New research indicates that the risk of chronic pain and related disability in adulthood significantly increases when individuals have experienced physical, sexual, or emotional abuse, or neglect during childhood, either in isolation or in conjunction with other forms of childhood trauma. The urgency of addressing adverse childhood experiences (ACEs), defined as potentially traumatic events occurring before the age of 18, is emphasized by these findings. The study, published in the European Journal of Psychotraumatology and encompassing 75 years of research involving 826,452 adults, reveals a heightened risk of chronic pain and pain-related disability in adulthood, particularly among those who suffered physical abuse. The cumulative impact of exposure to multiple ACEs further amplifies this risk.
Lead author Dr. André Bussières from McGill University’s School of Physical & Occupational Therapy in Canada expresses deep concern over the results, highlighting that over 1 billion children worldwide, comprising half of the global child population, are exposed to ACEs annually. This exposure places them at an elevated risk of experiencing chronic pain and disability later in life. Urgent interventions and support systems are deemed necessary to break the cycle of adversity and improve long-term health outcomes for individuals exposed to childhood trauma.
ACEs may manifest directly through physical, sexual, or emotional abuse, or neglect, or indirectly through environmental factors such as domestic violence, substance abuse, or parental loss. Chronic pain, affecting a substantial portion of the global population, is a leading cause of disability. Conditions like low back pain, arthritis, headache, and migraine can significantly impair daily functioning.
While previous research has established a positive relationship between ACEs and chronic pain in adulthood, knowledge gaps persist, especially regarding the association between specific types of ACEs and pain-related conditions, as well as the existence of a dose-response relationship.
To address these gaps, the authors conducted a systematic review of 85 studies, with results from 57 studies being pooled in meta-analyses. Key findings include a 45% increased likelihood of reporting chronic pain in adulthood for individuals exposed to direct ACEs, and childhood physical abuse being linked to a higher likelihood of both chronic pain and pain-related disability. The risk of chronic pain significantly escalates with exposure to any direct ACE, either alone or combined with indirect ACEs. Moreover, the likelihood of reporting chronic pain increases from exposure to one ACE to four or more ACEs.
The authors stress the urgency of addressing ACEs due to their prevalence and health consequences. They advocate for a more nuanced understanding of the relationship between ACEs and chronic pain to empower healthcare professionals and policymakers to devise targeted strategies for mitigating the long-term impact of early-life adversity on adult health. The authors also propose future research should delve into the biological mechanisms through which ACEs affect health across the lifespan, aiming to deepen understanding and develop strategies to mitigate their impact.
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