Background & Aims

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 vulnerabilities associated with various dimensions of young adult health and functioning, including pain, physical health, depression, anxiety, social isolation, and sleep disturbance. We hypothesized that adolescent vulnerabilities, including pain severity, emotional factors, and social/family factors, would be associated with adverse pain and health outcomes in young adulthood.

Methods

As part of a previous clinical trial [1], we recruited a cohort of 273 adolescents (ages 11-17, M age = 14) with chronic pain from 15 tertiary pain clinics in the United States and Canada. Approximately 6 years later, 229 of the original 273 individuals (81% participation rate) completed a follow-up survey as young adults (ages 18-25, M age = 21). Multiple linear regression models examined adolescent vulnerability factors (e.g., pain intensity, number of pain locations, pain interference, depressive symptoms, anxiety symptoms, social impairment, sleep quality, family dysfunction, parental protectiveness) as predictors for 8 young adult outcomes: pain intensity, pain interference, number of pain locations, global physical health, sleep disturbances, depressive symptoms, anxiety symptoms, and social isolation.

Results

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 adolescents with higher pain intensity, higher number of pain locations, lower sleep quality, and greater anxiety symptoms predicted worse pain outcomes in young adulthood. Moreover, lower adolescent sleep quality, greater anxiety symptoms, and greater family conflict predicted worse emotional and social health outcomes in adulthood.

Conclusions

Few studies have sought to understand the long-term impact of pediatric chronic pain and early risk factors for adverse adult outcomes. Consistent with prior research, our findings reveal that approximately three-quarters of our adolescent sample continued to experience chronic pain in young adulthood. Furthermore, our study uncovered a range of health challenges faced by youth once they reach young adulthood, including clinically elevated symptoms of depression, anxiety, and sleep disturbance. In addition, we identified several significant adolescent predictors of young adult outcomes, including pain intensity, higher number of pain locations, anxiety, poor sleep quality, and family dysfunction. These findings underscore the challenging transition and poor prognosis of youth with chronic pain into adulthood and highlight several promising avenues for further research and interventions to improve the health and well-being of this population.

References

[1] Palermo TM, Law EF, Fales J, Bromberg MH, Jessen-Fiddick T, Tai G. Internet-delivered cognitive-behavioral treatment for adolescents with chronic pain and their parents: a randomized controlled multicenter trial. Pain 2016;157(1):174-185.

[2] Horst S, Shelby G, Anderson J, Acra S, Polk DB, Saville BR, Garber J, Walker LS. Predicting persistence of functional abdominal pain from childhood into young adulthood. Clin Gastroenterol Hepatol 2014;12(12):2026-2032.

Presenting Author

Caitlin Murray

Poster Authors

Caitlin Murray

PhD

University of Washington

Lead Author

E-mail

Caitlin Murray

PhD

Lead Author

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Susmita Kashikar-Zuck

PhD

Cincinnati Children's Hospital Medical Center, Cincinnati, OH, US

Lead Author

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Rui Li

Seattle Children's Research Institute

Lead Author

E-mail

Chuan Zhou

PhD

Lead Author

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Tonya Palermo

Tonya Palermo

Lead Author

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Topics

  • Pain in Special Populations: Adolescents