The Role of Adverse Life Experiences in Chronic Pain

The Adverse Childhood Experiences study was the first longitudinal study of its kind to demonstrate the impact between early trauma and the onset of adult chronic illness, both mental and physical.
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The researchers, Dr Felitti and Dr Anda recruited over 17,000 people in the Kaiser Permanente Health Care System from 1995-97 with longterm follow up for tracking health outcomes.  The results of the study were initially published in the Journal of the American Medical Association in December 2001. (1)

The participants were surveyed  on trauma oriented questions based on 8 types of trauma and (later they added physical and emotional neglect for a total of 10).

Early trauma types or Adverse Childhood Experiences (ACE):

• Emotional, Physical and Sexual abuse
• Physical and Emotional neglect
• Mother treated violently
• Household substance abuse
• Household mental illness
• Parental separation or divorce
• Incarcerated household member​

Upon completion of the study, the outcomes were very clear:

• There was a definite connection between childhood trauma and adult onset of chronic disease.
• 2/3 of the adults in the study experienced 1 or more of the adverse childhood experience.
• The more ACES a person had, the greater chance of medical, mental and social issues as an adult.  With an ACE score of 4 or higher they found an increased risk for hepatitis, chronic lung disease, sexually transmitted infections, heart disease, cancer, diabetes, autoimmune diseases, depression, mental illness, suicide, alcohol, drug & tobacco addictions.  People with high ACE scores were more prone to violence, divorce, broken bones,  and more medical prescriptions. (2)

Without question, the ACES study is evidence to the impact that early chronic toxic stress has on the brain, the body and behaviors.  Since the initial publication of the ACES study, there have been numerous studies that have validated Anda and Felitti's outcomes. 

​As a physical therapist the majority of clients that I work with are in pain.  Many clients have had long standing pain in multiple areas, as well as having other symptoms such as depression/anxiety, GI disturbances, overactive bladders, hypothyroidism, migraines, etc.  I feel, that as a provider, I have the responsibility to educate and empower my clients to not only get out of pain, but to awaken their body to its full potential.  In order to fully heal, rather than putting on a temporary band aid (pharmaceuticals, cortisone injections, massages, hot/ice packs, CBD rubs) it is essential to get to the root.  The ACES study, and subsequent  "multiple studies worldwide have shown a dose-response relationship between traumatic events in childhood, such as abuse, neglect, or a dysfunctional home, and later development of chronic pain." (3)  Not all people are ready or willing to dig to the root.  Healing is not comfortable, but the reality is, is that the pains of childhood are alive and well in the tissues of the body.  And it is through the body that healing can begin.  Are you ready?

Infographic taken from the article Connecting the Dots: How Adverse Childhood Experiences Predispose to Chronic Pain. Click the pic to take you to the article.

Do you want to know your ACES score?

Go to the website www.acestoohigh.com to access the survey and discover your score.  This website is full of information and resources to begin to understand the connection between ACES and chronic illnesses.  There is hope for healing.  It is never too late.  Therapies that address both the body and mind are effective tools for the healing journey.  At ALIGN, I respect the nervous system; I am body-based and trauma informed.  I have completed my certification in the Prenatal and Perinatal Education Program, participated in online courses and have studied with Kathy Kain, the author of Nurturing Resilience: Helping Clients Move Forward from Developmental Trauma--An Integrative Somatic Approach.  "Kathy’s trainings cover various interwoven focus areas, including trauma recovery, somatic touch, self-regulation skills, and resilience. These focus areas ultimately weave together into a unified somatic approach to touch, awareness, and relationship."  If you are ready, there are many ways to begin the journey to heal.

Recommendation of body therapies that can be helpful for healing chronic illness

• Somatic Experiencing
• Sensorimotor Psychotherapy
• EMDR (Eye Movement Desensitization and Reprocessing
• Internal Family Systems
• Biodynamic Cranial Sacral Therapy
• Family Constellations Therapy
• Yoga Therapy

References:

1. JAMA. 2001;286(24):3089-3096.
2. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. 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 1998;14:245–258.
3. W. Clay Jackson, MD, DipTH.  Connecting the Dots: How Adverse Childhood Experiences Predispose to Chronic Pain.  Practical Pain Management.  2020;2:24-28.​

Articles not referenced in this blog that are informative resources:

• Toxic Stress: Effects, Prevention and Treatment
• The Cost of Stress
• The Lifelong Effects of Early Childhood Adversity and Toxic Stress

Susan McLaughlin is a physical therapist who specializes in the management of pelvic floor and orthopedic dysfunctions. She is the owner of ALIGN integration|movement in Salt Lake City, UT.  Helpful tips and other self care strategies can be found at www.alignforhealth.com.