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.

中文翻译：

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童年虐待和成年期慢性“全身”疼痛：使用英国生物样本库的反事实分析。


将童年不良经历与成年期慢性疼痛联系起来的证据主要是横断面的，可能会受到回忆偏倚的影响，并且不允许探索中介途径。我们使用因果框架分析了一个基于人群的大型队列 （UK Biobank），以确定儿童期虐待是否与成年期的慢性 “全身 ”疼痛有关。我们使用双倍稳健估计和逆概率权重来估计那些暴露于/未暴露于儿童虐待（虐待或忽视）的人之间慢性疼痛风险“全身”的差异。此外，我们研究了与成人压力生活事件的相互作用，并在广义线性模型中使用逆比值加权检查了中介。使用具有完整数据的病例 （n = 118,347），暴露者 （6.3%，95% 置信区间 [CI] 6.0%-6.5%） 患慢性 “全身” 疼痛的风险高于未暴露者 （4.0%;95% CI 3.8%-4.2%）。这种差异在按性别分层的分析中仍然存在。相反，当对阴性对照暴露（儿童期晒伤）重复分析时，女性的风险差异为 0.8% （95% CI 0.3%-1.3%） 和男性 0.5% （95% CI 0.1%-0.9%）。儿童期虐待和成年后生活事件具有相似的影响，当同时经历两者时，存在超加性风险 （1.2%;95% CI 0.6-1.7）。在中介分析中，总效应为相对风险 1.57 （95% CI 1.49-1.66），而通过所有中介的估计间接效应为相对风险 1.16 （95% CI 1.14-1.18）。减少儿童期虐待可能会预防成年期慢性广泛性疼痛的病例。压力大的成人事件和调解员可能会提供干预的机会。