Advertisement

Adverse Childhood Experiences (ACEs) and Internalizing Mental Health, Pain, and Quality of Life in Youth With Chronic Pain: A Longitudinal Examination

  • Sarah Nelson
    Affiliations
    Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts

    Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
    Search for articles by this author
  • Jaimie K. Beveridge
    Affiliations
    Department of Psychology, University of Calgary, Calgary, Alberta, Canada
    Search for articles by this author
  • Richelle Mychasiuk
    Affiliations
    Department of Psychology, University of Calgary, Calgary, Alberta, Canada

    Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada

    Hotchkiss Brain Institute, Calgary, Alberta, Canada

    Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
    Search for articles by this author
  • Melanie Noel
    Correspondence
    Address reprint requests to Melanie Noel, PhD, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
    Affiliations
    Department of Psychology, University of Calgary, Calgary, Alberta, Canada

    Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada

    Hotchkiss Brain Institute, Calgary, Alberta, Canada
    Search for articles by this author

      Highlights

      • Over time, youth with 3+ versus 0 adverse childhood experiences (ACEs) reported poorer quality of life.
      • Youth with 3+ versus 0 ACEs reported higher symptoms of PTSD, depression, and anxiety.
      • Functioning differed between youth exposed to different types of ACEs.
      • PTSD symptoms moderated the association between ACEs and anxiety symptoms.
      • ACEs influence the long-term functioning of youth with chronic pain.

      Abstract

      The aims of this longitudinal study were to 1) identify categories of adverse childhood experiences (ACEs) (ie, neglect, abuse, household dysfunction in childhood) that increase risk for internalizing mental health problems, pain-related impairment, and poorer quality of life and 2) examine the moderating role of posttraumatic stress symptoms (PTSS) in these associations, in a clinical sample of youth with chronic pain. At 2 timepoints, youth (N = 155; aged 10–18 years) completed measures of exposure to ACEs, PTSS, depressive and anxiety symptoms, pain intensity, pain interference, and quality of life. Multivariate analyses of variance, linear mixed modeling, and moderation analyses were conducted. Results from cross-sectional and longitudinal analyses were similar; youth with a history of 3+ ACEs reported significantly higher PTSS, depressive and anxiety symptoms, and poorer quality of life than youth with no ACE history. Results also revealed differences in functioning between youth exposed to different types of ACEs (ie, maltreatment only, household dysfunction only, both, none). Finally, PTSS was found to moderate the association between ACEs and anxiety and depressive symptoms. Findings underscore the influence that ACEs can have on the long-term functioning of youth with chronic pain as well as the important role of current PTSS in this association.

      Perspective

      This study found that the risk of poorer outcomes imposed by ACEs at baseline remains longitudinally and that posttraumatic stress symptoms (PTSS) moderate the relationship between ACEs and anxiety and depressive symptoms in youth with chronic pain. These results underscore the importance of assessing for ACEs and PTSS alongside chronic pain in youth.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Anda R
        • Tietjen G
        • Schulman E
        • Felitti V
        • Croft J.
        Adverse childhood experiences and frequent headaches in adults.
        Headache. 2010; 50: 1473-1481
        • Anda RF
        • Felitti VJ
        • Bremner JD
        • Walker JD
        • Whitfield C
        • Perry BD
        • Dube SR
        • Giles WH.
        The enduring effects of abuse and related adverse experiences in childhood.
        Eur Arch Psychiatry Clin Neurosci. 2006; 256: 174-186
        • As-Sanie S
        • Clevenger LA
        • Geisser ME
        • Williams DA
        • Roth RS.
        History of abuse and its relationship to pain experience and depression in women with chronic pelvic pain.
        Am J Obstet Gynecol. 2014; 210 (317.e311-318)
        • Atzl VM
        • Narayan AJ
        • Rivera LM
        • Lieberman AF.
        Adverse childhood experiences and prenatal mental health: Type of ACEs and age of maltreatment onset.
        J Fam Psychol. 2019; 33: 304
        • Beal SJ
        • Kashikar-Zuck S
        • King C
        • Black W
        • Barnes J
        • Noll JG.
        Heightened risk for pain in young adult women with a history of childhood maltreatment: A prospective longitudinal study.
        Pain. 2019; 161: 156-165
        • Bethell C
        • Jones J
        • Gombojav N
        • Linkenbach J
        • Sege R.
        Positive childhood experiences and adult mental and relational health in a statewide sample: Associations across adverse childhood experiences levels.
        JAMA Pediatr. 2019; 173 (e193007-e193007)
        • Bethell CD
        • Carle A
        • Hudziak J
        • Gombojav N
        • Powers K
        • Wade R
        • Braveman P.
        Methods to assess adverse childhood experiences of children and families: Toward approaches to promote child well-being in policy and practice.
        Acad Pediatr. 2017; 17: S51-S69
      1. Beveridge JK, Dobson KS, Madigan S, Yeates KO, Stone AL, Wilson AC, Salberg S, Mychasiuk R, Noel M. Adverse childhood experiences in parents of youth with chronic pain: Prevalence and comparison to a community-based sample. PAIN Rep, 5:e866, 2020.

        • Beveridge JK
        • Neville A
        • Wilson AC
        • Noel M.
        Intergenerational examination of pain and posttraumatic stress disorder symptoms among youth with chronic pain and their parents.
        Pain Rep. 2018; 3
        • Birnie KA
        • Dib K
        • Ouellette C
        • Dib MA
        • Nelson K
        • Pahtayken D
        • Baerg K
        • Chorney J
        • Forgeron P
        • Lamontagne C.
        Partnering for pain: A priority setting partnership to identify patient-oriented research priorities for pediatric chronic pain in Canada.
        CMAJ Open. 2019; 7: E654
        • Chan KS
        • Mangione-Smith R
        • Burwinkle TM
        • Rosen M
        • Varni JW.
        The PedsQL™: Reliability and validity of the short-form generic core scales and asthma module.
        Med Care. 2005; 43: 256-265
        • Chorpita BF
        • Moffitt CE
        • Gray J.
        Psychometric properties of the revised child anxiety and depression scale in a clinical sample.
        Behav Res Ther. 2005; 43: 309-322
        • Chorpita BF
        • Yim L
        • Moffitt C
        • Umemoto LA
        • Francis SE.
        Assessment of symptoms of DSM-IV anxiety and depression in children: A revised child anxiety and depression scale.
        Behav Res Ther. 2000; 38: 835-855
        • Cunningham NR
        • Cohen MB
        • Farrell MK
        • Mezoff AG
        • Lynch-Jordan A
        • Kashikar-Zuck S.
        Concordant parent-child reports of anxiety predict impairment in youth with functional abdominal pain.
        J Pediatr Gastroenterol Nutr. 2015; 60: 312-317
        • Davis DA
        • Luecken LJ
        • Zautra AJ.
        Are reports of childhood abuse related to the experience of chronic pain in adulthood?: A meta-analytic review of the literature.
        Clin J Pain. 2005; 21: 398-405
        • Diz-Chaves Y
        • Astiz M
        • Bellini MJ
        • Garcia-Segura LM.
        Prenatal stress increases the expression of proinflammatory cytokines and exacerbates the inflammatory response to LPS in the hippocampal formation of adult male mice.
        Brain Behav Immun. 2013; 28: 196-206
        • Felitti VJ
        • Anda RF
        • Nordenberg D
        • Williamson DF
        • Spitz AM
        • Edwards V
        • Koss MP
        • Marks JS.
        Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study.
        Am J Prev Med. 1998; 14: 245-258
        • Foa EB
        • Asnaani A
        • Zang Y
        • Capaldi S
        • Yeh R.
        Psychometrics of the child PTSD symptom scale for DSM-5 for trauma-exposed children and adolescents.
        J Clin Child Adolesc Psychol. 2018; 47: 38-46
        • Foa EB
        • Johnson KM
        • Feeny NC
        • Treadwell KR.
        The child PTSD symptom scale: A preliminary examination of its psychometric properties.
        J Clin Child Psychol. 2001; 30: 376-384
        • Ford DC
        • Merrick MT
        • Parks SE
        • Breiding MJ
        • Gilbert LK
        • Edwards VJ
        • Dhingra SS
        • Barile JP
        • Thompson WW.
        Examination of the factorial structure of adverse childhood experiences and recommendations for three subscale scores.
        Psychol Violence. 2014; 4: 432
        • Garrido EF
        • Weiler LM
        • Taussig HN.
        Adverse childhood experiences and health-risk behaviors in vulnerable early adolescents.
        J Early Adolesc. 2017; 38: 661-680
        • Gerson R
        • Rappaport N.
        Traumatic stress and posttraumatic stress disorder in youth: Recent research findings on clinical impact, assessment, and treatment.
        J Adolesc Health. 2013; 52: 137-143
        • Groenewald CB
        • Murray CB
        • Palermo TM.
        Adverse childhood experiences and chronic pain among children and adolescents in the United States.
        Pain Rep. 2020; 5: e839
        • Gunnar M
        • Quevedo K.
        The neurobiology of stress and development.
        Annu Rev Psychol. 2007; 58: 145-173
        • Hardt J
        • Rutter M.
        Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence.
        J Child Psychol Psychiatry. 2004; 45: 260-273
        • Harris PA
        • Taylor R
        • Minor BL
        • Elliott V
        • Fernandez M
        • O'Neal L
        • McLeod L
        • Delacqua G
        • Delacqua F
        • Kirby J
        The REDCap consortium: Building an international community of software platform partners.
        J Biomed Inform. 2019; 95103208
        • Harris PA
        • Taylor R
        • Thielke R
        • Payne J
        • Gonzalez N
        • Conde JG.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Hayes AF.
        Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach.
        New York, NY, Guilford Publications, 2017
        • Heathcote LC
        • Jacobs K
        • Van Ryckeghem DM
        • Fisher E
        • Eccleston C
        • Fox E
        • Lau JY.
        Attention bias modification training for adolescents with chronic pain: A randomized placebo-controlled trial.
        Pain. 2018; 159: 239-251
        • Holley AL
        • Wilson AC
        • Noel M
        • Palermo TM.
        Post-traumatic stress symptoms in children and adolescents with chronic pain: A topical review of the literature and a proposed framework for future research.
        Eur J Pain. 2016; 20: 1371-1383
        • Hollis F
        • Isgor C
        • Kabbaj M.
        The consequences of adolescent chronic unpredictable stress exposure on brain and behavior.
        Neuroscience. 2013; 249: 232-241
        • Jones GT
        • Power C
        • Macfarlane GJ.
        Adverse events in childhood and chronic widespread pain in adult life: Results from the 1958 British Birth Cohort Study.
        Pain. 2009; 143: 92-96
        • Jones JT
        • Cunningham N
        • Kashikar-Zuck S
        • Brunner HI.
        Pain, fatigue, and psychological impact on health-related quality of life in childhood-onset lupus.
        Arthritis Care Res (Hoboken). 2016; 68: 73-80
        • Kashikar-Zuck S
        • Carle A
        • Barnett K
        • Goldschneider KR
        • Sherry DD
        • Mara CA
        • Cunningham N
        • Farrell J
        • Tress J
        • DeWitt EM.
        Longitudinal evaluation of patient-reported outcomes measurement information systems measures in pediatric chronic pain.
        Pain. 2016; 157: 339-347
        • Kolb B
        • Mychasiuk R
        • Muhammad A
        • Li Y
        • Frost DO
        • Gibb R.
        Experience and the developing prefrontal cortex.
        Proc Natl Acad Sci. 2012; 109: 17186-17193
        • Liedl A
        • O'Donnell M
        • Creamer M
        • Silove D
        • McFarlane A
        • Knaevelsrud C
        • Bryant R
        Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms.
        Psychol Med. 2010; 40: 1215-1223
        • Logan DE
        • Williams SE
        • Carullo VP
        • Claar RL
        • Bruehl S
        • Berde CB.
        Children and adolescents with complex regional pain syndrome: More psychologically distressed than other children in pain?.
        Pain Res Manage. 2013; 18: 87-93
        • Martin SR
        • Zeltzer LK
        • Seidman LC
        • Allyn KE
        • Payne LA.
        Caregiver–child discrepancies in reports of child emotional symptoms in pediatric chronic pain.
        J Pediatr Psychol. 2020; 45: 359-369
        • McBeth J
        • Macfarlane GJ
        • Benjamin S
        • Morris S
        • Silman AJ.
        The association between tender points, psychological distress, and adverse childhood experiences: A community-based study.
        Arthritis Rheum. 1999; 42: 1397-1404
        • McEwen BS.
        Neurobiological and systemic effects of chronic stress.
        Chronic Stress. 2017; 1 (2470547017692328)
        • Mersky JP
        • Janczewski CE
        • Topitzes J.
        Rethinking the measurement of adversity: Moving toward second-generation research on adverse childhood experiences.
        Child Maltreat. 2017; 22: 58-68
        • Nader K.
        Assessment of Trauma in Youths: Understanding Issues of Age, Complexity, and Associated Variables.
        New York, NY, Routledge, 2016
        • Nelson S
        • Cunningham N.
        The impact of posttraumatic stress disorder on clinical presentation and psychosocial treatment response in youth with functional abdominal pain disorders: An exploratory study.
        Children. 2020; 7: 56
        • Nelson S
        • Cunningham N
        • Peugh J
        • Jagpal A
        • Arnold L
        • Lynch-Jordan A
        • Kashikar-Zuck S.
        Clinical profiles of young adults with juvenile-onset fibromyalgia with and without a history of trauma.
        Arthritis Care Res. 69:1636-1643, 2017;
        • Nelson S
        • Logan D.
        The role of adverse childhood experiences (ACEs) in school-related impairment in youth with chronic pain.
        J Pain. 2018; 19: S58
        • Nelson S
        • Simons L
        • Logan D.
        The incidence of adverse childhood experiences (ACEs) and their association with pain-related and psychosocial impairment in youth with chronic pain.
        Clin J Pain. 5:402-408, 2017;
        • Nelson S
        • Smith K
        • Sethna N
        • Logan D.
        Youth with chronic pain and a history of adverse childhood experiences in the context of multidisciplinary pain rehabilitation.
        Clin J Pain. 2019; 35: 420-427
        • Neville A
        • Griep Y
        • Palermo TM
        • Vervoort T
        • Schulte F
        • Yeates KO
        • Sumpton JE
        • Mychasiuk R
        • Noel M.
        A “dyadic dance”: Pain catastrophizing moderates the daily relationships between parent mood and protective responses and child chronic pain.
        Pain. 2020; 161: 1072-1082
        • Neville A
        • Jordan A
        • Beveridge JK
        • Pincus T
        • Noel M
        Diagnostic uncertainty in youth with chronic pain and their parents.
        J Pain. 2019; 20: 1080-1090
        • Neville A
        • Kopala-Sibley D
        • Soltani S
        • Asmundson GJG
        • Jordan A
        • Carleton RN
        • Yeates KO
        • Schulte F
        • Noel M.
        A longitudinal examination of the interpersonal fear avoidance model of pain: The role of intolerance of uncertainty.
        Pain. 2021; 162: 152-160
        • Neville A
        • Soltani S
        • Pavlova M
        • Noel M.
        Unravelling the relationship between parent and child PTSD and pediatric chronic pain: The mediating role of pain catastrophizing.
        J Pain. 2018; 19: 196-206
        • Noel M
        • Wilson AC
        • Holley AL
        • Durkin L
        • Patton M
        • Palermo TM.
        Posttraumatic stress disorder symptoms in youth with vs without chronic pain.
        Pain. 2016; 157: 2277-2284
        • Pacella ML
        • Hruska B
        • Delahanty DL.
        The physical health consequences of PTSD and PTSD symptoms: A meta-analytic review.
        J Anxiety Disord. 2013; 27: 33-46
        • Palermo TM
        • Fonareva I
        • Janosy NR.
        Sleep quality and efficiency in adolescents with chronic pain: Relationship with activity limitations and health-related quality of life.
        Behav Sleep Med. 2008; 6: 234-250
        • Palermo TM
        • Wilson AC
        • Peters M
        • Lewandowski A
        • Somhegyi H.
        Randomized controlled trial of an Internet-delivered family cognitive–behavioral therapy intervention for children and adolescents with chronic pain.
        Pain. 2009; 146: 205-213
        • Palermo TM
        • Witherspoon D
        • Valenzuela D
        • Drotar DD.
        Development and validation of the child activity limitations interview: A measure of pain-related functional impairment in school-age children and adolescents.
        Pain. 2004; 109: 461-470
        • Pavlova M
        • Kopala-Sibley DC
        • Nania C
        • Mychasiuk R
        • Christensen J
        • McPeak A
        • Tomfohr-Madsen L
        • Katz J
        • Palermo TM
        • Noel M.
        Sleep disturbance underlies the co-occurrence of trauma and pediatric chronic pain: A longitudinal examination.
        Pain. 2020; 161: 821-830
        • Pegram SE
        • Lumley MA
        • Jasinski MJ
        • Burns JW.
        Psychological trauma exposure and pain-related outcomes among people with chronic low back pain: Moderated mediation by thought suppression and social constraints.
        Ann Behav Med. 2017; 51: 316-320
        • Purewal SK
        • Bucci M
        • Gutiérrez Wang L
        • Koita K
        • Silvério Marques S
        • Oh D
        • Burke Harris N
        Screening for adverse childhood experiences (ACEs) in an integrated pediatric care model.
        Zero Three. 2016; 37: 10-17
        • Schlack R
        • Ravens-Sieberer U
        • Petermann F.
        Psychological problems, protective factors and health-related quality of life in youth affected by violence: The burden of the multiply victimised.
        J Adolesc. 2013; 36: 587-601
        • Shek DT
        • Ma C.
        Longitudinal data analyses using linear mixed models in SPSS: Concepts, procedures and illustrations.
        Sci World J. 2011; 11:42-76
        • Soltani S
        • van Ryckeghem DM
        • Vervoort T
        • Heathcote LC
        • Yeates K
        • Sears C
        • Noel M.
        Attentional biases in pediatric chronic pain: An eye-tracking study assessing the nature of the bias and its relation to attentional control.
        Pain. 2020; 161: 2263-2273
        • Spronk I
        • Legemate CM
        • Dokter J
        • Van Loey NE
        • van Baar ME
        • Polinder S.
        Predictors of health-related quality of life after burn injuries: A systematic review.
        Crit. Care. 2018; 22: 160
        • von Baeyer CL
        • Spagrud LJ
        • McCormick JC
        • Choo E
        • Neville K
        • Connelly MA.
        Three new datasets supporting use of the numerical rating cale (NRS-11) for children's self-reports of pain intensity.
        Pain. 2009; 143: 223-227
        • West BT.
        Analyzing longitudinal data with the linear mixed models procedure in SPSS.
        Eval Health Prof. 2009; 32: 207-228