Adverse childhood experiences and cancer pain: A national cross-sectional analysis of survivors' pain outcomes.
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CONTEXT: Adverse childhood experiences (ACEs) are linked to long-term health impacts, including increased pain prevalence. However, the relationship between ACEs and pain presence and pain control among cancer survivors is not well understood. OBJECTIVES: To examine the association between cumulative ACE exposure and (1) the presence of cancer-related physical pain and (2) the current perceived adequacy of pain control among adult survivors in the United States. METHODS: Behavioral Risk Factor Surveillance-System (BRFSS) data from 2019 to 2023 were analyzed, including 19,046 adults with self-reported cancer diagnoses and complete ACE data. Modified Poisson regression estimated crude and adjusted prevalence ratios (PRs, aPRs) for pain presence and pain control. Subgroup analyses were stratified by cancer type. Random forest models assessed ACE domain importance. RESULTS: A clear dose-response was found between ACEs and pain presence. Each additional ACE was associated with a 6% higher prevalence of pain (aPR = 1.058; 95% CI: 1.005-1.113). Pain prevalence increased from 7.2% (0 ACEs) to 25.4% (8 ACEs). ACEs were not significantly associated with pain control in adjusted models (aPR = 0.994; 95% CI: 0.973-1.016). Stratified analyses revealed stronger associations in certain cancer types, particularly leukemia, pharyngeal, and bladder. Random forest models identified household dysfunction and emotional/sexual abuse as key predictors of pain presence and pain control. CONCLUSION: ACEs are significantly associated with pain presence, but not with perceived pain control. These findings underscore the need for ACE-informed screening and trauma-informed care in survivorship planning to address cancer pain. KEY MESSAGE: Cancer survivors with adverse childhood experiences report higher prevalence of pain, but not significantly lower prevalence of adequate pain control. This study emphasizes the need for trauma-informed care to address the lasting influence of early adversity on cancer-related symptom burden.