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

Nicolson, Karen P.; Mills, Sarah; Senaratne, Dhaneesha; Smith, Blair H.

doi:10.1016/j.bjao.2023.100139

Cited by 14 publications

(6 citation statements)

References 98 publications

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“…A recent review found that a wide range of adverse childhood experiences is associated with the development, severity, and impact of chronic pain in adulthood and that the more severe the adverse experiences, the stronger this effect 4 .…”

Section: Introductionmentioning

confidence: 99%

Overview: Chronic Pain and Cannabis-Based Medicines

Karst

2024

Pharmacopsychiatry

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Chronic pain is primarily conceptualized as a disease in its own right when it is associated with emotional distress and functional impairment. Pathophysiologically, dysfunction of the cortico-mesolimbic connectome is of major importance, with overlapping signals in the nociceptive and stress systems. The endocannabinoid system plays an important role in the central processing of nociceptive signals and regulates the central stress response. Clinically, there is moderate evidence that cannabis-based medicines (CBM) can contribute to a significant reduction in pain, especially the associated pain effect, and improvement in physical function and sleep quality in a proportion of patients with chronic pain. The analgesic effect appears to be largely independent of the cause of pain. In this context, CBM preferentially regulates stress-associated pain processing.

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Section: Introductionmentioning

confidence: 99%

Overview: Chronic Pain and Cannabis-Based Medicines

Karst

2024

Pharmacopsychiatry

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“…Clinical or pathological anxiety involves increased feelings of dread that interfere with standard functioning and may be mediating hypervigilance, potentially contributing to or exacerbating pain experiences (Woo, 2010). Additionally, a recent systematic review documented high levels of ACEs in adults with chronic pain and showed that ACEs impacted the form, presence, severity, and extent of chronic pain in adults (Nicolson et al, 2023). Several studies have also shown the involvement of neuroanatomical reorganization, neurotrophin and monoamine depletion, neuroinflammation, and endocannabinoid system changes to the general experience of pain after trauma (Brown et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Anxiety, history of childhood adversity, and experiencing chronic pain in adulthood: A systematic literature review and meta‐analysis

Dalechek,

Caes,

McIntosh

et al. 2024

European Journal of Pain

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BackgroundWhen considering factors that may impact chronic pain experiences in adulthood, adverse childhood experiences (ACEs) and anxiety should be considered. The literature on the associations between these 3 variables remains unclear.ObjectiveTo summarize the existing literature on the relationship between ACEs and anxiety on chronic pain experience in adults, and examine the association between ACEs and anxiety.MethodsA systematic literature review (SLR) and meta‐analysis was used to examine adults (≥18) with a reported history of ACEs, self‐reported and/or diagnosed anxiety, and chronic pain. The SLR included quality appraisal according to the Joanna Briggs Institute tool.ResultsThe narrative summary indicated a significant association between ACEs, anxiety, and chronic pain experiences in adults. Of 52 selected studies, 79% reported a moderate–strong association. For ACE prevalence, the majority reported experiencing sexual abuse (50% [SD 16.01]), followed by physical abuse (46% [SD 20.7]). Other ACEs included emotional abuse (33% [SD 17.17]), emotional neglect (25% [SD 21.02]), and physical neglect (23% [SD 22.44]). Meta‐analyses showed moderate associations between anxiety and chronic pain (r = 0.30; 95% CI = [0.14, 0.45], p < 0.01) and between ACEs and anxiety (r = 0.26; 95% CI = [0.15, 0.36], p < 0.01), and that participants who experienced ACEs are around twice as likely to present chronic pain during adulthood (OR = 1.99; 95% CI = [1.53, 2.60], p < 0.01).ConclusionThe results of the SLR and meta‐analysis indicated that ACEs and anxiety influence chronic pain experience in adults. Given the relationship between ACEs and anxiety, there would be value in exploring this as a potential mediator in future studies.SignificanceThere was an unmet need to summarize the existing literature on the relationship between ACEs and anxiety on chronic pain experience in adults and the association between ACEs and anxiety. The results of this systematic review and meta‐analysis indicated that both ACEs and anxiety influenced chronic pain experience in adults and helped to inform the diverse literature on these potential relationships to date.

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“…Family strain and dysfunction have a negative impact on the flourishing of a child (2). Childhood adversity is associated with poorer health and the occurrence, severity, and impact of chronic pain in later life (3)(4)(5)(6)(7)(8)(9). Chronic pain negatively impacts family dynamics (10)(11)(12), and conversely, family strain negatively impacts pain experience (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

“…Reviews of the literature provide evidence that internal family systems contribute to chronic pain and treatment outcomes and should be a target for intervention (23)(24)(25). In 2023, a systematic review by Nicolson et al of 68 studies found strong associations between chronic pain in adulthood and a broad range of adverse childhood events including household dysfunction, bullying, living in fear, emotional trauma, and weak parental attachment (9). Nicolson et al (9) identified 15 different types of adverse childhood experiences, with emotional abuse being common, although there were no studies that specifically investigated childhood adversity through the lens of paternalistic family system power.…”

Section: Introductionmentioning

confidence: 99%

“…In 2023, a systematic review by Nicolson et al of 68 studies found strong associations between chronic pain in adulthood and a broad range of adverse childhood events including household dysfunction, bullying, living in fear, emotional trauma, and weak parental attachment (9). Nicolson et al (9) identified 15 different types of adverse childhood experiences, with emotional abuse being common, although there were no studies that specifically investigated childhood adversity through the lens of paternalistic family system power. In this article, we seek to uncover where paternalistic control and power reside within the family system, and how this may influence pain and its persistence.…”

Section: Introductionmentioning

confidence: 99%

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Hidden family rules: perspective on a dysfunctional paternalistic system and the persistence of pain

Hudson,

Johnson

2023

Front. Pain Res.

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This article explores how paternalistic control and power reside within the family system and how this may influence pain and its persistence. Drawing upon clinical case studies and existing literature, this exploration emphasises the role of paternal dysfunction in creating emotional memory images and delves into how this may influence the chronification and treatment resistance of pain (i.e., making pain “sticky”). We argue that a dysfunctional paternalistic family system, often characterised by authoritarian dynamics, emotional neglect, and abuse, results in adverse experiences and emotional memory images that create a fertile ground for the entrenchment and propagation of psychosomatic symptoms, including pain. Further, the paper emphasizes the potential intergenerational effects of such a scenario, where inherited “Family Rules” drive maladaptive coping mechanisms, which contribute to the persistence of psychological and physiological distress across generations. Understanding these complexities offers new perspectives on treating psychological disorders and their physiological ramifications. It also highlights the urgency of addressing dysfunctional familial dynamics in psychotherapeutic interventions for both immediate and long-term psychophysiological health outcomes.

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

Cited by 14 publications

References 98 publications

Overview: Chronic Pain and Cannabis-Based Medicines

Overview: Chronic Pain and Cannabis-Based Medicines

Anxiety, history of childhood adversity, and experiencing chronic pain in adulthood: A systematic literature review and meta‐analysis

Hidden family rules: perspective on a dysfunctional paternalistic system and the persistence of pain

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