Pain is Associated With Poorer Grades, Reduced Emotional Well-Being, and Attention Problems in Adolescents

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

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

The mediating role of anxiety/depression symptoms between adverse childhood experiences (ACEs) and somatic symptoms in adolescents

INTRODUCTION

This study examines the relationships among recent adverse childhood experiences (ACEs), somatic symptoms, and anxiety/depression symptoms during adolescence and whether anxiety/depression symptoms mediate the relationship between ACEs and somatic symptoms.

METHODS

Longitudinal prospective data from the Longitudinal Studies of Child Abuse and Neglect study of 1354 children and their primary caregivers in the United States was used in this study. A longitudinal cross-lagged path analysis among recent ACEs, anxiety/depression symptoms, and somatic symptoms at three points during adolescence (ages 12, 14, and 16 years) was conducted.

RESULTS

The sample was 51% female and 53% African American. The results indicated significant concurrent associations between recent ACEs and increased anxiety/depression symptoms at ages 12, 14, and 16 (β = .27, p < .001; β = .15, p < .001; β = .07, p < .05) and between anxiety/depression symptoms and increased somatic symptoms at ages 12, 14, and 16 years (β = .44, p < .001; β = .39, p < .001; β = .49, p < .001). Moreover, anxiety/depression symptoms significantly mediated the relationship between recent ACEs and concurrent somatic symptoms at ages 12, 14, and 16 years (β = .12, p < .001; β = .06, p < .001; β = .04, p < .05). However, there was no significant relationship between recent ACEs and somatic symptoms.

CONCLUSION

The findings suggest that anxiety/depression symptoms mediate the concurrent relationships between recent ACEs and somatic symptoms at ages 12, 14, and 16. Clinicians should consider assessing anxiety/depression symptoms and possible concurrent exposure to ACEs when caring for adolescents who present with somatic symptoms.

Relationship between acute pain trajectories after an emergency department visit and chronic pain: a Canadian prospective cohort study

OBJECTIVES

Inadequate acute pain management can reduce the quality of life, cause unnecessary suffering and can often lead to the development of chronic pain. Using group-based trajectory modelling, we previously identified six distinct pain intensity trajectories for the first 14-day postemergency department (ED) discharge; two linear ones with moderate or severe pain during follow-up (~40% of the patients) and four cubic polynomial order trajectories with mild or no pain at the end of the 14 days (low final pain trajectories). We assessed if previously described acute pain intensity trajectories over 14 days after ED discharge are predictive of chronic pain 3 months later.

DESIGN

Prospective cohort study.

SETTING

Tertiary care trauma centre academic hospital.

PARTICIPANTS

This study included 18 years and older ED patients who consulted for acute (≤2 weeks) pain conditions that were discharged with an opioid prescription. Patients completed a 14-day diary in which they listed their daily pain intensity (0-10 numeric rating scale).

OUTCOMES

Three months after ED visit, participants were questioned by phone about their current pain intensity (0-10 numeric rating scale). Chronic pain was defined as patients with current pain intensity ≥4 at 3 months.

RESULTS

A total of 305 participants remained in the study at 3 months, 49% were women and a mean age of 55±15 years. Twelve per cent (11.9; 95% CI 8.2 to 15.4) of patients had chronic pain at the 3-month follow-up. Controlling for age, sex and pain condition, patients with moderate or severe pain trajectories and those with only a severe pain trajectory were respectively 5.1 (95% CI 2.2 to 11.8) and 8.2 (95% CI 3.4 to 20.0) times more likely to develop chronic pain 3 months later compared with patients in the low final pain trajectories.

CONCLUSION

Specific acute pain trajectories following an ED visit are closely related to the development of chronic pain 3 months later.

TRIAL REGISTRATION NUMBER

NCT02799004; Results.

The Co-occurrence of Pediatric Chronic Pain and Depression: A Narrative Review and Conceptualization of Mutual Maintenance

OBJECTIVES

Internalizing mental health issues co-occur with pediatric chronic pain at high rates and are linked to worse pain and functioning. Although the field has prioritized anxiety and posttraumatic stress disorder, little is known about co-occurring depression and chronic pain in youth, despite its high prevalence. The purpose of this narrative review was to examine the existing literature on the co-occurrence of pediatric chronic pain and depressive disorders and symptoms and propose a conceptual model of mutual maintenance to guide future research.

METHODS

The literature from both fields of pediatric pain and developmental psychology were searched to review the evidence for the co-occurrence of pediatric chronic pain and depression. Conceptual models of co-occurring mental health issues and chronic pain, as well as child depression, were reviewed. From both literatures, we provide evidence for a number of proposed child, parent, and neurobiological factors that may serve to mutually maintain both conditions over time. On the basis of this evidence, we propose a conceptual model of mutual maintenance and highlight several areas for future research in this area.

RESULTS

Evidence was found for the prevalence of depression in pediatric chronic pain as well as the co-occurrence of both conditions. The key mutually maintaining factors identified and proposed included neurobiological, intrapersonal (eg, cognitive biases, sleep disturbances, emotion regulation, and behavioral inactivation), and interpersonal (eg, parent mental health and pain, genes, and parenting) factors.

DISCUSSION

Given the dearth of research on mutual maintenance in this area, this review and conceptual model could drive future research in this area. We argue for the development of tailored treatments for this unique population of youth to improve outcomes.

Specialized Rehabilitation Programs for Children and Adolescents with Severe Disabling Chronic Pain: Indications, Treatment and Outcomes

Children and adolescents with highly disabling chronic pain of high intensity and frequency are admitted to specialized pain rehabilitation programs. Some barriers to obtaining this specialized care include a lack of availability of treatment centers, a perceived social stigma and individual barriers such as socioeconomic status. Specialized rehabilitation programs for severe disabling chronic pain worldwide have similarities regarding admission criteria, structure and therapeutic orientation. They differ, however, regarding their exclusion criteria and program descriptions. The short- and long-term effectiveness of some rehabilitation programs is well documented. All countries should promote the establishment of future pediatric pain centers to improve the health care of children and adolescents suffering from severe chronic pain. Standardized reporting guidelines should be developed to describe treatments and outcomes to enable comparability across treatment centers.