Cumulative Trauma Exposures in Childhood and Adulthood and Pain Outcomes Among Older Adults

Background and Purpose: The majority of research on connections between trauma exposure and adult pain focuses on traumatic experiences in childhood. Less attention is paid to the role of trauma experienced during adulthood, especially among older adults. Among the limited studies that do exist, findings are mixed on whether adulthood trauma only contributes to pain outcomes. Our study explores these issues by examining the relationship between trauma exposure across the lifespan, from childhood to adulthood, and the onset of pain over six years among older adults, with an emphasis on the unique impact of adulthood trauma. We hypothesized that older adults who experienced any lifetime traumatic event are more likely to report pain than those with no traumatic history, and that both childhood and adulthood-specific trauma exposures would independently contribute to negative pain outcomes.

Method: Our study obtained data from the Health and Retirement Study, a nationally representative longitudinal biannual panel survey of adults over age 50. Our analytic sample only included participants who reported pain in the past 10 years, in order to ensure that adult trauma exposures preceded the onset of pain. Participants (N=7,076; 51% female) were between the ages of 50-99 (M=64.4 ± 10.8 years), primarily Non-Hispanic White (64.4%; Non-Hispanic Black=19.2%), married (61.8%), had a high school degree or less (64.3%), and reported no chronic health conditions (59.6%). A multi-level mixed effects logistic regression analysis was performed with repeated measures of pain over a six-year period as an outcome, childhood and adulthood traumatic events as exposures, and demographic and health-related covariates.

Results: Exposure to two or more childhood traumatic events was associated with higher odds of pain onset among older adults (OR=1.54; 95% CI: 1.09, 2.18) even after controlling for exposure to adulthood traumatic events, physical health comorbidities, poor self-rated health, and depression. Exposure to three or more different adulthood traumatic events was significantly related to a higher risk of pain onset in older adulthood (OR=1.52; 95% CI: 1.01, 2.29), regardless of a history of childhood trauma and after controlling for health covariates.

Conclusions and Implications: Our results provide novel insight into relationships between trauma exposures at different stages of life and pain outcomes in older adults. In congruence with the results of prior research, we found that cumulative trauma exposure during childhood and adulthood is associated with greater pain prevalence and severity. We expand on the existing literature by demonstrating that multiple trauma exposures during adulthood uniquely contribute to older adults’ pain outcomes, even among those with a prior history of childhood trauma. Our findings highlight the importance of screening for adulthood exposures to trauma, as cumulative trauma exposures can increase the likelihood of experiencing pain. We encourage future research exploring whether early identification of childhood and adulthood trauma and trauma-focused interventions help reduce the risk of chronic pain in older adulthood.