{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:57:25Z","timestamp":1777589845393,"version":"3.51.4"},"reference-count":118,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Centre for Philosophical and Humanistic Studies (UCP) through the Portuguese Foundation for Science and Technology","award":["UIDB\/00683\/2020"],"award-info":[{"award-number":["UIDB\/00683\/2020"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: Childhood trauma is increasingly recognized as a key risk factor for autonomic nervous system (ANS) dysregulation and chronic pain. However, the mechanisms underlying this association remain insufficiently explored, particularly within integrated healthcare frameworks. Objective: This study examined whether autonomic reactivity mediates the relationship between childhood trauma and pain severity while accounting for age and gender. Methods: A total of 124 participants\u201464 with formally documented interpersonal trauma and 60 without\u2014completed validated measures of childhood trauma (CTQ), cumulative trauma (LEC-17), autonomic reactivity (BPQ), and pain severity (BPI). Group comparisons, correlation analyses, and hierarchical regressions were used to assess associations among variables. A mediation model was used to test whether autonomic reactivity explained the trauma\u2013pain relationship. Results: Trauma-exposed participants showed significantly higher autonomic reactivity than those without, while pain severity did not differ significantly between groups (p &lt; 0.001). Childhood physical and emotional abuse was strongly associated with autonomic reactivity and moderately associated with pain severity but not directly linked to pain. Mediation analysis supported a full mediation, with childhood trauma predicting pain severity indirectly via autonomic reactivity (\u03b2 = 0.220, 95% CI [0.087\u20130.422], p = 0.009). A preliminary gender effect on the trauma\u2013ANS pathway was observed but was not sustained in weighted models correcting for sample imbalance. Conclusions: Autonomic dysregulation was found to mediate the link between childhood trauma and pain vulnerability. Incorporating autonomic assessment into trauma-informed, integrated healthcare could inform early detection and tailored interventions, with preliminary evidence suggesting generalizability across gender.<\/jats:p>","DOI":"10.3390\/healthcare13182310","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T10:06:25Z","timestamp":1758017185000},"page":"2310","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Autonomic Dysregulation Mediates the Association Between Childhood Trauma and Pain Severity: Evidence from a Mediation Model"],"prefix":"10.3390","volume":"13","author":[{"given":"Eleonora C. V.","family":"Costa","sequence":"first","affiliation":[{"name":"Centro de Estudos Filos\u00f3ficos e Human\u00edsticos, Faculdade de Filosofia e Ci\u00eancias Sociais, Universidade Cat\u00f3lica Portuguesa, 4710-297 Braga, Portugal"},{"name":"North Regional Health Administration, 4000-477 Porto, Portugal"}]},{"given":"Patr\u00edcia","family":"Gon\u00e7alves","sequence":"additional","affiliation":[{"name":"Centro de Estudos Filos\u00f3ficos e Human\u00edsticos, Faculdade de Filosofia e Ci\u00eancias Sociais, Universidade Cat\u00f3lica Portuguesa, 4710-297 Braga, Portugal"}]},{"given":"Fernando","family":"Martins","sequence":"additional","affiliation":[{"name":"Research and Support Center for Specific Victims, Portuguese Guarda Nacional Republicana, 1200-092 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1214-3060","authenticated-orcid":false,"given":"S\u00edlvia","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Research and Support Center for Specific Victims, Portuguese Guarda Nacional Republicana, 1200-092 Lisbon, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9262-0375","authenticated-orcid":false,"given":"Carla","family":"Pais-Vieira","sequence":"additional","affiliation":[{"name":"Department of Education and Psychology, University of Aveiro, 3810-198 Aveiro, Portugal"},{"name":"Centro de Investiga\u00e7\u00e3o Interdisciplinar em Sa\u00fade (CIIS), Faculdade de Ci\u00eancias da Sa\u00fade e Enfermagem (FCSE), Universidade Cat\u00f3lica Portuguesa, 1649-023 Lisbon, Portugal"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1001\/archgenpsychiatry.2008.508","article-title":"Childhood Trauma and Risk for Chronic Fatigue Syndrome: Association with Neuroendocrine Dysfunction","volume":"66","author":"Heim","year":"2009","journal-title":"Arch. 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