Consortium Against Pain InEquality (CAPE) - The impact of adverse childhood experiences on chronic pain and responses to treatment

CAPE's epidemiological work aims to find and analyse data that other universities and institutions have already collected, but that haven't yet been used to answer questions about adverse childhood experiences (ACEs) and pain.

We will look at ACEs and pain, considering other factors (such as mental health or support from friends or family) which may contribute to pain vulnerability. We will also try to find out if a relationship is specific to pain or is related to poor health more generally.

To do this, we will:

1. Identify large population-based cohort studies that we could use. A cohort is a group of people who have volunteered to have information (data) collected about them multiple times across their life or for a specific period of their life.
2. Apply for access to these data and numerically analyse them
3. Decide whether some studies would be improved with freshly collected information from the people in their cohorts, and arrange this with the investigators if possible

More than a third of adults in the UK are estimated to live with chronic pain, which can have a profound effect on their quality of life. Therefore, it is important to find ways to prevent people developing pain, or to help find treatments that work for those in pain. Adverse childhood experiences (ACEs) are known to contribute to health inequalities and have been associated with chronic pain in many studies, but the strength, detail, and quality of the evidence is not high. More also needs to be known about how ACEs might affect how well people with pain respond to treatment.

If we can identify who may be vulnerable to developing pain or which circumstances increase vulnerability following childhood adversity, it may give us insight into how we could reduce long-term harms or safely manage pain.

Mostly, we will conduct secondary analyses of large population-based studies, which means that we will analyse data that have already been collected. We will do this with shared data from existing cohort studies that have been stored - securely and with permission from the people in the cohort - at a university or other organisation. We may also ask to collect new data from some cohorts to analyse alongside existing data, if analyses would be improved with freshly collected information.

Data sharing is where research data is made available to researchers across different institutions. Before accessing any data, we would usually need to submit an application to the people who run the cohort study, explaining what we plan to do and why it is important. Then, agreements are set up between the researchers and data owners, to make sure legal and governance standards are met. Data must be shared and stored in a secure way, and will be anonymised, without any personal identifying information.

These data will allow us to look at factors across the lifecourse which are important for understanding the timing of experiences. We will numerically analyse the relevant information to better understand the factors that may contribute to, or protect against, later developing chronic pain after experiencing adversity in childhood. Looking at a variety of cohorts with differing characteristics enables us to compare the results from our analyses, seeing whether they are consistent across cohorts or whether there are different patterns we need to explain.

The more we can learn about the causal pathway, or different causal pathways, the better able we will be to prevent people becoming vulnerable to pain, using targeted treatments and support mechanisms. Stronger evidence is also valuable in raising awareness about the link between ACEs and chronic pain.

Childhood maltreatment and chronic “all over” body pain in adulthood

This article, published in PAIN, presents an analysis of UK Biobank data which has identified increased risk of chronic “all over” body pain for participants exposed to an ACE. This relationship was found for all types of maltreatment measured, in both men and women. A negative control showed minor associations with risk of chronic pain, suggesting that our results are not fully explained by recall bias.

You can read the full article via the link below:

• Kate A Timmins, Tim G Hales and Gary J Macfarlane, Childhood maltreatment and chronic “all over” body pain in adulthood: a counterfactual analysis using UK Biobank

British Pain Society (BPS) Annual Scientific Meeting 2023

An early output from this research was presented at BPS's annual conference in 2023. You can view our poster from this event here:

• Kate A Timmins, Jisha Babu, Tim G Hales, Lesley A Colvin and Gary J Macfarlane, Adverse childhood experiences and adult pain: opportunities and limitations of existing cohort data

You can find a supplementary list of the cohorts referred to in the poster here.

Chief investigator

• Professor Tim Hales (University of Dundee)

Principle investigator (UoA)

• Professor Gary Macfarlane

Co-investigators

• Dr Kate Timmins
• Mr Ross MacDonald

If you have any queries about CAPE, you can contact the study team via email at:

epidemiology@abdn.ac.uk