Background & Aims
Adverse childhood experiences (ACEs) have been associated with persistent brain changes, altered behaviour and stress reactivity, and an increased risk of physical and mental health morbidities, including chronic pain and depression. However, the underlying structural brain alterations remain poorly understood. This study aimed to investigate the associations between ACEs and chronic pain. More specifically, it investigated the brain’s grey matter volumes among participants who had reported experiencing chronic pain. Additionally, it examined the relationship between those who had reported chronic pain and ACEs in brain regions involved in pain perception and reward networks.
Methods
The Generation Scotland Scottish Family Health Study(GS:SFHS) dataset of around 24000 community-based participants contains socio-demographic and clinical data collected at study entry, including the Chronic Pain Grade (CPG) for people with pain for more than 3 months. We analysed a subset of the GS:SFHS participants who took part in the Stratifying Resilience and Depression Longitudinally (STRADL) study whose assessments included a structural Magnetic Resonance Imaging scan. Each participant completed ratings of childhood adversity using the Childhood Trauma Questionnaire (CTQ). Voxel-based morphometry (VBM) and Region of Interest (ROI) statistical analysis were performed on brain regions associated with pain perception and the reward network, including the nucleus accumbens (Nacc), thalamus, hippocampus, amygdala, cingulate, and orbitofrontal areas. ROI analysis was utilised in order to perform a more detailed examination of the impact and interaction between chronic pain and ACEs.
Results
The dataset included a total of 847 participants with a mean (SD) age of 59.03 (10.33); 525/847 were females; of these, 368 had reported experiencing chronic pain, and 245/368 were females. In the VBM analysis, reduction of the grey matter of the Nacc in participants who had reported chronic pain was observed compared to those without, as well as with the severity of more severe chronic pain. Moreover, the same pattern emerged in those who had reported ACEs, as well as for the combined impact of chronic pain and ACEs sub-scores. In the ROI analysis, further investigation confirmed the results from the VBM analysis. When examining chronic pain and ACEs separately, each exhibited a similar pattern: lower grey matter volume in the Nacc (p<.001). However, there was no noticeable difference in the effects of ACEs or Chronic pain, while when testing for the combined impact of chronic pain and ACEs, the effect appears to be synergistic (p<.001).
Conclusions
Both chronic pain and ACEs lead to comparable decreases in grey matter volume in the Nacc when considered independently. This study provides new insights into the neural substrates underlying the comorbidity of chronic pain and ACEs by demonstrating significant structural alterations in brain regions associated with reward processing.
References
1) Habota, Tina, Anca-Larisa Sandu, Gordon D. Waiter, Christopher J. McNeil, J. Douglas Steele, Jennifer A. Macfarlane, Heather C. Whalley et al. “Cohort profile for the STratifying Resilience and Depression Longitudinally (STRADL) study: A depression-focused investigation of Generation Scotland, using detailed clinical, cognitive, and neuroimaging assessments.” Wellcome open research 4 (2019).
2) Smith, Blair H., Archie Campbell, Pamela Linksted, Bridie Fitzpatrick, Cathy Jackson, Shona M. Kerr, Ian J. Deary et al. “Cohort Profile: Generation Scotland: Scottish Family Health Study (GS: SFHS). The study, its participants and their potential for genetic research on health and illness.” International journal of epidemiology 42, no. 3 (2013): 689-700.
Presenting Author
Georgia Antoniou
Poster Authors
Topics
- Pain Imaging