Unravelling the Relationship Between Adverse Childhood Experiences, Post-Traumatic Stress, and Pediatric Chronic Pain: An Integrative Examination

Children with chronic pain and their parents experience trauma symptoms at much higher rates than non-pain populations and trauma is linked to worse pain and functioning. Conceptual models of mutual maintenance posit that neurobiological, cognitive-behavioral, and interpersonal factors drive this relationship, but this has not yet been empirically shown in prospective research. Dr. Noel will present new prospective data from a cohort of treatment-seeking youth with chronic pain and their parents (N=200) integrating methods in brain-imaging eye-tracking, ecological momentary assessment, and activity monitoring demonstrating the roles of brain activation, cognitive biases, sleep disturbances and parent factors in the co-occurrence and maintenance of trauma (ACEs, PTSD) and pediatric chronic pain. Data demonstrating epigenetic and behavioural (parenting responses, sleep disturbances) mechanisms underlying the intergenerational  transmission of risk for pediatric chronic pain across generations will be presented. This will parallel preclinical findings from rodent model presented by co-presenter Dr. Mychasiuk. Overlapping epigenetic factors yielded from combining the animal and human models will be identified. New birth cohort data examining the role of parent ACEs in pregnancy and later development of chronic pain in adolescence, as well as underlying mechanisms, will also be presented. Implications for tailored, integrated interventions will be discussed.