Abstract
Objective: The present systematic review aimed to evaluate the association between childhood maltreatment and chronic pain, with specific attention to the temporal nature of the relationship and putative moderators, including, the nature (type), timing of occurrence, and magnitude of maltreatment; whether physical harm or injury occurred; and whether post-traumatic stress disorder (PTSD) subsequently developed. Method: We included studies that measured the prospective relationship between child maltreatment and pain. Medline, EMBASE, PsycINFO, and CINAHL were searched electronically up to 28 July 2019. We used accepted methodological procedures common to prognosis studies and preregistered our review (PROSPERO record ID 142169) as per Cochrane review recommendations. Results: Nine studies (17,340 participants) were included in the present review. Baseline participant age ranged from 2 years to more than 65 years. Follow-up intervals ranged from one year to 16 years. Of the nine studies included, three were deemed to have a high risk of bias. With the exception of one meta-analysis of three studies, results were combined using narrative synthesis. Results showed low to very low quality and conflicting evidence across the various types of maltreatment, with the higher quality studies pointing to the absence of direct (non-moderated and non-mediated) associations between maltreatment and pain. PTSD was revealed to be a potential mediator and/or moderator. Evidence was not found for other proposed moderators. Conclusions: Overall, there is an absence of evidence from high quality studies of an association between maltreatment and pain. Our results are limited by the small number of studies reporting the relationship between child maltreatment and pain using a prospective design. High quality studies, including prospective cohort studies and those that assess and report on the moderators described above, are needed to advance the literature.
Highlights
Other studies have failed to show a relationship between child maltreatment and pain [11], and even for those that have, there are a number of methodological concerns that limit these findings
We conducted a systematic review of the relationship between child maltreatment and chronic pain selecting for studies that used a prospective design and focusing on factors that are likely to shape this relationship
Raphael and Widom [26] showed evidence of moderation by post-traumatic stress disorder (PTSD) across maltreatment types. These results provide additional evidence for the key role of PTSD in the maltreatment–pain relation and point to a lack of specificity when comparing sexual abuse, physical abuse, and neglect
Summary
With at least one in seven children having experienced abuse and/or neglect in the past year [1]. These experiences are traumatic to the individual and have serious life-long consequences, including depression, anxiety, PTSD, and suicide [2,3,4,5,6]. Utilize studies that evaluate, in a prospective manner, the relationship between maltreatment and pain, including the use of substantiated measures of child maltreatment, to delineate the nature of this association [11,14]
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