https://orcid.org/0000-0002-2818-6949
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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.
HIGHLIGHTS
Previous meta-analyses highlighted the negative impact of adverse childhood experiences on physical, psychological, and behavioural health across the lifespan.
We found exposure to any direct adverse childhood experience, i.e. childhood sexual, physical, emotional abuse, or neglect alone or combined, increased the risk of reporting chronic pain and pain-related disability in adulthood.
The risk of reporting chronic painful disorders increased with increasing numbers of adverse childhood experiences.
Antecedentes: Se ha demostrado que las experiencias adversas en la infancia (ACE, por sus siglas en inglés) afectan negativamente la salud en la edad adulta. Faltan estimaciones de las asociaciones entre las ACEs y las enfermedades dolorosas crónicas.
Objetivos: Esta revisión sistemática y metaanálisis tuvo como objetivo evaluar las asociaciones entre la exposición a ACE y el dolor crónico y la discapacidad relacionada con el dolor en adultos.
Métodos: Buscamos en 10 bases de datos electrónicas desde su inicio hasta febrero de 2023. Incluimos estudios observacionales que evaluaron las asociaciones entre ACEs directas (abuso sexual, físico, y emocional en la infancia, o negligencia) solas o en combinación con ACEs indirectas (presenciar violencia doméstica, enfermedad mental en el hogar), y dolor crónico en adultos (≥3 meses de duración) y discapacidad relacionada con el dolor (actividades diarias limitadas por el dolor crónico). Pares de revisores extrajeron los datos de forma independiente y evaluaron los riesgos de sesgo de los estudios. Se utilizaron modelos de efectos aleatorios para calcular las medidas agrupadas de probabilidades ajustadas [aOR]. Tau cuadrado [T2], intervalos de predicción del 95% [PI 95%] e I2 expresaron la cantidad de heterogeneidad, y las meta regresiones y los metaanálisis de subgrupos investigaron las fuentes de heterogeneidad (PROSPERO: CRD42020150230).
Resultados: Identificamos 85 estudios que incluyeron 826.452 adultos, de los cuales 57 estudios se incluyeron en los metaanálisis. La calidad de los estudios fue en general buena o regular (n = 70). Las probabilidades de reportar dolor crónico en la edad adulta fueron significativamente mayores entre las personas expuestas a una ACE directa (ORa, 1,45; IC del 95%, 1,38–1,53). Las personas que reportaron abuso físico en la infancia tenían significativamente más probabilidades de reportar tanto dolor crónico (ORa, 1,50, IC 95, 1,39–1,64) como discapacidad relacionada con el dolor (1,46, IC 95, 1,03–2,08) durante la edad adulta. La exposición a cualquier ACE sola o combinada con ACEs indirectas aumenta significativamente las probabilidades de sufrir afecciones dolorosas crónicas en adultos (ORa, 1,54; IC del 95%, 1,44–1,65) y la discapacidad relacionada con el dolor (ORa, 1,29; IC del 95%, 1,01–1,66). El riesgo de dolor crónico en la edad adulta aumentó significativamente desde un ACE (aOR, 1.29, 95%CI, 1.22–1.37) a cuatro o más ACEs (1.95, 95%CI, 1.73–2.19).
Conclusiones: Las ACE únicas y acumulativas se asocian significativamente con el reporte de dolor crónico y discapacidad relacionada con el dolor en la edad adulta.
Authors contributions
Dr Bussières had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Bussières, Hancock, Hartvigsen with input from all authors
Acquisition, analysis, or interpretation of data: all authors
Drafting of the manuscript: Bussières, Hancock, Hartvigsen
Critical revision of the manuscript for important intellectual content: all authors
Statistical analysis: Bussières
Administrative, technical, or material support: Bussières, Chaudhry, Tolentino
Supervision: Bussières, Hancock, Hartvigsen
Other – review of excluded and included studies: all authors
developed the search: Boruff, Al Zoubi, Bussières
Disclosure statement
All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
The lead author AB (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data availability
The authors confirm that the data supporting the findings of this study are available within the article, its supplementary materials, and the published protocol.
Dissemination to participants and related patient and public communities
The dissemination plan targets a wide audience, including members of the public, patients, patient and public communities, health professionals, and experts in the specialty through various channels: written communication, events and conferences, networks, and social media.
Provenance and peer review
Not commissioned; externally peer reviewed.
Additional contributions
We thank Nazi Torabi, MLIS (University of Toronto), for peer review of the MEDLINE search strategy.
Completed checklist – MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies and the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols)