Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a stystematic review and meta-analysis

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. 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 ingles) afectan negativamente la salud en la edad adulta. Faltan estimaciones de las asociaciones entre las ACEs y las enfermedades dolorosas cronicas.Objetivos: Esta revision sistematica y metaanalisis tuvo como objetivo evaluar las asociaciones entre la exposicion a ACE y el dolor cronico y la discapacidad relacionada con el dolor en adultos.Metodos: Buscamos en 10 bases de datos electronicas desde su inicio hasta febrero de 2023. Incluimos estudios observacionales que evaluaron las asociaciones entre ACEs directas (abuso sexual, fisico, y emocional en la infancia, o negligencia) solas o en combinacion con ACEs indirectas (presenciar violencia domestica, enfermedad mental en el hogar), y dolor cronico en adultos (>= 3 meses de duracion) y discapacidad relacionada con el dolor (actividades diarias limitadas por el dolor cronico). 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 prediccion del 95% [PI 95%] e I2 expresaron la cantidad de heterogeneidad, y las meta regresiones y los metaanalisis 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 metaanalisis. La calidad de los estudios fue en general buena o regular (n = 70). Las probabilidades de reportar dolor cronico 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 fisico en la infancia tenian significativamente mas probabilidades de reportar tanto dolor cronico (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 exposicion a cualquier ACE sola o combinada con ACEs indirectas aumenta significativamente las probabilidades de sufrir afecciones dolorosas cronicas 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 cronico en la edad adulta aumento significativamente desde un ACE (aOR, 1.29, 95%CI, 1.22-1.37) a cuatro o mas ACEs (1.95, 95%CI, 1.73-2.19).Conclusiones: Las ACE unicas y acumulativas se asocian significativamente con el reporte de dolor cronico y discapacidad relacionada con el dolor en la edad adulta.