Objectives: This review outlines a conceptual framework adapted from the biopsychosocial model of pain to examine the relationship between adverse childhood experiences (ACEs) and chronic pain in youth to highlight the state of current research and guide future efforts. Methods: A review of the literature was performed in the areas of ACEs and health outcomes with general adult and pediatric populations in addition to studies within the pain literature. Potential relationships between ACEs, chronic pain, and its impact in youth are outlined and discussed. Results: The literature suggests an association between adverse outcomes of ACEs and chronic pain in children and adolescents although causal links have not been confirmed. However, ACEs are associated with multiple risk factors identified in the biopsychosocial model of pain, and may serve to exacerbate or confer heightened risk for pain and poor outcomes. Discussion: Adverse experiences in childhood may be associated with greater risk for the development/maintenance of chronic pain in youth. More research is needed on ACEs and how they uniquely affect the biopsychosocial mechanisms underlying chronic pain in children throughout the lifespan.

Objectives: Adverse childhood experiences (ACEs) in youth have been found to be frequently associated with several chronic illnesses, including chronic pain. However, this relationship remains poorly understood. Previous research has examined the association between ACEs and chronic pain, but these have primarily been examined in the context of adults with limited assessment of ACEs and individual pain conditions. The primary objectives of this study were to examine the incidence and psychological/pain-related correlates of ACEs in a sample of youth with chronic pain. Exploratory analyses were also examined using primary pain diagnosis and number of pain locations. Methods: Data were gathered using retrospective data from a clinical databank. Participants were 141 youth aged 9 to 19 with chronic pain who presented for evaluation at a multidisciplinary pain clinic. Information on ACEs exposure, pain diagnostic information, pain-related impairment, and psychosocial functioning were gathered via self-report and retrospective review of the medical record. Results: Results revealed that over 80% of youth with chronic pain reported at least 1 ACE in their lifetime. Further, multiple and univariate analyses of variance revealed that ACEs exposure is significantly associated with greater symptoms of anxiety, depression, and fear of pain, with ≥3 ACEs associated with greatest impairment in functioning. No relationships were found between ACEs and increased pain-related disability or pain intensity. Discussion: ACEs exposure in youth with chronic pain occurs frequently and can be associated with increased psychosocial but not functional impairment. Future research is needed to further examine the relationship between ACEs and chronic pain in youth in a prospective manner.

Objective: To examine the differential presentation(s) of psychological and health‐related outcomes in young adults with juvenile‐onset fibromyalgia (FM) with and without a history of trauma, compared to healthy controls.Methods: In total, 110 participants (86 with juvenile‐onset FM and 24 healthy controls, with a mean age of 23.4 years) completed a structured clinical interview to assess for trauma and psychological comorbidities, as well as self‐report questionnaires on pain, physical functioning, and health care utilization.Results: Of the juvenile‐onset FM participants, 37% (n = 32) reported a history of trauma. Three group comparisons (i.e., juvenile‐onset FM with trauma versus juvenile‐onset FM with no trauma versus healthy controls) revealed that juvenile‐onset FM participants significantly differed from healthy controls on all psychological and health‐related outcomes. Further, although juvenile‐onset FM participants with and without a history of trauma did not significantly differ on pain and physical functioning, juvenile‐onset FM participants with a history of trauma were significantly more likely to have psychological comorbidities.Conclusion: This is the first controlled study to examine the differential outcomes between juvenile‐onset FM participants with and without a history of trauma. Group comparisons between juvenile‐onset FM participants and healthy controls were consistent with previous research. Further, our findings indicate that juvenile‐onset FM participants with a history of trauma experience greater psychological, but not physical, impairment than juvenile‐onset FM participants without a history of trauma.

Pediatric chronic pain is common and responsible for significant healthcare burden. However, the mechanisms underlying the development and/or maintenance of pediatric chronic pain remain poorly understood. Allostatic load (AL), or wear and tear on the nervous system following significant or prolonged stress, has been proposed to play a role in the maintenance of chronic pain, but minimal research has examined this possibility. This gap in research is particularly notable given the high exposure to adverse childhood experiences (ACEs; abuse/neglect, etc.) and psychological stress in this population. Accordingly, the current study aimed to preliminarily examine the measurement of AL in a treatment-seeking pediatric pain population. Biomarkers were collected during an already scheduled new patient pain evaluation and included salivary cortisol, dehydroepiandrosterone (DHEA), and C-reactive protein, in addition to waist–hip ratio, body-mass index, and blood pressure. A total of 61 children and adolescents with chronic pain (Mage = 14.47 years; 88.5% female and white/Caucasian) completed study procedures and were included in analyses. Preliminary results indicated that a multifactorial AL composite is feasible to assess for in a tertiary pain treatment setting and that over 50% of youth with chronic pain were classified as high risk for AL (two or more risk factors). Further, it was found that individual AL risk factors were significantly associated with functional disability and that AL may moderate the association between psychosocial and functional outcomes. Given the pilot nature of this study, results should be used to inform future investigations with larger and more diverse pediatric pain samples.