The impact of adverse childhood experiences on cognitive behavioral interventions for chronic pain

Adverse childhood experiences (ACEs) increase the risk of developing chronic pain in adulthood. However, the impact of ACEs and specific ACEs subdomains on treatment response to cognitive behavioral interventions, which are among the frontline interventions for chronic pain, remains unexplored. This exploratory secondary analysis of a psychotherapy trial for chronic pain examined the associations among total ACEs and ACEs subdomains (household dysfunction and maltreatment) with pre-intervention level and treatment-related change in pain severity and interference. Trial participants (116 Veterans, M_age = 51.40; SD = 13.20) received one of two cognitive behavioral therapies for chronic pain that performed similarly in terms of pain outcomes. Participants completed self-report measures of ACEs at pre-treatment and measures of pain severity and interference at pre-treatment, weekly during treatment, post-treatment, and 3-month follow-up. There was a null association between ACEs (total and subdomains) and pain outcomes at pre-intervention. Higher total ACEs scores predicted significantly greater improvements in pain interference from pre-intervention to follow-up (p = .025). ACEs subdomains patterned differently with pain outcomes: higher maltreatment predicted significantly greater improvement in pain interference from pre-to-post-intervention (p = .049) and greater improvement from pre-intervention to follow-up, though above the threshold for statistical significance (p = .079). Further, higher household dysfunction predicted greater improvement in pain severity from pre-intervention to follow-up, though similarly above the threshold for statistical significance (p = .080). The present study yielded surprising and clinically informative results: cognitive behavioral interventions may be especially helpful for reducing pain interference in adults with higher ACEs. Furthermore, household dysfunction and maltreatment may be differentially associated with pain severity and interference. Future research is required to replicate the findings of this exploratory study.