Compass Opioid Stewardship 2026 Virtual Symposium-FREE NO CME-08-Trauma and ACE's-Christine Blake Smith-Handouts

08-Trauma and ACE's-Christine Blake Smith-Handouts

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The document is a conference presentation from the Compass Opioid Stewardship Program (March 2026) on how trauma and Adverse Childhood Experiences (ACEs) contribute to a “sensitized phenotype” involving chronic pain and mood symptoms. It reviews ACEs (abuse, neglect, household dysfunction such as substance use, mental illness, domestic violence, incarceration, divorce) and highlights the landmark Felitti/Anda ACE study showing a graded, dose-dependent relationship between higher ACE scores and increased adult disease burden, including depression, substance use, suicide attempts, cardiovascular and autoimmune disease, chronic pain, and early mortality.  <br /><br />The presenter explains “phenotype” as the observable clinical expression of biology interacting with environment, emphasizing that trauma-related patterns are biological rather than personality-based. A common trauma-associated clinical pattern includes heightened pain sensitivity, widespread symptoms, anxiety/depression overlap, sleep disturbance, hypervigilance or shutdown, high stress reactivity, medication sensitivity, disproportionate pain relative to imaging, multiple diagnoses, and difficulty tolerating change—reflecting a sensitized nervous system and central sensitization (“volume knob turned up” in CNS pain processing). ACEs may increase pain sensitivity by altering descending inhibitory pathways, cortisol regulation, neuroimmune signaling, and inflammatory tone, leading the brain to interpret neutral sensations as threat. Pain, anxiety, and depression often co-occur due to shared threat circuitry; imaging may not match symptoms because imaging shows structure while pain reflects processing shaped by memory, context, and perceived safety.  <br /><br />A case example (“Michelle”) illustrates chronic high-dose opioid therapy with persistent severe pain, likely combining central sensitization and opioid-induced hyperalgesia; with education and multimodal care (sleep treatment, counseling, PT, massage, osteopathic manipulation) she tapered from very high MME to minimal PRN oxycodone with controlled pain.  <br /><br />The talk stresses patients are not malingering; trauma-informed language can reduce shame and build alliance. Treatment priorities include education, sleep stabilization, gentle movement, nervous system regulation, trauma-informed therapy, and medications as support rather than the sole solution—also helping reduce clinician burnout by reframing challenging behaviors as sensitization rather than defiance.

Keywords

Adverse Childhood Experiences (ACEs)

trauma-informed care

central sensitization

sensitized phenotype

chronic pain

mood symptoms (anxiety and depression)

Felitti Anda ACE study

opioid-induced hyperalgesia

opioid tapering and multimodal pain management

neuroimmune and stress system dysregulation (cortisol/inflammation)