Longitudinal examination of associations with the onset of pediatric chronic pain at different pain locations.

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.

[Chronic pain in pediatric primary care : What do adolescents and parents expect and how do they perceive treatment?] / Pädiatrische Primärversorgung bei wiederkehrenden Schmerzen : Was erwarten Jugendliche und Eltern und wie nehmen sie die Behandlung wahr?

BACKGROUND AND OBJECTIVES: Recurrent pain in childhood and adolescence is a common health problem. Pediatricians are usually the patients' first contact person. The current study investigated patients' and parents' expectations when consulting a pediatrician and their rating of the treatment. MATERIALS AND METHODS: In 36 pediatric practices, 224 patients with recurrent pain and 273 parents participated in this cross-sectional tablet survey. The collected data included the motivation for arranging a physician consultation, pain concept, treatment expectations, and assessment of treatment. Additionally, the patients' age was investigated as an influencing factor. RESULTS: The patients' and parents' predominant motivation for arranging a consultation was the clarification of the cause of pain. Older patients were additionally motivated by frequent but ineffective drug use. Predominantly in older patients, a biopsychosocial pain explanation was identified. Approximately half of all patients and parents indicated biological and psychological influencing factors. The most frequent expectation of the consultation was obtaining information on pain management. Overall, consultations were rated very positively, especially when patients and parents felt understood and taken seriously. CONCLUSIONS: Information about the cause of pain and pain management are essential for patients and parents. Besides good communication, sufficient time resources of the practitioner are required.

Factors associated with physician consultation and medication use in children and adolescents with chronic pain: A scoping review and original data.

BACKGROUND: Although paediatric chronic pain is common, it is not yet clear which individuals with chronic pain are likely to seek health care for their pain. The aims of this study were to summarize the current evidence of the characteristics of children and adolescents with chronic pain who consult a physician or use medication for their pain. Additionally, we aimed to expand knowledge by further investigating key and promising, factors in a large community sample of adolescents. METHODS: First, using scoping review methodology, studies on health care utilisation in paediatric chronic pain were identified by the systematic literature search. Out of 1,158 articles, 12 were included for data extraction. Second, in a population-based cross-sectional survey, data of N = 2,280 adolescents (10-18 years) and their parents (N = 1,464), were analysed. Univariable logistic and multivariable LASSO regression models were calculated for adolescents with chronic pain (n = 749) to identify predictors of physician visits or analgesics intake due to pain, controlling for acute illness and injury. RESULTS: The scoping review identified higher pain intensity, frequency, severity and pain-related disability as significant individual factors associated with physician consultation. Female sex and higher pain intensity were associated with medication consumption. Multivariable analyses with cross-sectional data revealed only pain-related school absence to be associated with physician consultation; analgesic medication use was associated with school absence and higher pain intensity. CONCLUSION: Original data from this study support prior findings. School absence and pain intensity, plausible surrogates for pain severity, are the most relevant factors in health care utilisation due to chronic pain. SIGNIFICANCE: A scoping summary of existing research on predictors for physician consultation and medication use in children and adolescents with chronic pain is provided. Furthermore, the role of potential predictors for health care utilisation-sociodemographic, pain, school, psychological and parent-related characteristics-is analysed in a population-based cross-sectional survey. Controlling for illness and injuries, and using a strict chronic pain definition, the cross-sectional survey allows conclusions on healthcare utilisation specific to chronic pain in adolescents.

Intergenerational transmission of chronic pain-related disability: the explanatory effects of depressive symptoms.

ABSTRACT: Parents with chronic pain have a higher likelihood of having depression and anxiety and more often have children with these conditions. Depressive and anxious symptoms in children worsen pain-related disability and may be derived from exposure to their parents' symptoms. We assessed a model of intergenerational chronic pain-related disability that relies upon depressive and anxious symptoms of a mother and their child. Adolescents in grades 5 to 10 from 5 schools, and their mothers, completed standardized electronic questionnaires about pain. In maternal-offspring dyads (n = 1179), the mean offspring age was 12.7 years (SD = 1.7, range = 10-17) and 51% were girls. Logistic regression was used to investigate mother-offspring associations of chronic pain presence, and mediation models using multiple linear regression were used to investigate the proposed model. Adolescents of mothers with chronic pain had 1.67 (95% confidence interval [CI] = 1.29-2.16) times increased odds of chronic pain, with each year of exposure to maternal chronic pain associated with a 5% (odds ratio 95% CI = 1.01-1.10) increased likelihood of offspring chronic pain. Worse maternal pain-related disability was associated with worse offspring pain-related disability (ß = 0.20, 95% CI = 0.06-0.34). The mediation model indicated maternal and adolescent offspring symptoms of depression explained 36% of the relationship between maternal and offspring pain-related disability, with 11% explained by the intergenerational transmission of depression (serial mediation). We conclude that worse pain-related disability is associated between parent and child, and that depressive symptoms common to both mother and child play a key role in this relationship.

Severity of Chronic Pain in German Adolescent School Students: A Cross-sectional Study.

OBJECTIVES: Prevalence estimates of severe chronic pain in pediatric community samples are rare and inconclusive. This study aimed to (1) examine the prevalence of chronic pain severity grades in school children and (2) investigate differences between pain severity grades for pain-related characteristics, including pain locations, sociodemographic characteristics, emotional functioning, insomnia, school factors, and health care utilization. MATERIALS AND METHODS: This cross-sectional observational study was conducted with 2220 school students in Germany (52% female individuals, age: M=13.0; SD=1.8; range, 10 to 18 y). Pain severity was assessed using the validated Chronic Pain Grades for adolescents. Comparisons between Chronic Pain Grade subgroups of adolescent characteristics were conducted using χ2 tests, Kruskal-Wallis tests, and 1-way analysis of variance. RESULTS: In school students, 31.0% had chronic pain with 8.2% categorized as severe. Individuals with higher pain severity tended to be girls and have multisite pain, more symptoms of depression and generalized anxiety, and a higher emotional burden of pain. Individuals with higher pain severity also reported less school satisfaction, lower perceived school performance, and more insomnia. Pain medication intake and physician visits because of pain were more common in those with more severe pain. DISCUSSION: Severe chronic pain affects nearly 1 in 10 adolescent school students and is associated with several negative health outcomes and increased health care utilization. It is important to ensure that specialized pain treatment programs are available to these students and that they are aware of the different negative health outcomes associated with the pain condition.

Prevalence and associated psychosocial and health factors of chronic pain in adolescents: Differences by sex and age.

BACKGROUND: Chronic pain is a common issue in adolescents. Prevalence of pain and associated factors present differently in sex and age subgroups; however, the interaction of sex and age combined has not been thoroughly assessed. This study aimed to identify psychosocial and health factors associated with chronic pain in younger and older adolescent girls and boys. METHODS: Students from five schools in grades 5-10 self-completed a pain survey. Participants were 2,280 adolescents (52% girls) aged 10-18 years (M = 12.95, SD = 1.84). Data were analysed using multivariate logistic regression models. RESULTS: Chronic pain was present in 33% of participants. The risk of chronic pain increased by 29% in girls, compared to 16% in boys, per year of age (p = .039). Overall, depression (OR = 2.05, p < .001), anxiety (OR = 1.51, p < .001), lower school satisfaction (OR = 1.41, p = .034) and sleep issues (OR = 2.34, p < .001) were associated with chronic pain. Stratified analyses identified unique significant associations between chronic pain and psychosocial factors. In boys aged 10-13 years, higher socioeconomic status (OR = 1.76, p = .024) and poorer school performance (OR = 1.60, p = .027) were uniquely important; in girls aged 10-13 years, lower school satisfaction (OR = 2.92, p = .003) was associated with pain, and in older girls aged 14-18 years, anxiety (OR = 1.74, p = .009) was significantly associated with pain. When these differences were assessed statistically, only lower school satisfaction had significant differences between subgroups (p = .049). CONCLUSIONS: Many psychosocial and health factors are similarly important, with few differences, for chronic pain in girls and boys at different stages of adolescence. SIGNIFICANCE: We report evidence that negative psychosocial and health factors are related to a higher prevalence of chronic pain in adolescents. Furthermore, the relationships between anxiety, socioeconomic status, lower school satisfaction and lower school performance with pain may vary between adolescents of differing sexes and ages. Understanding how possible risk factors for chronic pain contribute differently to the pain experience of adolescent girls and boys is an important step towards lowering the prevalence of this common health condition.