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The Incidence of Adverse Childhood Experiences (ACEs) and Their Association With Pain-related and Psychosocial Impairment in Youth With Chronic Pain

Nelson, Sarah, PhD*,†; Simons, Laura, E., PhD; Logan, Deirdre, PhD*,†

The Clinical Journal of Pain: May 2018 - Volume 34 - Issue 5 - p 402–408
doi: 10.1097/AJP.0000000000000549
Original Articles

Objectives: 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.

Methods: 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: 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.

Discussion: 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.

*Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital

Department of Psychiatry, Harvard Medical School, Boston, MA

Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, CA

The authors declare no conflict of interest.

Reprints: Sarah Nelson, PhD, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA 02115 (e-mail:

Received May 9, 2017

Received in revised form July 5, 2017

Accepted August 15, 2017

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