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

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

Duration: 01 July 2021 – 30 June 2025
Funder: Medical Research Council and Versus Arthritis as part of the APDP initiative. 
Principal investigator (UoA): Professor Gary Macfarlane
Co-investigators (UoA): Dr Kate Timmins

Having a traumatic experience as a child – for example, abuse, neglect, violence, physical or emotional trauma, or living with hardship (such as severe financial difficulties) – can have a lifelong impact. Research has found that people who report having several adverse childhood experiences, or ACEs, are more likely to have health problems later in life. Our aim is to improve our understanding of how ACEs might lead to chronic pain in adulthood. We will approach this from a variety of angles, piecing together different types of evidence.

We will develop a new questionnaire to better capture these adverse experiences, bring together data from current studies to rigorously evaluate the evidence of a link, collect new data on young people with arthritis, and investigate biomarkers that may be associated with people being at high risk of developing chronic pain.

Investigators at the University of Aberdeen will lead the work which will use epidemiological methods to analyse the relationship between ACEs and chronic pain in existing large-scale data sets.

CAPE is part of the Advanced Pain Discovery Platform (APDP).

The main study website for CAPE is hosted externally here


What is the study about?

CAPE’s epidemiological work aims to find and analyse data that other universities and institutions have already collected, but that haven’t yet been used to answer questions about adverse childhood experiences (ACEs) and pain.

We will look at ACEs and pain, considering other factors (such as mental health or support from friends or family) which may contribute to pain vulnerability. We will also try to find out if a relationship is specific to pain or is related to poor health more generally.

To do this, we will:

  1. Identify large population-based cohort studies that we could use. A cohort is a group of people who have volunteered to have information (data) collected about them multiple times across their life or for a specific period of their life.
  2. Apply for access to these data and numerically analyse them
  3. Decide whether some studies would be improved with freshly collected information from the people in their cohorts, and arrange this with the investigators if possible
Why is this research important?

More than a third of adults in the UK are estimated to live with chronic pain, which can have a profound effect on their quality of life. Therefore, it is important to find ways to prevent people developing pain, or to help find treatments that work for those in pain. Adverse childhood experiences (ACEs) are known to contribute to health inequalities and have been associated with chronic pain in many studies, but the strength, detail, and quality of the evidence is not high. More also needs to be known about how ACEs might affect how well people with pain respond to treatment.

If we can identify who may be vulnerable to developing pain or which circumstances increase vulnerability following childhood adversity, it may give us insight into how we could reduce long-term harms or safely manage pain.

What will this research involve?

Mostly, we will conduct secondary analyses of large population-based studies, which means that we will analyse data that have already been collected. We will do this with shared data from existing cohort studies that have been stored - securely and with permission from the people in the cohort - at a university or other organisation. We may also ask to collect new data from some cohorts to analyse alongside existing data, if analyses would be improved with freshly collected information.

Data sharing is where research data is made available to researchers across different institutions. Before accessing any data, we would usually need to submit an application to the people who run the cohort study, explaining what we plan to do and why it is important. Then, agreements are set up between the researchers and data owners, to make sure legal and governance standards are met. Data must be shared and stored in a secure way, and will be anonymised, without any personal identifying information.

What will this study achieve?

These data will allow us to look at factors across the lifecourse which are important for understanding the timing of experiences. We will numerically analyse the relevant information to better understand the factors that may contribute to, or protect against, later developing chronic pain after experiencing adversity in childhood. Looking at a variety of cohorts with differing characteristics enables us to compare the results from our analyses, seeing whether they are consistent across cohorts or whether there are different patterns we need to explain.

The more we can learn about the causal pathway, or different causal pathways, the better able we will be to prevent people becoming vulnerable to pain, using targeted treatments and support mechanisms. Stronger evidence is also valuable in raising awareness about the link between ACEs and chronic pain.

What has the study found so far?

For an early output from this research you can view our poster 'Adverse childhood experiences and adult pain: opportunities and limitations of existing cohort data'* from the British Pain Society (BPS) Annual Scientific Meeting 2023. You can find a supplementary list of the cohorts referred to in the poster here.

*Kate A Timmins, Jisha Babu, Tim G Hales, Lesley A Colvin and Gary J Macfarlane

Study team

Chief investigator

Principle investigator (UoA)


Contact us

If you have any queries about CAPE, you can contact the study team via email at: