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Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Miró J. Immigration background as a risk factor of chronic pain and high-impact chronic pain in children and adolescents living in Spain: differences as a function of age. Pain 2024; 165:1372-1379. [PMID: 38189183 DOI: 10.1097/j.pain.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACT The number of people immigrating from one country to another is increasing worldwide. Research has shown that immigration background is associated with chronic pain (CP) and pain disability in adults. However, research in this issue in children and adolescents has yielded inconsistent results. The aims of this study were to examine (1) the association between immigration background, CP, high-impact chronic pain (HICP) in a community sample of children and adolescents; and (2) the extent these associations differed as a function of sex and age. Participants of this cross-sectional study were 1115 school children and adolescents (mean age = 11.67; 56% girls). Participants were asked to provide sociodemographic information and respond to a survey including measures of pain (location, extension, frequency, intensity, and interference). Results showed that having an immigration background was associated with a greater prevalence of CP (OR = 1.91, p <.001) and HICP (OR = 2.55, p <. 01). Furthermore, the association between immigration background and CP was higher in children (OR = 6.92, p <.001) and younger adolescents (OR = 1.66, p <.05) than in older adolescents. Children and adolescents with an immigration background are at higher risk for having CP -especially younger children- and HICP. More resources should be allocated in the prevention of CP and HICP in children and adolescents with an immigration background.
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Affiliation(s)
- Josep Roman-Juan
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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Roalsø ES, Klonteig S, Kraft B, Skarstein S, Aalberg M, Jonassen R. Associations between over-the-counter analgesics usage and symptoms of anxiety and depression in adolescents: a network analysis. BMC Psychiatry 2024; 24:366. [PMID: 38750535 PMCID: PMC11095036 DOI: 10.1186/s12888-024-05802-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The use of over-the-counter analgesics (OTCA) is common among adolescents and has been linked with increased symptoms of anxiety and depression. However, little is known about which specific symptoms are most strongly connected to OTCA usage. The current study assessed which anxiety and depression symptoms were most closely associated with OTCA usage in a large sample of adolescents and examined whether this differed across genders. METHOD The present study was based on data from 626,581 participants from the Ungdata survey in Norway. Associations between OTCA and anxiety and depression symptoms were examined using network analysis. Non-regularized partial-correlation networks were constructed to estimate the conditional dependent relations between the use of OTCA and symptoms while controlling for pain. Gender-specific networks were created for comparison. RESULTS OTCA usage was associated with most symptoms, even after controlling for pain, with the strongest associations with "sleep problems", "stiff or tense", "everything is a struggle" and "suddenly scared". There were some gender differences, showing that "sleep problems" and "hopeless" were more strongly related to OTCA usage in females, whereas "stiff or tense" was more strongly related to OTCA usage in males. CONCLUSION Overall, the somatic symptoms of anxiety and depression displayed the strongest associations with OTCA usage. When examining the gender-specific networks, both showed similar trends, although males exhibited slightly stronger associations between OTCA usage and somatic symptoms.
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Affiliation(s)
| | - Sandra Klonteig
- Advanced Health Intelligence and Brain-Inspired Technologies (ADEPT), Oslo Metropolitan University, Oslo, Norway
| | - Brage Kraft
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Division of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Siv Skarstein
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Marianne Aalberg
- Division of Mental Health Services, Akershus University Hospital, Akershus, Norway
| | - Rune Jonassen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Rau LM, Humberg C, Könning A, Rosenthal N, Stahlschmidt L, Wager J. Longitudinal examination of associations with the onset of pediatric chronic pain at different pain locations. Pain 2024:00006396-990000000-00596. [PMID: 38713802 DOI: 10.1097/j.pain.0000000000003237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 02/29/2024] [Indexed: 05/09/2024]
Abstract
ABSTRACT Chronic pain is a frequent phenomenon in pediatrics. Little research explores whether there are factors that uniquely predict or accompany the onset of new chronic pain in different locations of the body. In this study, we report pediatric pain data for 3 location subsamples-headache, abdominal pain, and musculoskeletal pain-of a large secondary school sample (N = 2280). We distinguished between participants who experienced an onset of chronic pain and participants who had no chronic pain at the respective pain location within a 1-year period. We used regression and multilevel models to compare the 2 groups regarding factors previously associated with chronic pain. Our results indicate that irrespective of location, the onset of chronic pain is predicted by psychosocial factors, in particular, symptoms of depression (odds ratio [OR] = 1.13-1.17, P < 0.01) and anxiety (OR = 1.12-1.21, P < 0.05). Although the onset of headache is predicted by psychosocial factors only, the onsets of abdominal and musculoskeletal pain are additionally predicted by physiological factors such as level of physical activity. Many of the predictors were also accompanying factors. Regarding chronic abdominal pain, sleep deficiency did not predict pain onset but was a co-occurring phenomenon. Our findings underline the importance of mental health factors in the pain onset at all 3 body locations, whereas in chronic abdominal and musculoskeletal pain, physiological factors should also be considered. Measures of model fit, however, indicate that the occurrence of chronic pain is more complex and not well predicted by these factors alone.
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Affiliation(s)
- Lisa-Marie Rau
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Clarissa Humberg
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Anna Könning
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Nicola Rosenthal
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
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Solé E, Roman-Juan J, Sánchez-Rodríguez E, Castarlenas E, Jensen MP, Miró J. School bullying and peer relationships in children with chronic pain. Pain 2024; 165:1169-1176. [PMID: 38015633 DOI: 10.1097/j.pain.0000000000003118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023]
Abstract
ABSTRACT Preliminary evidence suggests that there are significant associations between bullying and chronic pain, as well as between the quality of peer relationships and psychological function in youth with chronic pain. However, these findings have yet to be replicated, and the role that bullying plays in anxiety in children and adolescents with chronic pain has not yet been examined. This study sought to expand our understanding of the associations between measures of bullying and quality of peer relationships and pain-related function domains in a community sample of schoolchildren with chronic pain. One thousand one hundred fifteen schoolchildren participated in this study; 57% were girls, the mean age of the study sample was 11.67 years (SD = 2.47), and 46% reported having chronic pain. Participants completed measures of pain characteristics, pain interference, anxiety, and depressive symptoms, bullying (past and current), and quality of peer relationships. Youth with chronic pain reported a significantly higher percentage of being bullied in the past compared with youth without chronic pain. In the group of youth with chronic pain, the measures of past and current bullying, and quality of peer relationships, were not significantly associated with pain intensity, pain interference, or anxiety. However, having a history of being bullied and the quality of peer relationships were significantly associated with depressive symptom severity. The findings indicate that research to evaluate the potential causal role of bullying and the quality of peer relationships on pain-related function domains in youth with chronic pain is warranted.
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Affiliation(s)
- Ester Solé
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Josep Roman-Juan
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Jordi Miró
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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Celik G, Haney MÖ. The relationship of depressive symptoms with pain and analgesic use in Turkish adolescents. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2024; 37:e12464. [PMID: 38591776 DOI: 10.1111/jcap.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/10/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
PROBLEM This study aimed to determine the prevalence of depressive symptoms, pain (headache, abdominal pain, back pain) and analgesic use among Turkish adolescents. Additionally, it aimed to examine the association between depressive symptoms and pain and analgesic use in adolescents. METHODS This cross-sectional, correlational study was conducted in Izmir, Turkey with 954 adolescents aged 11-19 years. Data were collected with the "socio-demographic questionnaires" and the "Center for Epidemiologic Studies Depression Scale for Children". Analyzes were performed using descriptive statistics and multiple logistic regression analysis. FINDINGS Of the adolescents, 632 (66.2%) showed depressive symptoms. Of the adolescents, 424 (44.4%) experienced headache, 256 (26.8%) experienced abdominal pain, and 343 (36.0%) experienced back pain. A total of 309 (32.4%) adolescents used analgesics for headaches, 132 (13.8%) abdominal pain, and 47 (4.9%) for back pain. Female gender, high level maternal education, bad economic status, poor health perception, bad school success, pain and analgesic use were the correlated variables with adolescent depression. CONCLUSIONS The depressive symptoms, headache and back pain, and use of analgesics especially for headaches were common among adolescents. The results showed depression in adolescent correlated with pain (headache, abdominal pain, and back pain) and analgesic use. Regular screening is needed to assure early intervention of depression among adolescents.
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Affiliation(s)
| | - Meryem Öztürk Haney
- Public Health Nursing Department, Nursing Faculty, Dokuz Eylul University, İzmir, Türkiye
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Humberg C, Rau LM, Claus BB, Könning A, Stahlschmidt L, Wager J. Risk of Unfavorable Trajectories of Chronic Pain Severity-Results of a Longitudinal Study in School Children. THE JOURNAL OF PAIN 2024:104528. [PMID: 38588760 DOI: 10.1016/j.jpain.2024.104528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
Chronic pain is a common burden among children and adolescents associated with impairments in many aspects of life. Higher pain severity increases this burden. Subsequently, it is important to identify factors predicting the course of pain severity, classified by the chronic pain grading (CPG). In a 1-year longitudinal assessment of a general school-age population (N = 2,280), we aimed to identify biopsychosocial factors associated with CPG trajectories. We focused on children and adolescents who reported chronic pain at the start of the year (N = 689). Using longitudinal latent class analysis, we identified 3 classes of CPG trajectories over 1 year: 1) the "pain recovery group" exhibited initially moderate CPG scores that rapidly and consistently declined to a pain-free level, 2) the "continuously moderate pain severity group" displayed initially high CPG levels with a mild decline over time, and 3) the "continuously low pain severity group" had initially moderate CPG levels, which only slightly declined. In comparison to the pain recovery group, the continuously moderate pain severity group presented with heightened levels of anxiety (odds ratio [OR] = 1.12, 95% confidence interval [CI] [1.02, 1.24], P = .023), depression (OR = 1.10, 95% CI [1.01, 1.19], P = .029), and affective pain perception (OR = 1.10, 95% CI [1.02, 1.18], P = .010) and were more likely to be female (OR = 2.14, 95% CI [1.05, 4.35], P = .036). The continuously low pain severity group was predominantly female (OR = 1.65, 95% CI [1.10, 2.49], P = .016) compared to the pain recovery group. In conclusion, girls and individuals with impaired psychological well-being more often exhibit unfavorable trajectories of chronic pain severity. PERSPECTIVE: Pediatric chronic pain patients, particularly females and those exhibiting elevated anxiety or depression scores or heightened affective pain perception warrant special attention in health care. These individuals have a greater risk of an unfavorable trajectory of chronic pain severity and might need more urgent and specialized treatment.
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Affiliation(s)
- Clarissa Humberg
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lisa-Marie Rau
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Benedikt B Claus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Anna Könning
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany; PedScience Research Institute, Datteln, Germany.
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Krokstad MA, Sund E, Rangul V, Bauman A, Olsson C, Bjerkeset O. Secular trends in risk factors for adolescent anxiety and depression symptoms: the Young-HUNT studies 1995-2019, Norway. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02373-2. [PMID: 38578474 DOI: 10.1007/s00787-024-02373-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 01/08/2024] [Indexed: 04/06/2024]
Abstract
In recent decades, increases in mental health problems in adolescents have been reported from several large population-based surveys. This raises questions about changes in underlying risk and protective factors that can inform future intervention strategies. Population data were collected from 1995 to 2019 in three waves of the Young-HUNT studies in Norway to map decennial trends in the prevalence of established risk factors for, and their associations with, adolescent mental health problems. All adolescents (aged 13-19 years) attending lower and upper secondary school in the county of Trøndelag were invited, representing three historical cohorts of 25,245 unique adolescents. Mental health problems (HSCL-5) and established mental health risk factors were self-reported. Using a generalized linear model and linear regression, we calculated changes in relative and absolute differences between risk factors and mental health problems. Overall, the prevalence of established risk factors for mental health problems in adolescence increased markedly between 1995 and 2019, especially in girls. Prominent increases were observed for fatigue, bullying, musculoskeletal pain and migraine, loneliness, and overweight. Furthermore, with the exception of excess alcohol use and family economy, associations between each risk factor and adolescent mental health problems strengthened over the same time span in girls, but less among boys. Our findings suggest that several modifiable risk factors for poor mental health in adolescence are increasing, especially among girls, and should be targeted in community, school, and in clinical settings.
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Affiliation(s)
- Morten Austheim Krokstad
- Faculty of Health Sciences and Nursing, Nord Universitet-Levanger Campus, Levanger, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Erik Sund
- Faculty of Health Sciences and Nursing, Nord Universitet-Levanger Campus, Levanger, Norway
- Department of Public Health and Nursing, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Vegar Rangul
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Public Health and Nursing, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Craig Olsson
- Murdoch Children's Research Institute, Centre for Adolescent Health, The Royal Children's Hospital Melbourne Victoria, Parkville, Australia
- School of Psychology, Faculty of Health, Centre for Social and Early Emotional Development, Deakin University, Burwood, VIC, Australia
- Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Ottar Bjerkeset
- Faculty of Health Sciences and Nursing, Nord Universitet-Levanger Campus, Levanger, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Grothus S, Sommer A, Stahlschmidt L, Hirschfeld G, Höfel L, Linder R, Zernikow B, Wager J. Pediatric chronic pain grading-a revised classification of the severity of pediatric chronic pain. Pain 2024:00006396-990000000-00570. [PMID: 38595202 DOI: 10.1097/j.pain.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 02/08/2024] [Indexed: 04/11/2024]
Abstract
ABSTRACT In this study, we describe the development and validation of a revised Pediatric Chronic Pain Grading (P-CPG) for children aged 8 to 17 years that adds emotional impairment to previously used measures of pain intensity and functional impairment. Such a measure enables the assessment of chronic pain severity in different epidemiological and clinical populations, the stratification of treatment according to pain severity, and the monitoring of treatment outcome. The P-CPG was developed using a representative sample of school children with chronic pain (n = 454; Mage = 12.95, SD = 2.22). Construct validity and sensitivity to change were examined within a sample of N = 2448 children and adolescents (Mage = 12.71, SD = 2.47) comprising 3 subsamples (school n = 1562, primary care n = 129, and tertiary care n = 757) affected by chronic pain to varying extents. Results showed that P-CPG grades differed significantly among the 3 subsamples, with school children being least affected by chronic pain and tertiary care patients being most affected. As P-CPG grade increased, so did pain intensity, functional impairment, pain-related school absence, and emotional impairment. Convergent validity was demonstrated by significant positive correlations between the P-CPG and global ratings of pain severity as well as objective claims data; the latter reflects greater health care costs with increasing P-CPG scores. Sensitivity to change was supported by a significant reduction in baseline P-CPG grades 3 and 6 months after intensive interdisciplinary pain treatment in tertiary care sample. In conclusion, the P-CPG is an appropriate measure of pain severity in children and adolescents with chronic pain in clinical as well as epidemiological settings.
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Affiliation(s)
- Susanne Grothus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Ariane Sommer
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Gerrit Hirschfeld
- Faculty of Business, CareTech OWL University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Lea Höfel
- Center for Pain Therapy for Young People, Garmisch-Partenkirchen, Germany
| | | | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
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9
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Rau LM, Humberg C, Könning A, Claus BB, Stahlschmidt L, Wager J. Predictors and concomitants of the remission of frequent headache in pediatrics: A longitudinal community study. Headache 2024; 64:306-316. [PMID: 38440947 DOI: 10.1111/head.14690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE We aimed to examine factors associated with frequent headache remission in schoolchildren aged 10-18 years. BACKGROUND Frequent headache is a common health problem in adolescence, and some individuals in this population experience remission. Factors preceding headache remission as opposed to ongoing headache, and their development over time, have not been examined extensively. METHODS Data were derived from a large school sample (N = 2280). Over the course of 1 year, n = 156 adolescents experienced remission from frequent headaches, while n = 125 adolescents continued to have frequent headaches throughout the year. In this longitudinal case-control study, we predicted headache remission using demographic, pain, psychosocial, sleep, and physiological characteristics. Additionally, we sought to explore the development of psychosocial, sleep, and physiological characteristics in relation to remitted versus ongoing headache over the 1-year period. RESULTS A model containing the variables sex (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.248-0.76, p = 0.003), headache intensity (OR = 0.85, 95% CI = 0.73-0.99, p = 0.035), anxiety score (OR = 0.92, 95% CI = 0.85-1.01, p = 0.071), and depression score (OR = 0.94, 95% CI = 0.89-1.00, p = 0.041) predicted the outcome variable (remitted vs. non-remitted headache), explaining 17% of the variance in group membership. Schoolchildren reporting remitted headache at the end of the year exhibited lower depression (F[1, 557.01] = 45.77, p < 0.001) and anxiety scores (F[1, 557.01] = 21.72, p < 0.001), higher school satisfaction (F[1, 209.46] = 7.15, p = 0.008), and fewer difficulties falling asleep (F[1, 856.52] = 41.21, p < 0.001) or sleeping through the night (F[1, 731.12] = 26.42, p < 0.001) throughout the year compared to those with non-remitted headache. Depression scores declined significantly over the year in the group with remitted headache, whereas these scores remained constant in the group with non-remitted headache. CONCLUSION Our results suggest a correlation between headache remission and male sex, improved mental health, and reduced pain-related burden. Moreover, there was an observed decline in symptoms of depression during headache remission. Psychotherapy may be a promising treatment strategy for addressing frequent headaches reported by children and adolescents.
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Affiliation(s)
- Lisa-Marie Rau
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Clarissa Humberg
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Anna Könning
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Benedikt B Claus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
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10
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Kaplan CM, Schrepf A, Boehnke KF, He Y, Smith T, Williams DA, Bergmans R, Voepel-Lewis T, Hassett AL, Harris RE, Clauw DJ, Beltz AM, Harte SE. Risk Factors for the Development of Multisite Pain in Children. Clin J Pain 2023; 39:588-594. [PMID: 37440345 PMCID: PMC10592500 DOI: 10.1097/ajp.0000000000001148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE Chronic pain has economic costs on par with cardiovascular disease, diabetes, and cancer. Despite this impact on the health care system and increasing awareness of the relationship between pain and mortality, efforts to identify simple symptom-based risk factors for the development of pain, particularly in children, have fallen short. This is critically important as pain that manifests during childhood often persists into adulthood. To date, no longitudinal studies have examined symptoms in pain-free children that presage a new, multisite manifestation of pain in the future. We hypothesized that female sex, sleep problems, and heightened somatic symptoms complaints at baseline would be associated with the risk of developing new multisite pain 1 year later. METHODS Symptom assessments were completed by parents of youth (ages 9 to 10) enrolled in the Adolescent Brain Cognitive Development study. Multivariate logistic regression models focused on children who developed multisite pain 1 year later (n=331) and children who remained pain free (n=3335). RESULTS Female sex (odds ratio [OR]=1.35; 95% CI, 1.07, 1.71; P =0.01), elevated nonpainful somatic symptoms (OR=1.17; 95% CI, 1.06, 1.29; P <0.01), total sleep problems (OR=1.20; 95% CI, 1.07, 1.34; P <0.01), and attentional issues (OR=1.22; 95% CI, 1.10, 1.35; P <0.001) at baseline were associated with new multisite pain 1 year later. Baseline negative affect was not associated with new multisite pain. DISCUSSION Identifying symptom-based risk factors for multisite pain in children is critical for early prevention. Somatic awareness, sleep and attention problems represent actionable targets for early detection, treatment, and possible prevention of multisite pain in youth.
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Affiliation(s)
| | - Andrew Schrepf
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Kevin F Boehnke
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Ying He
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Tristin Smith
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | | | - Rachel Bergmans
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | | | - Afton L Hassett
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Richard E Harris
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
- Susan Samueli Integrative Health Institute, School of Medicine
- Department of Anesthesiology and Perioperative Care, School of Medicine, University of California at Irvine, Irvine, CA
| | - Daniel J Clauw
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
| | - Adriene M Beltz
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
- Department of Psychology, University of Michigan, Ann Arbor, MI
| | - Steven E Harte
- Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
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11
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Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Miró J. Psychological factors and pain medication use in adolescents with chronic pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1183-1188. [PMID: 37341626 DOI: 10.1093/pm/pnad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/20/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this study was to examine (1) the associations of anxiety, depressive symptoms, and pain catastrophizing with pain medication use in adolescents with chronic pain and (2) the extent to which these associations differed as a function of adolescents' sex. METHODS Cross-sectional data from 320 adolescents 12-18 years of age with chronic pain were drawn from an epidemiological study on pediatric chronic pain conducted in Reus (Catalonia, Spain). Participants were asked to provide sociodemographic information and respond to measures assessing pain (location, frequency, intensity, and interference), pain medication use, anxiety, depressive symptoms, and pain catastrophizing. Point biserial correlations were conducted to examine univariate associations between the psychological variables and pain medication use. Hierarchical logistic regression analysis was used to examine these associations while controlling for demographic characteristics, pain intensity, and pain interference. RESULTS Anxiety, depressive symptoms, and pain catastrophizing were significantly associated with pain medication use in univariate analyses. Regression analysis identified pain catastrophizing as a unique independent predictor of pain medication use after controlling for the effect of demographic variables (sex and age), pain intensity, and pain interference (odds ratio = 1.1, P < .05). No moderating effect of adolescents' sex on the associations between psychological factors and pain medication use was found. CONCLUSIONS Adolescents with chronic pain with higher levels of pain catastrophizing use pain medications more often. Research to examine the impact of interventions targeting pain catastrophizing on pain medication use among adolescents with chronic pain would be an important next step.
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Affiliation(s)
- Josep Roman-Juan
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, United States
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
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12
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Baumann-Larsen M, Zwart JA, Dyb G, Wentzel-Larsen T, Stangeland H, Storheim K, Stensland SØ. 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. Psychiatry Res 2023; 327:115400. [PMID: 37574601 DOI: 10.1016/j.psychres.2023.115400] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/14/2023] [Accepted: 07/30/2023] [Indexed: 08/15/2023]
Abstract
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.
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Affiliation(s)
- Monica Baumann-Larsen
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - John-Anker Zwart
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Grete Dyb
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway; Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Helle Stangeland
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Kjersti Storheim
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Synne Øien Stensland
- Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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13
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Alsaggaf F, Coyne I. Participation in everyday life for young people with chronic pain in Saudi Arabia: "you feel lacking in life and you feel that time is flying by". FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1099345. [PMID: 37275401 PMCID: PMC10235783 DOI: 10.3389/fresc.2023.1099345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/25/2023] [Indexed: 06/07/2023]
Abstract
Introduction Chronic pain is a common health problem that can have a significant impact on children and young people's daily life. Although research on pediatric chronic pain has been a priority globally, little is known about young people's experience of chronic pain in Saudi Arabia. Thus, this article reports on young people's experience of chronic pain and the impact on their lives in Saudi Arabia which forms part of a larger study. Methods Multiple case study design following Yin's (2018) approach was used. Purposeful and theoretical sampling were used to recruit young people aged 12 to 18 who had experienced chronic pain for at least three months, their parents, and their school personnel. The young people and their parents were recruited from a tertiary hospital located on the western side of Saudi Arabia while school personnel were recruited from the schools that young people attended. Data were collected through in-depth semi-structured face-to-face (n = 15) and telephone interviews (n = 25) from 40 participants (10 young people, 10 parents, and 20 school personnel). Interviews were recorded, transcribed verbatim, and translated from Arabic to English. Data were analyzed following two phases: (1) constant comparative analysis; and (2) cross-case analysis based on the work of Charmaz (2014) and Yin (2018) respectively. Findings Young people's experiences of chronic pain were categorized into three themes: (1) experiencing chronic pain; (2) impact of pain on quality of life; and (3) everyday strategies to manage chronic pain. All young people reported that their pain was caused by a chronic condition, where the most prevalent pains were musculoskeletal/joint pain, abdominal pain, and headache/migraine. Most young people had encountered challenges with misdiagnosis or delayed diagnosis as to the cause of their chronic pain. They described how their chronic pain interfered with their physical, psychological, and social functioning. They primarily managed their pain with medications and through self-care techniques. The findings also indicated that young people's generally positive attitude to their pain reflected their beliefs in Allah's power and the belief that such suffering should be borne according to their Islamic culture. Conclusion Chronic pain is a significant health phenomenon that tends to restrict the participation of young people in everyday life. However young people used a range of strategies to normalize the pain so that they could continue with their everyday activities like their peers.
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Affiliation(s)
- Fatimah Alsaggaf
- Nursing College, King Abdulaziz University, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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14
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Rader L, Freis SM, Friedman NP. Associations Between Adolescent Pain and Psychopathology in the Adolescent Brain Cognitive Development (ABCD) Study. Behav Genet 2023; 53:232-248. [PMID: 37036551 PMCID: PMC10246734 DOI: 10.1007/s10519-023-10138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 02/21/2023] [Indexed: 04/11/2023]
Abstract
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.
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Affiliation(s)
- Lydia Rader
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA.
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA.
| | - Samantha M Freis
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Naomi P Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
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15
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Albinni B, de Zambotti M, Iacovides S, Baker FC, King CD. The complexities of the sleep-pain relationship in adolescents: A critical review. Sleep Med Rev 2023; 67:101715. [PMID: 36463709 PMCID: PMC9868111 DOI: 10.1016/j.smrv.2022.101715] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
Chronic pain is a common and disabling condition in adolescents. Disturbed sleep is associated with many detrimental effects in adolescents with acute and chronic pain. While sleep and pain are known to share a reciprocal relationship, the sleep-pain relationship in adolescence warrants further contextualization within normally occurring maturation of several biopsychological processes. Since sleep and pain disorders begin to emerge in early adolescence and are often comorbid, there is a need for a comprehensive picture of their interrelation especially related to temporal relationships and mechanistic drivers. While existing reviews provide a solid foundation for the interaction between disturbed sleep and pain in youth, we will extend this review by highlighting current methodological challenges for both sleep and pain assessments, exploring the recent evidence for directionality in the sleep-pain relationship, reviewing potential mechanisms and factors underlying the relationship, and providing direction for future investigations. We will also highlight the potential role of digital technologies in advancing the understanding of the sleep and pain relationship. Ultimately, we anticipate this information will facilitate further research and inform the management of pain and poor sleep, which will ultimately improve the quality of life in adolescents and reduce the risk of pain persisting into adulthood.
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Affiliation(s)
- Benedetta Albinni
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Department of Psychology, University of Campania "Luigi Vanvitelli", Italy
| | | | - Stella Iacovides
- Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fiona C Baker
- Center for Health Sciences, SRI International, Menlo Park, CA, USA; Brain Function Research Group, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Division of Behavioral Medicine and Clinical Psychology, Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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16
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Strømme SH, Guddal MH, Fenstad AM, Visnes H, Zwart JA, Storheim K, Johnsen MB. Musculoskeletal pain is not clearly associated with the risk of anterior cruciate ligament reconstruction in adolescents. BMJ Open Sport Exerc Med 2023; 9:e001453. [PMID: 37200775 PMCID: PMC10186394 DOI: 10.1136/bmjsem-2022-001453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
Objectives The purpose of this study was to investigate whether self-reported musculoskeletal pain (MSP) was associated with a future anterior cruciate ligament reconstruction (ACLR). Methods In this population-based prospective cohort study, we included 8087 participants from the adolescent part of the Trøndelag Health Study (Young-HUNT) in Norway. The exposure was self-reported MSP from the Young-HUNT3 study (2006-2008), which was categorised into two MSP load groups (high MSP and low MSP) based on frequency and number of pain sites. The outcome was ACLRs recorded in the Norwegian Knee Ligament Register between 2006 and 2019. Logistic regression was used to investigate association between MSP load and ACLR, given as ORs with 95% CIs. All tests were two-sided and p values of ≤0.05 were considered statistically significant. Results 8087 adolescents were included. We identified a total of 99 ACLRs, with 6 ACLRs (0.9%) in adolescents who reported high MSP load and 93 ACLRs (1.3%) among those who reported low MSP load. Adolescents reporting high MSP load had 23% lower odds of an ACLR (OR 0.77, 95% CI 0.31 to 1.91) compared with adolescents with low MSP load. However, the CIs were very wide. Conclusion Self-reported high MSP load in adolescents was not associated with increased risk of future ACLR. Although the number of participants was high, the relatively few cases of ACLR mean that we cannot be conclusive about the presence or absence of an association.
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Affiliation(s)
- Sofie Hammernes Strømme
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Maren Hjelle Guddal
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Anne Marie Fenstad
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Håvard Visnes
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
- Oslo Sports Trauma Research Center, Norwegian School of Sports Sciences, Oslo, Norway
- Department of Orthopedics, Sørlandet Hospital, Kristiansand, Norway
| | - John-Anker Zwart
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjersti Storheim
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
| | - Marianne Bakke Johnsen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
- Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
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17
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Nilsen M, Weider S, Halse MK, Fiskum C, Wichstrøm L. Association of anxiety and depression to headache, abdominal- and musculoskeletal pain in children. FRONTIERS IN PAIN RESEARCH 2023; 4:1136145. [PMID: 37122816 PMCID: PMC10132025 DOI: 10.3389/fpain.2023.1136145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/23/2023] [Indexed: 05/02/2023] Open
Abstract
The comorbidity between recurrent pain, anxiety, and depression among children is frequent and well documented. However, only a few studies of the predictive effect of anxiety and depression on pain have adjusted for symptoms of the other disorder when examining the respective relations to different pain locations, rendering the unique contribution from anxiety and depression undetermined. In the current investigation we explore the strength of associations between pain at different locations with symptoms of anxiety and depression in a community sample of 10-year-old children (n = 703). The children were interviewed about the frequency of pain during the last 3 months. Parents and children were interviewed separately about symptoms of anxiety and depression using a semi-structured diagnostic interview. Results of three multivariate regression models for each of headache, abdominal and musculoskeletal pain revealed that depression was associated with musculoskeletal pain and headache, whereas anxiety was not. The associations for depression were not significantly stronger compared to anxiety. Gender-specific models found that depression was related to headache only among girls, but the association was not statistically different compared to boys. These results may, in turn, influence our interpretation of different forms of pain in children, with less weight given to abdominal symptoms viewed as a strong correlate with psychological problems, compared to for instance headache. The results provided no clear support for neither a differential relationship between anxiety and pain and depression and pain nor gender differences.
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Affiliation(s)
- Marianne Nilsen
- Department of Social Work, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Correspondence: Marianne Nilsen
| | - Siri Weider
- Department of Psychology, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marte Kathrine Halse
- Department of Psychology, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Charlotte Fiskum
- Department of Psychology, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Wichstrøm
- Department of Psychology, Faculty of Social and Educational Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Mental Health, St. Olav’s Hospital, Trondheim, Norway
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18
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Miró J, Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP. Chronic Pain and High Impact Chronic Pain in Children and Adolescents: A Cross-Sectional Study. THE JOURNAL OF PAIN 2022; 24:812-823. [PMID: 36577459 DOI: 10.1016/j.jpain.2022.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/26/2022]
Abstract
The aims of this study were to: 1) estimate the prevalence of chronic pain (CP) and high impact chronic pain (HICP) in a community sample of children and adolescents; and 2) compare groups (those without CP, those with CP but no HICP, and those with HICP) with respect to demographic variables, pain variables, and physical, psychological, and school-related function. One thousand one hundred and fifteen children and adolescents participated (56% girls; age: ߂ = 11.67; SD = 2.47; range = 8-18 years). The prevalence of CP and HICP was 46% and 5%, respectively, and was higher in girls and increased with age. Participants with HICP reported greater pain intensity and higher pain frequency than those with CP but no HICP. In addition, participants with HICP reported lower mobility, greater fatigue, worst sleep quality, more anxiety and depression symptoms, worst cognitive function, missing more school days, and worse perceived school performance. HICP is a prevalent condition in children and adolescents and is associated with many negative consequences. Stakeholders must be aware of this and ensure that treatment programs are available to reduce the individual and societal impact of HICP in young individuals. PERSPECTIVE: This article provides information on CP and HICP prevalence and impact in children and adolescents. By better understanding the nature and score of these conditions, we will be able to develop more effective early interventions to help this population and thereby reduce their long-term negative impact.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain.
| | - Josep Roman-Juan
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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19
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Scherrer JF, Salas J, Grucza R, Wilens T, Quinn PD, Sullivan MD, Rossom RC, Wright E, Piper B, Sanchez K, Lapham G. Prescription stimulant use during long-term opioid therapy and risk for opioid use disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100122. [PMID: 36844161 PMCID: PMC9949323 DOI: 10.1016/j.dadr.2022.100122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/15/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
Background Concurrent therapeutic prescribing of prescription stimulants with opioid analgesics is increasing in the United States. Stimulant medication use is associated with increased risk for long-term opioid therapy (LTOT), and LTOT is associated with increased risk for opioid use disorder (OUD). Aims To determine if stimulant prescriptions among those with LTOT (≥90 days) are associated with greater risk for opioid use disorder (OUD). Methods This retrospective cohort study from 2010 to 2018 used a United States, nationally distributed Optum© analytics Integrated Claims-Clinical dataset. Patients ≥18 years of age, and free of prevalent OUD in the two years prior to index were eligible. All patients had a new ≥90-day opioid prescription. The index date was day 91. We compared risk for new OUD diagnoses in patients with and without a prescription stimulant overlapping LTOT. Entropy balancing and weighting controlled for confounding factors. Results Patients (n = 5,712), were 57.7 (SD±14.9) years of age on average, majority female (59.8%) and 73.3% White race. Among patients with LTOT, 2.8% had overlapping stimulant prescriptions. Before controlling for confounding, dual stimulant-opioid prescriptions, compared to opioid only, were associated with OUD risk (HR = 1.75; 95%CI:1.17-2.61). After controlling for confounding, this association was no longer present (HR = 0.89; 95%CI:0.47-1.71). Results did not differ in sensitivity analyses limiting the cohort to those <56 years of age. Conclusions Dual stimulant use among patients with LTOT does not increase risk for OUD. Stimulants prescribed for ADHD and other conditions may not worsen opioid outcomes for some patients with LTOT.
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, U.S.A.,Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO 63104, U.S.A.,Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO 63104, U.S.A.,Corresponding author at: Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO 63110, U.S.A..
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, U.S.A.,Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, 1438 South Grand Blvd., St. Louis, MO 63104, U.S.A
| | - Richard Grucza
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, St. Louis, MO 63110, U.S.A.,Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO 63104, U.S.A.,Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO 63104, U.S.A
| | - Timothy Wilens
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, U.S.A.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215, U.S.A
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th St., Room 116, Bloomington, IN 47405, U.S.A
| | - Mark D. Sullivan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195, U.S.A
| | - Rebecca C. Rossom
- HealthPartners Institute, 8170 33rd Ave S, MS21112R, Minneapolis, MN 55425, U.S.A
| | - Eric Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, 190 Welles St., Forty Fort, PA 18704, U.S.A
| | - Brian Piper
- Center for Pharmacy Innovation and Outcomes, Geisinger Precision Health Center, 190 Welles St., Forty Fort, PA 18704, U.S.A.,Geisinger Commonwealth School of Medicine, Medical Sciences Building, 525 Pine St., Office 2108, Scranton, PA 18509, U.S.A
| | - Katherine Sanchez
- Trauma Research Consortium, Baylor Scott and White Research Institute, 3600 Gaston Ave., Barnett Tower, Suite 1202, Dallas, Texas 75246, U.S.A
| | - Gwen Lapham
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Ste. 1600, Seattle, WA 98101, U.S.A
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20
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Senger-Carpenter T, Scott EL, Isaman DJM, Lenko R, Seng J, Ploutz-Snyder R, Robinson-Lane SG, Cofield C, Chen B, Voepel-Lewis T. Biopsychosocial Attributes of Single-region and Multi-region Body Pain During Early Adolescence: Analysis of the ABCD Cohort. Clin J Pain 2022; 38:670-679. [PMID: 36094004 PMCID: PMC9561068 DOI: 10.1097/ajp.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
| | - Eric L. Scott
- Michigan Medicine Department of Pediatrics, The University of Michigan, Ann Arbor, MI 48109
- Michigan Medicine Department of Anesthesiology at The University of Michigan, Ann Arbor, MI 48109
| | - Deanna JM Isaman
- School of Nursing, The University of Michigan, Ann Arbor, MI 48109
| | - Rachel Lenko
- School of Nursing, The University of Michigan, Ann Arbor, MI 48109
| | - Julia Seng
- School of Nursing, The University of Michigan, Ann Arbor, MI 48109
| | | | | | - Cherie Cofield
- School of Nursing, The University of Michigan, Ann Arbor, MI 48109
| | - Bingxin Chen
- School of Nursing, The University of Michigan, Ann Arbor, MI 48109
| | - Terri Voepel-Lewis
- School of Nursing, The University of Michigan, Ann Arbor, MI 48109
- Michigan Medicine Department of Pediatrics, The University of Michigan, Ann Arbor, MI 48109
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21
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Rexwinkel R, Vlieger AM, Saps M, Tabbers MM, Benninga MA. A therapeutic guide on pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified. Eur J Pediatr 2022; 181:2603-2617. [PMID: 35460383 PMCID: PMC9192445 DOI: 10.1007/s00431-022-04459-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
Disorders of the gut-brain interaction negatively impact quality of life and carry a substantial socioeconomic burden. Irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) are common functional abdominal pain disorders in childhood. The pathophysiology is not fully understood, and high-quality intervention trials and international guidelines are missing. Therefore, the management of these disorders remains challenging. This review aims to provide an up-to-date overview of therapeutic possibilities for pediatric IBS or FAP-NOS and recommends management strategies. To prevent unnecessary referrals and extensive costs, it is fundamental to make a positive diagnosis of IBS or FAP-NOS in children with chronic abdominal pain with only minimal investigations. A tailor-made approach for each patient, based on the accompanying physical and psychological symptoms, is proposed to date. CONCLUSION Shared decision-making including non-pharmacological and pharmacological interventions should be considered and discussed with the family. WHAT IS KNOWN • Irritable bowel syndrome and functional abdominal pain-not otherwise specified are common in childhood. • Although the number of treatment options has grown recently, managing these disorders can be challenging and unsatisfactory, and no evidence-based international management guidelines are available. WHAT IS NEW • We suggest using a stepwise individualized approach to management, where after first-line management, both non-pharmacological and pharmacological interventions should be discussed.
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Affiliation(s)
- Robyn Rexwinkel
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands.
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Miguel Saps
- Department of Pediatric Gastroenterology, University of Miami, Miami, FL, USA
| | - Merit M Tabbers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands
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22
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Lucas R, Brandão M, Gorito V, Talih M. Refining the prediction of multisite pain in 13-year-old boys and girls by using parent-reported pain experiences in the first decade of life. Eur J Pain 2021; 26:695-708. [PMID: 34904323 PMCID: PMC9305734 DOI: 10.1002/ejp.1898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/10/2021] [Indexed: 11/11/2022]
Abstract
Background We evaluated different pain profiles as prospective predictors of multisite pain in 13‐year‐old adolescents (1300 girls and 1457 boys) enrolled in Generation XXI, a birth cohort study in Portugal. Methods Pain history was queried using the Luebeck Pain Questionnaire through parent proxy‐ (ages 7 and 10) and adolescent (age 13) self‐reports. We estimated the risk of multisite pain (2 or more pain sites) at age 13, according to previous pain experiences, including accumulation and timing. We defined five profiles that combined adverse features at ages 7 and 10 (recurrence, multisite, frequency, duration, intensity, triggers, activity restrictions, passive coping, and family history) and estimated their relative risks (RR) and likelihood ratios (LR) for adolescent multisite pain. Results At age 13, 39.2% of girls and 27.2% of boys reported multisite pain in the previous three months. The risk was higher among girls with multisite and recurrent pain at ages 7 and 10 than in girls without those adverse features, especially if psychosocial triggers were also present (RR 1.87; 95% confidence interval 1.36, 2.36 and LR 3.49; 1.53, 7.96). Boys with recurrent pain of higher frequency and causing activity restrictions at ages 7 and 10 had a higher risk of multisite pain at 13 (RR 2.05; 1.03, 3.05 and LR 3.06; 1.12, 8.39). Earlier adverse experiences were more predictive of future pain in girls than in boys. Conclusions Different profiles were useful to rule in future multisite pain in boys and girls. This provides clues for early stratification of chronic pain risk. Significance We identified sex‐specific pain features that can be collected by practitioners in the first decade of life to improve the stratification of children in terms of their future risk of a maladaptive pain experience in adolescence. Using a prospective population‐based cohort design, we show that early multisite pain and psychosocial triggers are relevant predictors of future multisite pain in girls, whereas repeated reports of high‐frequency pain leading to activity restrictions are predictive of adolescent multisite pain in boys.
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Affiliation(s)
- Raquel Lucas
- EPIUnit (Epidemiology Research Unit), ITR (Laboratory for Integrative and Translational Research in Population Health), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Maria Brandão
- EPIUnit (Epidemiology Research Unit), ITR (Laboratory for Integrative and Translational Research in Population Health), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Vanessa Gorito
- EPIUnit (Epidemiology Research Unit), ITR (Laboratory for Integrative and Translational Research in Population Health), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Makram Talih
- EPIUnit (Epidemiology Research Unit), ITR (Laboratory for Integrative and Translational Research in Population Health), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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23
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Henriksen M, Skrove M, Hoftun GB, Sund ER, Lydersen S, Kalvin CB, Sukhodolsky DG. Exposure to traumatic events poses greater risk for irritability in girls than in boys. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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24
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Solé E, Sharma S, Ferreira-Valente A, Pathak A, Sánchez-Rodríguez E, Jensen MP, Miró J. The associations between sleep disturbance, psychological dysfunction, pain intensity, and pain interference in children with chronic pain. PAIN MEDICINE 2021; 23:1106-1117. [PMID: 34850200 DOI: 10.1093/pm/pnab333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES This study aimed to better understand the associations between both sleep disturbance and psychological dysfunction (i.e., anxiety and depressive symptoms, and anger), and pain intensity and pain interference, in a sample of children with chronic pain. DESIGN Cross-sectional design. METHODS Three hundred and forty-two children with chronic pain (8-18 years) completed measures assessing pain intensity, pain interference, sleep disturbance, anxiety, depressive symptoms, and anger. Regression analyses examined the direct, interaction (with sex), and mediation effects of sleep quality and psychological dysfunction on pain intensity and interference. RESULTS Sleep disturbance was significantly associated with both pain intensity and pain interference. However, measures of psychological dysfunction were associated significantly only with pain interference. Sex did not moderate these associations. The measures of psychological dysfunction mediated the associations between sleep disturbance and pain interference, but not those between sleep disturbance and pain intensity. CONCLUSIONS The results confirmed significant cross-sectional associations between both sleep disturbance and psychological dysfunction and pain outcomes in children with chronic pain. Future research to test for causal associations is warranted.
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Affiliation(s)
- Ester Solé
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Saurab Sharma
- Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Alexandra Ferreira-Valente
- William James Center for Research, ISPA - Instituto Universitário, Lisbon, Portugal.,Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Anupa Pathak
- Centre for Musculoskeletal Outcomes Research, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
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25
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Wiwe Lipsker C, Hirvikoski T, Balter LJT, Bölte S, Lekander M, Holmström L, Wicksell RK. Autistic Traits and Attention-Deficit Hyperactivity Disorder Symptoms Associated With Greater Pain Interference and Depression, and Reduced Health-Related Quality of Life in Children With Chronic Pain. Front Neurosci 2021; 15:716887. [PMID: 34790087 PMCID: PMC8591303 DOI: 10.3389/fnins.2021.716887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022] Open
Abstract
Previous research indicates elevated levels of clinically significant traits and symptoms of autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD) in children with chronic pain, but associations with functioning and depression are yet unclear. The current study examined the relationships of autistic traits and ADHD symptoms with pain interference, depression, and health-related quality of life, as well as the mediating roles of insomnia and psychological inflexibility, in children with chronic pain (n = 146, 8–17 years, 102 girls) presenting at a tertiary pain clinic. Children completed measures of pain intensity, depression, pain interference, health-related quality of life, insomnia, and psychological inflexibility. Parents (n = 146, 111 mothers) completed measures to assess autistic traits and ADHD symptoms in their children. Children with clinically significant autistic traits and ADHD symptoms presented with significantly higher levels of depressive symptoms and pain interference, and significantly lower health-related quality of life, than did the other children. Autistic traits and ADHD symptoms contributed significantly to the prediction of pain interference and depressive symptoms, as well as health-related quality of life. Psychological inflexibility mediated the relationships between ADHD symptoms and autistic traits on the one hand and depression, pain interference, and health-related quality of life on the other, while insomnia mediated the relationships between ADHD symptoms and depression, pain interference, and health-related quality of life. All analyses were adjusted for demographics and pain intensity. Results suggest the utility of screening for neurodevelopmental disorders in children with chronic pain. Furthermore, the findings may indicate insomnia and skills related to psychological flexibility as potential treatment targets in interventions aiming at improving functioning and health-related quality of life in children with chronic pain and co-occurring symptoms of neurodevelopmental disorders.
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Affiliation(s)
| | - Tatja Hirvikoski
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Habilitation and Health, Stockholm, Sweden
| | - Leonie J T Balter
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Health Care Services, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Stockholm, Sweden.,Curtin Autism Research Group, Curtin School of Allied Health, Curtin University, Perth, WA, Australia
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Linda Holmström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Psychology, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Pain Clinic, Capio St. Göran's Hospital, Stockholm, Sweden
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26
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Over-the-counter analgesics use is associated with pain and psychological distress among adolescents: a mixed effects approach in cross-sectional survey data from Norway. BMC Public Health 2021; 21:2030. [PMID: 34742281 PMCID: PMC8572415 DOI: 10.1186/s12889-021-12054-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over-the-counter analgesics (OTCA) such as Paracetamol and Ibuprofen are frequently used by adolescents, and the route of administration and access at home allows unsupervised use. Psychological distress and pain occur simultaneously and are more common among females than among males. There is a dynamic interplay between on-label pain indications and psychological distress, and frequent OTCA use or misuse can exacerbate symptoms. No studies have to date provided an overview of frequent OTCA use in a larger population-based study. The current study used survey data to explore associations between and the relative predictive value of on-label pain indication and measures of psychological distress, together with sex differences for weekly OTCA use. METHODS This study included 349,528 adolescents aged 13-19. The data was collected annually between January 2014 and December 2018 as part of the Norwegian Young Data survey. Performance analysis was conducted to explore the relative roles and associations between on-label pain indication and psychological distress in weekly OTCA use. A mixed-effects logistic regression model was used to explore the unique contributions from four domains of on-label pain indication and psychological distress as measured by a combined measure of anxiety and depression (HSCL-10) and peer-bullying involvement as victims or bullies. RESULTS Thirty percent of females and 13 % of males use OTCA weekly. Headache is the strongest on-label pain predictor of weekly OTCA use, followed by abdominal pain. Depression and anxiety are the strongest psychological predictor of weekly OTCA use, and higher symptom levels and being female increase the strength of this association. Anxiety and depression also predict weekly OTCA use after controlling for physiological pain. CONCLUSIONS Sex, pain and anxiety and depression are inter-correlated and strong predictors of frequent OTCA use. Frequent OTCA use in the context of psychological distress may be a form of self-medication that can exacerbate symptoms and decrease psychosocial function. Longitudinal studies that explore causal trajectories between frequent on-label OTCA use and psychological distress are required. OTCA use among adolescents, and particularly among females, with anxiety and depression should be administered with caution and closely monitored.
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27
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Associations between pain, self-efficacy, sleep duration, and symptoms of depression in adolescents: a cross-sectional survey. BMC Public Health 2021; 21:1617. [PMID: 34482826 PMCID: PMC8418745 DOI: 10.1186/s12889-021-11680-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Although pain has been identified as an important public health problem among adolescents, few studies have investigated possible protective and risk factors for pain. The main aim of the present study was to investigate associations between prevalence of daily pain, self-efficacy, sleep duration, and symptoms of depression in a representative sample of Norwegian adolescents. Methods A comprehensive cross-sectional survey was completed by 12,867 junior high school students and high school students (response rate: 90%) aged 14–19 years. Logistic regression models were adjusted for age, gender, and parental educational level. Results We found a high prevalence of daily pain among adolescents, especially among girls (19%) compared with boys (7%). Short sleep duration was associated with increased odds ratios (ORs) of pain in the shoulders/neck (OR 1.3; 95% CI 1.3–2.0) and stomach (1.7; 1.2–2.4). Symptoms of depression were associated with increased ORs for all measured types of daily pain, including head (3.7; 3.0–4.6), shoulders/neck (3.9; 3.1–4.8), joints/muscles (4.3; 3.3–5.6), and stomach (5.5; 4.1–7.4). By contrast, self-efficacy was not associated with any form of daily pain. Conclusion Given the burden of pain, high incidence of pain problems, and strong association between pain and depression and, to some degree, short sleep duration, co-occurring symptoms may be an important area for research in the public health field. The results highlight the importance of early identification and prevention. Longitudinal studies are needed to understand better pain problems and their underlying mechanisms with the aim of developing targeted interventions.
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28
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Chumpitazi BP, Palermo TM, Hollier JM, Self MM, Czyzewski D, Weidler EM, Heitkemper M, Shulman RJ. Multisite Pain Is Highly Prevalent in Children with Functional Abdominal Pain Disorders and Is Associated with Increased Morbidity. J Pediatr 2021; 236:131-136. [PMID: 33940018 PMCID: PMC8403143 DOI: 10.1016/j.jpeds.2021.04.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/06/2021] [Accepted: 04/27/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To characterize the types of multisite pain experienced by children with functional abdominal pain disorders (FAPDs) and to examine differences in psychosocial distress, functional disability, and health-related quality of life in children with multisite pain vs abdominal pain alone. STUDY DESIGN Cross-sectional study of children ages 7-17 years (n = 406) with pediatric Rome III FAPDs recruited from both primary and tertiary care between January 2009 and June 2018. Subjects completed 14-day pain and stool diaries, as well as validated questionnaires assessing abdominal and nonabdominal pain symptoms, anxiety, depression, functional disability, and health-related quality of life. RESULTS In total, 295 (73%) children endorsed at least 1 co-occurring nonabdominal pain, thus, were categorized as having multisite pain with the following symptoms: 172 (42%) headaches, 143 (35%) chest pain, 134 (33%) muscle soreness, 110 (27%) back pain, 94 (23%) joint pain, and 87 (21%) extremity (arms and legs) pain. In addition, 200 children (49%) endorsed 2 or more nonabdominal pain symptoms. Participants with (vs without) multisite pain had significantly higher abdominal pain frequency (P < .001) and severity (P = .03), anxiety (P < .001), and depression (P < .001). Similarly, children with multisite pain (vs without) had significantly worse functional disability (P < .001) and health-related quality of life scores (P < .001). Increasing number of multisite pain sites (P < .001) was associated with increased functional disability when controlling for demographic and other clinical factors. CONCLUSIONS In children with FAPDs, nonabdominal multisite pain is highly prevalent and is associated with increased psychosocial distress, abdominal pain frequency and severity, functional disability, and lower health-related quality of life.
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Affiliation(s)
- Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA,Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX USA
| | - Tonya M. Palermo
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA USA,Department of Anesthesiology and Pain Medicine, University of Washington, Seattle WA
| | - John M. Hollier
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Mariella M. Self
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Danita Czyzewski
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Erica M. Weidler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA,Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX USA
| | - Margaret Heitkemper
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA USA
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA,Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX USA
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29
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Mikkelsen HT, Haraldstad K, Helseth S, Skarstein S, Småstuen MC, Rohde G. Pain and health-related quality of life in adolescents and the mediating role of self-esteem and self-efficacy: a cross-sectional study including adolescents and parents. BMC Psychol 2021; 9:128. [PMID: 34462000 PMCID: PMC8404017 DOI: 10.1186/s40359-021-00629-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 08/16/2021] [Indexed: 12/20/2022] Open
Abstract
Background To promote health-related quality of life (HRQOL) in adolescents with pain, it is important to study factors associated with pain. This study aimed to describe selected factors and pain in 14–15-year-old adolescents and their parents, to assess how these factors are associated with adolescent pain groups, and to explore whether the relationship between pain intensity and HRQOL in adolescents with persistent pain is mediated by self-esteem and self-efficacy. Methods A cross-sectional study was performed among 508 dyads of adolescents (14–15 years) and parents in a school-based setting. Among these, 148 adolescents had persistent pain. We explored the following variables: HRQOL, pain, self-efficacy, self-esteem, sleep, loneliness, stress and sociodemographic variables. All variables were assessed with well-validated instruments. HRQOL was measured with KIDSCREEN-27. Analyses included Chi-square, ANOVA, Mann–Whitney U tests, Kruskal–Wallis and the PROCESS macro method for mediation analyses. Results Adolescents with pain reported significantly higher levels of stress, loneliness and lack of sleep and lower levels of self-efficacy, self-esteem and HRQOL compared to adolescents without pain. More girls than boys reported pain. Adolescents with persistent pain scored significantly worse on self-esteem, stress, loneliness, lack of sleep, school absence, pain and HRQOL compared to adolescents with shorter pain duration. Adolescent pain groups did not differ significantly considering parental factors. However, more adolescents with persistent pain reported that someone in their family had pain. The associations between pain intensity and the HRQOL subscales in adolescents with persistent pain were completely mediated by self-esteem, but not by self-efficacy. The highest degree of mediation was estimated for the HRQOL subscale school environment (indirect effect = 73.5%). Conclusions Our findings highlight the complexity within adolescent pain, demonstrating that adolescents with pain differ from adolescents without pain when it comes to gender, school absence, factors within-person and between-persons. Longer pain duration makes adolescents more vulnerable. We confirm the importance of resilience factors for HRQOL but indicate that self-esteem is more important than self-efficacy. To promote HRQOL in adolescents with persistent pain, a strengthening of both their self-esteem and self-efficacy is recommended. We highlight the need for an individual, holistic approach to adolescent pain. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00629-z.
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Affiliation(s)
- Hilde Timenes Mikkelsen
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.
| | - Kristin Haraldstad
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway
| | - Sølvi Helseth
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Siv Skarstein
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Milada Cvancarova Småstuen
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Nursing and Health Promotion, Faculty of Health Sciences, Metropolitan University, Oslo, Norway
| | - Gudrun Rohde
- Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, 4604, Kristiansand, Norway.,Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
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Palit S, Palermo TM, Fillingim RB, Bartley EJ. Topical Review: Examining Multidomain Pain Resilience in Late Adolescents and Young Adults. J Pediatr Psychol 2021; 46:280-285. [PMID: 33197259 PMCID: PMC7977437 DOI: 10.1093/jpepsy/jsaa108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/05/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Upwards of 14% of late adolescents and young adults (AYAs) experience chronic pain; however, limited research has focused on factors specifically influencing late AYAs as they transition to adulthood. In this topical review, we propose a conceptual model of multidomain pain resilience (MDPR) in late AYAs with chronic pain that extends existing pain resilience literature, including the Ecological Resilience-Risk Model for Pediatric Chronic Pain. METHOD A conceptual framework for MDPR in late AYAs was developed from the existing literature on resilience in young people with chronic pain. Gaps in knowledge specific to late AYAs are identified, and relevant research examining MDPR in adults with pain are summarized to inform applications of this concept to youth as they transition to adulthood. RESULTS Few studies have explored resilience factors in pediatric pain. Of note, these endeavors have largely neglected late adolescence and young adulthood, despite unique considerations germane to this crucial developmental period. Existing research has also focused exclusively on assessing resilience as a unitary, rather than a multidimensional construct. Although limited, MDPR has been examined in midlife and older adults with chronic pain, highlighting the need to expand prior models of pain resilience and extend these principles to emerging adulthood. CONCLUSIONS Understanding MDPR in late AYAs with chronic pain may provide insights regarding measurable and modifiable resilience factors (e.g., adaptive and personal resources) that promote healthy pain-related outcomes (e.g., reduced pain and enhanced physical functioning) and optimize prevention and/or treatment strategies for this group.
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Affiliation(s)
- Shreela Palit
- Department of Community Dentistry and Behavioral Science, University of Florida
- Pain Research & Intervention Center of Excellence (PRICE), University of Florida
| | - Tonya M Palermo
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
- Department of Anesthesiology and Pain Medicine, University of Washington
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida
- Pain Research & Intervention Center of Excellence (PRICE), University of Florida
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida
- Pain Research & Intervention Center of Excellence (PRICE), University of Florida
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A High Psychological and Somatic Symptom Profile and Family Health Factors Predict New or Persistent Pain During Early Adolescence. Clin J Pain 2021; 37:86-93. [PMID: 33165022 DOI: 10.1097/ajp.0000000000000896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Persistent or recurrent pain is common among adolescents and is associated with poor functioning. The purpose of this study was to determine whether preteens who present with pain, and higher, co-occurring psychological and somatic symptoms (PSS) are at higher risk for persistent pain than other children. MATERIALS AND METHODS We conducted a secondary analysis of the longitudinal Adolescent Brain and Cognitive Development database (version 2.0.1) that includes 11,863 children aged 9 to 12 years. We differentiated children into baseline Pain/PSS profiles using the Child Behavior Checklist assessments of pain, cognitive-fogginess, somatic symptoms, depression, and anxiety and the Sleep Disorder Survey-Children somnolence subscale. We examined whether Pain/PSS profile predicted 1-year new/persistent pain when controlled for child characteristics and intergenerational mental health factors. RESULTS Four profiles were differentiated: No Pain/Low PSS, No Pain/High PSS, Pain/Low PSS, Pain/High PSS. Trauma exposure and family symptoms were associated with increased odds of being in the higher PSS groups. Baseline symptom profile predicted 14% of the variance in new/persistent pain at 1-year. Compared with the No Pain/Low PSS group, an increased odds of 1-year new or persistent pain was found in children with No Pain/High PSS (adjusted odds ratio [OR]: 1.44; [95% confidence interval: 1.14, 1.82]), Pain/Low PSS (adjusted OR: 4.69 [4.01, 5.48]) and Pain/High PSS (adjusted OR: 5.48 [4.35, 6.91]). DISCUSSION Preteen children with higher comorbid Pain/PSS symptomology were at higher risk for new or persistent pain at 1 year when controlled for important child and family characteristics. Findings support the importance of considering co-occurring symptoms when evaluating children with pain.
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Gårdvik KS, Rygg M, Torgersen T, Lydersen S, Indredavik MS. Psychiatric morbidity, somatic comorbidity and substance use in an adolescent psychiatric population at 3-year follow-up. Eur Child Adolesc Psychiatry 2021; 30:1095-1112. [PMID: 32671493 PMCID: PMC8295167 DOI: 10.1007/s00787-020-01602-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 07/08/2020] [Indexed: 12/28/2022]
Abstract
Knowledge is scarce on the course of psychiatric disorders in adolescence. We aimed to assess changes in the frequency of psychiatric disorders, somatic disorders, pain, and substance use in a clinical psychiatric cohort from adolescence to young adulthood. This study is part of the Health Survey in Department of Children and Youth, St. Olavs Hospital, Norway. At age 13-18 years, 717 (43.5% of eligible) participated in the first study visit (T1) in 2009-2011, 549 were reassessed 3 years later with telephone interview (T2), and 464 had diagnostic evaluation at both time points. Data included: ICD-10 diagnoses (T1), DSM-IV diagnoses (T2), self-reported pain and substance use (T1 and T2). The overall rate of psychiatric disorders decreased (T1 vs. T2: 94.8% vs. 72.2%, p < 0.001); while, an increased rate of anxiety disorders was marked among girls (37.5% vs. 55.9%, p < 0.001), with accompanying raised frequencies of psychiatric comorbidity (14.1% vs. 42.6%, p < 0.001), somatic comorbidity (9.4% vs. 19.5%, p = 0.001), chronic pain (31.6% vs. 49.4%, p < 0.001), smoking, alcohol use and trying illicit drugs. Chronic pain, smoking and trying illicit drugs were associated with persisting psychiatric disorders, with highest risk differences for girls (RD = 25.4%, p = 0.002, RD = 15.6%, p = 0.008, RD = 18.0%, p = 0.001, respectively). Three out of four adolescents still had a psychiatric disorder after 3 years. Unlike boys, girls had an increasing rate of anxiety disorders and comorbidities. Chronic pain, smoking and trying illicit drugs were associated with persisting psychiatric disorders. Despite methodological limitations, these findings emphasize the importance of early targeted intervention for adolescents with psychiatric disorders.
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Affiliation(s)
- Kari Skulstad Gårdvik
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.
- Division of Mental Health Care, Department of Children and Youth, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Marite Rygg
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Terje Torgersen
- Division of Mental Health Care, Department of Østmarka, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit Sæbø Indredavik
- Department of Clinical and Molecular Medicine (IKOM), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Abstract
This study examined risk factors of physical aggression during transition from early to late adolescence using a two-wave longitudinal study. Specifically, we examined if risk factors in early adolescence predict physically aggressive behavior starting in late adolescence and why some adolescents desist physical aggressive behavior while others do not. The study sample consisted of 2289 Norwegian adolescents (1235 girls) who participated in the Young-HUNT1 study (mean age 14.5) and the follow-up study 4 years later, Young-HUNT2 study (mean age 18.4). One in six young adolescents reported engaging in physical fights. Moreover, physical aggression in early adolescence was significantly associated with male gender, attention problems, academic problems, being bullied, drinking alcohol, and smoking. Male gender and heavy drinking during early adolescence increased the risk for newly emerging aggressive behavior in late adolescence, whereas heavy drinking during early adolescence was a predictor for persistent versus desisting aggressive behavior in late adolescence.
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Severity of Chronic Pain in German Adolescent School Students. Clin J Pain 2020; 37:118-125. [DOI: 10.1097/ajp.0000000000000898] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023]
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Könning A, Rosenthal N, Friese M, Hirschfeld G, Brown D, Wager J. Factors associated with physician consultation and medication use in children and adolescents with chronic pain: A scoping review and original data. Eur J Pain 2020; 25:88-106. [DOI: 10.1002/ejp.1661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Könning
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care Faculty of Health School of Medicine Witten/Herdecke University Witten Germany
| | - Nicola Rosenthal
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care Faculty of Health School of Medicine Witten/Herdecke University Witten Germany
| | - Michelle Friese
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care Faculty of Health School of Medicine Witten/Herdecke University Witten Germany
| | - Gerrit Hirschfeld
- Department for Business and Health University of Applied Sciences Bielefeld Bielefeld Germany
| | - Donnamay Brown
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
| | - Julia Wager
- German Paediatric Pain CentreChildren’s and Adolescents’ Hospital Datteln Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care Faculty of Health School of Medicine Witten/Herdecke University Witten Germany
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36
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Baseline Characteristics of a Dyadic Cohort of Mothers With Chronic Pain and Their Children. Clin J Pain 2020; 36:782-792. [PMID: 32701524 DOI: 10.1097/ajp.0000000000000864] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES A growing body of research has demonstrated a robust link between parental chronic pain and child pain and psychological function. Although the association between parent and child pain is strong, there are limited data to understand environmental and behavioral processes that account for the association and how this develops over time. This longitudinal cohort study was designed to understand the potential mechanisms that confer risk or resilience for chronic pain among child offspring of mothers with chronic pain. METHODS The current paper presents baseline data on the cohort to describe the pain and psychosocial characteristics of mothers with chronic pain and their 8- to 12-year-old children. A total of 400 mothers with chronic pain and their children were enrolled into the longitudinal study and completed measures of pain, physical, and psychosocial functioning. RESULTS Mothers reported a range of pain and pain-related disability and were grouped into 4 pain grades (PGs) representing different pain and disability levels. Mothers in these groups differed on rates of widespread pain and opioid use. Maternal PGs also differed by physical function, fatigue, sleep disturbance, and psychological function. Most children in this sample reported pain and psychosocial symptoms in the nonclinical range, and child variables did not differ by maternal PG. Maternal disability and function were concurrently associated with child psychosocial function. DISCUSSION While maternal PGs map broadly onto several dimensions of maternal functioning, they were not significantly related to child pain or function. Results may help identify potential protective factors in the intergenerational transmission of risk for chronic pain.
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Seko Y, Lamptey DL, Nalder E, King G. Assessing resiliency in paediatric rehabilitation: A critical review of assessment tools and applications. Child Care Health Dev 2020; 46:249-267. [PMID: 31944352 DOI: 10.1111/cch.12743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUNDS Resiliency has attracted a growing interest in paediatric rehabilitation as a key capacity for disabled children and their families to thrive. This study aimed to identify measures used to assess resiliency of disabled children/youth and their families and critically appraise the current use of resiliency measures to inform future research and practice. METHODS A two-stage search strategy was employed. First, systematic reviews of resiliency measures published since 2000 were searched. Second, full names of measures identified in at least two systematic reviews were searched across four electronic databases. Included studies assessed resiliency among children/youth (0-18 years old) with chronic health conditions and/or disabilities and their families. Identified articles were then analysed to discern the study's definition of resiliency, authors' rationales for measurement selection, and types of perceived adversities facing the study participants. RESULTS From an initial yield of 25 measures identified in five systematic reviews, 11 were analysed in two or more reviews. The second stage yielded 41 empirical studies published between 2012 and 2018, which used 8 of the 11 resiliency measures searched by name. Of 41, 17 studies measured resiliency of disabled children/youth, 23 assessed resiliency within family members, and 1 studied both children/youth and their families. Our critical appraisal identified inconsistencies between the studies' definition of resiliency and chosen measures' operationalization, implicit assumption of disabilities as a developmental risk that automatically results in life adversities, and the tendency among family studies to reduce resiliency down to stress coping skills. Research that encompasses contextual factors and developmental influences is lacking. CONCLUSIONS There is a need for a situated measurement approach that captures multiple interacting factors shaping resiliency over one's life course. Resiliency measures would benefit from a greater focus on a person-environment transaction and an alternative definition of resiliency that accounts for multiple capacities to navigate through disabling environments.
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Affiliation(s)
- Yukari Seko
- School of Professional Communication, Ryerson University, Toronto, Ontario, Canada
| | | | - Emily Nalder
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gillian King
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Wager J, Brown D, Kupitz A, Rosenthal N, Zernikow B. Prevalence and associated psychosocial and health factors of chronic pain in adolescents: Differences by sex and age. Eur J Pain 2020; 24:761-772. [DOI: 10.1002/ejp.1526] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/19/2019] [Accepted: 12/24/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
| | - Donnamay Brown
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
| | - Anna Kupitz
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
| | - Nicola Rosenthal
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine Witten/Herdecke University Witten Germany
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Abstract
Musculoskeletal (MSK) pain is frequently reported among adolescents and children and is a common reason for consultation in primary care. Our aim is to examine its prevalence in 6-year-old children in a general population and to assess associations with physical and psychosocial factors. Data from the Generation R Study, a population-based cohort, was used. Prevalence and characteristics of MSK pain were assessed with parent-reported questionnaires at 6 years of age (N = 6200). Demographics and data on physical activity, sedentary behaviors, previous reported MSK pain, and behavioral problems were extracted from questionnaires. The body mass index SD score was calculated from objectively measured weight and height. A 3-month prevalence of 10.0% was found for MSK pain in children, of which one-third was chronic, and 44.6% experienced together with pain at other sites. Univariate analyses showed that boys and children with lower socioeconomic status reported MSK pain more frequently compared to other pain and no pain. Although no associations were found between MSK pain and children's body mass index and physical activity level, children with MSK pain were more likely to watch television ≥2 hours/day. Multivariable analysis showed significant associations for MSK pain at 3 years of age (odds ratio 5.10, 95% confidence interval 3.25-7.98) and behavioral problems (odds ratio 2.10, 95% confidence interval 1.19-3.72) with the presence of MSK pain. So, MSK pain is already common in young children and is often chronic or recurrent. Previous reported MSK pain and behavioral problems are independently associated with MSK pain in the studied population.
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Asztély K, Kopp S, Gillberg C, Waern M, Bergman S. Chronic Pain And Health-Related Quality Of Life In Women With Autism And/Or ADHD: A Prospective Longitudinal Study. J Pain Res 2019; 12:2925-2932. [PMID: 31695481 PMCID: PMC6804669 DOI: 10.2147/jpr.s212422] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 09/30/2019] [Indexed: 01/22/2023] Open
Abstract
Purpose To investigate the prevalence of chronic pain and its association with health-related quality of life (HRQoL) in a group of women, diagnosed with autism spectrum disorder (ASD) and/or attention deficit hyperactive disorder (ADHD) in childhood. Patients and methods Prospective longitudinal 16–19 years follow-up study of 100 Swedish females diagnosed with ASD and/or ADHD in childhood/adolescence. Seventy-seven of the women were included in the current sub-study, using validated measures of pain perception and quality of life. Results A large majority of the women (76.6%) reported chronic pain. HRQoL was low overall and lower still for those reporting chronic pain. Women with ADHD who had ongoing treatment with stimulants reported a significant lower prevalence of chronic widespread pain (CWP) than those not treated. Conclusion Comorbidity with chronic pain is common in women with ASD and/or ADHD and important to address in the clinic since it is associated with an already low HRQoL. Treatment for ADHD might reduce the pain in some cases.
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Affiliation(s)
- Karin Asztély
- Department of Public Health and Community Medicine, Sahlgrenska Academy Institute of Medicine, Göteborg, Sweden
| | - Svenny Kopp
- Gillberg Neuropsychiatric Centre, Sahlgrenska Academy Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatric Centre, Sahlgrenska Academy Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Margda Waern
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy Institute of Neuroscience and Physiology, Göteborg, Sweden
| | - Stefan Bergman
- Department of Public Health and Community Medicine, Sahlgrenska Academy Institute of Medicine, Göteborg, Sweden
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Heikkala E, Paananen M, Taimela S, Auvinen J, Karppinen J. Associations of co‐occurring psychosocial and lifestyle factors with multisite musculoskeletal pain during late adolescence—A birth cohort study. Eur J Pain 2019; 23:1486-1496. [DOI: 10.1002/ejp.1414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 04/26/2019] [Accepted: 05/05/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Eveliina Heikkala
- Medical Research Center Oulu University of Oulu and Oulu University Hospital Oulu Finland
- Rovaniemi Health Center Rovaniemi Finland
| | - Markus Paananen
- Medical Research Center Oulu University of Oulu and Oulu University Hospital Oulu Finland
| | - Simo Taimela
- Department of Orthopedics and Traumatology Helsinki University Hospital, Töölö hospital Helsinki Finland
- Clinicum, Department of Orthopedics and Traumatology University of Helsinki Helsinki Finland
| | - Juha Auvinen
- Medical Research Center Oulu University of Oulu and Oulu University Hospital Oulu Finland
- Oulunkaari Health Center Ii Finland
| | - Jaro Karppinen
- Medical Research Center Oulu University of Oulu and Oulu University Hospital Oulu Finland
- Center for Life Course Health Research University of Oulu Finland
- Finnish Institute of Occupational Health Oulu Finland
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Chronic Widespread Pain and Fibromyalgia Syndrome: Life-Course Risk Markers in Young People. Pain Res Manag 2019; 2019:6584753. [PMID: 31191788 PMCID: PMC6525804 DOI: 10.1155/2019/6584753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 03/12/2019] [Indexed: 12/11/2022]
Abstract
Although the life-course concept of risk markers as potential etiological influences is well established in epidemiology, it has not featured in academic publications or clinical practice in the context of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Studies of risk markers are required considerations for evaluation of patients and for research because there is no single cause, pathological feature, laboratory finding, or biomarker for CWP or FMS. The early-life risk markers identified by extensive literature review with best evidence for potential causal influence on the development and progression of CWP and FMS include genetic factors, premature birth, female sex, early childhood adversity, cognitive and psychosocial influences, impaired sleep, primary pain disorders, multiregional pain, physical trauma, infectious illness, obesity and inactivity, hypermobility of joints, iron deficiency, and small-fiber polyneuropathy. The case history illustrates the potential etiological influence of multiple risk markers offset by personal resilience.
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Østerås B, Sigmundsson H, Haga M. Psychometric Properties of the Perceived Stress Questionnaire (PSQ) in 15-16 Years Old Norwegian Adolescents. Front Psychol 2018; 9:1850. [PMID: 30327631 PMCID: PMC6174244 DOI: 10.3389/fpsyg.2018.01850] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 09/10/2018] [Indexed: 01/18/2023] Open
Abstract
A better understanding about prerequisites of health and well-being in adolescents is important to prevent chronicity and comorbidities of stress and to improve health promotion in this group. For this purpose, useful instruments are required. The Perceived Stress Questionnaire (PSQ) is developed for research, with an emphasis on predictive validity. The PSQ comprises different components of stress, and the instrument might be useful in studying prerequisites and predictors of health and well-being in adolescents. However, the instrument has not been evaluated in Norwegian psychosomatic populations and in adolescents. Moreover, the factor structure of the PSQ seems to vary between populations, and invariance across gender and concurrent validity regarding mindfulness are not previously tested. The objective of this study were to evaluate the psychometric properties of the Norwegian version of the PSQ in adolescents, including evaluate the fit of previously proposed PSQ-models in females and males and test measurement invariance across gender. Concurrent validity with respect to mindfulness (Mindful Attention Awareness Scale- Adolescent [MAAS-A]) was preliminary evaluated. Confirmatory factor analysis for each previously proposed model was conducted, separately for females and males. Multi-group factor analyses were performed to test measurement invariance of the different PSQ-models across gender. The associations between the PSQ and the MAAS-A and inter-scale correlations were preliminary evaluated. Preceding the data collection and main analyses, the instruments were translated to Norwegian following standardized procedures. The participants in study were Norwegian adolescents aged 15-16 years (N = 524). The overall PSQ performance seemed to correspond to previous findings, and internal consistency was supported across gender. A four-factor model of the PSQ showed best fit to the data in both females and males and configural and metric invariance seemed supported. Full scalar invariance was not supported for the four-factor model, implying that cross-group comparisons (between females and males) on latent means may be uncertain and must be interpreted with caution. Concurrent validity with respect to mindfulness (MAAS-A) was preliminary supported. Further studies might be needed to confirm the findings from this study.
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Affiliation(s)
- Berit Østerås
- Department of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology, Trondheim, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hermundur Sigmundsson
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monika Haga
- Department of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology, Trondheim, Norway
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44
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Gobina I, Villberg J, Välimaa R, Tynjälä J, Whitehead R, Cosma A, Brooks F, Cavallo F, Ng K, de Matos MG, Villerusa A. Prevalence of self-reported chronic pain among adolescents: Evidence from 42 countries and regions. Eur J Pain 2018; 23:316-326. [DOI: 10.1002/ejp.1306] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/07/2018] [Accepted: 08/07/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Inese Gobina
- Department of Public Health and Epidemiology; Institute of Public Health; Rīga Stradinš University; Rīga Latvia
| | - Jari Villberg
- Faculty of Sport and Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - Raili Välimaa
- Faculty of Sport and Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - Jorma Tynjälä
- Faculty of Sport and Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | | | - Alina Cosma
- Child and Adolescent Health Research Unit (CAHRU); School of Medicine; University of St Andrews; St Andrews UK
| | - Fiona Brooks
- Faculty of Health; University of Technology Sydney; Ultimo New South Wales Australia
| | - Franco Cavallo
- Department of Public Health and Paediatrics; School of Medicine; University of Torino; Torino Italy
| | - Kwok Ng
- Physical Education and Sport Sciences Department; University of Limerick; Limerick Ireland
| | | | - Anita Villerusa
- Department of Public Health and Epidemiology; Institute of Public Health; Rīga Stradinš University; Rīga Latvia
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45
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Borgman S, Ericsson I, Clausson EK, Garmy P. The Relationship Between Reported Pain and Depressive Symptoms Among Adolescents. J Sch Nurs 2018; 36:87-93. [PMID: 30009657 DOI: 10.1177/1059840518787007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Pain and depressive symptoms are common reasons for adolescents to contact the school nurse. The aim was to describe the prevalence of pain (headache, abdominal pain, and back pain) and depressive symptoms among adolescents and to examine whether there is an association between pain and depressive symptoms. This cross-sectional survey included students (N = 639) in Sweden (median age: 16 years). Over half of the female participants (56%) and one third of male participants (33%) had weekly headaches, abdominal pain, or back pain. Almost every second girl (48%) and one in four boys (25%) had depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale, scores ≥ 16). There was a significant association between having pain (headache, abdominal pain, or back pain) and having depressive symptoms. It is of great importance for school nurses to adequately identify and treat the cause of pain and other factors contributing to depression.
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Affiliation(s)
- Sofie Borgman
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Ida Ericsson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Eva K Clausson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Pernilla Garmy
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden.,Medical Faculty, Clinical Health Promotion Centre, Lund University, Lund, Sweden
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46
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Relationship between pubertal timing and chronic nonspecific pain in adolescent girls: the Young-HUNT3 study (2006-2008). Pain 2018; 158:1554-1560. [PMID: 28520646 DOI: 10.1097/j.pain.0000000000000950] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to examine a possible relationship between early puberty and chronic nonspecific pain in 13- to 18-year-old girls. All adolescents in Nord-Trøndelag County, Norway, were invited to participate in the Young-HUNT3 study (2006-2008). Of the invited girls, 81% answered the questionnaire and of these 3982 were 13 to 18 years of age. Menarche and perceived physical maturation were used as exposure measures. Early menarche was defined as <12 years, normal menarche as ≥12 and <14 years, and late menarche as ≥14 years. Perceived physical maturation was divided into maturing earlier, the same or later than others of their own age. The main outcome measure was chronic nonspecific pain, defined as pain in at least one location not related to any known disease or injury, for at least once a week during the last 3 months. The median age at menarche was 13.2 years. Chronic nonspecific pain was more prevalent among girls with early menarche (68%, 95% CI: 64%-72%) compared to girls with either normal (55%, 95% CI: 53%-57%), late (50%, 95% CI: 46%-54%), or no menarche (35%, 95% CI: 29%-40%). The association persisted after adjusting for age, body mass index, socioeconomic factors, and anxiety and depression. A similar association was found between girls that perceived themselves as earlier physically matured than their peers and chronic nonspecific pain. Headache/migraine was the most common type of chronic nonspecific pain regardless of menarcheal age. In all reported locations, pain was more prevalent in the group with early menarche compared to normal or late menarche.
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47
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Østerås B, Sigmundsson H, Haga M. Physical Fitness Levels Do Not Affect Stress Levels in a Sample of Norwegian Adolescents. Front Psychol 2017; 8:2176. [PMID: 29326625 PMCID: PMC5733357 DOI: 10.3389/fpsyg.2017.02176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/29/2017] [Indexed: 01/23/2023] Open
Abstract
Physical inactivity, low physical fitness, and perceived stress during adolescence are presumed to be risk factors for various disorders and subjective health complaints. On the other hand, physical activity and physical fitness, as well as mindfulness qualities, are regarded as prerequisites for health and well-being in children and adolescent, possibly by moderating the negative effects of stress and protecting against stress-related health complaints. Previous studies have suggested gender differences in the relationship between physical activity/physical fitness and psychological variables. The main objective in this study was to evaluate how physical fitness, along with mindfulness qualities (MAAS-A), pain, and BMI, relate to stress (PSQ) in adolescents. Secondary objectives were to explore the relationship between physical fitness, mindfulness (MAAS-A), and BMI more explicitly in the study sample, as well as to evaluate possible gender differences. The cross-sectional sample included 102 Norwegian pupils in 10th grade (15 or 16 years). Study measurements were four items from the Test of Physical Fitness (TPF), the Norwegian version of the four-factor Perceived Stress Questionnaire (PSQ), the Norwegian version of the Mindful Attention Awareness Scale-Adolescent (MAAS-A), and BMI (recorded in terms of self-reported height and weight). Additionally, pain was measured in terms of localization, number of pain sites, duration, and intensity (Visual analogue scale; VAS). According to the regression analyses, physical fitness could not explain any variation in stress among the adolescents. Nevertheless, there were some negative associations between one stress factor (lack of joy) and components of physical fitness at a group level, possibly influenced by conditions not measured in this study. As opposed to physical fitness, mindfulness qualities, and to some degree gender, seemed to explain variation in stress among the adolescents. None of the physical fitness components were associated to mindfulness (MAAS-A), but some components seemed negatively related to BMI, particularly among the males. Among the females, higher physical fitness (in terms of endurance) seemed related to reduced number of pain sites. Of note, the cross-sectional design did not allow us to determine any causal direction among the variables.
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Affiliation(s)
- Berit Østerås
- Department of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology, Trondheim, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Hermundur Sigmundsson
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Monika Haga
- Department of Neuromedicine and Movement Science (INB), Norwegian University of Science and Technology, Trondheim, Norway
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48
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Eckhoff C, Straume B, Kvernmo S. Multisite musculoskeletal pain in adolescence as a predictor of medical and social welfare benefits in young adulthood: The Norwegian Arctic Adolescent Health Cohort Study. Eur J Pain 2017; 21:1697-1706. [PMID: 28685909 DOI: 10.1002/ejp.1078] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pain in adolescence is associated with mental health problems, the main reason for work disability in young adults. This study explores the relationship between multisite musculoskeletal pain in adolescence and later medical (sickness and medical rehabilitation benefits) and social welfare benefits, adjusted for sociodemographic, adolescent psychosocial and mental health problems. METHODS Data were obtained by linkage between the National Insurance Registry (2003-11) and the Norwegian Arctic Adolescent Health Study, a school-based survey in North Norway (2003-05), accepted by 3987 fifteen- to sixteen-year-olds (68% of the total population). The start of the follow-up time was July 1st of the corresponding year the participants responded to the health study. Musculoskeletal pain was measured by the number of musculoskeletal pain sites. RESULTS We found a positive linear relationship between adolescent musculoskeletal pain sites and the occurrence of medical and social welfare benefits in young adulthood (p ≤ 0.001). Adolescent musculoskeletal pain was a significant predictor of sickness (p < 0.001) and social welfare benefits in females (p = 0.036), when adjusted for adolescent psychosocial and mental health problems. The most important adolescent psychosocial predictors were externalizing problems, less parental involvement and adverse life events. CONCLUSION Adolescent multisite musculoskeletal pain was found to be an important predictor of later sickness and social welfare benefit receipt from adolescence to young adulthood. SIGNIFICANCE Adolescents with multisite musculoskeletal pain are at substantially increased risk of health and social difficulties into young adulthood. Identification and interventions for these adolescent problems could alleviate this risk and be a sound socioeconomic investment.
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Affiliation(s)
- C Eckhoff
- Department of Child and Adolescent Psychiatry, Division of Child and Adolescent Health, University Hospital North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
| | - B Straume
- Department of Community Medicine, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
| | - S Kvernmo
- Department of Child and Adolescent Psychiatry, Division of Child and Adolescent Health, University Hospital North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
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49
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Eckhoff C, Straume B, Kvernmo S. Multisite musculoskeletal pain in adolescence and later mental health disorders: a population-based registry study of Norwegian youth: the NAAHS cohort study. BMJ Open 2017; 7:e012035. [PMID: 28188150 PMCID: PMC5306523 DOI: 10.1136/bmjopen-2016-012035] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 10/12/2016] [Accepted: 10/21/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To examine the association between multisite musculoskeletal pain in adolescence and mental health disorders in young adulthood. DESIGN AND SETTING Data were obtained from a linkage between the Norwegian Patient Registry (2008-2012) and the Norwegian Arctic Adolescent Health Study, a school-based survey conducted among 10th grade students in North Norway (2003-2005). PARTICIPANTS In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage. OUTCOME MEASURES Mental healthcare use and disorders from age 18-20 to 23-25 years (5 years). METHODS Musculoskeletal pain was measured by the number of musculoskeletal pain sites. Multivariable logistic regression was used to explore the association with later mental healthcare use and disorders. RESULTS Multisite adolescent musculoskeletal pain was significantly associated with an increase in mental healthcare use and mental health disorders in young adulthood. The relationship was stronger for anxiety and mood disorders, in both genders. Overall, the association between musculoskeletal pain and later mental health problems was attenuated after controlling for adolescent psychosocial and mental health problems, not by physical or sedentary activity. This could be due to confounding or mediation. However, when examining different mental health disorders, we found musculoskeletal pain to be significantly associated with anxiety disorders, and showing a strong trend in mood disorders, when adjusted for the adolescent factors. CONCLUSIONS Physicians should be aware that multisite adolescent pain is associated with mental health problems in adolescence, and that these adolescents are at increased risk of mental health disorders in young adulthood. As youth troubled by mental health problems commonly present physical symptoms it is important to examine for psychosocial problems in order to offer early interventions.
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Affiliation(s)
- Christian Eckhoff
- Department of Child and Adolescent Psychiatry, Division of Child and Adolescent Health, University Hospital North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
| | - Bjørn Straume
- Department of Community Medicine, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
| | - Siv Kvernmo
- Department of Child and Adolescent Psychiatry, Division of Child and Adolescent Health, University Hospital North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Artic University of Norway, Tromsø, Norway
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50
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Höfel L, Draheim N, Häfner R, Haas JP. [Pain syndrome of the musculoskeletal system in children and adolescents]. Z Rheumatol 2017; 75:292-302. [PMID: 26892925 DOI: 10.1007/s00393-016-0061-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic pain syndromes in children and adolescents are defined as continuous or recurrent pain without an underlying causative diagnosis and lasting for more than 3 months. It is estimated that every fourth child in Germany suffers from chronic pain with every twentieth suffering from extreme recurrent pain. The incidence of chronic pain in children and adolescents is increasing with headache, abdominal pain and musculoskeletal pain being the most frequent. The quality of life declines not only due to the pain but to relieving postural and psychological factors, such as fear and sadness. School attendance, social activities and hobbies are mostly affected. This review summarizes the background of chronic pain syndromes and introduces a multimodal therapeutic approach.
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Affiliation(s)
- L Höfel
- Zentrum für Schmerztherapie junger Menschen, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - N Draheim
- Zentrum für Schmerztherapie junger Menschen, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - R Häfner
- Zentrum für Schmerztherapie junger Menschen, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland
| | - J P Haas
- Zentrum für Schmerztherapie junger Menschen, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland.
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