Adverse childhood experiences (ACEs) affect adult mental health and tend to contribute to greater symptoms of depression and more frequent suicide attempts. Given the relationship between symptoms of depression and patient-reported outcomes (PROs), adversity in childhood might be associated with PROs in patients seeking care for musculoskeletal problems. We studied people seeking upper extremity musculoskeletal specialty care and found no association between ACE scores and pain intensity or activity tolerance. Greater ACE scores were independently associated with diagnosed mental comorbidities both when analyzed on the continuum and categorized but not with greater levels of health anxiety, symptoms of depression, or catastrophic thinking.

ACEs may not contribute to greater pain intensity or magnitude of physical limitations unless they are accompanied by greater health anxiety or less effective coping strategies. Adverse events can contribute to anxiety and depression, but perhaps they sometimes lead to development of resilience and effective coping strategies. Future research might address whether ACEs affect symptoms and limitations in younger adult patients and patients with more severe musculoskeletal pathology such as major traumatic injuries.

References

1. Ottenhoff JSE, Kortlever JTP, Boersma EZ, Laverty DC, Ring D, Driscoll MD. Adverse Childhood Experiences Are Not Associated With Patient-reported Outcome Measures in Patients With Musculoskeletal Illness. Clin Orthop Relat Res. 2019 Jan;477(1):219-228. doi: 10.1097/CORR.0000000000000519. PubMed PMID: 30586342.