Adverse Childhood Experiences (
ACEs
) in Patients With Persistent Pain Are Associated With Low Health‐Related Quality of Life and Distress—Perceived Injustice Mediates the Association Between
Teemu Miettinen, Reetta Sipilä, Jaakko Ilola, Jörn Lötsch, Eija Kalso ABSTRACT
Background
Adverse childhood experiences (ACEs) are associated with poor health in adulthood and may predispose individuals to anxiety‐related problems and somatic morbidity. However, their role in persistent pain is not fully understood. This study assessed several factors that may link ACEs with persistent pain and offer possible treatment targets.
Methods
This cross‐sectional study included two cohorts of patients attending tertiary pain care (total n = 644). We examined associations between ACEs, health‐related quality of life (HRQoL), comorbid conditions, pain‐related measures and psychological factors, including perceived injustice related to pain.
Results
Increases in the number of ACEs from two to three and from five to six were associated with lower HRQoL and more comorbid conditions. Medium ACE burden (3–5 ACEs) associated with more depression and other psychiatric comorbidities than low ACE burden (0–2 ACEs) (34.5% vs. 22.9%, p < 0.05; 12.2% vs. 3.3%, p < 0.05, respectively). High ACE burden (≥ 6 ACEs) associated also with more asthma (29.3% vs. 13.7%, p < 0.05). ACEs were associated with all anxiety‐ and distress‐related factors, correlations being relevant with depression ( r = 0.26), trait anxiety ( r = 0.25) and worry ( r = 0.24). Among the pain‐related outcomes, only pain interference was significantly associated with ACEs ( r = 0.13), and this association was statistically fully mediated by injustice perceptions.
Conclusions
ACE burden was associated with reduced HRQoL, psychological distress and pain interference. Perceived injustice mediated the association between ACEs and pain interference, possibly representing a treatment target for patients with pain and high ACE burden.
Significance Statement
This study shows that patients treated in tertiary pain care report a high number of ACEs, stress‐ and anxiety‐related processes and perceptions of injustice, which may contribute to pain persistence and may offer potential targets for treatment.