{"title":"Childhood maltreatment and chronic \"all over\" body pain in adulthood: a counterfactual analysis using UK Biobank.","authors":"Kate A Timmins, Tim G Hales, Gary J Macfarlane","doi":"10.1097/j.pain.0000000000003457","DOIUrl":null,"url":null,"abstract":"<p><strong>Abstract: </strong>Evidence linking adverse childhood experiences and chronic pain in adulthood is largely cross-sectional, potentially subject to recall bias and does not allow exploration of mediating pathways. We analysed a large population-based cohort (UK Biobank) using a causal framework, to determine if childhood maltreatment is related to chronic \"all over\" body pain in adulthood. We used doubly robust estimation with inverse probability weights to estimate the difference in risk of chronic pain \"all over\" between those exposed/not exposed to childhood maltreatment (abuse or neglect). In addition, we looked at interaction with adult stressful life events and examined mediation using inverse odds weighting in a generalized linear model. Using cases with complete data (n = 118,347), the risk of chronic \"all over\" body pain was higher in the exposed (6.3%, 95% confidence interval [CI] 6.0%-6.5%) than in the unexposed (4.0%; 95% CI 3.8%-4.2%). This difference remained in analyses stratified by sex. Conversely, when analyses were repeated with a negative control exposure, childhood sunburn, risk differences were 0.8% in women (95% CI 0.3%-1.3%) and 0.5% in men (95% CI 0.1%-0.9%). Childhood maltreatment and adult life events had similar effects, and there was a supra-additive risk (1.2%; 95% CI 0.6-1.7) when experiencing both. In mediation analyses, the total effect was a relative risk of 1.57 (95% CI 1.49-1.66), while the estimated indirect effect via all mediators was relative risk 1.16 (95% CI 1.14-1.18). Reducing childhood maltreatment would likely prevent cases of chronic widespread pain in adulthood. Stressful adult events and mediators may offer opportunities for intervention.</p>","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":""},"PeriodicalIF":5.9000,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"PAIN®","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/j.pain.0000000000003457","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Abstract: Evidence linking adverse childhood experiences and chronic pain in adulthood is largely cross-sectional, potentially subject to recall bias and does not allow exploration of mediating pathways. We analysed a large population-based cohort (UK Biobank) using a causal framework, to determine if childhood maltreatment is related to chronic "all over" body pain in adulthood. We used doubly robust estimation with inverse probability weights to estimate the difference in risk of chronic pain "all over" between those exposed/not exposed to childhood maltreatment (abuse or neglect). In addition, we looked at interaction with adult stressful life events and examined mediation using inverse odds weighting in a generalized linear model. Using cases with complete data (n = 118,347), the risk of chronic "all over" body pain was higher in the exposed (6.3%, 95% confidence interval [CI] 6.0%-6.5%) than in the unexposed (4.0%; 95% CI 3.8%-4.2%). This difference remained in analyses stratified by sex. Conversely, when analyses were repeated with a negative control exposure, childhood sunburn, risk differences were 0.8% in women (95% CI 0.3%-1.3%) and 0.5% in men (95% CI 0.1%-0.9%). Childhood maltreatment and adult life events had similar effects, and there was a supra-additive risk (1.2%; 95% CI 0.6-1.7) when experiencing both. In mediation analyses, the total effect was a relative risk of 1.57 (95% CI 1.49-1.66), while the estimated indirect effect via all mediators was relative risk 1.16 (95% CI 1.14-1.18). Reducing childhood maltreatment would likely prevent cases of chronic widespread pain in adulthood. Stressful adult events and mediators may offer opportunities for intervention.
摘要:将童年的不良经历与成年后的慢性疼痛联系起来的证据大多是横断面的,可能会受到回忆偏差的影响,而且无法探索中介途径。我们采用因果框架分析了一个大型人群队列(英国生物库),以确定童年虐待是否与成年后 "全身 "慢性疼痛有关。我们使用反概率加权的双重稳健估计法来估算暴露于/未暴露于童年虐待(虐待或忽视)的人群之间 "全身 "慢性疼痛风险的差异。此外,我们还研究了与成人生活压力事件的交互作用,并在广义线性模型中使用反概率加权法研究了中介作用。利用数据完整的病例(n = 118,347),受虐待者罹患慢性 "全身 "疼痛的风险(6.3%,95% 置信区间 [CI] 6.0%-6.5%)高于未受虐待者(4.0%;95% CI 3.8%-4.2%)。在按性别进行分层分析时,这一差异依然存在。相反,当使用负面对照暴露(童年晒伤)进行重复分析时,女性的风险差异为 0.8%(95% CI 0.3%-1.3%),男性为 0.5%(95% CI 0.1%-0.9%)。童年虐待和成人生活事件具有相似的影响,当同时经历这两种事件时,存在超加成风险(1.2%;95% CI 0.6-1.7)。在中介分析中,总效应的相对风险为 1.57(95% CI 1.49-1.66),而通过所有中介因素估计的间接效应的相对风险为 1.16(95% CI 1.14-1.18)。减少童年时期的虐待可能会预防成年后慢性广泛性疼痛的病例。成年后的压力事件和中介因素可能会为干预提供机会。
期刊介绍:
PAIN® is the official publication of the International Association for the Study of Pain and publishes original research on the nature,mechanisms and treatment of pain.PAIN® provides a forum for the dissemination of research in the basic and clinical sciences of multidisciplinary interest.