Adverse childhood experiences (ACEs) are potentially traumatic events that occur in childhood such as experiencing abuse or neglect; witnessing violence at home; or having a family member incarcerated or addicted to substances such as drugs or alcohol. In the UK, 50% of Welsh adults (Public Health Wales 2018) and 47% of English adults (Bellis et al., 2014) have experienced at least one ACE during childhood. The cumulative effect of multiple, overlapping ACEs, have been shown to increase the risk and severity of chronic conditions including cancer, heart disease and chronic pain including musculoskeletal conditions in adults but we do not know what the effects are more immediately, within childhood and adolescence.

One such consequence of early adversity is chronic and persistent pain and significantly impacts quality of life and well-being (Fisher et al., 2016; Caes et al., 2015; IASP ICD 2016). The strongest evidence for an association comes from Groenewald and colleagues (2020) who investigated in a nationally representative sample of over 48,000 American children and found that those with a history of ACEs had an increased risk of chronic pain. The association increased in a dose-dependent manner and was driven by parental substance misuse ACEs and poverty ACEs.

There has been little attention within longitudinal population-based birth cohort studies, such as ALSPAC, exploring the relationship between comprehensively assessed ACEs and pain in children (Nelson et al., 2017). It would be more clinically relevant to identify the specific ACE types that most contribute to pain outcomes. We could use this to better inform intervention strategies for pain management with meaningful clinical and empirical value in children and adolescents with persistent pain conditions.