Childhood trauma linked to chronic pain in adulthood

Physical, sexual, or emotional abuse, or neglect, either alone or combined with other types of childhood trauma, increases the risk of chronic pain and related disability in adulthood, according to new research.

These new findings underscore the urgency of addressing adverse childhood experiences (ACEs) – potentially traumatic events that occur before 18 years of age – and taking steps to mitigate their long-term impact on people's health.

The study reviews research carried out across 75 years, involving 826,452 adults. Published in the peer-reviewed journal European Journal of Psychotraumatology, it reveals that individuals who have been exposed to various forms of traumatic events in childhood are at an increased risk of experiencing chronic pain and pain-related disability in adulthood, particularly those subjected to physical abuse. The cumulative impact of exposure to multiple ACEs further exacerbates this risk.

"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 in life," says lead author Dr André Bussières, from the School of Physical & Occupational Therapy at McGill University, in Canada.

"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."

ACEs may affect a child or teenager directly through physical, sexual, or emotional abuse, or neglect – or indirectly through exposure to environmental factors like domestic violence, living with substance abuse or parental loss. Chronic pain, affecting between one-third and one-half of the UK population alone, is one of the leading causes of disability worldwide. Long-term painful conditions such as low back pain, arthritis, headache and migraine, can affect a person's daily functioning to the point they can't work, eat properly, or participate in physical activities.

Previous research has indicated a positive relationship between exposure to ACEs and chronic pain in adulthood. However, there are still gaps in knowledge – particularly around which type of ACEs are associated with specific pain-related conditions, or whether a dose-response relationship exists.

To help address these gaps, the authors carried out a systematic review that included 85 studies. Of those, results from 57 studies could be pooled in meta-analyses. They found that:

• Individuals exposed to a direct ACE, whether physical, sexual, or emotional abuse, or neglect, were 45% more likely to report chronic pain in adulthood compared to those not exposed.

• Childhood physical abuse was associated with a higher likelihood of reporting both chronic pain and pain-related disability.

• The odds of reporting chronic pain or pain-related disability in adulthood increased with exposure to any direct ACE, either alone or combined with indirect ACEs.

• The risk of reporting chronic pain in adulthood significantly increased from exposure to one ACE to four or more ACEs.

These results underscore the urgency of addressing ACES, particularly in light of their prevalence and health repercussions."

Jan Hartvigsen, senior author, Professor from the University of Southern Denmark

"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 authors propose that future research should delve into the biological mechanisms through which ACEs affect health across the lifespan, aiming to deepen understanding and develop ways to mitigate their impact.