What is this summary about?
This summarises a journal article describing an analysis we did with data from the UK Biobank, a study which has collected medical and other information from half a million people in the UK. We carried out secondary analyses on the data gathered by the UK Biobank researchers, which means we did not collect the data ourselves, but got permission from the data owners to safely and securely access and analyse the UK Biobank data.
Why did we do this analysis?
We did this work as part of the Consortium Against Pain InEquality (CAPE), which has gathered together a group of researchers and experts (including people with lived experience) to try to improve our understanding of how adverse childhood experiences – like abuse, neglect, physical or emotional trauma – might lead to chronic (long-lasting) pain in adulthood.
You can read more about CAPE on the University of Aberdeen and University of Dundee study webpages.
What did we do?
In this analysis of UK Biobank, we wanted to estimate how much of an effect there was of having been abused or neglected as a child on later developing chronic pain all over the body. Using patterns of data from over 100,000 people aged over 50, we modelled what it may have been like if all of the people had experienced abuse and neglect as a child, and compared that to what it may have been like if no one had been maltreated as a child: counting in each scenario how many people would have had chronic pain all over the body. This is known as a counterfactual analysis.
What did we find?
The number of women with chronic all-over body pain went from 5% (when no one was maltreated) to 8% (if everyone was maltreated). For men, the numbers were 1% to 4%. Some of this effect is explained by poor mental health (depression and anxiety) resulting from the maltreatment, which could then have gone on to cause the chronic pain.
Experiencing a traumatic event as an adult also had a similar effect: when we modelled, using patterns in the data, what it would have been like if everyone had recently (within the past two years) experienced a bereavement, divorce, serious illness, an assault or financial difficulties, we found a higher number of people with chronic pain all over, compared to a scenario where no one had had any of these traumas recently. The effect of recent trauma was even greater for those people who had also experienced childhood maltreatment.
Can we trust these results?
When you ask people about events which happened many years ago, there is always the worry that memory might affect what people report back. To check if differences in memory influenced our results, we also looked at another childhood experience – serious sunburn. At the same time that people were asked about experiences of childhood maltreatment, people were asked how many times as a child they had had sunburn that blistered or hurt for 2 or more days. We would not expect sunburn as a child to cause chronic pain later in life, so if we found a difference in chronic pain if people were sunburnt or not, we might suspect that the patterns we were seeing in the data were because of something else (like memory bias). Our analysis showed, when we modelled what it would have been like if the people had all been sunburnt as a child or if no one had, there wasn’t much difference in the numbers of people with chronic pain all over. This makes us think it’s not just memory differences that are causing the effects we see when we model childhood maltreatment.
It is important to note that the majority of people in UK Biobank are of White ethnicity. We do not know if we would see the same patterns in people of other ethnicities, and it is important that further research is done involving a more diverse selection of people.
What does this mean?
There might still be other factors – that were not measured in this study – that are involved in developing chronic pain all over. But these results suggest that stopping childhood maltreatment from happening would likely prevent cases of chronic pain in adulthood. We also think the results show that we could find optimal times to help support people, such as when they experience a traumatic event as an adult, and that treating survivors of maltreatment for depression and anxiety could be important for preventing chronic pain. The next steps would be to design and evaluate if these preventative measures could work.
Who funded this study?
The study was funded under the Advanced Pain Discovery Platform (MR/W002566/1).
Where can I read more?
Click here for access to the full paper.