Dr. Jillian Miller | CIHR Grant Success!

Development of Pain in Youth Exposed to Trauma.

Adverse childhood experiences (ACEs) are traumatic events occurring prior to age 18 years. By the age of 16 years, more than 65% of youth will undergo at least one ACE; with 13% of youth subsequently developing post-traumatic stress symptoms (PTSS). Well-established is the association between PTSS and chronic pain. Chronic pain (pain > 3 months) is alarmingly prevalent in adolescence, affecting one in five Canadian youth, and costing upwards of $19 billion CAD/year. Youth with chronic pain have clinically elevated PTSS (32%) as compared to their pain-free peers (8%). Among youth with chronic pain, higher levels of PTSS are associated with higher reports of pain intensity and pain interference. It has been proposed that ACEs and PTSS might increase the risk for chronic pain by altering brain networks activated in response to both trauma and pain. To explore the longitudinal relationships between trauma, brain development and pain, our study team brings together extensive expertise in pediatric pain, trauma, neuroimaging, and biostatistics. We will invite chronic pain-free youth aged 13-14 years from the community to undergo an MRI and pain sensory testing and reporting, annually during adolescence. We will examine the extent that ACEs and PTSS which occurred either prior to and/or during the assessment period are associated with altered brain structural and functional connectivity and the development of pain symptomology in youth. Early identification and appropriate pain management may prevent the transition from acute to chronic pain. Therefore, this research may lead to changes in assessment, access, and clinical practice across health centres. As well, it may be an important step in understanding the mechanisms underlying the development of chronic pain in youth. This could lead to targeted, evidence-based interventions preventing the persistence of pain and mental health problems into adulthood.