Childhood trauma, such as sexual, physical, or emotional abuse, or neglect, is associated with chronic pain later in life.
Adults with a history of childhood trauma such as sexual, physical, or emotional abuse, or neglect, have a higher risk for both pain and pain-related disability, according to study findings published in the European Journal of Psychotraumatology.
Adverse childhood experiences (ACEs) have been previously associated with pain in adulthood, but it has remained unclear what types and degrees of exposure to ACE may increase the risk for chronic pain and pain-related disability later in life. Previous analyses have included small sample sizes, unclear exposure and outcome definitions, and inconsistent inclusion of comparison groups. To evaluate the associations between exposure to ACEs and chronic pain and pain-related disability in adults, researchers conducted a systematic review and meta-analysis.
The researchers identified 85 cross-sectional observational studies, of which 57 were included in meta-analyses, with a population of 826,452 individuals (mean age, 44). The studies reported on ACEs during childhood including abuse and neglect (direct exposure) to other household and socioeconomic (indirect) exposures. The studies further reported musculoskeletal disorders and/or nonmusculoskeletal chronic pain, such as headache, migraine, fibromyalgia, and irritable bowel syndrome, as defined by the International Association for the Study of Pain (IASP), and quantified any associated disability.
The likelihood of reporting chronic pain conditions later in life was significantly higher among individuals exposed to direct childhood ACEs (adjusted odds ratio [aOR], 1.45; 95% CI, 1.38-1.53), including neglect (aOR, 1.38; 95% CI, 1.15-1.66), sexual abuse (aOR, 1.37; 95% CI, 1.25-1.49), and emotional abuse (aOR, 1.56; 95% CI, 1.36-1.78) compared with those with ACE.
Individuals who had experienced childhood physical abuse were more likely to report not only chronic pain (aOR, 1.50; 95% CI, 1.39–1.64) but also pain-related disability (aOR, 1.46; 95%CI, 1.03–2.08). This result was not influenced by sensitivity analysis.
The researchers also found that exposure to any ACE, including indirect exposures, had higher odds of developing any of a variety of musculoskeletal and nonmusculoskeletal pain conditions (aOR, 1.53; 95% CI, 1.42–1.65), as well as pain-related disability (aOR, 1.29; 95% CI, 1.01–1.66), in adulthood.
No significant association was identified between pooled estimates for chronic pain or pain-related disability outcome and measured covariate such as country, setting, or year of publication.
Study limitations included the potential lack of accuracy of self-reported ACEs and the cross-sectional designs of the included studies that did not differentiate between cause and effect and are prone to selection and recall bias.
The researchers suggested that these results underscore the need for trauma-informed care for chronic pain in adults. They concluded, “Over 1 billion children — half of all children in the world — are exposed to physical, sexual, or emotional violence or neglect each year. The endemic magnitude of ACEs, their health consequences, and their combined attributable costs … compel urgent action.”
Note: This article originally appeared on Psychiatry Advisor
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