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Review
. 2022 Jun 10:3:923866.
doi: 10.3389/fpain.2022.923866. eCollection 2022.

The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care

Lydia V Tidmarsh  1 , Richard Harrison  1 , Deepak Ravindran  2 , Samantha L Matthews  1 , Katherine A Finlay  1
Affiliations
Review

The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care

Lydia V Tidmarsh et al. Front Pain Res (Lausanne). .

Abstract

Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.

Keywords: ACEs; chronic pain; fear-avoidance; pain catastrophizing; person-centered care; treatment adherence and completion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. . Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. (2012) 380:2163–96. 10.1016/S0140-6736(12)61729-2 - DOI - PMC - PubMed
    1. Fayaz A, Croft P, Langford RM, Donaldson LJ, Jones GT. Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies. BMJ Open. (2016) 6:e010364. 10.1136/bmjopen-2015-010364 - DOI - PMC - PubMed
    1. Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, et al. . The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain. (2020) 161:1976–82. 10.1097/j.pain.0000000000001939 - DOI - PMC - PubMed
    1. Sachs-Ericsson NJ, Sheffler JL, Stanley IH, Piazza JR, Preacher KJ. When emotional pain becomes physical: adverse childhood experiences, pain, and the role of mood and anxiety disorders: when emotional pain becomes physical. J Clin Psychol. (2017) 73:1403–28. 10.1002/jclp.22444 - DOI - PMC - PubMed
    1. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. . Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. Am J Prev Med. (1998) 14:245–58. 10.1016/S0749-3797(98)00017-8 - DOI - PubMed