BACKGROUND There is well-established evidence linking adverse childhood experiences (ACEs) and chronic pain in adulthood. It is less clear how ACE exposure might influence the response to chronic pain treatment. In this systematic review, we synthesise the literature assessing the impact of ACE exposure on outcomes relating to the use, benefits, and harms of analgesic medications (analgesia-related outcomes). METHODS We searched seven databases from inception to September 26, 2023, for studies investigating adverse events in childhood (<18 yr) and any analgesia-related outcome during adulthood (≥18 yr). Title/abstract screening, full-text review, data extraction, and risk of bias assessment were performed independently by two authors. Given the high degree of study heterogeneity, a narrative synthesis was performed. RESULTS From 7531 records, 66 studies met inclusion criteria, involving 137 395 participants. Analgesia-related outcomes were classed into six categories: use of analgesics (n=12), analgesic side-effects (n=4), substance misuse (n=45), lifetime drug overdose (n=2), endogenous pain signalling (n=4), and other outcomes (n=2). No studies assessed the effect of ACE exposure on the potential benefits of analgesics. ACE exposure was associated with greater use of analgesic medication, higher incidence of analgesic medication side-effects, greater risk and severity of substance misuse, greater risk of drug overdose, and greater risk of attempted suicide in opioid dependency. CONCLUSIONS Adverse childhood experience exposure is associated with poor analgesia-related outcomes, so individual assessment adverse childhood experiences is important when considering the treatment of chronic pain. However, significant gaps in the literature remain, especially relating to the use and harms of non opioid analgesics. SYSTEMATIC REVIEW PROTOCOL CRD42023389870 (PROSPERO).

中文翻译：

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童年不良经历对镇痛相关结果的影响：系统评价。


背景 有确凿的证据表明，童年不良经历 （ACEs） 与成年期的慢性疼痛有关。目前尚不清楚 ACE 暴露如何影响对慢性疼痛治疗的反应。在本系统综述中，我们综合了评估 ACE 暴露对镇痛药物的使用、益处和危害相关结果（镇痛相关结果）影响的文献。方法 我们检索了从建库到 2023 年 9 月 26 日的 7 个数据库，以查找调查儿童期不良事件 （<18 岁） 和成年期 （≥18 岁） 任何镇痛相关结局的研究。标题/摘要筛选、全文审查、资料提取和偏倚风险评估由两位作者独立进行。鉴于研究的高度异质性，进行了叙述性综合。结果 从 7531 条记录中，66 项研究符合纳入标准，涉及 137 395 名研究对象。镇痛相关结局分为六类：镇痛药的使用（n=12）、镇痛药副作用（n=4）、物质滥用（n=45）、终生药物过量（n=2）、内源性疼痛信号（n=4）和其他结局（n=2）。没有研究评估ACE暴露对镇痛药潜在益处的影响。ACE 暴露与镇痛药的使用增加、镇痛药副作用发生率增加、物质滥用的风险和严重程度增加、药物过量风险增加以及阿片类药物依赖中自杀未遂的风险增加有关。结论 童年期不良经历暴露与镇痛相关结局不良相关，因此在考虑治疗慢性疼痛时，个体评估不良童年经历很重要。 然而，文献中仍然存在重大空白，尤其是与非阿片类镇痛药的使用和危害有关。系统评价方案 CRD42023389870 （PROSPERO）。