Adult chronic pain 45% more likely after childhood trauma, study finds
New research has found that exposure to childhood trauma increases the likelihood of experiencing chronic pain, such as back and neck pain, in adulthood. The risk increased significantly with exposure to multiple adverse childhood experiences, highlighting the importance of addressing childhood trauma to mitigate its impact on long-term health.
Adverse childhood experiences (ACEs) such as physical, sexual, or emotional abuse or neglect by a parent or caregiver cause direct harm to a child or teenager. The harm can come about indirectly as a result of household dysfunction, parental death, divorce, or a parent’s sickness or substance abuse.
Previous research has highlighted the negative impacts of ACEs on physical, psychological, and behavioral health, impacts that can continue into adulthood. A recent study led by researchers from McGill University, Canada, examined the relationship between exposure to childhood trauma and chronic pain in adulthood and yielded some troubling results.
“These results are extremely concerning, particularly as over 1 billion children – half of the global child population – are exposed to ACEs each year, putting them at increased risk of chronic pain and disability later,” said André Bussières, lead and corresponding author of the study. “There is an urgent need to develop targeted interventions and support systems to break the cycle of adversity and improve long-term health outcomes for those individuals who have been exposed to childhood trauma.”
The researchers performed a systematic review and meta-analysis of 85 studies carried out over a span of 75 years and involving 826,452 adults. They excluded research based on high-risk populations such as people who are homeless, incarcerated or with a primary diagnosis of substance abuse because few individuals in these populations have low ACE exposure. They also excluded people born severely prematurely, as it’s known to modify the pain pathway, leading to altered pain in adulthood, and they excluded those with clear explanations for their pain, such as fractures, sprains, burns, disease, neuropathy, or cancer.
Compared to those who reported no ACEs, the odds of reporting chronic pain conditions later in life were 45% higher among individuals exposed to a direct ACE, including physical, sexual, or emotional abuse or neglect. Individuals reporting childhood physical abuse were significantly more likely to report chronic pain and pain-related disability during adulthood.
Individuals exposed to any ACEs, alone or combined with indirect ACEs, were significantly more likely to report painful chronic conditions in adulthood, including undifferentiated chronic pain, any painful musculoskeletal disorders (MSDs), arthritis, back or neck pain, fibromyalgia, headache and migraine, irritable bowel syndrome, and pelvic pain. Exposure to any ACEs increased the odds of pain-related disability. The risk of any adult chronic pain significantly increased from one AEC to four or more AECs, regardless of the pain condition.
“Our findings suggest ACE exposure is associated with the most common and costly chronic pain conditions, including back and neck pain and other MSDs, which account for the highest total health care spending compared to other health conditions,” said the researchers. “People with ACEs tend to have a higher chronic disease burden, barriers to treatment engagement, and greater health care utilization in adulthood.”
While the mechanisms underlying the association between ACEs and chronic pain are poorly understood, the researchers posited some research-based hypotheses. Emerging evidence has linked ACEs to changes in genetic expression that affect the brain’s structure and function. ACEs may be associated with heightened pain sensitivity later in life. Childhood neglect predicts a flattening of cortisol levels in adulthood, which, in turn, predicts elevated daily pain and emotional symptoms such as depression and anxiety.
“These results underscore the urgency of addressing ACEs, particularly in light of their prevalence and health repercussions,” said Jan Hartvigsen, a study co-author. “A more nuanced understanding of the precise relationship between ACEs and chronic pain will empower healthcare professionals and policymakers to devise targeted strategies to help diminish the long-term impact of early-life adversity on adult health.”
The researchers propose undertaking further studies to delve into the biological mechanisms through which ACEs affect health across the lifespan.
The study was published in the European Journal of Psychotraumatology.
Source: McGill University