Chronic physical illness in early life and risk of chronic widespread and regional pain at age 68: evidence from the 1946 British birth cohort

What is the association between childhood adversity and subsequent chronic pain in adulthood? A systematic review

Background

Adverse childhood experiences and chronic pain are complex problems affecting millions of people worldwide, and result in significant healthcare utilisation. Our review aimed to determine known associations between adversity in childhood and chronic pain in adulthood.

Methods

We performed a prospectively registered systematic review (PROSPERO ID: 135625). Six electronic databases (Pubmed, Medline, Cochrane, Scopus, APA PsycNet, Web of Science) were searched from January 1, 2009 until May 30, 2022. Titles and abstracts were screened, and all original research studies examining associations between adverse childhood experiences and chronic pain in adulthood were considered for inclusion. Full texts were reviewed, and a narrative synthesis was used to identify themes from extracted data. Ten percent of studies were dual reviewed to assess inter-rater reliability. Quality assessment of study methodology was undertaken using recognised tools.

Results

Sixty-eight eligible studies describing 196 130 participants were included. Studies covered 15 different types of childhood adversity and 10 different chronic pain diagnoses. Dual reviewed papers had a Cohen's kappa reliability rating of 0.71. Most studies were of retrospective nature and of good quality. There were consistent associations between adverse childhood experiences and chronic pain in adulthood, with a 'dose'-dependent relationship. Poor mental health was found to mediate the detrimental connection between adverse childhood experiences and chronic pain.

Conclusion

A strong association was found between adverse childhood experiences and chronic pain in adulthood. Adverse childhood experiences should be considered in patient assessment, and early intervention to prevent adverse childhood experiences may help reduce the genesis of chronic pain. Further research into assessment and interventions to address adverse childhood experiences is needed.

Early life factors associated with the experiences of pain in later life: evidence from a population based study in India

BACKGROUND

The influence of early life factors is becoming increasingly apparent as studies investigate how experiences, resources, and constraints in childhood affect health and well-being later in life. The present study contributes to this literature by examining the association between several early life factors and self-reported pain among older adults in India.

METHODS

Data come from the 2017-18 wave 1 of the Longitudinal Ageing Study of India (LASI). The sample size includes 28,050 older adults aged 60 and above (13,509 men and 14,541 women). Pain is a self-reported, dichotomous measure where participants responded to whether they were often troubled with pain and whether this experience interfered with their ability to carry out daily household chores. Early life factors, which are retrospective accounts of experiences, included the respondent's position in birth order, their health status, school absenteeism, being bedridden, family socioeconomic status (SES), and their parent's experience with chronic disease. Logistic regression analysis is employed to examine the unadjusted and adjusted average marginal effects (AME) of selected domains of early life factors associated with the probability of experiencing pain.

RESULTS

22.8% of men and 32.3% of women reported pain that interfered with daily activities. Pain was higher among men (AME: 0.01, confidence interval (CI): 0.01-0.03) and women (AME: 0.02, CI: 0.01-0.04) with third or fourth birth order compared to counterparts with first birth order. Both men (AME: -0.02, CI: -0.04-0.01) and women (AME: -0.07, CI: -0.09 - -0.04) having a fair childhood health status reported a lower probability of pain. The probability of pain was higher among both men (AME: 0.03, CI: 0.01-0.07) and women (AME: 0.07, CI: 0.03-0.13) who were bedridden due to sickness in their childhood. Similarly, the pain likelihood was higher among men who missed school for more than a month due to health problems (AME: 0.04, CI: -0.01-0.09). Men and women with poor financial condition in their childhood reported (AME: 0.04, CI: 0.01-0.07) a higher probability of experiencing pain relative to their peers who reported a more financially advantaged early life.

CONCLUSIONS

Findings of the present study add to the empirical literature on the association between early life factors and later life health and well-being. They also are pertinent to health care providers and practitioners working in pain management, as this knowledge better positions them to identify older adults most susceptible to pain. Moreover, findings of our study underscore that the interventions to ensure health and well-being in later life must start far earlier in the life course.

The risk factors for self-reported fibromyalgia with and without multiple somatic symptoms: The Lifelines cohort study

OBJECTIVE

The numerous risk factors for fibromyalgia reflect its heterogeneous nature. This study assessed whether the predictors of fibromyalgia onset vary according to number of prior somatic symptoms.

METHODS

The prospective, population-based Lifelines cohort study included 138,617 adults without fibromyalgia or marked muscle pain. At baseline socio-demographic status, physical and psychiatric disorders, psycho-social and behavioural variables were assessed as potential predictors. At follow-up (mean 2.4 years later) new onsets of fibromyalgia were recorded by self-report. The predictors of new onsets of self-reported fibromyalgia were assessed using logistic regression with interaction terms between key variables and number of somatic symptoms.

RESULTS

At follow-up 679 (0.5%) participants reported new onset fibromyalgia. The strongest predictors were: female sex, rheumatoid and osteo-arthritis, IBS, impaired sleep, migraine, few years of education and impairment by bodily pain. Interaction terms with somatic symptoms were significant for years of education, low income, rheumatoid arthritis and no. of analgesics; these were predictors only for fibromyalgia with few somatic symptoms. Participants with multiple somatic symptoms had a higher number of predictors than those with few somatic symptoms.

CONCLUSION

This study suggests that people developing self-reported fibromyalgia with multiple pre-existing somatic symptoms have a high risk factor load reflecting risk factors for both fibromyalgia and multiple somatic symptoms. Self-reported fibromyalgia with few somatic symptoms has fewer predictors which may be specific to fibromyalgia. Future research could usefully study whether different pathophysiological mechanisms occur when fibromyalgia is preceded by high or low number of somatic symptoms.

The relationship between regional pain with or without neuropathic symptoms and chronic widespread pain

Neuropathic pain was relatively rare and predicted a small number of chronic widespread pain cases. Using these estimates, treatments targeting neuropathic pain would at best prevent 6% of chronic widespread pain cases.

This study was performed to test whether the risk of developing chronic widespread pain (CWP) in those with regional pain was augmented in those with symptoms of neuropathic pain (NP). Persons free of CWP completed the Douleur Neuropathique 4 (scores ≥3 indicating NP); demographics; Hospital Anxiety and Depression scale; Pittsburgh Sleep Quality Index; and pain medications. Participants were classified as having no pain, regional pain with no symptoms of NP (), or regional pain with symptoms of NP (NP). At the 12-month follow-up, participants with CWP were identified. Logistic regression estimated the odds ratio, with 95% confidence intervals, of CWP in the and NP groups compared with no pain, and NP compared with . Partial population attributable risks estimated the proportion of CWP attributable to baseline or NP exposure. One thousand one hundred sixty-two participants completed the baseline DN4 and provided pain data at follow-up: 523 (45.0%) had no baseline pain, 562 (48.4%) , and 77 (6.6%) NP. One hundred fifty-three (13.2%) had CWP at 12 months: 19 (3.6%) no pain, 108 (19.2%) , and 26 (33.8%) NP. (2.9 [1.9-4.3]) and NP (2.1 [1.1-4.0]) predicted CWP after adjusting for demographics, Hospital Anxiety and Depression scale, Pittsburgh Sleep Quality Index, and medications. The partial population attributable risk was 41.3% (25.2-54.0) for and 6.0% (0.1-11.6) for NP. The NP group were not more likely to develop CWP when compared directly with (1.5 [0.8-2.8]). Neuropathic pain was relatively rare and predicted a small number of new-onset CWP cases. Using these estimates, treatments targeting NP would at best prevent 6% of CWP cases.

Longitudinal profiles of back pain across adulthood and their relationship with childhood factors: evidence from the 1946 British birth cohort

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In a British birth cohort study, 4 distinct long-term back pain profiles were identified, each of which was associated with different early life risk factors.

This study aimed to (1) characterise long-term profiles of back pain across adulthood and (2) examine whether childhood risk factors were associated with these profiles, using data from 3271 participants in the Medical Research Council National Survey of Health and Development. A longitudinal latent class analysis was conducted on binary outcomes of back pain at ages 31, 36, 43, 53, 60 to 64, and 68 years. Multinomial logistic regression models were used to examine associations between selected childhood risk factors and class membership; adjusted for sex, adult body size, health status and behaviours, socioeconomic position, and family history of back pain. Four profiles of back pain were identified: no or occasional pain (57.7%), early-adulthood only (16.1%), mid-adulthood onset (16.9%), and persistent (9.4%). The “no or occasional” profile was treated as the referent category in subsequent analyses. After adjustment, taller height at age 7 years was associated with a higher likelihood of early-adulthood only (relative risk ratio per 1 SD increase in height = 1.31 [95% confidence interval: 1.05-1.65]) and persistent pain (relative risk ratio = 1.33 [95% confidence interval: 1.01-1.74]) in women (P for sex interaction = 0.01). Factors associated with an increased risk of persistent pain in both sexes were abdominal pain, poorest care in childhood, and poorer maternal health. Abdominal pain and poorest housing quality were also associated with an increased likelihood of mid-adulthood onset pain. These findings suggest that there are different long-term profiles of back pain, each of which is associated with different early life risk factors. This highlights the potential importance of early life interventions for the prevention and management of back pain.

Lifetime socioeconomic circumstances and chronic pain in later adulthood: findings from a British birth cohort study

OBJECTIVES

To investigate associations between a range of different indicators of socioeconomic position (SEP: occupational class, education, household overcrowding and tenure, and experience of financial hardship) across life and chronic widespread and regional pain (CWP and CRP) at age 68.

DESIGN

Prospective birth cohort; the Medical Research Council National Survey of Health and Development.

SETTING

England, Scotland and Wales.

PARTICIPANTS

Up to 2378 men and women who have been followed-up since birth in 1946 to age 68.

PRIMARY OUTCOME MEASURES

On the basis of their self-report of pain at age 68, participants were classified as: CWP (American College of Rheumatology criteria), CRP (pain of at least 3 months' duration but that does not meet the definition of CWP), other pain (<3 months in duration) or no pain.

RESULTS

At age 68, the prevalence of CWP was 13.3% and 7.8% in women and men, respectively, and that of CRP was 32.3% and 28.7% in women and men, respectively. There was no clear evidence that indicators of SEP in childhood or later adulthood were associated with pain. Having experienced (vs not) financial hardship and being a tenant (vs owner-occupier) in earlier adulthood were both associated with an increased risk of CWP; for example, moderate hardship adjusted relative risk ratio (RRR_adj) 2.32 (95% CI: 1.19 to 4.52) and most hardship RRR_adj 4.44 (95% CI: 2.02 to 9.77). Accumulation of financial hardship across earlier and later adulthood was also associated with an increased risk of CWP.

CONCLUSIONS

Consideration of socioeconomic factors in earlier adulthood may be important when identifying targets for intervention to prevent CWP in later life.

Lifetime cigarette smoking and chronic widespread and regional pain in later adulthood: evidence from the 1946 British birth cohort study

OBJECTIVE

To examine whether different lifetime patterns of cigarette smoking are associated with chronic widespread pain (CWP) and chronic regional pain (CRP) at age 68.

DESIGN

Prospective cohort study.

SETTING

England, Scotland and Wales.

PARTICIPANTS

Up to 2347 men and women from the Medical Research Council National Survey of Health and Development, who have been followed up since birth in 1946 and provided sufficient information on cigarette smoking across adulthood to be classified as never smoker, predominantly non-smoker, predominantly smoker or lifelong smoker and pain assessment at age 68.

PRIMARY OUTCOME MEASURES

Pain was self-reported at age 68, and CWP was defined according to American College of Rheumatology criteria. Participants who reported having pain for ≥3 months but who did not meet the CWP definition were classified as having CRP; those who reported pain which had lasted for <3 months were classified as 'other' pain. No pain was the reference group.

RESULTS

Findings from multinomial logistic regression models indicated that compared with never smokers, predominantly non-smokers, predominantly smokers and lifelong smokers all had an increased risk of CWP; relative risk ratios=1.70(95% CI 1.16 to 2.49); 2.10(95% CI 1.34 to 3.28) and 1.88(95% CI 0.99 to 3.57), respectively, after adjusting for sex, own occupational class, educational level, body mass index, leisure time physical activity, alcohol intake, long-standing illness and symptoms of anxiety and depression. No association was observed between smoking history and CRP or other pain.

CONCLUSIONS

These results suggest that exposure to cigarette smoking at any stage in adulthood was associated with higher risk of CWP in later adulthood; highlighting the ongoing importance of smoking prevention programmes. It also suggests that assessment of lifetime smoking behaviour may be more useful in identifying those at greater risk of CWP in later life than assessment of current smoking status.

Markers of pubertal timing and leisure-time physical activity from ages 36 to 68 years: findings from a British birth cohort

OBJECTIVES

We aimed to examine associations between markers of pubertal timing and leisure-time physical activity (LTPA) from ages 36 to 68 years in men and women from the Medical Research Council National Survey of Health and Development.

STUDY DESIGN

Pubertal timing was ascertained by physicians at age 14-15 years. Boys were grouped, based on their secondary sexual characteristics, as prepubescent, in early-stage puberty, advanced stage puberty or fully mature at age 14-15 years. Girls were grouped as reaching menarche ≤11, 12, 13 or ≥14 years. LTPA was reported at ages 36, 43, 53, 60-64 and 68 years and classified as active or inactive at each age. Associations were examined using standard and mixed-effects logistic regression models.

RESULTS

Of 5362 singleton births recruited, 1499 men and 1409 women had at least one measure of LTPA and data on pubertal timing and selected covariates. When compared with men that were fully mature at age 14-15 years, those that were in advanced stage and early-stage puberty, but not the prepubescent stage, had lower likelihood of LTPA at younger but not older adult ages (p=0.06 for pubertal status-by-age at LTPA interaction in mixed-effects model). For example, fully adjusted ORs of LTPA (vs no LTPA) at ages 36 and 68 years, respectively, for advanced puberty versus fully mature were 0.69 (95% CIs 0.50 to 0.96) and 1.03 (0.72 to 1.47). Age at menarche was not associated with LTPA at any age (p_interaction with age at LTPA=0.9). For example, OR (from mixed-effects model) of LTPA between 36 and 68 years was 1.23 (0.93, 1.63) for menarche at 13 vs ≤11 years.

CONCLUSIONS

In a nationally representative study, there was little evidence to suggest that pubertal timing was an important correlate of LTPA between ages 36 and 68 years. Maturity-related variations in adolescents' LTPA may be transitory and lose importance over time.