New research finds that trauma experienced in childhood increases the likelihood of experiencing chronic pain, such as back and neck pain, in adulthood. This risk increases significantly with exposure to multiple adverse childhood experiences, highlighting the importance of addressing childhood trauma to mitigate its long-term health effects.
Adverse childhood experiences (ACEs), such as physical abuse, sexual abuse, emotional abuse, or neglect by a parent or caregiver, can cause direct harm to a child or adolescent. This harm can also occur indirectly through family dysfunction, death of a parent, divorce, parental illness, or substance abuse.
Previous research has highlighted the negative effects of ACEs on physical, mental and behavioral health, which may persist into adulthood. A recent study led by researchers at Canada's McGill University examined the relationship between childhood trauma and chronic pain in adulthood, and came up with some worrying results.
"These results are very concerning, especially since more than 1 billion children each year - half of the global child population - are affected by ACEs, putting them at increased risk of chronic pain and disability later in life," said André Bussières, first 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 the long-term health of those who have experienced childhood trauma."
The researchers conducted a systematic review and meta-analysis of 85 studies spanning 75 years and involving 826,452 adults. They excluded studies based on high-risk populations such as people who are homeless, incarcerated, or have a primary diagnosis of substance abuse, because few of these groups are affected by lower ACEs. They also excluded severely preterm infants, because prematurity is known to alter pain pathways, leading to altered pain in adulthood, and those with a clear explanation for the pain, such as those with fractures, sprains, burns, disease, neuropathy, or cancer.
Compared with people who did not report ACEs, people who directly experienced ACEs (including physical abuse, sexual abuse, emotional abuse, or neglect) were 45% more likely to later report chronic pain. People who reported childhood physical abuse had significantly higher odds of reporting chronic pain and pain-related disability in adulthood.
Individuals who experienced any ACE event, alone or in combination with indirect ACE events, were significantly more likely to report chronic pain symptoms in adulthood, including undifferentiated chronic pain, any painful musculoskeletal disorders (MSDs), arthritis, back or neck pain, fibromyalgia, headaches and migraines, irritable bowel syndrome, and pelvic pain. Exposure to any ACEs increases the odds of pain-related disability. From one AEC to four or more AECs, the risk of chronic pain in adults increases significantly regardless of pain status.
"Our findings indicate that exposure to ACEs is associated with the most common and most expensive chronic pain conditions, including back and neck pain and other MSDs, which account for the highest proportion of total health care spending compared with other health conditions. People with ACEs tend to have higher chronic disease burden, barriers to treatment participation, and greater health care use in adulthood," the researchers said.
Although little is known about the mechanisms linking ACEs to chronic pain, researchers have proposed some research-based hypotheses. Emerging evidence suggests that ACE is associated with changes in gene expression that affect brain structure and function. ACEs may be associated with increased pain sensitivity later in life. Childhood neglect predicts lower cortisol levels in adulthood, which in turn predicts increased daily pain and mood symptoms such as depression and anxiety.
"These results underscore the urgency of addressing ACEs, especially given their prevalence and impact on health," said study co-author Jan Hartvigsen. "A more granular understanding of the precise relationship between ACEs and chronic pain will empower healthcare professionals and policymakers to develop targeted strategies to help mitigate the long-term effects of early life adversity on adult health."
The researchers recommend further research to delve into the biological mechanisms by which ACE affects health across the lifespan.
The study was published in the European Journal of Psychotraumatology.