Abstract Adolescent chronic pain may lead to persistent disability and long-term health impairments in adulthood. However, our understanding of which youth are more likely to experience adverse ...outcomes remains limited. To address this gap, this longitudinal cohort study examined adolescent predictors of various dimensions of young adult health and functioning, including pain, physical health, depression, anxiety, social isolation, and sleep disturbance. As part of a previous clinical trial, we recruited a cohort of adolescents (ages 11-17 years, M age = 14 years) with non–disease-related chronic pain from 15 tertiary pain clinics in North America. Approximately 6 years later, 229 of the original 273 individuals (81% participation rate) completed a follow-up survey as young adults (ages 18-25 years, M age = 21 years). At the young adult follow-up, 73% reported continued chronic pain, with two-thirds experiencing moderate-to-severe pain interference. Youth reported several adverse health outcomes, including below-average physical health (37%), clinically elevated depression (42%), clinically elevated anxiety (48%), and sleep disturbances (77%). Multivariate regression analyses controlling for sociodemographic characteristics revealed that higher pain intensity, more pain locations, lower sleep quality, and greater anxiety symptoms in adolescence predicted worse pain outcomes in young adulthood. Moreover, lower sleep quality, greater anxiety symptoms, and worse family functioning predicted worse physical and psychosocial health in adulthood. These findings represent an important first step toward identifying ways to optimize psychological pain interventions. Tailored psychological pain interventions can directly target adolescent vulnerabilities, including mood, sleep, and family risk factors, with the potential to disrupt a lifelong trajectory of pain and suffering.
Objective
Family factors and emotional functioning can play an important role in the ability of adolescents with juvenile primary fibromyalgia syndrome (JPFS) to cope with their condition and ...function in their everyday lives. The primary objectives of this study were to determine 1) whether adolescents with JPFS and their caregivers differed from healthy age‐matched comparison peers and their caregivers in terms of emotional distress and functional impairment; 2) whether there were any differences in the family environment of adolescents with JPFS compared with healthy comparison peers; and 3) which individual‐, caregiver‐, and family‐level variables were associated with functional impairment in adolescents with JPFS.
Methods
Participants were 47 adolescents with JPFS recruited from a pediatric rheumatology clinic and 46 comparison peers without chronic illness matched for age, sex, and race. Participants and their caregivers (all mothers) completed a battery of standardized measures administered in their homes.
Results
Adolescents with JPFS had greater internalizing and externalizing symptoms than healthy comparison peers. Mothers of adolescents with JPFS reported twice as many pain conditions and significantly greater depressive symptoms than mothers of comparison peers. The JPFS group also had poorer overall family functioning and more conflicted family relationships. In adolescents with JPFS, maternal pain history was associated with significantly higher functional impairment.
Conclusion
Increased distress and chronic pain are evident in families of adolescents with JPFS, and family relationships are also impacted. Implications for child functional impairment and the need for inclusion of caregivers in treatment are discussed.
OBJECTIVESThe primary aim of this study was to describe pain characteristics, coping strategies, depression, and functional disability in children and adolescents with chronic pain and to examine ...potential factors that are associated with functional disability in a pediatric pain population. The secondary aim of this study was to compare functional disability in two chronic pain conditionslocalized musculoskeletal pain and chronic daily headaches.
SUBJECTSThe participants in this study were 73 pediatric pain patients with a variety of chronic pain conditions. Subjects in the second part of the study were a subset of patients (N = 44) from the pain clinic sample with chronic localized musculoskeletal pain and a subset of patients (N = 38) from the headache center of the same hospital who had chronic daily headaches.
DESIGNPatients completed self-report measures of pain intensity, depression, coping strategies, coping efficacy, and functional disability.
RESULTSResults indicated that chronic pain had a substantial impact on the children's lives and that depression was strongly associated with functional disability. Maladaptive coping was correlated with depression and disability; however, maladaptive coping was not independently associated with functional disability. A comparison between the two groups found significant differences in pain intensity and functional disability. The localized musculoskeletal pain group reported higher levels of disability and more difficulty coping than the chronic daily headache group.
CONCLUSIONSThe implications for treatment of chronic pain in children are discussed with an emphasis on greater attention to developmental issues and their relation to coping, emotional functioning, and disability in pediatric pain. Further research examining differences in coping and disability between different pediatric pain groups is also warranted.
Juvenile fibromyalgia (JFM) is a chronic and debilitating noninflammatory musculoskeletal pain syndrome that is typically diagnosed in adolescence. There are no specific medical tests or disease ...markers to diagnose the condition, and classification is based on patient report of pain and other associated symptoms after ruling out other underlying medical causes. JFM can be disabling in multiple life domains and therefore, a multidimensional assessment of JFM is recommended to gain a full picture of the extent of JFM symptoms along with their impact on physical and emotional functioning and quality of life. The following updated review outlines evidence-based measures useful in the assessment of school-age children and adolescents with JFM. New measures include 1) the Pain and Symptom Assessment Tool (PSAT) that offers a standardized tool for the classification of fibromyalgia in pediatric patients and 2) the Patient-Reported Outcomes Measurement Information System (PROMIS®) Pediatric Pain Interference, Anxiety, and Depression Scales. Updated information is presented on previously established measures that assess the impact of JFM on functioning and quality of life - the Functional Disability Inventory (FDI) and the Pediatric Quality of Life Inventory (PedsQL) 3.0 Rheumatology Module Pain and Hurt Scale, are also discussed. In general, there are increasing options for validated patient-reported outcome measures available to measure the spectrum of symptoms in JFM and assess impact on daily life. Greater consistency in identification of JFM and use of standardized assessment tools will undoubtedly lead to higher quality research much needed in this relatively understudied musculoskeletal pain condition.
Appropriate outcome measures and high-quality intervention trials are critical to advancing care for children with chronic pain. Our aim was to update a core outcome set for pediatric chronic pain ...interventions. The first phase involved collecting providers', patients', and parents' perspectives about treatment of pediatric chronic pain to understand clinically meaningful outcomes to be routinely measured. The second phase was to reach consensus of mandatory and optional outcome domains following the OMERACT framework. A modified Delphi study with 2 rounds was conducted including 3 stakeholder groups: children with chronic pain (n = 93), their parents (n = 90), and health care providers who treat youth with chronic pain (n = 52). Quantitative and qualitative data from round 1 of the Delphi study were summarized to identify important outcomes, which were condensed to a list of 10 outcome domains. Round 2 surveys were analyzed to determine the importance of the 10 domains and their relative ranking in each stakeholder group. A virtual consensus conference was held with the steering committee to reach consensus on a set of recommended outcome domains for pediatric chronic pain clinical trials. It was determined, by unanimous vote, that pain severity, pain interference with daily living, overall well-being, and adverse events, including death, would be considered mandatory domains to be assessed in all trials of any type of intervention. Emotional functioning, physical functioning, and sleep were important but optional domains. Last, the research agenda identifies several important emerging areas, including biomarkers. Future work includes selecting appropriate validated measures to assess each outcome domain.
Juvenile-onset fibromyalgia (JFM) is a poorly understood chronic pain condition most commonly affecting adolescent girls. The condition is characterized by widespread musculoskeletal pain and other ...associated symptoms, including fatigue, nonrestorative sleep, headaches, irritable bowel symptoms, dysautonomia and mood disorders such as anxiety and/or depression. In the past few years, there has been a greater focus on understanding JFM in adolescents. Research studies have provided insight into the clinical characteristics of this condition and its effect on both short-term and long-term psychosocial and physical functioning. The importance of early and effective intervention is being recognized, as research has shown that symptoms of JFM tend to persist and do not resolve over time as was previously believed. Efforts to improve treatments for JFM are underway, and new evidence strongly points to the potential benefits of cognitive-behavioural therapy on improving mood and daily functioning. Research into pharmacotherapy and other nonpharmacological options is in progress. Advancements in the understanding of adult fibromyalgia have paved the way for future studies on diagnosis, assessment and management of JFM. This Review focuses on our current knowledge of the condition, provides an update of the latest research advances, and highlights areas for further study.
Randomized control trials (RCTs) have long been the gold standard for allowing causal inferences to be made regarding the efficacy of a treatment under investigation, but traditional RCT data ...analysis perspectives do not take into account a common reality: imperfect participant compliance to treatment. Recent advances in both maximum likelihood parameter estimation and mixture modeling methodology have enabled treatment effects to be estimated, in the presence of less than ideal levels of participant compliance, via a Complier Average Causal Effect (CACE) structural equation mixture model. CACE is described in contrast to “intent to treat” (ITT), “per protocol”, and “as treated” RCT data analysis perspectives. CACE model assumptions, specification, estimation, and interpretation will all be demonstrated with simulated data generated from a randomized controlled trial of cognitive-behavioral therapy for Juvenile Fibromyalgia. CACE analysis model figures, linear model equations, and Mplus estimation syntax examples are all provided.
Data needed to reproduce analyses in this article are available as supplemental materials (online only) in the Appendix of this article.
Recent studies have raised significant concern about the high prevalence of childhood abuse in adults with chronic daily headache (CDH). In a survey of 1,348 adult migraine patients, it was found ...that 21% of patients reported a history of childhood physical abuse and 25% reported a history of sexual abuse. Data from the Adverse Childhood Experiences study and other studies have also found that childhood physical abuse and other forms of maltreatment were significantly associated with migraine headache. Although retrospective studies seem to provide strong evidence for an association between childhood abuse and CDH, one prospective longitudinal study did not find a difference between those with and without a documented history of childhood abuse in terms of their risk for chronic pain in adulthood. Zafar et al specifically examine the prevalence of physical and sexual abuse in these clinically referred children and adolescents with CDH and compare headache characteristics, headache-related disability, depressive symptoms, and quality of life between those who reported a history of abuse and those who did not.
Previous systematic reviews have summarized the prevalence and impact of chronic pain in "average" pediatric (ie, school-age children) and adult (ie, middle-aged individuals) age groups. To the best ...of our knowledge, this is the first study to describe the prevalence of chronic pain in the subgroup of individuals who fall in between established boundaries of "childhood" and "adulthood"-known as young adulthood. The goal of this research was to meta-analyze prevalence data on pain in young adults based on available data published between 2008 and 2020. Searches were identified with MEDLINE, Embase, and PsycINFO. We included general population and university-based studies presenting prevalence estimates of chronic pain (pain lasting ≥3 months) in young adults. We identified 43 articles providing prevalence estimates across a combined population of 97,437 young adult respondents (age range: 15-34 years), with studies undertaken in 22 countries. Available data allowed for stratification of prevalence according to pain condition. The overall pooled random-effect prevalence rate of chronic pain in young adults was 11.6%, suggesting that 1 in every 9 young adults experience chronic pain worldwide. Prevalence rates varied considerably according to pain condition. Estimates did not vary according to sex, geographic location, and several study methodological characteristics (ie, population type, sampling area, sampling year, investigation period, and assessment method). Overall, young adult chronic pain is common and should be recognized as a major public health concern. Considering the difficulties young adults face accessing adult health care, greater attention is needed to develop transition programs and evidence-based treatments tailored to the unique needs of this age group.
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