UBC Theses and Dissertations

UBC Theses Logo

UBC Theses and Dissertations

Childhood emotional abuse : relationships with injection drug use and chronic pain Prangnell, Amy


Background: Childhood emotional abuse is an under-researched but significant public health problem. Impacts may include a higher risk for initiating injection drug use, as indicated by emerging evidence. Yet in Canada, there is a lack of research among people who inject drugs (PWID) regarding the impact of childhood emotional abuse on chronic pain and related outcomes. As such, this thesis will examine the relationships between childhood emotional abuse, injection drug use, and adult chronic pain. Methods: A systematic literature search was undertaken to identify previous studies that investigated relationships between childhood abuse (sexual, physical, or emotional) and adult injection drug use. Drawing on longitudinal cohort data from the Vancouver Injection Drug User Study (VIDUS) and the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) between June 2014 and November 2016, I employed generalized estimating equations (GEE) to examine potential associations between childhood emotional abuse and adult chronic pain among PWID (Study Two), and between childhood emotional abuse and adult pain interference among PWID with chronic pain (Study Three). Results: Among the 17 articles included in the systematic review, there was strong evidence for physical abuse increasing the risk of adult injection drug use, with mixed results for sexual and emotional abuse. Study Two included 1459 PWID. In a multivariable GEE analysis, experiencing childhood emotional abuse was significantly and positively associated with experiencing chronic pain after adjusting for other types of childhood abuse and relevant socio-demographic, drug-use, and health related confounders. Study Three followed 822 PWID with chronic pain. In a multivariable GEE analysis, childhood emotional abuse remained significantly and positively associated with pain interference after adjusting for relevant socio-demographic, drug-use, and health related confounders. In addition, a history of mental illness diagnosis partially mediated this association. Conclusions: Findings of this thesis emphasize the detrimental and long-term impact of childhood abuse. It is imperative to utilize a variety of universal and targeted approaches in order to prevent childhood abuse. The results also further strengthen the rationale for expanding trauma-informed care approaches for chronic pain management, combined with strategies to prevent or ameliorate mental illness.

Item Media

Item Citations and Data


Attribution-NonCommercial-NoDerivatives 4.0 International