Development of Pain Symptoms in Youth Exposed to Traumatic Experiences

Summary

Pain is one of the most under-diagnosed and inadequately treated medical conditions. Pediatric chronic pain, defined as pain occurring 3 months or more is alarmingly prevalent in adolescence, affecting 1 in 4 Canadian youth. Moreover, it is a growing epidemic, costing upwards of $19 billion CAD/year. Unmanaged pain during childhood can lead to persistent pain and internalizing mental health conditions (e.g., post-traumatic stress disorder [PTSD], anxiety, depression) into adulthood. Therefore, pediatric chronic pain is a major public health concern. Adverse childhood experiences (ACEs) are stressful or traumatic events occurring prior to age 18 years. Youth with chronic pain disproportionately report being exposed to more ACEs than the general population. Consequently, they are more likely to develop post-traumatic stress symptoms (PTSS) and PTSD. Concurrent pain and PTSS have been linked to increased pain intensity and sensitivity. However, despite support for a relationship between ACEs and chronic pain, the mechanisms underlying this association remain unclear. The present study will invite chronic pain-free youth aged 12-18 years from the community to undergo an MRI and pain sensory testing and reporting, annually during adolescence. We will examine the extent that ACEs and PTSS which occurred either prior to and/or during the assessment period are associated with altered brain structural and functional connectivity and the development of pain symptomology in youth. Early identification and appropriate pain management may prevent the transition from acute to chronic pain. Therefore, this research may lead to changes in assessment, access, and clinical practice across health centres. As well, it may be an important step in understanding the mechanisms underlying the development of chronic pain in youth. This could lead to targeted, evidence-based interventions preventing the persistence of pain and mental health problems into adulthood.