What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review

Karen P. Nicolson*, Sarah E.E. Mills, Dhaneesha N.S. Senaratne, Lesley A. Colvin, Blair H. Smith

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Abstract

Background
Adverse childhood experiences and chronic pain are complex problems affecting millions of people worldwide, and result in significant healthcare utilisation. Our review aimed to determine known associations between adversity in childhood and chronic pain in adulthood.

Methods
We performed a prospectively registered systematic review (PROSPERO ID: 135625). Six electronic databases (Pubmed, Medline, Cochrane, Scopus, APA PsycNet, Web of Science) were searched from January 1, 2009 until May 30, 2022. Titles and abstracts were screened, and all original research studies examining associations between adverse childhood experiences and chronic pain in adulthood were considered for inclusion. Full texts were reviewed, and a narrative synthesis was used to identify themes from extracted data. Ten percent of studies were dual reviewed to assess inter-rater reliability. Quality assessment of study methodology was undertaken using recognised tools.

Results
Sixty-eight eligible studies describing 196 130 participants were included. Studies covered 15 different types of childhood adversity and 10 different chronic pain diagnoses. Dual reviewed papers had a Cohen's kappa reliability rating of 0.71. Most studies were of retrospective nature and of good quality. There were consistent associations between adverse childhood experiences and chronic pain in adulthood, with a ‘dose’-dependent relationship. Poor mental health was found to mediate the detrimental connection between adverse childhood experiences and chronic pain.

Conclusion
A strong association was found between adverse childhood experiences and chronic pain in adulthood. Adverse childhood experiences should be considered in patient assessment, and early intervention to prevent adverse childhood experiences may help reduce the genesis of chronic pain. Further research into assessment and interventions to address adverse childhood experiences is needed.
Original languageEnglish
Article number100139
Number of pages11
JournalBJA Open
Volume6
Early online date7 Jun 2023
DOIs
Publication statusPublished - 7 Jun 2023

Keywords

  • Adverse childhood experiences
  • Childhood adversity
  • Childhood trauma
  • Chronic pain
  • Systematic review

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