Childhood and Adolescent Adversity and Chronic Pain
Marin, Teresa Johanne
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This dissertation used systematic review methods to examine the relationship between early life adversities and chronic pain later in life, with a focus on the temporal nature of the relationship and proposed moderating factors, such as the type, timing, and intensity of the adverse experience, whether or not it resulted in physical harm, and the presence or absence of subsequent posttraumatic stress disorder (PTSD) and related states. The first review paper aimed to examine the prospective relationship between child maltreatment and chronic pain, and the second review paper aimed to examine the prospective relationship between bullying victimization and chronic pain. Electronic searches of Medline, EMBASE, PsycINFO, and CINAHL were conducted. Standard methodological procedures consistent with Cochrane reviews of prognosis studies were used. The child maltreatment review included nine studies (17,340 participants). Findings revealed low to very low quality conflicting evidence across maltreatment types (sexual, physical and verbal/emotional abuse, neglect, and exposure to domestic partner violence), with the higher quality studies pointing to the absence of a direct (non-moderated and non-mediated) association between maltreatment and pain. PTSD was identified as a potential moderator and/or mediator. There was no available evidence regarding other proposed moderators. The bullying victimization review included four studies (6,275 participants). Findings revealed very low quality evidence of increased risk of pain among victimized compared to non-victimized youth, but the effect size was small and not clinically important. Only one study examined the inverse association (i.e., from pain to victimization), and there was not enough evidence to conduct a meaningful analysis of the proposed moderators. Overall, study findings were limited by the dearth of evidence on the prospective relationship between early life adversities and pain. Across the two reviews, only 13 prospective studies met the inclusion criteria, of which only four studies measured and reported chronic pain as a primary outcome. High quality studies that measure and report key features of child maltreatment and bullying victimization, moderating factors, such as the presence or absence of PTSD and bodily injury, and chronic pain outcomes, such as pain severity and pain interference, are needed to advance the literature on the relationship between child and adolescent adversities and the emergence of chronic pain.