Childhood maltreatment is associated with chronic pain in adults. The goals of this study were 1) to examine this relation in youth placed in foster care with high levels of maltreatment exposure, and 2) to investigate the relation between maltreatment frequency and acute pain, and maltreatment frequency and general chronic health condition. Participants included 403 youth ages 8–19 who resided in foster or residential/group homes. Youth with more maltreatment events had higher odds of chronic pain in a dose response fashion. There was no significant relation between maltreatment type and pain diagnosis, or maltreatment and general chronic health condition. This study examined both self- and case file report of maltreatment frequency and type in association with chronic pain, acute pain, and general chronic health condition in a sample of youth in foster care, providing evidence that more maltreatment exposure increases the likelihood of chronic pain, even in youth. This suggests that it may not take decades for the overloaded stress response system to lead to a serious pain condition, but that this process may occur much earlier in the lifespan. The findings have important implications for professionals working to prevent and treat the effects of child maltreatment or chronic pain.
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Anda, R., Tietjen, G., Schulman, E., Felitti, V., & Croft, J. (2010). Adverse childhood experiences and frequent headaches in adults. Headache: The Journal of Head and Face Pain, 50, 1473–1481.
Barnett, D., Manly, J. T., & Cicchetti, D. (1993). Defining child maltreatment: The interface between policy and research. In D. Cicchetti & S. L. Toth (Eds.), Child Abuse, Child Development, and Social Policy (pp. 7–73). Norwood: Ablex.
Bolger, K. E., & Patterson, C. J. (2001). Developmental pathways from child maltreatment to peer rejection. Child Development, 72, 549–568.
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98, 310–357.
Dickerson, S. S., & Kemeny, M. E. (2004). Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130, 355–391.
Elliott, A., Smith, B., Hannaford, P., Smith, W., & Chambers, W. (2002). The course of chronic pain in the community: Results of a 4-year follow-up study. Pain, 99, 299–307.
English, D. J., & Longscan Investigators. (1997). Modified maltreatment classification system (MMCS). For more information visit the LONGSCAN website at http://www.iprc.unc.edu/longscan. Accessed 4 Sept 2014.
English, D. J., Graham, J. C., Litrownik, A. J., Everson, M., & Bangdiwala, S. I. (2005). Defining maltreatment chronicity: Are there differences in child outcomes? Child Abuse & Neglect, 29, 575–595.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.
Flaherty, E. G., Thompson, R., Litrownik, A. J., Zolotor, A. J., Dubowitz, H., Runyan, D. K., English, D. J., & Everson, M. D. (2009). Adverse childhood exposures and reported child health at age 12. Academic Pediatrics, 9, 150–156.
Glaser, R., & Kiecolt-Glaser, J. K. (2005). Stress-induced immune dysfunction: Implications for health. Nature Reviews Immunology, 5, 243–251.
Green, C. R., Flowe-Valencia, H., Rosenblum, L., & Tait, A. R. (2001). The role of childhood and adulthood abuse among women presenting for chronic pain management. The Clinical Journal of Pain, 17, 359–364.
Hambrick, E. P., Tunno, A. M., Gabrielli, J., Jackson, Y., & Belz, C. (2014). Using multiple informants to assess child maltreatment: Concordance between case file and youth self-report. Journal of Aggression, Maltreatment & Trauma, 23, 751–771.
Hostinar, C. E., Sullivan, R. M., & Gunnar, M. R. (2014). Psychobiological mechanisms underlying the social buffering of the HPA axis: A review of animal models and human studies across development. Psychological Bulletin, 140, 1–47.
Huffhines, L., Tunno, A. M., Cho, B., Hambrick, E. P., Campos, I., Lichty, B., & Jackson, Y. (2016). Case file coding of child maltreatment: Methods, challenges, and innovations in a longitudinal project of youth in foster care. Children and Youth Services Review, 67, 254–262.
Imbierowicz, K., & Egle, U. T. (2003). Childhood adversities in patients with fibromyalgia and somatoform pain disorder. European Journal of Pain, 7, 113–119.
Jackson, Y., Gabrielli, J., Tunno, A. M., & Hambrick, E. P. (2012). Strategies for longitudinal research with youth in foster care: A demonstration of methods, barriers, and innovations. Children and Youth Services Review, 34, 1208–1213.
Jee, S. H., Barth, R. P., Szilagyi, M. A., Szilagyi, P. G., Aida, M., & Davis, M. M. (2006). Factors associated with chronic conditions among children in foster care. Journal of Health Care for the Poor and Underserved, 17, 328–341.
Jones, G. T., Power, C., & Macfarlane, G. J. (2009). Adverse events in childhood and chronic widespread pain in adult life: Results from the 1958 British birth cohort study. Pain, 143, 92–96.
Kendall-Tackett, K. (2001). Chronic pain: The next frontier in child maltreatment research. Child Abuse & Neglect, 25, 997–1000.
King, S., Chambers, C. T., Huguet, A., MacNevin, R. C., McGrath, P. J., Parker, L., & MacDonald, A. J. (2011). The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain, 152, 2729–2738.
Knight, E. D., Runyan, D. K., Dubowitz, H., Brandford, C., Kotch, J., Litrownik, A., & Hunter, W. (2000). Methodological and ethical challenges associated with child self-report of maltreatment: Solutions implemented by the LongSCAN consortium. Journal of Interpersonal Violence, 15, 760–775.
Kopec, J. A., & Sayre, E. C. (2005). Stressful experiences in childhood and chronic back pain in the general population. The Clinical Journal of Pain, 21, 478–483.
Lampe, A., Doering, S., Rumpold, G., Sölder, E., Krismer, M., Kantner-Rumplmair, W., Schubert, C., & Söllner, W. (2003). Chronic pain syndromes and their relation to childhood abuse and stressful life events. Journal of Psychosomatic Research, 54, 361–367.
Litrownik, A. J., Lau, A., English, D. J., Briggs, E., Newton, R. R., Romney, S., & Dubowitz, H. (2005). Measuring the severity of child maltreatment. Child Abuse & Neglect, 29, 553–573.
Merskey, H., & Bogduk, N. (1994). Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. International Association for the Study of Pain. Seattle: IASP Press.
Miller, G. E., Chen, E., & Zhou, E. S. (2007). If it goes up, must it come down? Chronic stress and the hypothalamic-pituitary-adrenocortical axis in humans. Psychological Bulletin, 133, 25–45.
Miller, G. E., Chen, E., & Parker, K. J. (2011). Psychological stress in childhood and susceptibility to the chronic diseases of aging: Moving towards a model of behavioral and biological mechanisms. Psychological Bulletin, 137, 959–997.
Nusslock, R., & Miller, G. E. (2016). Early-life adversity and physical and emotional health across the lifespan: A neuroimmune network hypothesis. Biological Psychiatry, 80, 23–32.
Palermo, T. M., Valrie, C. R., & Karlson, C. W. (2014). Family and parent influences on pediatric chronic pain: A developmental perspective. American Psychologist, 69, 142.
Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130, 601–630.
Shonkoff, J. P., Garner, A. S., Siegel, B. S., Dobbins, M. I., Earls, M. F., McGuinn, L., … Committee on Early Childhood, Adoption, and Dependent Care. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129, e232–e246.
Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics. Boston: Allyn & Bacon/Pearson Education.
Van Der Lee, J. H., Mokkink, L. B., Grootenhuis, M. A., Heymans, H. S., & Offringa, M. (2007). Definitions and measurement of chronic health conditions in childhood: A systematic review. JAMA, 297, 2741–2751.
Van Hecke, O., Torrance, N., & Smith, B. H. (2013). Chronic pain epidemiology and its clinical relevance. British Journal of Anaesthesia, 111, 13–18.
This research was supported by funding from the National Institutes of Mental Health, RO1 Grant MH079252-03 to Yo Jackson, Principal Investigator, as well as funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, F31 grant 1F31HD088020-01A1 awarded to Lindsay Huffhines.
Disclosure of Interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Ethical Standards and Informed Consent
All participants and their caregivers received information about the study, the voluntary nature of participation, and limits to confidentiality before provision of informed consent and assent at the start of each data-collection meeting. The authors’ university institutional review board and the State Department of Family Services review board provided approval for the study.
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Huffhines, L., Jackson, Y. Child Maltreatment, Chronic Pain, and Other Chronic Health Conditions in Youth in Foster Care. Journ Child Adol Trauma 12, 437–445 (2019). https://doi.org/10.1007/s40653-019-0248-x
- Chronic pain
- Acute pain
- Chronic illness
- Physical health
- Childhood maltreatment
- Childhood adversity
- Foster care