Consortium Against Pain inEquality (CAPE)

Consortium Against Pain inEquality (CAPE) - The impact of adverse childhood experiences on chronic pain and responses to treatment 

The Consortium Against Pain inEquality (CAPE) investigated how difficult experiences in childhood may contribute to  long-term pain and influence responses to pain treatment. The team worked with people living with chronic pain and people with lived experience of adverse childhood experiences (ACEs), researchers and healthcare experts to better understand why some people are more likely to develop chronic pain in adulthood. We hope this research will lead to safer and more effective treatments and personalised support for people living with pain. 

Research overview 

The CAPE project will explore how adverse childhood experiences, or ACEs, might contribute to an increased vulnerability to chronic pain in adulthood. ACEs are very stressful or harmful events that happen in childhood which can include abuse, neglect, or witnessing violence at home. The project will bring together scientists, healthcare professionals and people with lived experience of chronic pain to understand how ACEs can affect health later in life. It will also look at how ACEs affect the way people respond to pain medicines and other treatments to more safely manage pain. Not everyone who experiences ACEs will develop chronic pain. CAPE also investigated factors that may protect health and promote resilience following adversity. 

What is the aim of this research? 

We want to better understand the impact of ACEs on chronic pain and responses to treatment. The CAPE team will investigate the effects of ACEs on health inequalities and the experience of chronic pain in adulthood. By bringing together information about people’s lives, health, relationships, genes and biology, we hope to find better ways to support people living with chronic pain. 

Why is this research important? 

ACEs such as abuse, neglect, or deprivation can have a lifelong impact, making it more likely for people to have health problems later in life. We aim to understand how ACEs might contribute to pain in the future, with the expectation that a better understanding of the mechanisms of pain can lead to better treatment.  

People who experience chronic pain can face challenges in finding the right treatment to manage their pain. Current treatments for chronic pain often focus on the use of pain relief medication, which can cause side effects, be addictive and become less effective over time. These detrimental effects may also be more likely in those exposed to ACEs. 

At the moment, health services do not have a clear, joined-up way to understand how ACEs affect pain or its treatment. This research could help doctors and researchers better recognise people’s individual needs and improve care for people who are often most affected, leading to more effective and safer treatment options. 

What are we doing? 

CAPE brought together five connected strands of research. Together, they examined ACEs, chronic pain and responses to treatment from biological, psychological and social perspectives.  

Creating an ACE questionnaire 

CAPE co-developed and carried out an initial evaluation of the CAPE-ACEQ questionnaire, working throughout with people with lived experience of ACEs and chronic pain. Existing questionnaires were reviewed and the questions were designed to capture a broad range of experiences using careful and sensitive wording. The CAPE-ACEQ is not yet ready for routine clinical use. Further evaluation in larger and more diverse populations, development of its scoring, and work with clinicians will be required before clinical implementation.  

Using information from large health studies 

We will use information from large research studies, such as UK Biobank. These studies include health information from many people. We have looked at links between ACEs, chronic pain, mental health, relationships, medicines and health records. This may help us understand why some people are more likely to develop long-term pain or have problems with treatment. 

Learning from young people with arthritis 

We have worked with young people who have juvenile idiopathic arthritis. This is a type of arthritis that starts in childhood and can cause joint pain and swelling. We have collected information about pain, sleep, mood, tiredness, health and social factors. This will help us understand why pain improves for some young people but continues or gets worse for others. 

Looking at brain changes 

We have used brain scans to look for changes in the brain that may be linked to ACEs and chronic pain. Brain scans can show the structure of the brain and how different parts of the brain work. This may help explain why pain becomes long lasting for some people. 

Seeking biological markers for chronic pain 

The team studied biological markers in blood samples, including epigenetic changes called DNA methylation, which may help explain differences in vulnerability and resilience.  

What have we learned so far? 

Findings from the project team include: 

• Evidence consistent with a causal relationship between childhood maltreatment and chronic widespread pain in adulthood. Childhood maltreatment and chronic "all over" body pain in adulthood: a counterfactual analysis using UK Biobank - Pain 
• Laboratory studies showed that early-life adversity increased persistent inflammatory pain sensitivity and altered responses to morphine. early-life adversity increases persistent inflammatory hypersensitivity. 
• Working with People's Voice Media, CAPE curated community reports describing lived experiences of pain and perspectives on childhood adversity. These accounts have informed resources used in training health professionals. 
• The co-development and initial evaluation of the CAPE-ACEQ questionnaire. 
• Population studies found associations between ACEs, chronic pain, and multimorbidity, alongside emerging evidence linking ACEs to age acceleration through genetic changes known as DNA methylation. 

What happens next? 

The team hopes this research will lead to better pain care. The findings could help health professionals understand each person’s needs more clearly and choose safer, more suitable support. The research may also help shape public health work that reduces harm and improves outcomes for people who have lived through difficult childhood experiences. 

Some of the research that started during the CAPE consortium will continue within the Arthritis UK Research Consortium: Musculoskeletal Epidemiology - Better Lives, Safer Journey as well as through other projects developed from CAPE’s findings.