Adverse life events

The Connection Between Chronic Pain & Adverse Life Events

The basis of musculoskeletal pain is biomechanical. Yet, emotional trauma is the single most influential factor in determining the severity of chronic pain a population of patients will suffer. However, many chronic pain sufferers do not identify as having any significant trauma. Some because they legitimately don’t. Many others because they do, but were just not aware.

Emotional trauma does not solely arise after life’s newsworthy events; assaults, car crashes, bombs and the like. Difficult childhood experiences and relationship adversity are thought to be the most common sources of trauma. Experts sometimes use the terms ‘big T Trauma’ and ‘small t trauma’ to highlight the fact that trauma exists on a spectrum.

In truth, we stand about as much chance of making it through life with zero trauma as we do of avoiding all viruses. Trauma is baked into the human cake. Even our births are profoundly traumatising in many instances.

Trauma-based disorders are a kind of neurological residue. They are what gets left behind when adverse events exceed our ability to ‘cope’ in a given moment. When we are ‘overwhelmed’. The threshold for this varies greatly from person to person across a lifetime. Children are particularly susceptible.

Researchers refer to the stresses that lead to trauma as ‘Adverse Life Experiences’ (ALEs) and ‘Adverse Childhood Experiences’ (ACEs). We all have differing levels of exposure to ALEs and ACEs. And we all have differing levels of sensitivity to ALEs and ACEs.

ALEs and ACEs are known to be key factors in determining human health and human pain in all its forms.

In the 1600s, our health and well-being were ravaged by a constellation of viruses and bacteria that we didn’t even know existed. In the 21st century, trauma caused by ALEs and ACEs has a similarly vast and unseen impact on the health of society.

The public health crises we face today in the West are no longer communicable diseases. They are non-communicable conditions like cancers, cardiovascular disease, respiratory disorders, diabetes and chronic pain. Countless recent studies show that ‘adverse life events’ play a key role in perpetuating our main public healthcare crises.  

Sometimes research speaks louder than words. So consider the following statements published in highly reputable scientific journals. *Some are fractionally reworded for ease of reading; the meaning has been carefully preserved.

Adverse childhood experiences (ACEs) show strong cumulative associations with ill health across the life course.

  British Medical Journal 2023

It is important to note that psychosocial factors contribute significantly to pain persistence, response to conservative treatment and rehabilitation, and the likelihood of developing a disability –  Journal of Multidisciplinary Healthcare

Adverse life events (ALEs) are a risk factor for chronic pain.  The Journal of Pain 2021

..adverse childhood experiences were associated with a significantly elevated risk of type 2 diabetes in adulthood. Participants who had experienced an adverse childhood experience had a 32% increased risk of developing type 2 diabetes later in life.’  The British Medical Journal 2021

‘Adverse childhood experiences are an important risk factor for the development of lung diseases in adulthood.’  European Journal of Psychotraumatology 2020

‘Older adults with lifetime ‘partial PTSD’ have elevated rates of gastritis, angina pectoris, arthritis, and poorer physical functioning’. Journal of the American Geriatric Society 2012

‘The findings from our review suggest that child maltreatment and other early adversities may increase a person’s cancer risk. Additional research is needed to understand better the mechanisms driving this relationship.’  Paediatrics 2016

It is important to note that psychosocial factors contribute significantly to pain persistence, response to conservative treatment and rehabilitation, and the likelihood of developing a disability –  Journal of Multidisciplinary Healthcare

‘Active duty military personnel with PTSD may have an elevated risk of a range of autoimmune diseases, regardless of combat experience or prior trauma.                                 BMC Psychiatry 2020

Chronic pain patients with post-traumatic stress symptoms (PTSS) reported significantly higher levels of pain intensity, pain-related disability, depression, and anxiety    Journal Of Pain Research, 2018

‘Studies worldwide have shown a relationship between traumatic events in childhood and the later development of chronic pain. Pain 2020

‘Mothers with a high adverse childhood experience score had an increased risk of hypertensive disorders in pregnancy and preterm birth. These results underscore how remote events may reverberate through the life course.’  Obstetrics & Gynaecology 2021.

‘There is considerable evidence that stressful early life events influence a variety of physical health problems later in life. Childhood adversity has been linked to elevated rates of morbidity and mortality from a number of chronic diseases.’  Brain Behaviour and Immunity 2013.

‘Children exposed to higher psychological stress have higher cortisol levels and greater risk of common diseases of childhood, including otitis media, viral infections, asthma, dermatitis, urticaria, intestinal infectious diseases, and urinary tract infections.’ British Medical Journal 2020

‘Childhood adversities are associated with a greater risk of adult conditions, including cardiovascular disease, stroke, cancer (excluding skin cancer), asthma, chronic obstructive pulmonary disease, kidney disease, diabetes, overweight or obesity, and depression, as well as increased health risk behaviours.’  British Medical Journal 2020.

‘meta-analysis found a significant association between the level of childhood psychosocial stressors and telomere length across 27 samples, including 16,238 participants’    Frontiers in Psychology 2021  * Telomeres are the protective caps at the tips of chromosomes that play an important role in cell ageing.

 ‘Adverse childhood experiences are associated with immune dysregulation across many indices, including illness and infection susceptibility, latent herpesvirus reactivation, and immune response to tumours.’ Frontiers In Psychology 2021

‘Childhood adversity is associated with a host of mental and physical health problems across the lifespan. Individuals who have experienced childhood adversity are at a greater risk for morbidity and premature mortality than those not exposed to childhood adversity.Frontiers In Psychology 2021

‘The occurrence of financial hardship and hospitalisation had a direct association with migraine diagnosis and frequency. The death of a close relative was also independently associated with the highest migraine frequency.’ BMC Public Health 2014

‘Adverse childhood experiences are associated with pain, including headaches, in adulthood.’ Headache Journal 2022

‘Exposure to a single adverse childhood experience increases the risks of poorer outcomes across health-harming behaviours, sexual health, mental well-being and criminal domains. Toxic stress can arise from physical and sexual abuse, but other more prevalent adverse childhood experiences (e.g., verbal abuse, parental separation) may also contribute substantively to poorer life course health.’  British Medical Journal 2023

‘…our results indicate that adverse childhood experiences are highly prevalent amongst adolescent mothers and important risk factors for migraine.’  Journal of Psychosomatic Research 2021

‘Children and adolescents with adverse childhood experiences had an increased risk for chronic pain, and this association increased in a dose-dependent fashion.’  Pain Reports 2021

‘ Adverse life events were a risk factor for the onset of chronic multisite musculoskeletal pain, suggesting that psychosocial factors play a role in triggering the development of this condition.’  Annals of Rheumatic Diseases 2016

‘Specifically, the types of traumas mostly associated with cardiovascular disease were emotional neglect, emotional and physical abuse, harassment and sexual abuse, especially if experienced before 18 years of age. The study confirmed that childhood trauma has a greater impact on adult cardiovascular health and that the burden is worst in women’. Healthcare 2021

‘An increasing body of evidence demonstrates that PTSD is associated with a significant body of physical morbidity in the form of chronic musculoskeletal pain, hypertension, hyperlipidaemia, obesity and cardiovascular disease.’  World Psychiatry Journal

There are two main ways that life adversity leads to serious long-term health issues. 

The first factor is the physical strain of living with a body/mind system that doesn’t believe the environment is safe. Which gradually leads to serious dysregulation of body systems. 

The second factor is that when we are suffering terribly, we tend to make destructive lifestyle choices and neglect basic self-care.

The impacts of trauma and adverse life events on public health are a vast and largely unseen health crisis. Yet,  despite what research has shown, we still appear to be a  long way from developing a ‘trauma-informed’ health system. Sadly chronic pain is very, very much a part of this grim situation.

The good news is that trauma and the residue of adverse life events are treatable with the right methods.

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