The Influence of Adverse Childhood Experiences in Pain Management: Mechanisms, Processes, and Trauma-Informed Care

Abstract

Adverse childhood experiences (ACEs) increase the likelihood of reduced physical and psychological health in adulthood. Though understanding and psychological management of traumatic experiences is growing, the empirical exploration of ACEs and physical clinical outcomes remains under-represented and under-explored. This topical review aimed to highlight the role of ACEs in the experience of chronic pain, pain management services and clinical decision making by: (1) providing an overview of the relationship between ACEs and chronic pain; (2) identifying biopsychosocial mechanisms through which ACEs may increase risk of persistent pain; (3) highlighting the impact of ACEs on patient adherence and completion of pain management treatment; and (4) providing practical clinical implications for pain management. Review findings demonstrated that in chronic pain, ACEs are associated with increased pain complications, pain catastrophizing and depression and the combination of these factors further heightens the risk of early treatment attrition. The pervasive detrimental impacts of the COVID-19 pandemic on ACEs and their cyclical effects on pain are discussed in the context of psychological decline during long treatment waitlists. The review highlights how people with pain can be further supported in pain services by maintaining trauma-informed practices and acknowledging the impact of ACEs on chronic pain and detrimental health outcomes. Clinicians who are ACE-informed have the potential to minimize the negative influence of ACEs on treatment outcomes, ultimately optimizing the impact of pain management services.

Is post-traumatic stress disorder a risk factor for development of opioid use disorder among individuals with chronic non-cancer pain? A systematic review

“…Trauma-informed care is based on the foundational premise of accepting the ubiquitous prevalence and lifelong impact of trauma on an individual living with CNCP and utilises a biopsychosocial approach to provide a safe and trustful environment to empower the individual towards a holistic painmanagement treatment. 41 Our findings are also in line with those of four other studies [42][43][44][45] that examined the relationship between CNCP, PTSD and nonmedical use of prescription opioids (not diagnosable as OUD and hence these studies did not meet the eligibility criteria for this review). These identified fourstudies [42][43][44][45] reported a significant association between PTSD and non-medical use of prescription opioid among the CNCP individuals.…”

Traumatic Events, Posttraumatic Stress Disorder, and Central Sensitization in Chronic Pain Patients of a German University Outpatient Pain Clinic

“…As long as a specific therapy for patients with chronic pain and a traumatic background has not been established, a holistic, person-centered and trauma-informed care approach seems to be elementary. This approach emphasizes the importance of active and compassionate listening from the first encounter ( 50 ). The frequent occurrence of PTSD as comorbidity and the severity of symptoms should make healthcare professionals working in pain management aware of and sensitive to their patients.…”

Prevalence of medically induced psychological trauma and its influence on women's health

“…The outcomes included increased health risks for substance abuse and mood disorders as well as for continuous relationship to diseases of other systems (cardiovascular, gastrointestinal, pulmonary, and skeletal). ACEs lead to poor health of those patients, pain catastrophizing 7 as well as immense healthcare costs. The first estimates of the burden of the disease are available and the total annual expenditure due to ACEs was calculated to be US$581 billion in Europe 8 …”