Stress, Loneliness and Resilience in the Relationship Between Adverse Childhood Experiences and Chronic Pain

Adverse Childhood Experiences (ACEs) are recognized risk factors for chronic pain in adulthood, yet the underlying mechanisms remain unclear. A sample of 595 adults completed validated self-report measures assessing ACEs, perceived stress, loneliness, resilience, and chronic pain. Correlational analyses and a path analysis with multiple mediators were conducted to examine direct and indirect pathways linking ACEs to chronic pain. ACEs were positively associated with higher levels of perceived stress and loneliness, both of which significantly mediated the relationship between ACEs and chronic pain. In contrast, resilience demonstrated a protective mediating role, partially explaining the association between ACEs and chronic pain in a negative direction. These findings suggest that stress and loneliness represent key risk pathways linking early adversity to chronic pain, whereas resilience functions as a protective psychological mechanism. Interventions aimed at reducing stress and loneliness while fostering resilience may help mitigate the long-term impact of ACEs on chronic pain.