Adverse childhood experiences and pain in early adolescence: A study in the Generation XXI cohort

BACKGROUND: The cross-sectional association between Adverse Childhood Experiences (ACEs) reports and adult pain conditions is well-established. Studies in children are scarce, yet evidence indicates that ACEs may trigger a health-damaging cascade, especially in stress-sensitive developmental stages of higher brain plasticity. We aimed to examine the associations between ACEs and pain experiences in childhood and adolescence. METHODS: Participant data from the third (2016-17) and fourth waves (2018-20) of the Generation XXI birth cohort study (2005-06) was used. ACEs were reported by children aged 10 and 13 using a 15-item questionnaire. Recent pain experiences (i.e., presence of pain episodes, number of pain sites, and pain intensity) were measured using structured questionnaires. Pain episodes were reported a week prior to the interview at age 10 and in the previous three months at age 13. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were obtained from binary and multinomial logistic regression analyses. RESULTS: ACEs reported until the age of 10 were associated with pain experiences (i.e., presence of pain episodes, number of pain sites, and pain intensity), with higher number of events conferring a greater risk of experiencing pain at age 10 (aOR 3.18 for ≥6 ACEs; 95% CI [2.19, 4.74]). ACEs until age 10 were associated with pain reports at 13 years. Further, each point increase in ACEs at age 10 increased 9% the odds of reporting pain at age 13 (OR 1.09; 95% CI [1.07, 1.12]). No interaction was observed between ACEs score at ages 10 and 13 was (OR 0.99; CI [0.98-1.00]), showing that the effect of ACEs at age 10 on recent pain at age 13 was not moderated by the ACEs at age 13. CONCLUSIONS: Adverse experiences occurring during the first years of life may predict pain conditions later in life. KEY MESSAGES: • A dose-response association was observed between the cumulative number of ACEs and reports of pain in 10-year-old children. • Embodiment of ACEs starts as early as childhood, and pain related to ACEs begins earlier than previously reported.