Role of Neighborhood Disadvantage and Adverse Childhood Experiences on Conditioned Pain Modulation in a Chronic Low Back Sample

Adverse childhood experiences (ACEs) represent a risk factor for chronic pain. Yet less research has examined the socioeconomic context within which these associations exist. Research on social conditions may elucidate mechanisms that contribute to pain disparities. Healthcare access, exposure to crime, and living conditions, which cluster at the neighborhood-level, likely exert a modulatory effect upon the role of ACEs and chronic pain in adulthood. This study examined (1) the relationship between ACEs and conditioned pain modulation (CPM), and (2) the moderating effect of area-level deprivation index (ADI) in sample of adults with chronic low back pain. One hundred and eighty-three adults (53% female, 62.8% non-Hispanic Black) completed quantitative sensory testing of endogenous pain modulation and psychosocial surveys. ADI moderated the association between ACEs and CPM (B = 1.00, CI [0.30, 1.71] p = 0.01). Greater ACEs were associated with a less efficient CPM response for individuals with low ADI (B = -5.21, CI [-8.66, -1.76], p < 0.01). ACEs were not associated with CPM for those with average (B = 1.20, CI [-3.54, 1.14], p = 0.31) or high ADI (B = 2.81, CI [-1.04, 6.66], p = 0.15). ACEs may be associated with diminished ability to inhibit pain, especially among individuals living in less deprivation. The association between ACEs and CPM was weakest adults residing in the most deprivation. People from disadvantaged backgrounds may experience numerous psychosocial stressors that hinder CPM, making it difficult to assess the specific impact of ACES. Funded by National Institutes of Health under award number R01MD0104.