Department of Anesthesiology, Pain, and Perioperative Medicine, Division of Pain Medicine, Boston Children's Hospital.
Departments of Psychiatry.
Clin J Pain. 2019 May;35(5):420-427. doi: 10.1097/AJP.0000000000000686.
Previous research has shown that youth with chronic pain who presented for a multidisciplinary evaluation report a history of adverse childhood experiences (ACEs) (eg, abuse, neglect, parent/guardian separation or divorce) at a high rate (over 80%) and that those with pain and ACEs experience increased psychosocial impairment. Outside of chronic pain, evidence also suggests that youth with a history of ACEs experience poorer treatment outcomes. However, no study to date has examined treatment outcomes in youth with chronic pain and a history of ACEs. The current study aimed to examine the role of ACEs in multidisciplinary intensive pain rehabilitation treatment outcomes for youth with chronic pain.
The sample included 305 youth who had undergone intensive pain rehabilitation. Outcomes examined included pain-related and psychosocial impairment measured at baseline and discharge from the program.
Results indicated that ∼59% of this sample reported a history of ACEs with ∼21% reporting a history of ≥2 ACEs. At baseline, youth with an ACEs history reported higher somatic symptoms. However, no significant interaction was found across treatment timepoints between ACEs history and time.
ACEs history was not a significant factor in treatment outcomes for youth with chronic pain who presented to intensive pain rehabilitation. However, the difference in report of ACEs history across treatment settings indicates that ACEs may be a barrier for youth to engage in recommended outpatient treatment before presenting to pain rehabilitation. Research is needed to further examine this phenomenon.
先前的研究表明，在接受多学科评估的慢性疼痛青少年中，有 80%以上（超过 80%）的人报告有不良童年经历（ACEs）（例如，虐待、忽视、父母/监护人分离或离婚），而那些有疼痛和 ACEs 的人则经历了更多的心理社会障碍。除了慢性疼痛之外，有证据表明，有 ACEs 病史的青少年的治疗效果更差。然而，迄今为止，尚无研究探讨有 ACEs 病史的慢性疼痛青少年的治疗结果。本研究旨在研究 ACEs 在慢性疼痛青少年多学科强化疼痛康复治疗结果中的作用。
该样本包括 305 名接受过强化疼痛康复治疗的青少年。评估的结果包括基线和项目结束时的疼痛相关和心理社会障碍。
结果表明，该样本中约有 59%的人有 ACEs 病史，约有 21%的人有≥2 项 ACEs 病史。在基线时，有 ACEs 病史的青少年报告有更高的躯体症状。然而，在治疗时间点上，ACEs 病史与时间之间没有显著的交互作用。
ACEs 病史不是接受强化疼痛康复治疗的慢性疼痛青少年治疗结果的重要因素。然而，在治疗环境中 ACEs 病史的报告差异表明，ACEs 可能是青少年在接受疼痛康复治疗之前接受推荐的门诊治疗的障碍。需要进一步研究这一现象。
