Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis

• Published in: European journal of psychotraumatology Vol. 14; no. 2; p. 2284025
• Main Authors: Bussières, André, Hancock, Mark J, Elklit, Ask, Ferreira, Manuela L, Ferreira, Paulo H, Stone, Laura S, Wideman, Timothy H, Boruff, Jill T, Al Zoubi, Fadi, Chaudhry, Fauzia, Tolentino, Raymond, Hartvigsen, Jan
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 2023; Taylor & Francis Group
• Subjects: Adult; Adverse Childhood Experiences; chronic pain; Chronic Pain - epidemiology; emotional abuse; Humans; Mental Disorders; neglect; physical abuse; Review; Sex Offenses; sexual abuse; chronic pain; dolor crónico; emotional abuse; musculoskeletal pain; negligencia; physical abuse; meta-analysis; dolor musculoesquelético; systematic review; sexual abuse; pain-related disability; Experiencia adversa en la infancia; abuso sexual; abuso emocional; metaanálisis; Adverse childhood experiences; discapacidad relacionada con el dolor; abuso físico; revisión sistemática; neglect
• ISSN: 2000-8066; 2000-8066
• DOI: 10.1080/20008066.2023.2284025

Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking. This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults. We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T ], 95% prediction intervals [95%PI] and I expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230). We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (  = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19). Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.