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The study aims to explore how adverse childhood experiences relate to pain incidence and multisite pain trajectories, considering mental health factors.

January 24, 2026Open Access

Adverse childhood experiences and pain incidence and multisite trajectories among middle-aged and older Chinese adults

Key Points

The study aims to explore how adverse childhood experiences relate to pain incidence and multisite pain trajectories, considering mental health factors.
Analyzed data from the China Health and Retirement Longitudinal Study (2011–2020)
Utilized two samples: pain-free individuals and those with repeated pain measures
Measured adverse childhood experiences using a cumulative index of 13 adversities
Employed statistical models including Cox proportional hazards and multinomial logistic models
Identified three multisite pain trajectories: minimal, increasing, and high multisite pain.
Higher adverse childhood experience scores were linked to a 20% increased risk of incident pain.
Individuals with high ACE scores had nearly four times greater odds of belonging to high multisite pain trajectories.
Depressive symptoms mediated a significant portion of the ACEs to pain association, while social isolation had minimal mediation effects.

Abstract

Abstract Introduction: Pain is prevalent among middle-aged and older adults, and adverse childhood experiences (ACEs) may contribute to its development; however, mechanisms linking ACEs to pain remain unclear. Objectives: This study investigates the association between ACEs and incident pain and multisite pain trajectories, focusing on mediation by depressive symptoms and social isolation. Methods: We used China Health and Retirement Longitudinal Study data (2011–2020). We analyzed 2 samples: an incidence cohort of pain-free at baseline (n = 9,252) and a trajectory cohort with repeated pain measures (n = 9,935). Pain was assessed at each wave by self-reported presence and multisite pain trajectories. Adverse childhood experiences were measured using a cumulative index of 13 adversities. Cox proportional hazards models, group-based trajectory modeling, and multinomial logistic models estimated associations with incident pain and trajectory group membership. Multiple mediation analyses quantified indirect effects of depressive symptoms and social isolation. Results: We identified 3 multisite pain trajectories: minimal multisite (46.33%), increasing multisite (38.93%), and high multisite (14.74%). Higher ACEs scores (≥4) were associated with increased risk of incident pain (hazard ratio = 1.20, 95% confidence interval CI: 1.10–1.32) and membership in high multisite trajectories (odds ratio = 3.97, 95% CI: 3.05–5.17). In parallel mediation models, depressive symptoms mediated up to 28.25% of the ACEs–pain association for high multisite trajectories, whereas social isolation showed minimal effects. Conclusion: Adverse childhood experiences were linked to incident and multisite pain, largely through depressive symptoms. Targeting psychological health may mitigate the impact of ACEs on pain outcomes, suggesting a need for interventions addressing early-life exposures and mental health interventions in aging populations.

Adverse childhood experiences and pain incidence and multisite trajectories among middle-aged and older Chinese adults

Key Points

Abstract

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