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

不良童年经历（ace）包括身体或精神虐待、忽视和家庭暴力。世界卫生组织将ace描述为最常见和最严重的儿童压力源。大约一半的人可能会忍受至少一种，但暴露于几种环境的孩子在以后的生活中可能会出现更多的健康问题，包括慢性疼痛。暴露于多种ACE与社会剥夺之间存在联系，而暴露于ACE的可能性对男孩和年轻母亲的孩子来说更高。尽管有充分的证据表明ace会导致健康不平等，但目前还没有广泛的筛查或系统的方法来减少长期危害。造成这种情况的原因包括现有评估方法的局限性，以及很少考虑到可能增加脆弱性的其他因素。我们的CAPE联盟将汇集来自不同背景的人，如科学家、有ACE和慢性疼痛生活经验的人、临床研究人员、流行病学家和心理学家。我们将采用一种包容性的方法，整合生物、心理、社会和文化因素，以了解ACE对慢性疼痛的影响以及人们对治疗的反应。有5个相关的工作包：我们的目标是开发一种基于问卷的评估，以捕捉ace。我们将分析目前的方法，看看哪一种效果最好。除此之外，我们将使用人们的第一手资料，以确保ace和慢性疼痛的生活经历准确反映在我们的方法中。我们将与患者合作伙伴一起收集这些信息，开发并测试一份新的ACE问卷（CAPE ACEQ）。2. CAPE ACEQ将用于丰富大规模人口研究数据集（例如UK Biobank）中已有的数据。我们还将收集有关疼痛和社会互动（成人关系）的数据。我们将把它与处方、健康记录（包括心理健康记录）联系起来，以确定易受慢性疼痛影响的心理社会因素，以及暴露于ace的人对治疗的不良反应。我们将研究慢性疼痛负担的增加是否会导致贫困社区中阿片类药物处方和相关不良事件的增加，慢性疼痛对暴露于多种ace的人群的影响不成比例。我们将从伦敦一家专科医院的一大群患有幼年特发性关节炎（JIA）的年轻患者中收集关于疼痛、其影响（情绪、睡眠、疲劳等）、ace、健康和社会因素的类似数据。我们将能够理解是什么因素导致了这些年轻人不同的疼痛途径和结果。4. 我们将使用来自现有人群研究的脑成像数据和来自年轻JIA组的新脑成像数据，以确定在暴露于ace的患者中，是否存在可能与不良疼痛发展和处方结果相关的脑结构和/或功能变化。我们将寻找暴露于多次ace的人对慢性疼痛的脆弱性或恢复力的生物学标记和治疗。为此，我们将从捐赠的样本中研究遗传因素，并测试脑细胞的特性。一项名为洛锡安出生队列的人口研究的参与者将被问及他们接触ace的情况。许多人已经同意在死后捐献脑组织，并且已经为多能干细胞的生产提供了血液。这些特殊的细胞将分化成脑细胞。我们预计，将ace与慢性疼痛和治疗结果联系起来的高质量证据，结合心理健康和社会支持知识，将为制定个性化疼痛管理方法和确定公共卫生干预措施以改善结果提供基础。

Adverse childhood experiences (ACEs) include physical or emotional abuse, neglect, and domestic violence. The World Health Organisation describes ACEs as the commonest and most intense childhood stressors. About half of us may endure at least one, but children exposed to several are likely to have more health problems later in life, including chronic pain. There are links between exposure to multiple ACEs and social deprivation and the likelihood of ACE exposure is higher for boys, and for children of a young mother. Although there is good evidence that ACEs contribute to health inequalities, there is no widespread screening or systematic approach to reducing long term harms. Reasons for this include limitations in existing assessment approaches, and little consideration of other factors that might increase vulnerability. Our CAPE consortium will bring together people from a wide range of backgrounds- such as scientists, people with lived experience of ACE and chronic pain, clinical researchers, epidemiologists and psychologists. We will use an inclusive approach to integrate biological, psychological, social and cultural factors to understand the impact of ACE on chronic pain and how people respond to treatment. There are 5 related work packages:1. We aim to develop a questionnaire-based assessment that captures ACEs. We will analyse current approaches to see which ones work best. Alongside this we will use people's first-hand accounts, to ensure that lived experiences of ACEs and chronic pain, are accurately reflected in our approach. Working with patient partners we will bring together this information to develop and test a new ACE questionnaire (the CAPE ACEQ). 2. The CAPE ACEQ will be used to enrich pre-existing data in large scale population research datasets, (e.g. UK Biobank). We will also collect data about pain and social interactions (adult relationships). We will link this to prescribing, health records (including mental health) to identify psychosocial factors that create vulnerability to chronic pain and adverse responses to treatment in those exposed to ACEs. We will examine whether the increased burden of chronic pain, which disproportionately affects those exposed to multiple ACEs, leads to higher levels of opioid prescribing and associated adverse events observed in deprived communities.3. We will collect similar data on pain, its impact (mood, sleep, fatigue etc), ACEs, health and social factors from a large group of young patients suffering from a condition called juvenile idiopathic arthritis (JIA), who attend a specialist unit in London. We will be able to understand what factors lead to different pain routes and outcomes in these young people. 4. We will use brain imaging data from the existing population studies and new brain imaging from the young JIA group, to establish whether there are changes in brain structure and/or function that may be associated with the development of poor pain and prescribing outcomes in those exposed to ACEs.5. We will seek biological markers of vulnerability or resilience to chronic pain and treatment in those exposed to multiple ACEs. For this we will study genetic factors, and test properties of brain cells, from donated samples. Participants in a population study called the Lothian Birth Cohort will be asked about their exposure to ACEs. Many have consented to donate brain tissue post-mortem and have already provided blood for the production of pluripotent stem cells. These special cells will be differentiated to form brain cells. We anticipate that high quality evidence linking ACEs to chronic pain and treatment outcomes, combined with knowledge of mental health and social support, will provide a basis to develop individualised approaches to pain management and identify public health interventions to improve outcomes.