背景:不良童年经历(ACEs)已被证明对成年后的健康产生负面影响。缺乏对ACE与慢性疼痛状况之间关联的估计。目的:本系统评价和荟萃分析旨在评估成人ACEs暴露与慢性疼痛和疼痛相关残疾之间的关系。方法:从成立到2023年2月,我们检索了10个电子数据库。我们纳入了评估直接ACE(儿童期性行为,物理,情感虐待,或忽视)单独或与间接ACE(目睹家庭暴力,家庭精神疾病),和成人慢性疼痛(持续时间≥3个月)和疼痛相关的残疾(日常活动受慢性疼痛限制)。成对的审稿人独立提取数据并评估研究偏倚风险。随机效应模型用于计算合并的调整比值比[aOR]。Tau平方[T2],95%预测区间[95%PI]和I2表示异质性的数量,荟萃回归和亚组荟萃分析调查了异质性的来源(PROSPERO:CRD42020150230)。结果:我们确定了85项研究,包括826,452名成年人,其中57项研究纳入荟萃分析。研究质量总体良好或一般(n=70)。在成年后报告慢性疼痛的几率在暴露于直接ACE的个体中显著更高(aOR,1.45,95CI,1.38-1.53)。报告儿童身体虐待的个体更有可能报告两种慢性疼痛(aOR,1.50,95CI,1.39-1.64)和成年期疼痛相关残疾(1.46,95CI,1.03-2.08)。单独暴露于任何ACEs或与间接ACEs联合显着增加成人慢性疼痛状况的几率(aOR,1.53、95CI、1.42-1.65)和疼痛相关残疾(aOR,1.29;95CI,1.01-1.66)。成年期慢性疼痛的风险从一次ACE(aOR,1.29,95CI,1.22-1.37)至四个或更多个ACE(1.95,95CI,1.73-2.19)。结论:单一和累积ACE与成人慢性疼痛和疼痛相关残疾的报告显着相关。
先前的荟萃分析强调了不良童年经历对身体的负面影响,心理,和整个生命周期的行为健康。我们发现有任何直接的不良童年经历,即童年时期的性行为,物理,情感虐待,或单独或组合的忽视,增加了成年后报告慢性疼痛和疼痛相关残疾的风险.报告慢性疼痛性疾病的风险随着不良童年经历的增加而增加。
Background: Adverse childhood experiences (ACEs) have been shown to negatively affect health in adulthood. Estimates of associations between ACEs and chronic painful conditions are lacking.Objectives: This systematic review and meta-analysis aimed to evaluate associations between exposure to ACEs and chronic pain and pain-related disability in adults.Methods: We searched 10 electronic databases from inception to February 2023. We included observational studies assessing associations between direct ACEs (childhood sexual, physical, emotional abuse, or neglect) alone or in combination with indirect ACEs (witnessing domestic violence, household mental illness), and adult chronic pain (≥3 months duration) and pain-related disability (daily activities limited by chronic pain). Pairs of reviewers independently extracted data and assessed study risks of bias. Random-effect models were used to calculate pooled adjusted odds ratios [aOR]. Tau square [T2], 95% prediction intervals [95%PI] and I2 expressed the amount of heterogeneity, and meta-regressions and subgroup meta-analyses investigated sources of heterogeneity (PROSPERO: CRD42020150230).Results: We identified 85 studies including 826,452 adults of which 57 studies were included in meta-analyses. Study quality was generally good or fair (n = 70). The odds of reporting chronic pain in adulthood were significantly higher among individuals exposed to a direct ACE (aOR, 1.45, 95%CI, 1.38-1.53). Individuals reporting childhood physical abuse were significantly more likely to report both chronic pain (aOR, 1.50, 95CI, 1.39-1.64) and pain-related disability (1.46, 95CI, 1.03-2.08) during adulthood. Exposure to any ACEs alone or combined with indirect ACEs significantly increase the odds of adult chronic painful conditions (aOR, 1.53, 95%CI, 1.42-1.65) and pain-related disability (aOR, 1.29; 95%CI, 1.01-1.66). The risk of chronic pain in adulthood significantly increased from one ACE (aOR, 1.29, 95%CI, 1.22-1.37) to four or more ACEs (1.95, 95%CI, 1.73-2.19).Conclusions: Single and cumulative ACEs are significantly associated with reporting of chronic pain and pain-related disability as an adult.
Previous meta-analyses highlighted the negative impact of adverse childhood experiences on physical, psychological, and behavioural health across the lifespan.We found exposure to any direct adverse childhood experience, i.e. childhood sexual, physical, emotional abuse, or neglect alone or combined, increased the risk of reporting chronic pain and pain-related disability in adulthood.The risk of reporting chronic painful disorders increased with increasing numbers of adverse childhood experiences.