Pain Rehabilitation Program, Mary Free Bed Rehabilitation Hospital.
Michigan State University College of Human Medicine, Grand Rapids, MI.
Clin J Pain. 2021 May 1;37(5):321-329. doi: 10.1097/AJP.0000000000000924.
Adverse childhood experiences (ACEs) are commonly reported by individuals with chronic pain. However, little is known about how ACE exposure influences treatment outcomes. The goal of the current study was to evaluate group and treatment-related differences among adults with varying levels of ACE exposure participating in a pain rehabilitation treatment program.
Adult participants (N=269) were categorized as 0 ACEs (n=65), 1 to 2 ACEs (n=87), or ≥3 ACEs (n=117). Participants completed self-report measures of pain, physical functioning, and psychosocial functioning at intake and discharge from a 10-week interdisciplinary pain rehabilitation program.
ACE exposure was frequently endorsed in this sample, with the majority of participants (78.5%) reporting at least 1 form of childhood adversity. Adults in the ≥3 ACEs group reported a greater level of impairment in mental health symptoms and adjustment to chronic pain; however, all groups endorsed treatment improvements and there were no differences in response to treatment. There were also no differences between groups on measures of pain or physical functioning at intake or discharge.
ACE exposure appears common among treatment-seeking adults with chronic pain and is associated with increased clinical complexity. However, adults with and without exposure to ACEs endorsed significant improvements in pain and functioning following participation in an interdisciplinary pain rehabilitation program. This model of treatment may be especially well situated to address the biopsychosocial contributions to pain among those with a history of adversity.
慢性疼痛患者常自述曾经历过不良的童年经历（ACEs）。然而，人们对 ACE 暴露如何影响治疗结果知之甚少。本研究的目的是评估在参加疼痛康复治疗项目的不同 ACE 暴露水平的成年人中，群体和治疗相关的差异。
将成年参与者（N=269）分为 0 ACEs（n=65）、1 至 2 ACEs（n=87）或≥3 ACEs（n=117）。参与者在参加为期 10 周的跨学科疼痛康复项目时和出院时完成了疼痛、身体功能和心理社会功能的自我报告测量。
在该样本中，ACE 暴露频繁发生，大多数参与者（78.5%）报告至少有一种形式的童年逆境。≥3 ACEs 组的成年人报告心理健康症状和对慢性疼痛的适应程度更高的障碍；然而，所有组都报告了治疗改善，并且对治疗没有差异。在入组时或出院时，疼痛或身体功能的测量也没有组间差异。
ACE 暴露在寻求治疗的慢性疼痛成年人中似乎很常见，并且与临床复杂性增加有关。然而，在参加跨学科疼痛康复治疗项目后，有和没有 ACE 暴露的成年人在疼痛和功能方面都有显著改善。这种治疗模式可能特别适合解决那些有逆境史的人疼痛的生物心理社会因素。
