Altered psychophysiological reactivity as a prognostic indicator of early childhood stress in chronic pain.

There is considerable evidence that early life stress (ELS) can have a lasting impact upon adult physiology. Various childhood (and even prenatal) stressors such as parental separation, neglect, and trauma, can leave an enduring impact upon immune, autonomic and endocrine systems. These changes are increasingly understood to represent vulnerabilities to developing later life medical (and psychological) morbidity. In this article it is hypothesized that these enduring physiological changes may also serve as markers to detect the presence of ELS or rather it's impact upon the individual. Until now, the detection of ELS has relied primarily upon self-report measures that have obvious limitations. If a reliable and objective means of detecting the impact of ELS can be established using physiological means, then one potential application would be in the chronic pain population. At present it remains unclear why for a given injury, some acute pain subjects progress to develop chronic pain, while others make a full recovery. The evidence to date points more to psychosocial factors than nociceptive parameters. The hypothesis proposed in this manuscript that ELS results in altered physiological reactivity may offer in part an explanation for this puzzling variable transition to chronic pain.