Adverse childhood experiences and chronic pain among children and adolescents in the United States.

OBJECTIVE

To evaluate the association between adverse childhood experiences (ACEs) and chronic pain during childhood and adolescence.

METHODS

Cross-sectional analysis of the 2016-2017 National Survey of Children's Health, including 48,567 child participants of 6 to 17 years of age. Parents of children reported on 9 ACEs. Chronic pain was defined as parents reporting that their children had "frequent or chronic difficulty with repeated or chronic physical pain, including headache or other back or body pain during the past 12 months." Multivariate logistic regression analysis adjusted for sociodemographic and health-related factors.

RESULTS

In this nationally representative sample, 49.8% of children were exposed to one or more ACEs during their lifetime. Children with exposure to 1 or more ACEs had higher rates of chronic pain (8.7%) as compared to those with no reported ACEs (4.8%). In multivariate analysis, children with ACEs had increased odds for chronic pain (adjusted odds ratio [aOR]: 1.6, 95% confidence interval [CI]: 1.3-2.2, for 0 vs 1 ACE and aOR: 2.7, 95% CI: 2.1-3.4 for 0 vs 4+ ACEs). The strongest associations of individually measured ACEs with chronic pain included financial instability (aOR: 1.9, 95% CI: 1.6-2.2), living with a mentally ill adult (aOR: 1.8, 95% CI: 1.5-2.2), and having experienced discrimination based on race (aOR: 1.7, 95% CI: 1.3-2.2).

CONCLUSIONS

Children and adolescents with ACEs had increased risk for chronic pain, and this association increased in a dose-dependent fashion.