Background & Aims

Previous studies suggest that exposure to multiple adverse childhood experiences (ACEs) increases the likelihood of chronic pain in adulthood (1). However, most studies focus on a restricted set of ACEs (emotional, physical, and sexual abuse) and limited pain assessment. Furthermore, it is not known whether associations endure in the elderly. The Consortium Against Pain Inequality (CAPE) has developed a pain and ACEs questionnaire (PACE-Q) and implemented it in the Lothian Birth Cohort 1936 (LBC1936). The PACE-Q contains 44 items relating to pain and 26 items relating to ACEs that were based on a recent instrument used in UK Biobank and the World Health Organisation’s International ACE Questionnaire, respectively, modified by input from people with lived experiences and pain researchers.

We validated the PACE-Q in LBC1936 and performed exploratory analysis to examine potential associations between ACEs and pain outcomes in the elderly.

Methods

The PACE-Q, mailed to 342 LBC participants born in 1936, was returned by 229 (51% female), a 67% response rate. Descriptive statistics were explored for the purposes of validating the PACE-Q. We performed exploratory analysis comparing exposure to ACEs (grouped into 13 categories: emotional, physical, and sexual abuse; emotional and physical neglect; 5 household challenges; 3 external challenges) in those reporting chronic pain (>3 months) and no chronic pain. We also examined the frequency of ACEs with sex and deprivation levels of LBC1936 participants at age 11. The face validity of the adjusted items used in PACE-Q were affirmed by participants of CAPE including pain researchers and individuals with lived experiences, prior to the use of the instrument in LBC1936.

Results

Overall, 61% of participants reported chronic pain while 11%, 17%, 17%, 25%, and 31% participants reported exposure to 0, 1, 2, 3, ?4 ACE categories, respectively. Furthermore, males reported higher exposure to 4+ ACEs than females (?2 (1, 131) = 14.1, p = 0.0002, while females reported higher rates of chronic pain (71% of females compared with 51% of males: ?2 (1, 217) = 9.2, p = 0.002). Of individuals with chronic pain, 84% reported multiple painful sites. By contrast to previous studies in younger populations, in which there were strong associations, there was no significant association between ACEs and chronic pain (odds ratio of 1.47 [0.50 – 4.36], p = 0.49, in those reporting 4+ ACEs compared to those reporting 0 ACE). There was also no significant difference in pain intensities between participants reporting 0 ACEs and 4+ ACEs (VAS pain scores (± SD) of 3.9 ± 1.8 and 4.8 ± 1.7, respectively; F(4, 124) = 0.91, p = 0.46).

Conclusions

Individuals remaining in LBC1936 report high rates of chronic pain and exposure to multiple ACEs. However, unlike observations in younger adults, there is no significant association between chronic pain and ACEs in LBC1936 participants. Reasons for this difference will be explored. The participants in this study represent those surviving to an advanced age who may have characteristics that have made them resilient to the adverse health effects of exposure to ACEs.

References

(1) Nicolson KP, Mills SEE, Senaratne DNS, Colvin LA, Smith BH. What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review. BJA Open 2023;6:100139.

Presenting Author

Sam Singleton

Poster Authors

Tim Hales

PhD

University Of Dundee

Lead Author

E-mail

Samuel Singleton

PhD

University of Dundee

Lead Author

E-mail

Dhaneesha Senaratne

University of Dundee

Lead Author

E-mail

Jeanette Spiteri

BA

University of Dundee

Lead Author

E-mail

Paul Redmond

PhD

University of Edinburgh

Lead Author

E-mail

Janine Rennie

BSc

University of Dundee

Lead Author

E-mail

Kate Timmins

PhD

University of Aberdeen

Lead Author

E-mail

Madeleine Verriotis

PhD

University College London

Lead Author

E-mail

Suellen Walker

UCL GOS Institute of Child Health

Lead Author

E-mail

Debajit Sen

MBBS

University College London

Lead Author

E-mail

Gary Macfarlane

MBChB

University of Aberdeen

Lead Author

E-mail

Lesley Colvin

University of Dundee

Lead Author

E-mail

Line Caes

University of Stirling

Lead Author

E-mail

Simon Cox

PhD

University of Edinburgh

Lead Author

E-mail

Topics

  • Epidemiology