From Adverse Childhood Experience to Pain Inequality: Translational Pathways and Global Equity

Pain inequality is a global health issue that requires a multidisciplinary approach to identify its causes and seek effective approaches to care and prevention. Many recent studies suggest that adverse childhood experiences (ACEs) are powerful contributors to chronic pain and health inequalities. Exposure to ACEs, including abuse, neglect, poverty, and family instability, can affect neurodevelopment, epigenetics, the immune system and stress pathways, producing lasting vulnerability to chronic pain and responses to treatment.

Is there now sufficient evidence for recommending the global adoption of trauma-informed approaches to pain management? The panel will use real time web-based polling to seek the opinions from those in attendance. The workshop will connect molecular mechanisms with lived social realities, exploring how early adversity provokes unequal pain outcomes across the lifespan and across the globe. The panel will seek explanations as to how adversity becomes biologically embedded. Importantly, not all people exposed to childhood adversity experience poor health outcomes, so what are the triggers of vulnerability and how may their identification provide strategies for equitable prevention and care? How would asking about early trauma help reduce pain inequality?

Workshop aims:
This workshop will synthesise emerging evidence from genetics, neurodevelopment, psychosocial, and immunological research to explain how early adversity may influence pain vulnerability. It will explore the rationale for embedding adversity measures in research and practice to advance trauma-informed and equity-focused pain care.

Programme and contributions:
Prof Tim Hales (University of Dundee, Scotland) will introduce the Consortium Against Pain inEquality (CAPE) translational research framework. He will present preclinical findings linking early life adversity to altered pain and responses to opioids. He will also present population cohort data and explore the role for epigenetics in mediating links between ACEs and chronic pain.

Prof Suellen Walker (UCL Great Ormond Street Institute of Child Health, England) will integrate developmental neurobiology and clinical paediatric pain research, demonstrating how early-life stress and injury alter nociceptive system maturation, and can be associated with longer-term changes in somatosensory function and pain experience.

Dr Luda Diatchenko (McGill University, Canada) will present genetic and molecular discoveries identifying pain-vulnerability genotypes and potential stress-response pathways. She will explore how genetic predisposition interacts with environmental adversity to shape lifelong pain susceptibility.

Dr Gill Bedwell (University of Cape Town, South Africa) will discuss evidence linking childhood adversity to immune system changes and present findings from a heterogenous South African sample that challenge the prevailing theory that childhood adversity primes the inflammatory system for hyper-responsiveness. She will integrate this with a discussion of how social adversity and healthcare inequities shape pain experience and access to treatment in low-resource settings, outlining interdisciplinary, community-based strategies for equitable pain management.

Cross-context relevance:
The workshop connects molecular mechanisms with lived social realities, exploring how early adversity leads to unequal pain outcomes across the lifespan and across the globe. It offers a model for integrating biological and societal perspectives, appealing to neuroscientists, clinicians, and policymakers seeking translational, globally relevant solutions to pain inequality.