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Bussières A, Hancock MJ, Elklit A, Ferreira ML, Ferreira PH, Stone LS, Wideman TH, Boruff JT, Al Zoubi F, Chaudhry F, Tolentino R, Hartvigsen J. Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis. Eur J Psychotraumatol 2023; 14:2284025. [PMID: 38111090 PMCID: PMC10993817 DOI: 10.1080/20008066.2023.2284025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/22/2023] [Indexed: 12/20/2023] Open
Abstract
Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: 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 [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 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).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.
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Affiliation(s)
- André Bussières
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Mark J. Hancock
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Ask Elklit
- National Centre for Psychotraumatology, Department of Psychology, University of Southern DenmarkOdense, Denmark
| | - Manuela L. Ferreira
- Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paulo H. Ferreira
- Musculoskeletal Health, Faculty of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Laura S. Stone
- Faculty of Dentistry, McGill University, Montreal, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
- Department of Anesthesiology, Faculty of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Timothy H. Wideman
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Jill T. Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Canada
| | - Fadi Al Zoubi
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Fauzia Chaudhry
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Raymond Tolentino
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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Contextualizing Adverse Childhood Experiences: The Intersections of Individual and Community Adversity. J Youth Adolesc 2023; 52:570-584. [PMID: 36445650 DOI: 10.1007/s10964-022-01713-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022]
Abstract
Adverse Childhood Experiences (ACEs) are traumatic childhood events that can undermine youth development, and are linked to chronic health problems, mental illness, and risk-taking behaviors in adulthood. ACEs are preventable, yet effective response strategies require comprehensive conceptualization and measurement of adversity. Although typically measured as individual experiences in the family and home (e.g., abuse, neglect), adversity also exists outside the home, in the many contexts in which youth development unfolds (e.g., communities, neighborhoods). Yet, such contexts and experiences are often absent in ACEs research. Using data from a nationally representative youth sample, this study addresses that gap, advancing a measure that contextualizes individual-level ACEs within social and structural domains of community-level adversity. Among 13,267 youth (mean age = 15.25 [range 12-18]; 51% female; 71% White; 13% Black; 10% Hispanic; 3% Asian; 2% American Indian/Multiracial), 61% and 73% were exposed to at least one individual and community ACE, respectively, while 15% of youth reported severe individual ACE exposure (≥3 ACEs) and 20% were exposed to severe (≥3) community ACEs. All ACE exposures were associated with problem behaviors later in adolescence, but youth reporting both severe individual and community ACEs were especially at high risk for later violence, delinquency, and other health-risk behaviors. These findings highlight that community adversity exacerbates the damaging effects of individual/family adversity and thus should be addressed in efforts to prevent ACEs and reduce their long-term harm.
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