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systematic review

Adverse Childhood Experiences and Chronic Low Back Pain

Teaser: 

Kelachi Nsitem, MSc (Clin Epi), MD Candidate,1 Sean D Christie, MD, FRCSC,2

1McMaster University, Class of 2028
2Head, Division of Neurosurgery and Sustainability Leader, Dalhousie University and Nova Scotia Health.


CLINICAL TOOLS

Abstract: While adverse childhood experiences (ACE) is a risk for chronic pain broadly, their specific association with chronic low back pain (cLBP) and recommended management remains unclear. We conducted a systematic review and demonstrated substantial heterogeneity reflecting methodological variability and inconsistent results. However, there was moderate evidence that increasing number of ACE and emotional abuse was associated with cLBP. This suggests a need for an individualized biopsychosocial approach to management with best practice of a trauma informed approach.
Key Words: low back pain, chronic pain, adverse childhood experiences, childhood adversity, systematic review, meta-analysis.

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Pre-test CME Quiz Post-test CME Quiz
Adverse childhood experiences (ACE) are any preventable act that results in harm, or potential for harm to a child. ACE include but are not limited to, direct acts or witnessing of various forms of abuse, including physical, mental, emotional and sexual
ACE is a risk factor for chronic pain and our systematic review demonstrate moderate evidence that increasing ACE and emotional abuse specifically
A holistic biopsychosocial approach is critical in the management of chronic low back pain CLBP in the setting of ACE
Consider assessing for ACEs in the management of CLBP, especially if there is failure of a biomedical focused approach.
Patients with ACE are at risk for further harm and it is recommended that a trauma informed care approach should be used.
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Related Terms: Back Health, low back pain, chronic pain, adverse childhood experiences, childhood adversity, systematic review, meta-analysis