Background: Adverse childhood experiences (ACEs) are often reported by youths with chronic pain, and both ACEs and chronic pain disrupt how information is processed. However, it is unknown whether changes to shared neural networks underlie the relationship between ACEs and the development of pain symptoms. This study explored the relationships between ACEs, brain efficiency, and pain symptomology in youth.Methods: A community sample of youths aged 14–18 years underwent MRIs, answered trauma and pain questionnaires, and underwent pain sensory testing, twice, 3 months apart (N_baseline = 44; N_follow‐up = 42). Sensory testing determined thresholds for mechanical and thermal stimuli. Global and local network efficiencies were evaluated using graph theory. Generalized estimating equations were applied to examine whether brain efficiency moderated the relationships between ACEs, pain intensity, and pain sensitivity (i.e., mechanical detection, heat pain, and temperature change thresholds).Results: There was a significant interaction between ACEs and global brain efficiency in association with pain intensity (β = −0.31, p = 0.02) and heat pain (β = −0.29, p = 0.004). Lower global brain efficiency exacerbated the relationship between ACEs and pain intensity (θ_{X → Y|W = −1.16} = 0.37, p = 0.05), and heat pain sensitivity (θ_{X → Y|W = −1.30} = 0.44, p = 0.05). Higher global brain efficiency ameliorated the relationship between ACEs and pain intensity (θ_{X → Y|W = 1.75} = −0.53, p = 0.05).Conclusions: The relationship between ACEs and pain symptomology was comparable to chronic pain phenotypes (i.e., higher pain intensity and pain thresholds) and may vary as a function of brain efficiency in youth. This stresses the importance of assessing for pain symptoms in trauma‐exposed youth, as earlier identification and intervention are critical in preventing the chronification of pain.Significance: This article explores the relationship between ACEs, pain symptomology, and brain efficiency in youth. ACEs may affect how the brain processes information, including pain. Youths with lower brain efficiencies that were exposed to more ACEs have pain symptomology comparable to youths with chronic pain. Understanding this relationship is important for the earlier identification of pain symptoms, particularly in vulnerable populations such as youths exposed to trauma, and is critical for preventing the chronification of pain.

Background: Approximately 25% of adolescents live with chronic pain, with many reporting symptoms of functional impairment and poor sleep quality. Both chronic pain and poor sleep quality can negatively impact brain functional connectivity and efficiency. Better sleep quality may improve pain outcomes through its relationship with brain functional connectivity. Methods: This pilot prospective cohort study used data from 24 adolescents with chronic pain (aged 10–18 years) participating in an Intensive Interdisciplinary Pain Treatment (IIPT) at the Alberta Children’s Hospital. Data were collected within the first couple of weeks prior to starting IIPT and on the last day of the 3-week IIPT program. Sleep quality was assessed using the modified Adolescent Sleep-Wake Scale. Resting-state functional MRI data were obtained, and graph-theory metrics were applied to assess small-world brain networks. Questionnaires were used to obtain self-reported functional disability data. Paired t-tests were applied to evaluate changes in outcomes from pre- to post-IIPT, and moderation analyses were used to examine the relationships between sleep, small-world brain network connectivity, and functional disability. Results: Total sleep quality (p = 0.005) increased, and functional disability (p = 0.020) decreased, between baseline and discharge from IIPT. Small-world brain networks did not change pre- to post-IIPT (p > 0.05). Unlike adolescents with high small-worldness (p = 0.665), adolescents with low to moderate small-world brain characteristics (1SD below or at the mean) who reported better sleep quality reported less functional disability (all p ≤ 0.001) over time. Conclusions: The IIPT program was associated with improvements in sleep quality and functional disability. Better sleep quality together with greater small-worldness was associated with less pain-related disability. This suggests that it is equally important for IIPTs to target sleep problems in adolescents with chronic pain, as this may have a key role in producing long-term improvements in pain outcomes.