Nelson Sarah, Simons Laura E, Logan Deirdre
Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children's Hospital.
Department of Psychiatry, Harvard Medical School, Boston, MA.
Clin J Pain. 2018 May;34(5):402-408. doi: 10.1097/AJP.0000000000000549.
Adverse childhood experiences (ACEs) in youth have been found to be frequently associated with several chronic illnesses, including chronic pain. However, this relationship remains poorly understood. Previous research has examined the association between ACEs and chronic pain, but these have primarily been examined in the context of adults with limited assessment of ACEs and individual pain conditions. The primary objectives of this study were to examine the incidence and psychological/pain-related correlates of ACEs in a sample of youth with chronic pain. Exploratory analyses were also examined using primary pain diagnosis and number of pain locations.
Data were gathered using retrospective data from a clinical databank. Participants were 141 youth aged 9 to 19 with chronic pain who presented for evaluation at a multidisciplinary pain clinic. Information on ACEs exposure, pain diagnostic information, pain-related impairment, and psychosocial functioning were gathered via self-report and retrospective review of the medical record.
Results revealed that over 80% of youth with chronic pain reported at least 1 ACE in their lifetime. Further, multiple and univariate analyses of variance revealed that ACEs exposure is significantly associated with greater symptoms of anxiety, depression, and fear of pain, with ≥3 ACEs associated with greatest impairment in functioning. No relationships were found between ACEs and increased pain-related disability or pain intensity.
ACEs exposure in youth with chronic pain occurs frequently and can be associated with increased psychosocial but not functional impairment. Future research is needed to further examine the relationship between ACEs and chronic pain in youth in a prospective manner.
研究发现青少年时期的不良童年经历（ACEs）常常与多种慢性疾病相关，包括慢性疼痛。然而，这种关系仍未得到充分理解。此前的研究探讨了ACEs与慢性疼痛之间的关联，但主要是在成年人中进行的，对ACEs和个体疼痛状况的评估有限。本研究的主要目的是在患有慢性疼痛的青少年样本中，考察ACEs的发生率以及与心理/疼痛相关的关联因素。还使用主要疼痛诊断和疼痛部位数量进行了探索性分析。
数据收集自临床数据库的回顾性数据。参与者为141名年龄在9至19岁之间患有慢性疼痛的青少年，他们在多学科疼痛诊所接受评估。通过自我报告和对病历的回顾性审查，收集了有关ACEs暴露、疼痛诊断信息、疼痛相关损伤和心理社会功能的信息。
结果显示，超过80%患有慢性疼痛的青少年报告其一生中至少经历过1次ACEs。此外，多因素和单因素方差分析显示，ACEs暴露与焦虑、抑郁和疼痛恐惧的症状加重显著相关，≥3次ACEs与功能损害最大相关。未发现ACEs与疼痛相关残疾增加或疼痛强度之间存在关联。
患有慢性疼痛的青少年中ACEs暴露频繁发生，并且可能与心理社会功能损害增加相关，但与功能损害无关。未来需要进一步以前瞻性方式研究ACEs与青少年慢性疼痛之间的关系。
