully specified. Adversity exposure typically predicts undesirable outcomes, suggesting that lack of all adversity is optimal. However, we hypothesized that among individuals faced with CBP, a history of a low level of lifetime adversity would yield protective effects, manifested as lower impairment and healthcare utilization. Adult members of a national panel (N=396) endorsed a history of CBP when reporting their physical health status in an online survey; they further reported their functional impairment and healthcare utilization. Respondents had previously completed a survey of lifetime exposure to adverse events. Significant U-shaped quadratic relationships emerged between adversity and self-rated functional impairment (p<0.001), disabled employment status (p<0.001), frequency of physician/clinic visits for CBP (p<0.01), prescription (but not over-the-counter) analgesic use (p<0.01), and comorbid depression treatment seeking (p<0.01). Specifically, people with some lifetime adversity reported less impairment and healthcare utilization than people who had experienced either no adversity or a high level of adversity. Additional analyses failed to support alternative explanations of the findings. Implications for understanding and promoting resilience in the context of CBP are discussed.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adaptation, Psychological*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety / epidemiology
  • Back Pain / epidemiology
  • Back Pain / physiopathology
  • Back Pain / psychology*
  • Back Pain / therapy
  • Chronic Disease
  • Delivery of Health Care / methods
  • Delivery of Health Care / statistics & numerical data*
  • Depression / epidemiology
  • Employment
  • Female
  • Health Status
  • Humans
  • Life Change Events*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Surveys and Questionnaires
  • Young Adult