Restricted accessResearch articleFirst published online 2026
From childhood struggles to adult strains: A systematic review of the impact of adverse childhood experiences on psycho-emotional functioning,pain outcomes,and quality of life in populations experiencing chronic pain
Adverse childhood experiences (ACEs) are well-documented risk factors for later health problems, such as chronic pain and mental illness. We aimed to synthesise the impact of childhood trauma on psycho-emotional disorders, pain perception and cognitions, and quality of life in individuals with chronic pain. A systematic review was conducted following PRISMA guidelines for systematic reviews and meta-analyses. Eligible studies were identified by searching PubMed, PsychINFO, Embase, and Web of Science, with publication dates from 1988 to April 2023. Inclusion criteria were formulated according to the PECOS framework, and relevant research articles were screened for inclusion. Evidence from 18 studies highlights the significant impact of ACEs (and their typologies) on patients’ psycho-emotional well-being, pain outcomes, and overall quality of life, with a cumulative effect emerging. However, significant methodological limitations, such as the lack of standardised measures to classify childhood adversity, prevent us from drawing definitive conclusions about the reported associations. The findings underscore the importance of integrated approaches to pain management that centre on the patient’s life history and psycho-emotional status. Future research should address current limitations to strengthen our understanding of the role of ACEs in chronic pain research.
BreivikHCollettBVentafriddaV, et al.Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain2006; 10(4): 287. https://doi.org/10.1016/j.ejpain.2005.06.009
3.
MillsSEENicolsonKPSmithBH. Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth2019; 123(2): e273–e283. https://doi.org/10.1016/j.bja.2019.03.023
4.
BeversKWattsLWattsL, et al.The biopsychosocial model of the assessment, prevention, and treatment of chronic pain. US Neurol2016; 12(02): 98. https://doi.org/10.17925/usn.2016.12.02.98
5.
RajaSNCarrDBCohenM, et al.The revised international association for the study of pain definition of pain: concepts, challenges, and compromises. Pain2020; 161(9): 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939
KroenkeKWuJBairMJ, et al.Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care. J Pain2011; 12(9): 964–973. https://doi.org/10.1016/j.jpain.2011.03.003
8.
SkadbergRMMooreTMElledgeLC. A 20-year study of the bidirectional relationship between anxious and depressive symptomology and pain medication usage. Pain Manag2020; 10(1): 13–22. https://doi.org/10.2217/pmt-2019-0037
9.
CastilloRCWegenerSTHeinsSE, et al.Longitudinal relationships between anxiety, depression, and pain: results from a two-year cohort study of lower extremity trauma patients. Pain2013; 154(12): 2860–2866. https://doi.org/10.1016/j.pain.2013.08.025
10.
AngstFBenzTLehmannS, et al.Extended overview of the longitudinal pain-depression association: a comparison of six cohorts treated for specific chronic pain conditions. J Affect Disord2020; 273: 508–516. https://doi.org/10.1016/j.jad.2020.05.044
11.
KalmakisKAChandlerGE. Adverse childhood experiences: towards a clear conceptual meaning. J Adv Nurs2014; 70(7): 1489–1501. https://doi.org/10.1111/jan.12329
12.
HughesKFordKBellisMA, et al.Health and financial costs of adverse childhood experiences in 28 European countries: a systematic review and meta-analysis. Lancet Public Health2021; 6(11): e848–e857. https://doi.org/10.1016/S2468-2667(21)00232-2
13.
NicolsonKPMillsSEESenaratneDNS, et al.What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review. BJA Open2023; 6: 100139. https://doi.org/10.1016/j.bjao.2023.100139
14.
RacineNDevereauxCCookeJE, et al.Adverse childhood experiences and maternal anxiety and depression: a meta-analysis. BMC Psychiatry2021; 21(1): 28. https://doi.org/10.1186/s12888-020-03017-w
15.
FrewenPZhuJLaniusR. Lifetime traumatic stressors and adverse childhood experiences uniquely predict concurrent PTSD, complex PTSD, and dissociative subtype of PTSD symptoms whereas recent adult non-traumatic stressors do not: results from an online survey study. Eur J Psychotraumatol2019; 10(1): 1606625. https://doi.org/10.1080/20008198.2019.1606625
16.
CarboneEAPuglieseVBruniA, et al.Adverse childhood experiences and clinical severity in bipolar disorder and schizophrenia: a transdiagnostic two-step cluster analysis. J Affect Disord2019; 259: 104–111. https://doi.org/10.1016/j.jad.2019.08.049
17.
LezaLSiriaSLópez-GoñiJJ, et al.Adverse childhood experiences (ACEs) and substance use disorder (SUD): a scoping review. Drug Alcohol Depend2021; 221: 108563. https://doi.org/10.1016/j.drugalcdep.2021.108563
18.
BuntingLMcCartanCDavidsonG, et al.The influence of adverse and positive childhood experiences on young people’s mental health and experiences of self-harm and suicidal ideation. Child Abuse Negl2023; 140: 106159. https://doi.org/10.1016/j.chiabu.2023.106159
19.
FelittiVJAndaRFNordenbergD, et al.Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med1998; 14(4): 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8
20.
MorganRLWhaleyPThayerKA, et al.Identifying the PECO: a framework for formulating good questions to explore the association of environmental and other exposures with health outcomes. Environment international. Environ Int2018; 121: 1027–1031. https://doi.org/10.1016/j.envint.2018.07.015
21.
MoherDLiberatiATetzlaffJ, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg2010; 8(5): 336–341. https://doi.org/10.1016/j.ijsu.2010.02.007
22.
AhmedKKMDhubaibBEA. Zotero: a bibliographic assistant to researcher. J Pharmacol Pharmacother2011; 2(4): 303–305.
23.
As-SanieSClevengerLAGeisserME, et al.History of abuse and its relationship to pain experience and depression in women with chronic pelvic pain. Am J Obstet Gynecol2014; 210(4): 317.e1–317.e8. https://doi.org/10.1016/j.ajog.2013.12.048
24.
BrennenstuhlSFuller-ThomsonE. The painful legacy of childhood violence: migraine headaches among adult survivors of adverse childhood experiences. Headache2015; 55(7): 973–983. https://doi.org/10.1111/head.12614
25.
CranerJRLakeESBarrAC, et al.Childhood adversity among adults with chronic pain: Prevalence and association with pain-related outcomes. Clin J Pain2022; 38(9): 551–561. https://doi.org/10.1097/AJP.0000000000001054
26.
CranerJRLakeES. Adverse childhood experiences and chronic pain rehabilitation treatment outcomes in adults. Clin J Pain2021; 37(5): 321–329. https://doi.org/10.1097/AJP.0000000000000924
27.
DennisCHClohessyDSStoneAL, et al.Adverse childhood experiences in mothers with chronic pain and intergenerational impact on children. J Pain2019; 20(10): 1209–1217. https://doi.org/10.1016/j.jpain.2019.04.004
28.
EriksenAMAScheiBHansenKL, et al.Childhood violence and adult chronic pain among indigenous Sami and non-Sami populations in Norway: a SAMINOR 2 questionnaire study. Int J Circumpolar Health2016; 75(1): 32798. https://doi.org/10.3402/ijch.v75.32798
29.
Hart-JohnsonTGreenCR. The impact of sexual or physical abuse history on pain-related outcomes among blacks and whites with chronic pain: gender influence. Pain Med2012; 13(2): 229–242. https://doi.org/10.1111/j.1526-4637.2011.01312.x
30.
LampeADoeringSRumpoldG, et al.Chronic pain syndromes and their relation to childhood abuse and stressful life events. J Psychosom Res2003; 54(4): 361–367. https://doi.org/10.1016/s0022-3999(02)00399-9
31.
NicolALSiebergCBClauwDJ, et al.The association between a history of lifetime traumatic events and pain severity, physical function, and affective distress in patients with chronic pain. J Pain2016; 17(12): 1334–1348. https://doi.org/10.1016/j.jpain.2016.09.003
32.
OrtizRBallardEDMachado-VieiraR, et al.Quantifying the influence of child abuse history on the cardinal symptoms of fibromyalgia. Clin Exp Rheumatol2016; 34(2 Suppl 96): S59–S66.
33.
PiontekKApfelbacherCKetelsG, et al.Depression partially mediates the association of adverse childhood experiences with pain intensity in patients with chronic pelvic pain syndrome: results from a cross-sectional patient survey. Pain Med2021; 22(5): 1174–1184. https://doi.org/10.1093/pm/pnaa325
34.
Poli-NetoOBTawashaKASRomãoAPMS, et al.History of childhood maltreatment and symptoms of anxiety and depression in women with chronic pelvic pain. J Psychosom Obstet Gynecol2018; 39(2): 83–89. https://doi.org/10.1080/0167482X.2017.1306515
35.
SchrepfANaliboffBWilliamsDA, et al.Adverse childhood experiences and symptoms of urologic chronic pelvic pain syndrome: a multidisciplinary approach to the study of chronic pelvic pain research network study. Ann Behav Med2018; 52(10): 865–877. https://doi.org/10.1093/abm/kax060
36.
TesarzJEichWTreedeRD, et al.Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study. Pain2016; 157(8): 1799–1809. https://doi.org/10.1097/j.pain.0000000000000586
37.
TietjenGEBrandesJLDigreKB, et al.History of childhood maltreatment is associated with comorbid depression in women with migraine. Neurology2007; 69(10): 959–968. https://doi.org/10.1212/01.wnl.0000271383.60376.67
38.
TietjenGEBrandesJLPeterlinBL, et al.Childhood maltreatment and migraine (part I). Prevalence and adult revictimization: a multicenter headache clinic survey. Headache2010; 50(1): 20–31. https://doi.org/10.1111/j.1526-4610.2009.01556.x
39.
TietjenGEBrandesJLPeterlinBL, et al.Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification. Headache2010; 50(1): 32–41. https://doi.org/10.1111/j.1526-4610.2009.01557.x
40.
TietjenGEBrandesJLPeterlinBL, et al.Childhood maltreatment and migraine (part III). Association with comorbid pain conditions. Headache2010; 50(1): 42–51. https://doi.org/10.1111/j.1526-4610.2009.01558.x
41.
DownesMJBrennanMLWilliamsHC, et al.Development of a critical appraisal tool to assess the quality of cross-sectional studies (AXIS). BMJ Open2016; 6(12): e011458. https://doi.org/10.1136/bmjopen-2016-011458
MoolaSMunnZTufanaruC, et al.Chapter 7: Systematic reviews of etiology and risk . In: AromatarisEMunnZ (Editors). JBI Manual for Evidence Synthesis. JBI, 2020. Available fromhttps://synthesismanual.jbi.global
44.
HooperCAWarwickI. Gender and the politics of service provision for adults with a history of childhood sexual abuse. Crit Soc Policy2006; 26(2): 467–479. https://doi.org/10.1177/0261018306062596
45.
SivagurunathanMOrchardTMacDermidJC, et al.Barriers and facilitators affecting self-disclosure among male survivors of child sexual abuse: the service providers’ perspective. Child Abuse Negl2019; 88: 455–465. https://doi.org/10.1016/j.chiabu.2018.08.015
46.
HughesKBellisMAHardcastleKA, et al.The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health2017; 2(8): e356–e366. https://doi.org/10.1016/S2468-2667(17)30118-4
47.
PetruccelliKDavisJBermanT. Adverse childhood experiences and associated health outcomes: a systematic review and meta-analysis. Child Abuse Negl2019; 97: 104127. https://doi.org/10.1016/j.chiabu.2019.104127
TidmarshLVHarrisonRRavindranD, et al.The influence of adverse childhood experiences in pain management: mechanisms, processes, and trauma-informed care. Front Pain Res, [Internet]. 10 juin 2022 [cité 30 sept 2024];3. Disponible sur: https://doi.org/10.3389/fpain.2022.923866/full
50.
HermanJPFigueiredoHMuellerNK, et al.Central mechanisms of stress integration: hierarchical circuitry controlling hypothalamo–pituitary–adrenocortical responsiveness. Frontiers in Neuroendocrinology2003; 24(3): 151–180. https://doi.org/10.1016/j.yfrne.2003.07.001
51.
DahmenBPuetzVBScharkeW, et al.Effects of early-life adversity on hippocampal structures and associated HPA axis functions. Dev Neurosci2018; 40(1): 13–22. https://doi.org/10.1159/000484238
52.
ZhuLJLiuMYLiH, et al.The different roles of glucocorticoids in the hippocampus and hypothalamus in chronic stress-induced HPA axis hyperactivity. Homberg J, éditeur. PLoS One2014; 9(5): e97689. https://doi.org/10.1371/journal.pone.0097689
53.
LiuWGeTLengY, et al.The role of neural plasticity in depression: from hippocampus to prefrontal cortex. Neural Plast2017; 2017: 1–11. https://doi.org/10.1155/2017/6871089
54.
DixonMLThiruchselvamRToddR, et al.Emotion and the prefrontal cortex: an integrative review. Psychol Bull2017; 143(10): 1033–1081. https://doi.org/10.1037/bul0000096
55.
MokhtariTTuYHuL. Involvement of the hippocampus in chronic pain and depression. Brain Science Advances2019; 5(4): 288–298. https://doi.org/10.26599/bsa.2019.9050025
56.
SehlmeyerCSchöningSZwitserloodP, et al.Human fear conditioning and extinction in neuroimaging: a systematic review. PLoS One2009; 4(6): e5865. https://doi.org/10.1371/journal.pone.0005865
57.
SergerieKChocholCArmonyJL. The role of the amygdala in emotional processing: a quantitative meta-analysis of functional neuroimaging studies. Neuroscience & Biobehavioral Reviews2008; 32(4): 811–830. https://doi.org/10.1016/j.neubiorev.2007.12.002
58.
ZhuYGaoHTongL, et al.Emotion regulation of hippocampus using real-time fMRI neurofeedback in healthy human. Front Hum Neurosci2019; 13: 242. https://doi.org/10.3389/fnhum.2019.00242
SimonsLEMoultonEALinnmanC, et al.The human amygdala and pain: evidence from neuroimaging. Hum Brain Mapp2012; 35(2): 527–538. https://doi.org/10.1002/hbm.22199
61.
JiRRNackleyAHuhY, et al.Neuroinflammation and central sensitization in chronic and widespread pain. Anesthesiology2018; 129(2): 343–366. https://doi.org/10.1097/ALN.0000000000002130
GilliamWPSchumannMECranerJR, et al.Examining the effectiveness of pain rehabilitation on chronic pain and post-traumatic symptoms. J Behav Med2020; 43(6): 956–967. https://doi.org/10.1007/s10865-020-00160-3
64.
SweeneyAPerôtCCallardF, et al.Out of the silence: towards grassroots and trauma-informed support for people who have experienced sexual violence and abuse. Epidemiol Psychiatr Sci2019; 28(6): 598–602. https://doi.org/10.1017/S2045796019000131
65.
PassarelaCd MMendesDDMariJd J. A systematic review to study the efficacy of cognitive behavioral therapy for sexually abused children and adolescents with posttraumatic stress disorder. Arch Clin Psychiatry (São Paulo)2010; 37: 60–65. https://doi.org/10.1590/s0101-60832010000200006
66.
GrummittLKellyEBarrettE, et al.Targets for intervention to prevent substance use in young people exposed to childhood adversity: a systematic review. Aslam MS, éditeur. PLoS One2021; 16(6): e0252815. https://doi.org/10.1371/journal.pone.0252815
67.
BerzenskiSR. Distinct emotion regulation skills explain psychopathology and problems in social relationships following childhood emotional abuse and neglect. Dev Psychopathol2019; 31(02): 483–496. https://doi.org/10.1017/S0954579418000020
68.
LacyJWStarkCEL. The neuroscience of memory: implications for the courtroom. Nat Rev Neurosci2013; 14(9): 649–658. https://doi.org/10.1038/nrn3563
69.
AskimKKnardahlS. The influence of affective state on subjective-report measurements: evidence from experimental manipulations of mood. Front Psychol2021; 12: 601083. https://doi.org/10.3389/fpsyg.2021.601083
70.
ChalmerMAHansenTFLebedevaER, et al.Proposed new diagnostic criteria for chronic migraine. Cephalalgia2020; 40(4): 399–406. https://doi.org/10.1177/0333102419877171
71.
MalaveLVan DijkMTAnackerC. Early life adversity shapes neural circuit function during sensitive postnatal developmental periods. Transl Psychiatry2022; 12(1): 306. https://doi.org/10.1038/s41398-022-02092-9
72.
NavaltaCPMcGeeLUnderwoodJ. Adverse childhood experiences, brain development, and mental health: a call for neurocounseling. J Ment Health Counsel2018; 40(3): 266–278. https://doi.org/10.17744/mehc.40.3.07
73.
GeloOBraakmannDBenetkaG. Quantitative and qualitative research: beyond the debate. Integr Psych Behav2008; 42(3): 266–290. https://doi.org/10.1007/s12124-008-9078-3
74.
DevaneyJFrederickJSprattT. Opening the time capsule of ACEs: reflections on how we conceptualise children’s experiences of adversity and the issue of temporality. Br J Soc Work2021; 51(6): 2247–2263. https://doi.org/10.1093/bjsw/bcaa126
75.
TarquinioCLTrousselardMRotondaC, et al.Réflexions autour du champ de recherche des expériences adverses vécues durant l’enfance (Adverse Childhood Experiences [ACEs]) — vers une clarification conceptuelle. Annales Médico-Psychologiques, Revue Psychiatrique2023; 181(2): 128–136. https://doi.org/10.1016/j.amp.2022.05.007
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
