How Are Chronic Pain, Childhood Trauma, and Adult Violence Connected?

What you need to know

• Chronic pain in adulthood is associated with adverse childhood experiences (ACEs) and experiencing violence as an adult
• People who experienced 4 or more ACEs were more likely to have chronic pain and experience violence as adults
• Experiencing violence as an adult was even more strongly linked to chronic pain than childhood trauma

Background

Chronic pain is a major health problem that significantly impacts quality of life for many people. Research has shown that difficult experiences early in life, like childhood trauma, can affect health and wellbeing later on. This study aimed to examine how chronic pain in Icelandic adults relates to adverse childhood experiences and experiencing violence as an adult.

The study

This was a large survey of over 5,500 adults in Iceland aged 18-80. Participants answered questions about:

• Chronic pain (defined as pain lasting 3 months or longer)
• Adverse childhood experiences (ACEs) before age 18
• Experiencing physical, emotional, or sexual violence as an adult

The researchers looked at how these factors were related to each other.

Chronic pain is common

About 40% of participants reported having chronic pain. This is similar to rates found in previous studies in Iceland. The most common reasons given for chronic pain were:

• Muscle inflammation (39%)
• Physical wear and tear from long-term strain (30%)
• Osteoarthritis (25%)
• Injuries from accidents (23%)
• Fibromyalgia (20%)

Many people experienced childhood adversity

Over 60% of participants reported at least one adverse childhood experience. About 16% had experienced 4 or more ACEs. Women were more likely than men to have experienced multiple ACEs (21% vs 13% had 4+ ACEs).

The ACE questionnaire asks about experiences like:

• Living with someone with mental illness or substance abuse issues
• Parents separating or divorcing
• Witnessing domestic violence
• Experiencing abuse or neglect

Research shows that having 4 or more ACEs significantly increases the risk of health problems later in life.

Violence in adulthood was also common

Many participants reported experiencing violence as adults:

• 20% experienced physical violence
• 35% experienced emotional abuse
• 22% experienced sexual violence

Women were much more likely than men to report sexual violence (33% vs 8%).

Links between childhood trauma, adult violence, and chronic pain

The study found several important connections:

1. People who experienced 4 or more ACEs were more likely to have chronic pain as adults.

2. Those with 4+ ACEs were also more likely to experience violence as adults.

3. Experiencing violence as an adult was linked to higher rates of chronic pain. This connection was even stronger than the link between childhood trauma and chronic pain.

4. Both childhood trauma and adult violence were independently associated with increased risk of chronic pain.

Why might these factors be connected?

There are likely complex reasons for the relationships between childhood trauma, adult violence, and chronic pain. Some possibilities the researchers discuss:

Biological effects of trauma

Experiencing trauma, especially in childhood, can affect the body’s stress response systems. This may make people more sensitive to pain and stress later in life.

Repeated trauma can lead to changes in the nervous system, hormones, and immune system. These changes may increase vulnerability to chronic pain and other health issues.

Psychological and behavioral impacts

People who experience trauma may be more likely to develop unhealthy coping mechanisms like substance use. This could increase risk of further trauma or health problems.

Childhood trauma may also affect cognitive and emotional development in ways that increase vulnerability to re-victimization and health issues as an adult.

Cumulative effects

Experiencing both childhood trauma and adult violence may have compounding negative effects on physical and mental health, including chronic pain.

Implications

The findings highlight the long-lasting impacts of childhood adversity and violence on health. They suggest several important implications:

For healthcare providers

• Ask about history of trauma and violence when assessing patients with chronic pain
• Consider trauma-informed approaches to pain management
• Be aware that patients with chronic pain may have complex trauma histories requiring sensitive care

For prevention efforts

• Early intervention to prevent and mitigate effects of childhood adversity is critical
• Violence prevention across the lifespan may help reduce chronic pain
• Building resilience factors may help buffer against negative health effects of trauma

For future research

• Examine protective factors that may reduce health impacts of trauma
• Study mechanisms linking trauma to chronic pain
• Evaluate trauma-informed interventions for chronic pain

Limitations

As a cross-sectional study, this research cannot prove causal relationships between trauma, violence, and chronic pain. The experiences may be connected in complex ways.

Additionally, the study relied on participants’ memories of past experiences, which can be imperfect. Despite these limitations, the large sample size and consistency with other research lend strength to the findings.

Conclusions

• Chronic pain in adulthood is associated with both childhood trauma and experiencing violence as an adult
• People with multiple adverse childhood experiences are at higher risk of both chronic pain and violence in adulthood
• Healthcare providers should consider trauma history when treating chronic pain patients
• Prevention of childhood adversity and violence across the lifespan may help reduce chronic pain

This study highlights the long-reaching effects of trauma on health. It underscores the importance of trauma-informed approaches in healthcare and prevention efforts to improve pain management and overall wellbeing.