Characterizing Chronic Pain and Adverse Childhood Experiences in the Lesbian, Gay, Bisexual, Transgender, or Queer Community

Abstract

BACKGROUND: Childhood adversity is associated with chronic pain in adulthood. Additionally, individuals identifying as lesbian, gay, bisexual, transgender, or queer (LGBTQ+) report a greater prevalence of chronic pain and increased adverse childhood experiences (ACEs). While the LGTBQ+ community has a disproportionately high chronic disease burden, limited research has been conducted on the associations between chronic pain conditions or intensity and childhood adversity in this population. METHODS: In this cross-sectional study, participants were 18 years or older, LGBTQ+ identifying, and reported chronic pain. Surveys were electronically distributed from August to November 2022 via LGBTQ+ organization email listservs and social media platforms. The survey included demographics and validated questionnaires measuring chronic pain (The Chronic Pain Questionnaire) and childhood adversity (ACE score). In analysis, ACE scores of 4 or more were defined as high. RESULTS: Responses from 136 individuals (average age of 29 ± 7.4 years) were analyzed. The mean for participants’ average pain rating in the last 6 months was 5.9 of 10. Participants’ worst pain was rated at least a 7 of 10 for 80% of respondents. Half (47%) had high ACE scores, and high ACE scores were significantly associated with higher average pain scores (6.27 ± 1.79, mean difference = −2.22, P = .028, 95% confidence interval [CI], –1.2 to −0.0), and higher perceived current pain ratings (4.53 ± 2.16, mean difference = −2.78, P = .007, 95% CI, –1.9 to −0.3). Transgender and gender diverse (TGD) participants (n = 75) had higher ACE scores (3.91 ± 1.78) and current pain scores compared to cisgender individuals (3.9 ± 1.8 vs 3.0 ± 1.9, P = .009, 95% CI, 0.0–0.3). History of any sexual trauma was prevalent in 36.7% and was associated with chronic pain located in the pelvic region (P = .016, effect size estimate 0.21). Specific histories of forced sexual and touch encounters were associated with a specific diagnosis of fibromyalgia (P = .008, effect size estimate 0.31 and P = .037, effect size estimate 0.31, respectively). CONCLUSIONS: Childhood adversity and chronic pain’s dose-dependent relationship among our LGBTQ+ sample indicates a need to explore trauma’s role in perceived pain. Given sexual trauma’s association with pain location and diagnosis, type of trauma may also be crucial in understanding chronic pain development. Research into the relationships between childhood adversity, sexuality, gender identity, and chronic pain could improve chronic pain prevention and management for the LGBTQ+ community.