Childhood Trauma Raises Risk of Chronic Pain and Other Health Problems in Adults
/By Crystal Lindell
A new study has found links between childhood trauma, chronic pain and several health problems in adults, according to research published in JAMA Network Open.
Many previous studies have found that adverse childhood experiences (ACEs) increase the risk of chronic pain in adulthood. This study goes further, finding links between ACEs and severe pain, poor mental health, back and hearing problems, gastrointestinal issues, and hypertension at age 50.
However, it remains unclear how much of that association may be causation and how much is simple correlation. There is also a very real concern that the study will add to the stigma that chronic pain patients already face in the medical community.
The research, which was conducted by a team of scientists at the University of Aberdeen, followed over 16,000 participants in the UK who were enrolled in the National Child Development Study. All were born during one week in 1958 in England, Scotland or Wales, and were interviewed when they turned 50.
Researchers asked about their current health and whether they experienced any childhood trauma, such as abuse, neglect, bullying, divorce and financial stress, or if they had witnessed substance abuse, criminal activity or mental illness in their family.
While most studies report associations between ACEs and a single health outcome, researchers say this is the first research to look at a broad range of health outcomes.
They found that mental health problems and severe pain in adults had the strongest connections to childhood trauma. Men and women who experienced childhood adversity were more likely to suffer from depression, anxiety, and chronic pain at 50.
Women who had an ACE were also more likely to have digestive problems, asthma or bronchitis compared to women who did not experience childhood trauma.
It’s important to note that the “higher risk” was often marginal, at best. For example, while 8.7% of men who experienced childhood trauma had severe pain at 50, that compares to 4.88% of men with severe pain at 50 who did not have an ACE. That’s just a 4% difference.
The same is true for women. Researchers found that 11.22% of women with childhood trauma had severe pain at 50, compared to 7.53% of women with no history of ACE. Again, just a 4% difference. Most researchers look for at least a 5% difference before calling an outcome “statistically significant.”
Little or no association was found between ACEs and migraine, hay fever or rhinitis, eyesight problems, or skin problems.
Researchers found that the more trauma experienced, the greater the impact on health at age 50. People who experienced four or more types of childhood adversity had the highest risk of developing health problems as adults. Abuse, neglect, and family conflict had the most wide-ranging consequences. Just one adverse childhood event was found to increase the risk of dying before age 50.
The research was partly funded by Versus Arthritis, the UK’s largest charity supporting people with arthritis.
"This important research highlights the strong relationship between early childhood adversity and severe pain in adulthood. Findings suggest that our earliest experiences may be driving the health inequalities we know exist for people living with chronic pain,” Deborah Alsina, CEO of Versus Arthritis, said in a press release.
"Tackling childhood adversity is vital if our governments are serious about reducing the burden of chronic pain for the next generation."
Early Intervention and Prevention
Researchers say the study highlights the importance of preventing childhood trauma and providing early support to at-risk families.
"Going forward, screening for ACEs in primary care settings, and targeted interventions for at-risk individuals, may help reduce the burden of chronic pain, mental ill-health, and other poor health outcomes,” said lead author Gary Macfarlane, PhD, Chair of Epidemiology at the University of Aberdeen.
"While 'broad spectrum' interventions remain important to ameliorate the impact of ACEs, a targeted approach, considering types of ACE, could address specific vulnerabilities — particularly mental ill-health and severe pain.”
That’s an important goal, but for adults already suffering from health issues that could be linked to childhood trauma, that doesn’t offer much help.
In the real world, studies like this are very often used to dismiss the health problems people suffer. That's especially true for chronic pain.
Patients are often told their pain was caused by childhood trauma, and doctors use that as an excuse to invalidate their symptoms and withhold treatments like opioid pain medication. This gets especially frustrating when a history of childhood trauma is then used to claim that a patient is more likely to abuse opioids.
Many doctors seem to believe that if childhood trauma is the direct cause of a health issue, then the only real treatment is mental health services. This can contribute to the stereotype that chronic pain is “all in your head” or that patients are “just looking for attention.”
There is also the question of causation vs correlation. For example, many health conditions are hereditary, including those that cause chronic pain, like arthritis and Ehlers-Danlos Syndrome.
Parents who grew up with those health problems may be more likely to have negative experiences with their children. Chronic pain drains time, money and energy, which then impacts someone's ability to be a present parent. So a parent with chronic pain may be more likely to neglect their child, not out of malice but out of necessity, as they deal with their own health issues.
Then when the child grows up and has chronic pain, it seems like it could be related to childhood trauma when it may be actually be a case of simple genetics.
While it is important to find better ways to respond to children who have experienced trauma, it’s also important that such research is not used to dismiss adults dealing with health issues. For many adults, the current trauma of living with chronic pain is more pressing than what they experienced in childhood.
