Trajectories of pain and anxiety in a longitudinal cohort of adolescent twins

Temporal relationship between pain and mental health conditions among children and young people - A population-based register study in Sweden

Both pain and mental health conditions are common among young people. They often co-occur, but we wanted to investigate further whether it is pain (abdominal pain, headache, musculoskeletal pain, menstrual pain) that precedes mental health conditions (depression, anxiety, stress, phobia) or whether it is the other way around, mental health conditions that precedes pain. Using electronic health records - the Skåne Healthcare Register - we identified and followed young people aged 7-18 over a 13-year period and tracked all their registered diagnoses. Using Poisson regression, we analyzed the incidence rate ratio (IRR) of being diagnosed with mental health conditions after an initial diagnosis of pain and vice versa the IRR of being diagnosed with pain after an initial diagnosis of a mental health condition. Among individuals with pain, 12 054 (23%) later received a diagnosis of a mental health condition. The IRR for a mental health condition after pain was 2.86 (95% CI 2.78-2.94) compared to not having pain, adjusted for age, sex and prior healthcare consultations. Among individuals with mental health conditions, 3688 (17%) later received a diagnosis of pain. The adjusted IRR was 1.57 (95% CI=1.52-1.63). Compared to boys, girls had consistently higher estimates and the same was found for the younger individuals compared to the older ones. Individuals with pain have a threefold increased risk of developing mental health conditions while the risk of developing pain after mental health conditions was lower although still elevated compared to young people seeking care regardless of cause. PERSPECTIVE: Young people with pain have a threefold increased risk of developing mental health conditions while the reverse risk is lower but still elevated compared to young people without these conditions. Healthcare professionals must recognize the interplay between pain and mental health in young patients when diagnosing and planning treatment. DATA AVAILABILITY: The data included in this study are stored within the Skåne county council. To access similar data, The Swedish National Board of Health and welfare and The Skåne county council can provide information about how to apply for access.

Chronic pain is specifically associated with updating working memory: a longitudinal twin study

ABSTRACT

Worse executive function (EF) is associated with chronic pain and could mechanistically contribute to pain chronification. It is unclear whether there is overall impairment in EFs or whether there are impairments in specific cognitive domains. Furthermore, the possible genetic risk underlying these associations has not been tested. Participants were from the Colorado Longitudinal Twin study; 786 same-sex twins completed a battery of EF tasks at ages 23 and/or 28 and 634 of these twins self-reported chronic pain at mean age = 28.1; prevalence = 27.76% using the Brief Pain History Questionnaire. The EF tasks were used to define a Common EF factor and 2 factors specific to updating working memory and shifting mental set. We estimated the phenotypic and genetic associations of stable EF variance across ages 23 and 28, as well as EF variance unique to age 28, with pain. With respect to stable EF variance, pain phenotypically correlated with the Updating-specific factor (r = -0.21, P = 0.008) but did not significantly correlate with the Common EF factor (r = -0.06, P = 0.350) nor with the Shifting-specific factor (r = -0.03, P = 0.709). There were no significant phenotypic correlations between pain and EF variance unique to age 28. A twin model indicated that pain and Updating-specific variance share genetic risk (rA = -0.46, P = 0.005) but not environmental risk (rE = 0.05, P = 0.844). Updating working memory shares a phenotypic and genetic relationship with pain in young adults. Impairments in gating or monitoring pain signals may play a mechanistic role in pain development.

Modulation of Comorbid Chronic Neuropathic Pain and Anxiety-Like Behaviors by Glutamatergic Neurons in the Ventrolateral Periaqueductal Gray and the Analgesic and Anxiolytic Effects of Electroacupuncture

Comorbid chronic neuropathic pain and anxiety is a common disease that represents a major clinical challenge. The underlying mechanisms of chronic neuropathic pain and anxiety are not entirely understood, which limits the exploration of effective treatment methods. Glutamatergic neurons in the ventrolateral periaqueductal gray (vlPAG) have been implicated in regulating pain, but the potential roles of the vlPAG in neuropathic pain-induced anxiety have not been investigated. Herein, whole-cell recording and immunofluorescence showed that the excitability of CamkIIα neurons in the vlPAG (vlPAGCamkIIα+ neurons) was decreased in mice with spared nerve injury (SNI), while electroacupuncture (EA) activated these neurons. We also showed that chemogenetic inhibition of vlPAGCamkIIα+ neurons resulted in allodynia and anxiety-like behaviors in naive mice. Furthermore, chemogenetic activation of vlPAGCamkIIα+ neurons reduced anxiety-like behaviors and allodynia in mice with SNI, and EA had a similar effect in alleviating these symptoms. Nevertheless, EA combined with chemogenetic activation failed to further relieve allodynia and anxiety-like behaviors. Artificial inhibition of vlPAGCamkIIα+ neurons abolished the analgesic and anxiolytic effects of EA. Overall, our study reveals a novel mechanism of neuropathic pain-induced anxiety and shows that EA may relieve comorbid chronic neuropathic pain and anxiety by activating vlPAGCamkIIα+ neurons.

Identifying Weekly Trajectories of Pain Severity Using Daily Data From an mHealth Study: Cluster Analysis

BACKGROUND

People with chronic pain experience variability in their trajectories of pain severity. Previous studies have explored pain trajectories by clustering sparse data; however, to understand daily pain variability, there is a need to identify clusters of weekly trajectories using daily pain data. Between-week variability can be explored by quantifying the week-to-week movement between these clusters. We propose that future work can use clusters of pain severity in a forecasting model for short-term (eg, daily fluctuations) and longer-term (eg, weekly patterns) variability. Specifically, future work can use clusters of weekly trajectories to predict between-cluster movement and within-cluster variability in pain severity.

OBJECTIVE

This study aims to understand clusters of common weekly patterns as a first stage in developing a pain-forecasting model.

METHODS

Data from a population-based mobile health study were used to compile weekly pain trajectories (n=21,919) that were then clustered using a k-medoids algorithm. Sensitivity analyses tested the impact of assumptions related to the ordinal and longitudinal structure of the data. The characteristics of people within clusters were examined, and a transition analysis was conducted to understand the movement of people between consecutive weekly clusters.

RESULTS

Four clusters were identified representing trajectories of no or low pain (1714/21,919, 7.82%), mild pain (8246/21,919, 37.62%), moderate pain (8376/21,919, 38.21%), and severe pain (3583/21,919, 16.35%). Sensitivity analyses confirmed the 4-cluster solution, and the resulting clusters were similar to those in the main analysis, with at least 85% of the trajectories belonging to the same cluster as in the main analysis. Male participants spent longer (participant mean 7.9, 95% bootstrap CI 6%-9.9%) in the no or low pain cluster than female participants (participant mean 6.5, 95% bootstrap CI 5.7%-7.3%). Younger people (aged 17-24 y) spent longer (participant mean 28.3, 95% bootstrap CI 19.3%-38.5%) in the severe pain cluster than older people (aged 65-86 y; participant mean 9.8, 95% bootstrap CI 7.7%-12.3%). People with fibromyalgia (participant mean 31.5, 95% bootstrap CI 28.5%-34.4%) and neuropathic pain (participant mean 31.1, 95% bootstrap CI 27.3%-34.9%) spent longer in the severe pain cluster than those with other conditions, and people with rheumatoid arthritis spent longer (participant mean 7.8, 95% bootstrap CI 6.1%-9.6%) in the no or low pain cluster than those with other conditions. There were 12,267 pairs of consecutive weeks that contributed to the transition analysis. The empirical percentage remaining in the same cluster across consecutive weeks was 65.96% (8091/12,267). When movement between clusters occurred, the highest percentage of movement was to an adjacent cluster.

CONCLUSIONS

The clusters of pain severity identified in this study provide a parsimonious description of the weekly experiences of people with chronic pain. These clusters could be used for future study of between-cluster movement and within-cluster variability to develop accurate and stakeholder-informed pain-forecasting tools.

A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar

Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.

Killing pain? A prospective population-based study on trauma exposure in childhood as predictor for frequent use of over-the-counter analgesics in young adulthood. The HUNT study

Frequent and increasing use of over-the-counter analgesics (OTCA) is a public health concern. Pain conditions and psychological distress are related to frequent OTCA use, and as exposure to potentially traumatic events (PTE) in childhood appears to increase risk of experiencing such symptoms, we aimed to assess childhood PTEs and related symptoms in adolescence as predictors for frequent OTCA use in young adulthood. Prospective population survey data were used (n = 2947, 59.1% female, 10-13 years follow-up). Exposure to PTEs, symptoms of post-traumatic stress, anxiety and depression, musculoskeletal pain and headache were assessed in adolescence (13-19 years). Use of OTCA was assessed in young adulthood (22-32 years) and use of OTCA to treat musculoskeletal pain and headache served as separate outcomes in ordinal logistic regression analyses. Overall, exposure to childhood PTEs, particularly direct interpersonal violence, was significantly and consistently related to more frequent use of OTCA to treat musculoskeletal pain and headaches in young adulthood. Adjusting for psychological symptoms and pain attenuated associations, indicating that these symptoms are of importance for the relationship between traumatic events and OTCA use. These findings emphasize the need to address symptomatology and underlying causes at an early age.

Associations Between Adolescent Pain and Psychopathology in the Adolescent Brain Cognitive Development (ABCD) Study

Pain and psychopathology co-occur in adolescence, but the directionality and etiology of these associations are unclear. Using the pain questionnaire and the Child Behavior Checklist from the Adolescent Brain Cognitive Development study (n = 10,414 children [770 twin pairs] aged 12-13), we estimated longitudinal, co-twin control, and twin models to evaluate the nature of these associations. In two-wave cross-lag panel models, there were small cross-lag effects that suggested bidirectional associations. However, the co-twin control models suggested that most associations were familial. Pain at age 12 and 13 was mostly environmental (A = 0-12%, C = 15-30%, E = 70-73%) and the twin models suggested that associations with psychopathology were primarily due to shared environmental correlations. The exception was externalizing, which had a phenotypic prospective effect on pain, a significant within-family component, and a non-shared environmental correlation at age 12. Environmental risk factors may play a role in pain-psychopathology co-occurrence. Future studies can examine risk factors such as stressful life events.

We need to talk: The urgent conversation on chronic pain, mental health, prescribing patterns and the opioid crisis

The opioid crisis’ pathways from first exposure onwards to eventual illnesses and fatalities are multiple, intertwined and difficult to dissect. Here, we offer a multidisciplinary appraisal of the relationships among mental health, chronic pain, prescribing patterns worldwide and the opioid crisis. Because the opioid crisis’ toll is especially harsh on young people, emphasis is given on data regarding the younger strata of the population. Because analgesic opioid prescription constitute a recognised entry point towards misuse, opioid use disorder, and ultimately overdose, prescribing patterns across different countries are examined as a modifiable hazard factor along these pathways of risk. Psychiatrists are called to play a more compelling role in this urgent conversation, as they are uniquely placed to provide synthesis and lead action among the different fields of knowledge and care that lie at the crossroads of the opioid crisis. Psychiatrists are also ideally positioned to gauge and disseminate the foundations for diagnosis and clinical management of mental conditions associated with chronic pain, including the identification of hazardous and protective factors. It is our hope to spark more interdisciplinary exchanges and encourage psychiatrists worldwide to become leaders in an urgent conversation with interlocutors from the clinical and basic sciences, policy makers and stakeholders including clients and their families.

Adolescent anxiety and pain problems: A joint, genome-wide investigation and pathway-based analysis

Both common pain and anxiety problems are widespread, debilitating and often begin in childhood-adolescence. Twin studies indicate that this co-occurrence is likely due to shared elements of risk, rather than reciprocal causation. A joint genome-wide investigation and pathway/network-based analysis of adolescent anxiety and pain problems can identify genetic pathways that subserve shared etiopathogenetic mechanisms. Pathway-based analyses were performed in the independent samples of: The Quebec Newborn Twin Study (QNTS; 246 twin pairs and 321 parents), the Longitudinal Study of Child Development in Quebec (QLSCD; n = 754), and in the combined QNTS and QLSCD sample. Multiple suggestive associations (p<1×10-5), and several enriched pathways were found after FDR correction for both phenotypes in the QNTS; many nominally-significant enriched pathways overlapped between pain problems and anxiety symptoms (uncorrected p<0.05) and yielded results consistent with previous studies of pain or anxiety. The QLSCD and the combined QNTS and QLSCD sample yielded similar findings. We replicated an association between the pathway involved in the regulation of myotube differentiation (GO:0010830) and both pain and anxiety problems in the QLSDC and the combined QNTS and QLSCD sample. Although limited by sample size and thus power, these data provide an initial support to conjoint molecular investigations of adolescent pain and anxiety problems. Understanding the etiology underlying pain and anxiety co-occurrence in this age range is relevant to address the nature of comorbidity and its developmental pathways, and shape intervention. The replication across samples implies that these effects are reliable and possess external validity.

Biopsychosocial Attributes of Single-region and Multi-region Body Pain During Early Adolescence: Analysis of the ABCD Cohort

OBJECTIVES

Multi-region pain during adolescence is associated with a higher symptom burden and lower quality of life. The purpose of this study was to describe and compare the biopsychosocial attributes of single-region and multi-region pain among healthy young adolescents.

MATERIALS AND METHODS

We analyzed data from 10,320 children aged 10.6 to 14 years who self-reported pain in the Adolescent Brain and Cognitive Development Study. Pain was coded as single-region or multi-region based on body map data.

RESULTS

One in 5 young adolescents indicated recent multi-region pain. Sequential regression supported improved model fit when psychological and sociocultural factors were added to a biological model of pain; however, these models improved the classification of multi-region but not single-region pain. A significant interaction effect of sex and puberty remained constant across models with increased odds of pain at each advancing pubertal stage for both sexes compared with prepuberty, but no difference between girls and boys at late puberty (adjusted odds ratio [OR]=2.45 [1.72, 3.49] and adjusted OR=1.63 [1.20, 2.23], respectively). Psychological factors improved the classification of multi-region pain with significant effects of anxiety, somatic symptoms, and somnolence. Finally, compared with White and non-Hispanic children, Black and Hispanic children were less likely to report pain (adjusted OR=0.70 [0.61, 0.80]; adjusted OR=0.88 [0.78, 0.99], respectively) but had significantly higher pain interference when pain was present (adjusted OR=1.49 [1.29, 1.73] and adjusted OR=1.20 [1.06, 1.35], respectively).

DISCUSSION

Pain is a biopsychosocial phenomenon, but psychological and sociocultural features may be more relevant for multi-region compared with single-region pain during early adolescence.

Pain and suicidality in children and adolescents: a longitudinal population-based study

Suicidality is a common public health concern in young people. Previous research has highlighted pain as a key correlate of suicidality in young people. However, the long-term experience of pain may vary between individuals, and the relationship between distinct pain trajectories and suicidality is poorly understood. This study aims to describe the number and nature of distinct pain trajectories, their demographic and clinical correlates, including baseline suicidality, and whether identified pain trajectories may predict future suicidality. Secondary data analyses were performed, using longitudinal data from the British Child and Adolescent Mental Health Survey (N = 7977), collected at five timepoints between 2004 and 2007 on a population-based sample of UK youth (5-16 years). Data were collected from up to three respondents (parents, teachers, and 11 + year-olds). Latent Class Growth Analysis was used to identify distinct pain trajectories, explore predictors of these trajectories, and establish whether trajectories predicted future suicidality. We identified the following four pain trajectories: increasing (33.6%), decreasing (4.5%), persistent/recurrent probability of pain (15.7%), and no pain (46.2%). Pain trajectories were associated with unique demographic and clinical correlates. Only the persistent/recurrent (vs. no-pain) trajectory was predicted by baseline suicidality (aOR = 2.24; 95% bootstrap-CI = 1.59-3.26). Furthermore, the persistent/recurrent trajectory predicted future suicidality (aOR = 1.03, 95% bootstrap-CI = 1.01-1.06), after controlling for baseline suicidality, psychiatric disorder, age, and gender. Findings provide a better understanding of correlates associated with distinct pain trajectories and long-term risk of suicidality in young people, suggesting a bidirectional pain-suicidality association and emphasising the need of targeted support for young people with persistent/recurrent pain.

Adolescent pain, anxiety, and depressive problems: a twin study of their co-occurrence and the relationship to substance use

ABSTRACT

Data on the etiological factors underlying the co-occurrence of common adolescent pain with anxiety and depression symptoms are very limited. Opioid prescriptions for adolescent pain problems are on the rise in North America and constitute a risk factor for diversion, misuse, and substance use. In this study, we aimed to investigate the phenotypic and etiological association among pain, depression, and anxiety and to test their link to substance use in adolescents. By taking advantage of the Italian National Twin Registry and of the relatively low incidence of opioid prescriptions in Italy, we applied multivariate modelling analyses to 748 Italian adolescent twins (374 pairs, mean age 16 ± 1.24 years). Twins' responses to the Achenbach Youth Self-Report questionnaire were used to build a composite adolescent pain index and to measure anxiety, depression, and substance use. All monozygotic within-pair correlations were higher than the dizygotic correlations, indicating genetic influences for adolescent pain, anxiety, and depressive problems. A common latent liability factor influenced by genetic and environmental elements shared among pain, depression, and anxiety provided the best fit to explain the co-occurrence of adolescent pain, anxiety, and depression problems. A common phenotypic factor capturing all 3 phenotypes was positively associated (β = 0.19, P < 0.001, confidence interval: 0.10-0.27) with substance use. These findings indicate that several intertwined mechanisms, including genetic factors, can explain a shared liability to common adolescent pain, anxiety, and depression problems. Their association with substance use remains traceable even in societies with relatively low prevalence of opioid prescriptions.

Mood and anxiety profiles differentially associate with physical conditions in US adolescents

BACKGROUND

Mood and anxiety are widely associated with physical conditions, but research and treatment are complicated by their overlap, clinical heterogeneity, and manifestation on a spectrum rather than as discrete disorders. In contrast to previous work relying on threshold-level disorders, we examined the association between empirically-derived profiles of mood and anxiety syndromes with physical conditions in a nationally-representative sample of US adolescents.

METHODS

Participants were 2,911 adolescents (aged 13-18) from the National Comorbidity Survey-Adolescent Supplement who provided information on physical conditions and reported at least one lifetime mood-anxiety 'syndrome' based on direct interviews with the Composite International Diagnostic Interview Version 3.0. Mood-anxiety syndromes reflected 3-level ratings from subthreshold to severe distress/impairment, and subtyped mood episodes. Stepwise latent profile analysis identified mood-anxiety profiles and tested associations with physical conditions.

RESULTS

Three mood-anxiety profiles were identified: "Mood-GAD" (25.6%)-non-atypical depression, mania, generalized anxiety; "Atypical-Panic" (11.3%)-atypical depression, panic; and "Reference" (63.1%)-lower mood and anxiety except specific phobia. Headaches were more prevalent in Mood-GAD and Atypical-Panic than Reference (47.9%, 50.1%, and 37.7%, respectively; p=0.011). Heart problems were more common in Mood-GAD than Atypical-Panic (7.4% v 2.2%, p=0.004) and Reference, with back/neck pain more prevalent in Mood-GAD than Reference (22.5% v 15.3%, p=0.016).

LIMITATIONS

Broad categories of physical conditions without information on specific diagnoses; replication regarding specificity is recommended.

CONCLUSIONS

Heart problems and pain-related conditions were differentially associated with specific mood-anxiety profiles. Subtyping depression and anxiety-inclusive of subthreshold syndromes-and their patterns of clustering may facilitate etiologic and intervention work in multimorbidity.

Adolescent pain: appraisal of the construct and trajectory prediction-by-symptom between age 12 and 17 years in a Canadian twin birth cohort

ABSTRACT

Adolescent pain is common and continues into adulthood, leading to negative long-term outcomes including substance-related morbidity: an empirical definition of its construct may inform the early detection of persistent pain trajectories. These secondary analyses of a classical twin study assessed whether: headaches, back pains, abdominal pain, chest pains, stabbing/throbbing pain, gastric pain/nausea, measured in 501 pairs across 5 waves between age 12-17, fit a unitary construct, or constitute independent manifestations. We then assessed which symptoms were associated with a steady, 'frequent pain' trajectory that is associated with risk for early opioid prescriptions. Item Response Theory results indicated that all 6 pain symptoms index a unitary construct. Binary logistic regressions identified 'back pain' as the only symptom consistently associated with membership in the 'frequent adolescent pain' trajectory (OR:1.66-3.38) at all 5 measurement waves. Receiver Operating Characteristic analyses computed the discriminating power of symptoms to determine participants' membership into the 'frequent' trajectory: they yielded acceptable (.7-.8) to excellent (.8-.9) area under the curve (AUC) values for all 6 symptoms. The highest AUC was attained by 'back pain' at age 14 (.835); for multiple cut-off thresholds of symptom frequency, 'back pain' showed good sensitivity/false alarm probability trade-offs, predominantly in the 13-14-15 age range, to predict the 'frequent pain' trajectory. These data support a unitary conceptualization and assessment of adolescent pain, which is advantageous for epidemiological, clinical, and translational purposes. Persistent back pain constitutes a sensitive indicator of a steady trajectory of adolescent pain.

A cross sectional study of non-medical use of prescription opioids and suicidal behaviors among adolescents

Background

Non-medical use of prescription opioids (NMUPO), defined as taking an opioid in a manner or dose other than prescribed, taking someone else’s, or for the feelings that it produces, has been reported by 5 to 20% of adolescents, and is associated with a two fold increase in suicidal behaviors among adolescents. Adolescents with long-term health problems (LTHP) have poorer mental health and may seek NMUPO for pain relief that is not obtained through standard care. For this study, we measured the association between NMUPO and suicidal behaviors, and further assessed effect modification by LTHP hypothesizing the association between NMUPO and suicidal behaviors was stronger for adolescents with LTHP.

Findings

For students with LTHP, 13.5% reported suicide ideation, while 8.0% of students without LTHP reported suicide ideation. For suicide attempt, 4.4% of students with LTHP reported a suicide attempt, while 2.1% of students without LTHP reported a suicide attempt. The proportion of students who reported suicide ideation and attempts increased with higher occasions of NMUPO. Adjusted logistic regression models found increased odds of suicide ideation (OR (95% CI): 1–5 occasions: 2.3 (2.0–2.6); > 6 occasions: 2.7 (2.2–3.8)) and suicide attempts (OR (95% CI): 1–5 occasions: 3.2 (2.7–3.7); > 6 occasions: 4.1 (3.1–5.3)) for students who reported NMUPO. An interaction term for NMUPO and LTHP was then added to the models. Effect modification was not present on the multiplicative scale. On the additive scale, evidence of effect modification was observed: higher risk was indicated for students with LTHP versus no LTHP for both suicide ideation (Predicted risk (95%CI): > 6 occasions NMUPO, LTHP: 0.24 (0.18–0.29); No LTHP: 0.16 (0.13–0.18)) and attempt (Predicted risk (95%CI): 1–5 occasions NMUPO, LTHP: 0.08 (0.07–0.10); No LTHP: 0.05 (0.05–0.06); > 6 occasions NMUPO, LTHP: 0.11 (0.07–0.15); No LTHP: 0.06 (0.05–0.08)).

Conclusions

The results affirmed that NMUPO is associated with suicidal behaviors among adolescents. A pattern also emerged of higher risk of suicidal behaviors for those with LTHP who reported NMUPO. Areas of further inquiry should explore chronic medical or pain conditions as possible modifying pathways that could exacerbate the effects of NMUPO on suicidal behaviors specific to an adolescent population.

COVID-19 Pandemic Impact and Response in Canadian Pediatric Chronic Pain Care: A National Survey of Medical Directors and Pain Professionals

Background: The COVID-19 pandemic presents one of the greatest threats to pediatric pain care seen in generations. Due to public health restrictions, many pediatric pain clinics halted in-person appointments, delaying and disrupting access to care. There is no existing research on the impacts of COVID-19 on pediatric chronic pain care in Canada or the challenges experienced by health care professionals and pain clinics.

Aims: The aim of this study was to evaluate the impact of COVID-19 on Canadian pediatric chronic pain care by documenting how health care professionals provided care during the first six months of the pandemic.

Methods: Two Canadian online cross-sectional surveys were conducted: one among Canadian pediatric pain clinic directors (Study 1) and another among multidisciplinary pediatric pain health care professionals (Study 2).

Results: Responses from 13/13 Canadian pediatric pain clinics/rehabilitation programs indicated that all clinics provided virtual care during the pandemic. No significant changes were reported on the frequency of appointment requests. Most clinics reported no perceived change in patient pain levels (n = 9/13, 69%) or occurrence of pain flares (n = 10/13, 77%). Results from 151 individual health care professionals indicated that the majority (90%) of non–emergency department respondents were providing virtual care. The main challenges of virtual care included technological barriers, financial concerns, infrastructure and logistics, privacy, and clinical challenges.

Conclusions: This study documented the impact of the COVID-19 pandemic on pediatric chronic pain care in Canada and highlighted the rapid shift to using virtual solutions. Simultaneously, respondents outlined current challenges and potential solutions to consider in the development of virtual care guidelines and policy in Canada.

Association of body pain and chronic disease: evidence from a 7-year population-based study in China

BACKGROUND

Evidence is limited on the risk impact of body pain on future chronic disease. The present study aimed to investigate the association between body pain and chronic diseases.

METHODS

Data were analyzed using four waves of the China Health and Retirement Longitudinal Study with 17 708 individual respondents aged 45 years and older. The association between body pain and chronic disease was estimated in both a cross-sectional cohort (2011) and a longitudinal cohort (2011-2018). The key outcomes include the incidence of overall and any specific chronic diseases. The associations among different body pain sites and 10 independent chronic disease risks were also assessed.

FINDINGS

A total of 17 128 participants in 2011 were included in the cross-sectional cohort and 5611 participants were included in the 2011-2018 longitudinal cohort. Body pain showed an association with overall chronic disease in both the cross-sectional models (OR 2.71, 95% CI 2.47 to 2.98) and longitudinal model (risk ratio (RR) 1.21, 95% CI 1.07 to 1.35). Moreover, body pain was found to be associated with an increased risk of chronic respiratory disease (RR 1.43, 95% CI 1.06 to 1.92), heart disease (RR 1.45, 95% CI 1.12 to 1.89), kidney disease (RR 1.83, 95% CI 1.28 to 2.6), and digestive disease (RR 1.48, 95% CI 1.17 to 1.88).

CONCLUSION

Body pain is associated with major disease and mortality. Future clinical research should be targeted to whether or not improved pain control can mitigate this population-level disease burden.

Pain in the Developing Brain: Early Life Factors Alter Nociception and Neurobiological Function in Adolescent Rats

Although adverse early experiences prime individuals to be at increased risk for chronic pain, little research has examined the trauma–pain relationship in early life or the underlying mechanisms that drive pathology over time. Given that early experiences can potentiate the nociceptive response, this study aimed to examine the effects of a high-fat, high-sugar (HFHS) diet and early life stress (maternal separation [MS]) on pain outcomes in male and female adolescent rats. Half of the rats also underwent a plantar-incision surgery to investigate how the pain system responded to a mildly painful stimuli in adolescence. Compared with controls, animals that were on the HFHS diet, experienced MS, or had exposure to both, exhibited increased anxiety-like behavior and altered thermal and mechanical nociception at baseline and following the surgery. Advanced magnetic resonance imaging demonstrated that the HFHS diet and MS altered the maturation of the brain, leading to changes in brain volume and diffusivity within the anterior cingulate, amygdala, corpus callosum, nucleus accumbens, and thalamus, while also modifying the integrity of the corticospinal tracts. The effects of MS and HFHS diet were often cumulative, producing exacerbated pain sensitivity and increased neurobiological change. As early experiences are modifiable, understanding their role in pain may provide targets for early intervention/prevention.