Adverse Childhood Experiences: Triple the Risk for Chronic Pain Later

"Chronic pain (CP) in adult life is a widespread and potentially disability-associated experience: About twelve to 14 percent of people in Europe and 19 percent of the US population report chronic pain conditions, with seven to 14 percent also reporting moderate to severe disability as a result. Chronic pain is one of the leading causes of 'years lived with disability' worldwide and also has a strong socioeconomic effect. In Europe, the average annual costs due to chronic pain range between three and ten percent of the gross domestic product," wrote David Riedl (Ludwig Boltzmann Institute for Rehabilitation Research/Vienna and University Clinic for Psychiatry/Innsbruck) and other researchers in the journal "Diagnostics".

Study Shows Link Between Traumatic Childhood Experiences and Chronic Pain

According to the scientists, it has been known for some time that depression, anxiety disorders, and trauma are often associated with chronic pain conditions. Conversely, depression and anxiety disorders are frequently comorbidities of chronic pain. "Furthermore, traumatic experiences, especially adverse childhood experiences (ACEs), can act as long-term risk factors that increase the susceptibility to chronic pain in adulthood," the experts wrote. However, the period during which children or adolescents are most vulnerable to this was previously unclear.

The study was conducted with inpatients and patients who visited the outpatient clinics of seven departments of the University Clinic Innsbruck (ENT, trauma and neurosurgery, neurology, gynecology, internal medicine, and radiology). A total of 2,577 participants took part in the study. During the waiting times, they filled out detailed questionnaires. Nearly one-third of the participants (average age around 47 years) reported chronic pain lasting more than six months. The questions related to psychological and physical abuse or neglect, traumatic experiences suffered, stress experiences, and finally the pain symptomatology.

Nearly 30 percent of all study participants reported one to three severely distressing negative childhood experiences, about six percent reported more frequent negative childhood experiences. The most frequently mentioned was emotional abuse (around 18 percent), followed by abuse by parents, etc. In third place (twelve percent) was physical or psychological neglect.

Particularly Vulnerable in Prepuberty

The risk for the later occurrence of chronic pain conditions was apparently literally "dose-dependent." "Compared to patients without adverse childhood experiences, the frequency of chronic pain conditions increased by a factor of 1.5 with one to three such experiences," the experts found. With four or more such distressing experiences, the risk of chronic pain tripled.

With an AI system including machine learning, the phase of the affected individuals was finally identified in which they were most vulnerable to later negative consequences of adverse childhood experiences. "This is the first study to demonstrate a time dependency of the connection between adverse childhood experiences and chronic pain conditions (in adulthood; note)," the study summary states. The key point: abuse, poor treatment in psychological or physical terms, neglect, and trauma "between the ages of ten and twelve" are the most important prognostic factors for later occurring chronic pain.

The early detection of such situations to which children may be exposed and psychosocial support in the given case would be one of the core tasks for health professionals, the scientists state. This could also prevent consequences of adverse childhood experiences that occur after many years.

(APA/Red.)

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