Child maltreatment elevated the risk of late-life chronic pain: a biopsychosocial framework from the UK Biobank cohort

Abstract Understanding the development of chronic pain (CP) is challenging due to its multifactorial etiology. Child maltreatment (CM), encompassing various types of neglect and abuse affecting more than one-third of the population, is a critical aspect of early-life adversity with long-lasting impacts. It is increasingly recognized for its role in altering biopsychosocial processes, potentially increasing vulnerability to CP. However, the exact path connecting CM to CP is not fully elucidated, primarily attributable to limitations in prior research, including insufficient sample sizes, inadequate consideration of comprehensive mediative variables, and a lack of longitudinal data. To address these gaps, our study utilizes a large-scale dataset (n = 150,989) comprising both cross-sectional and longitudinal data, along with an extensive range of biopsychosocial variables. Our findings reveal that all types of CMs, except physical neglect, significantly increase the risk of CP, and all types of CPs, except headache, were affected by CM. Furthermore, we demonstrate that individuals with CM histories are more predisposed to comorbid CP conditions. Importantly, biopsychosocial factors are found to explain over 60% of the association between CM and CP, with psychological factors playing a key role. This study not only characterizes the relationship between CM and CP but also underscores the influence of psychosocial elements in this dynamic interplay. These findings offer important insights into the long-term impacts of CM and provide a foundation for developing targeted therapeutic and preventive strategies for CP.