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.
Li et al. (Fri,) studied this question.