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Childhood Adversity Linked to Adult Chronic Pain

Pauline Anderson



Adults who experienced a traumatic event in childhood such as sexual, physical, or emotional abuse or neglect are 45% more likely to report chronic pain, results of a systematic review and meta-analysis suggested.


  • Researchers identified 85 mostly cross-sectional observational studies spanning 75 years with a total population of 826,452 participants (mean age of 44 years) and included 57 studies in the meta-analysis.
  • Included studies reported angiotensin-converting enzymes (ACEs) in childhood (directly through physical, sexual, or emotional abuse or neglect or indirectly through household dysfunction or living environments such as parental mental illness, divorce, severe illness, or death) and tested the association with adult chronic pain, including musculoskeletal disorders (MSDs) and non-MSDs such as headache, migraine, fibromyalgia, and irritable bowel syndrome, in patients with and without ACEs.
  • A separate meta-analysis that examined outcomes of chronic pain and pain-related disability, such as limited daily activities, for individuals exposed to direct ACEs and to at least two types of ACEs vs no ACEs was also conducted.


  • The odds of reporting chronic pain conditions later in life was significantly higher among those exposed to a direct ACE (adjusted odds ratio [aOR], 1.45; 95% CI, = 1.38-1.53), including childhood neglect (aOR, 1.38; 95% CI, 1.15-1.66), sexual abuse (aOR, 1.37; 95% CI, 1.25-1.49), and emotional abuse (aOR, 1.56; 95% CI, 1.36-1.78), than among those without ACE.
  • Adults having experienced childhood physical abuse were significantly more likely to report chronic pain (aOR, 1.50; 95% CI, 1.39-1.64; 27 studies) and pain-related disability (aOR, 1.46; 95% CI, 1.03-2.08).
  • Exposure to any ACE alone or combined with indirect ACEs significantly increased odds of adult chronic painful conditions (aOR, 1.53; 95% CI, 1.42-1.65) and odds of pain-related disability (aOR, 1.29; 95% CI, 1.01-1.66).
  • There was no significant association between pooled estimates for the outcome of chronic pain or pain-related disability and any measured covariate including country, setting, or year of publication.


"These results are extremely concerning, particularly as over 1 billion children — half of the global child population — are exposed to ACEs each year," lead author André Bussières, School of Physical & Occupational Therapy, McGill University, Montreal, Quebec, Canada, said in a press release, adding there is "an urgent need to develop targeted interventions and support systems" to improve long-term health outcomes for individuals exposed to childhood trauma.


The study was conducted by Bussières and colleagues. It was published online on December 18, 2023, in the European Journal of Psychotraumatology.


The accuracy of self-reported ACEs is uncertain. Most (84%) included studies used cross-sectional designs that do not distinguish between cause and effect and are prone to selection and recall bias. Analyses of subgroup differences were underpowered because of the small number of studies included for each ACE. As few studies were eligible to explore the association between emotional abuse or neglect and disability, the strength of this association may be underestimated.


The authors report no relevant disclosures.



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