•Pain symptoms in adolescents are associated with default mode network connectivity.•More frequent pain is associated with more connectivity to the superior frontal gyrus.•Higher pain intensity is ...associated with less connectivity to the cerebellum.
Pain during adolescence is common and is associated with future pain chronicity and mental health in adulthood. However, understanding of the neural underpinnings of chronic pain has largely come from studies in adults, with recent studies in adolescents suggesting potentially unique neural features during this vulnerable developmental period. In addition to alterations in the pain network, resting state functional magnetic resonance imaging studies in adults suggest alterations in the default mode network (DMN), involved in internally-driven, self-referential thought, may underlie chronic pain; however, these findings have yet to be examined in adolescents. The current study sought to investigate associations between pain frequency and intensity, and disruptions in DMN connectivity, in adolescents. Adolescents (ages 12–20) with varying levels of pain frequency and intensity, recruited from a pediatric pain clinic and the local community (n = 86; 60% female), underwent resting state functional magnetic resonance imaging. Using independent components analysis, the DMN was identified and correlated voxel-wise to assess associations between pain frequency and intensity and DMN connectivity. Findings revealed that adolescents with greater pain frequency demonstrated greater DMN to superior frontal gyrus connectivity, while adolescents with greater pain intensity demonstrated lesser DMN to cerebellum (lobule VIII) connectivity, during rest. These findings suggest that increasing levels of pain are associated with potential desegregation of the DMN and the prefrontal cortex, important for cognitive control, and with novel patterns of DMN to cerebellum connectivity. These findings may prove beneficial as neurobiological targets for future treatment efforts in adolescents.
Adverse childhood experiences (ACEs; ie, exposure to abuse, neglect, household dysfunction in childhood) are associated with poor mental and physical health outcomes across the lifespan. Emerging ...research suggests parent ACEs also confer risk for poor child outcomes. The relation between parent ACEs and child pain in youth with chronic pain has not yet been examined. The aim of the current longitudinal study was to examine the associations among parent ACEs, parent health, and child pain, in a clinical sample of youth with chronic pain.
In total, 192 youth (75.5% female, 10 to 18 y old) and one of their parents (92.2% female) were recruited from tertiary pediatric chronic pain clinics in Canada. At baseline, parents completed self-report measures of ACEs, chronic pain status, anxiety and depressive symptoms, and posttraumatic stress disorder symptoms. At a 3-month follow-up, youth completed self-report measures of pain intensity and pain interference.
Regression and mediation analyses revealed that parent ACEs significantly predicted parent chronic pain status and depressive symptoms, but not parent anxiety or posttraumatic stress disorder symptoms. Moreover, parent ACEs were not significantly related to youth pain, either directly or indirectly through parent health variables.
Findings suggest that an intergenerational cascade from parent ACEs to parent health to child pain was not present in the current sample. Further research that examines the role of parent ACEs in the development of child chronic pain, as well as other risk and resiliency factors that may mediate or moderate the association between parent ACEs and child chronic pain, is needed.
Chronic pain and ADHD are common conditions among youth that negatively impact functioning. This review fills a critical gap by summarizing current research on chronic pain and ADHD comorbidity, and ...it proposes a conceptual model of shared associations and underlying mechanisms.
The aims of the current study were to: (1) review the extant literature and present estimates of the prevalence of comorbid non-headache chronic pain and ADHD in youth and (2) describe potential shared mechanisms for ADHD and chronic non-headache pain in youth. We also outline future directions to inform future research and interventions directed to youth with comorbid pain and ADHD.
A scoping review of the literature was performed in MEDLINE, PsycInfo, and Cochrane Database of Systematic Reviews using a wide range of search terms related to pain, Attention Deficit-Hyperactivity Disorder, childhood, adolescence, and young adulthood.
Eleven published studies were included in the review. These studies examined the prevalence of chronic pain among youth with ADHD, the prevalence of ADHD in chronic pain samples, and the association between chronic pain and ADHD among youth. Findings revealed results from studies indicating a higher prevalence of ADHD among youth with chronic pain and a higher prevalence of chronic pain in samples of youth with ADHD.
Findings from this scoping review suggest an association between chronic pain and ADHD among youth. Little research was found to examine the etiology of this association. Future studies should examine underlying mechanisms of comorbid chronic pain and ADHD.
Posttraumatic stress disorder (PTSD) symptoms are prevalent among youth with chronic pain, and associated with poorer pain outcomes and health-related quality of life (HRQoL). Conceptual models ...suggest that parent factors, including parents' own chronic pain, may be linked to higher co-occurring pain and PTSD symptoms and lower HRQoL in children. However, this has not been empirically examined.
The aim of this study was to examine the relationship between parental chronic pain and (1) parent PTSD symptoms, (2) child PTSD symptoms, (3) child pain outcomes, and (4) child HRQoL in a sample of treatment-seeking youth with chronic pain and their parents.
Youth (n = 173) aged 8 to 18 years and parents (n = 204) recruited from a tertiary-level pediatric chronic pain program completed psychometrically-sound measures of pain and PTSD symptoms. Youth also completed measures of pain interference and HRQoL.
Half of the parents in this sample reported chronic pain. A series of analyses of covariances revealed that parents with vs without chronic pain reported significantly higher PTSD symptoms, and children of parents with vs without chronic pain reported significantly higher PTSD symptoms and pain interference and lower HRQoL.
Findings from this study suggest that having a parent with chronic pain may confer additional risk for children with chronic pain experiencing higher PTSD symptoms, poorer pain outcomes, and lower HRQoL than having a parent without chronic pain. This could be due to genetics or social learning. Future longitudinal research is needed to understand how parental pain influences co-occurring pain and PTSD symptoms, and HRQoL, in children.
Objective: Children of mothers with chronic pain are at increased risk for poor health, but few studies have examined what characteristics of maternal chronic pain may be associated with children's ...risk. This study identified subgroups of mothers based on patterns of pain, physical function, and emotional function on the 29-item Patient-Reported Outcomes Measurement Information System® (PROMIS-29®) and evaluated associations between maternal subgroups and children's pain and emotional functioning. Methods: Mothers with chronic pain (n = 334) completed the PROMIS-29® and reported on pain intensity, pain interference, physical functioning, anxiety, depression, fatigue, sleep disturbance, and participation in social activities. Mothers and their school-age children also completed measures of child pain and emotional functioning. Results: Latent profile analysis of PROMIS® domains indicated a 4-class solution (Group 1: 13.5%, Group 2: 9.9%, Group 3: 43.5%, and Group 4: 32.9%). Group 4 reported the most severe pain, psychological distress, and sleep disturbances and the lowest functioning. Group 1 reported the lowest pain, psychological distress, and sleep disturbances and the highest functioning, while Groups 2 and 3 represented moderate symptoms. Groups significantly differed on maternal reports of children's pain frequency, but not intensity, and children's self-reported somatic symptoms. Further, child depressive symptoms (mother-proxy and self-reported), anxiety (mother-proxy reported), and pain catastrophizing (self-reported) differed by maternal group. Conclusions: Patterns of maternal symptoms and functioning were associated with pain frequency and emotional symptoms in children. Further examination of individual differences in mothers with chronic pain that may confer risk for chronic pain and psychological disorders in children is warranted.
This study aimed to (1) identify differences in sleep behaviors, sleep quality, pre-sleep arousal and prevalence of insomnia symptoms in adolescents with chronic pain compared to a healthy age and ...sex-matched cohort and (2) examine pain intensity, pubertal development, depression, and pre-sleep arousal as risk factors for insomnia symptoms. Participants included 115 adolescents, 12-18 years of age (73.0% female), 59 youth with chronic pain and 56 healthy youth. During a home-based assessment, adolescents completed validated measures of pain, sleep quality, sleep hygiene, pre-sleep arousal, depressive symptoms, and pubertal development. Findings revealed a significantly higher percentage of adolescents with chronic pain reporting symptoms of insomnia (54.2%) compared to healthy adolescents (19.6%), p<.001. Youth with chronic pain also reported higher cognitive and somatic arousal at bedtime, and lower sleep quality compared to the healthy cohort. In a logistic regression, two factors emerged as significant predictors of insomnia, having chronic pain (OR=6.09) and higher levels of cognitive pre-sleep arousal (OR=1.24). Level of pain intensity did not predict insomnia. While sleep disruption may initially relate to pain, these symptoms may persist into a separate primary sleep disorder over time due to other behavioral and psychosocial factors. Assessment of insomnia may be important for identifying behavioral targets for the delivery of sleep-specific interventions to youth with chronic pain.
Rheumatoid arthritis (RA) is an autoimmune disease in which the joint lining or synovium becomes highly inflamed and majorly contributes to disease progression. Understanding pathogenic processes in ...RA synovium is critical for identifying therapeutic targets. We performed laser capture microscopy (LCM) followed by RNA sequencing (LCM-RNAseq) to study regional transcriptomes throughout RA synovium.
Synovial lining, sublining, and vessel samples were captured by LCM from seven patients with RA and seven patients with osteoarthritis (OA). RNAseq was performed on RNA extracted from captured tissue. Principal component analysis was performed on the sample set by disease state. Differential expression analysis was performed between disease states based on log
fold change and q value parameters. Pathway analysis was performed using the Reactome Pathway Database on differentially expressed genes among disease states. Significantly enriched pathways in each synovial region were selected based on the false discovery rate.
RA and OA transcriptomes were distinguishable by principal component analysis. Pairwise comparisons of synovial lining, sublining, and vessel samples between RA and OA revealed substantial differences in transcriptional patterns throughout the synovium. Hierarchical clustering of pathways based on significance revealed a pattern of association between biologic function and synovial topology. Analysis of pathways uniquely enriched in each region revealed distinct phenotypic abnormalities. As examples, RA lining samples were marked by anomalous immune cell signaling, RA sublining samples were marked by aberrant cell cycle, and RA vessel samples were marked by alterations in heme scavenging.
LCM-RNAseq confirms reported transcriptional differences between the RA synovium and the OA synovium and provides evidence supporting a relationship between synovial topology and molecular anomalies in RA.
The longitudinal relations of emotion regulation profiles to temperament and adjustment in a community sample of preadolescents (N = 196, 8-11 years at Time 1) were investigated using person-oriented ...latent profile analysis (LPA). Temperament, emotion regulation, and adjustment were measured at 3 different time points, with each time point occurring 1 year apart. LPA identified 5 frustration and 4 anxiety regulation profiles based on children's physiological, behavioral, and self-reported reactions to emotion-eliciting tasks. The relation of effortful control to conduct problems was mediated by frustration regulation profiles, as was the relation of effortful control to depression. Anxiety regulation profiles did not mediate relations between temperament and adjustment.
The course of pediatric musculoskeletal pain from acute to chronic has not been well described and there is limited understanding of how to identify individuals with new-onset pain who may be ...predisposed to developing persisting symptoms. Thus, the purpose of this study was to describe the clinical phonotype of treatment-seeking youth with new-onset musculoskeletal pain compared with youth with and without chronic pain. Further, we tested predictors of pain-related disability and pain sensitivity in the new-onset pain sample.
Participants were 191 youth, ages 10 to 17 years, representing 3 cohorts (new-onset musculoskeletal pain, chronic musculoskeletal pain, and a comparison group without chronic pain). Participants completed questionnaire measures of pain characteristics, psychological functioning, sleep, and pain-related disability. They also attended a laboratory visit to complete an experimental pain assessment using heat and cold stimuli to assess pain sensitivity and conditioned pain modulation.
Findings revealed youth with new-onset musculoskeletal pain had a distinct clinical phenotype where symptoms of pain and disability were in the mid-range between those of youth with diagnosed chronic musculoskeletal pain and youth in the community without chronic pain. Linear regressions within the new-onset pain sample demonstrated poorer sleep quality and higher pain fear predicted greater pain-related disability, and pain catastrophizing predicted cold pressor sensitivity.
Clinical phenotyping of youth with new-onset musculoskeletal pain highlights factors relevant to the pain experience. Future research can examine the roles of these variables in predicting longitudinal risk for chronic pain and disability.
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