Background & Aims
Pain is a normal part of childhood. Before children are 17 years of age, one third will experience a fracture and almost all children will experience a soft tissue injury [1]. For children attending an Emergency Department, previous research has shown that 35% of children can report chronic pain 4 months after the injury [3]. There are a number of proposed risk factors, investigated in adult samples that might also be relevant to children, such as higher depression and anxiety [2, 4]. In children, considering their developmental context is critical, such parents behaviours and mental health, and pubertal development. We aimed to determine risk factors of developing chronic pain onset, and those factors that were associated with higher physical disability and pain interference, 3 months after injury.
Methods
We recruited children and adolescents (8-18 years of age) from a Fracture Clinic in the UK. The primary outcome was chronic pain onset, defined chronic pain as >4/10 on a numerical rating scale at 3 months post-injury. Secondary outcomes included physical disability assessed with the Functional Disability Inventory and pain interference assessed with the PROMIS Pain Interference 8a survey.
Children and their primary caregiver completed online questionnaires at baseline (after injury) and 3 months. Children completed questionnaires assessing biopsychosocial risk factors including age, sex, pubertal status, anxiety, depression, fear of pain, pain worry, adverse life events, and sleep in children. The primary caregiver also completed online questionnaires on parent anxiety, depression, parent pain catastrophising, and protective behaviours.
Results
We found 17/118 (14%) of children reported chronic pain 3 months after injury. We found group differences between children who developed chronic pain and those who recovered at baseline; children who developed chronic pain reported higher pain intensity, disability, pain interference, child depression, fear of pain, and catastrophic thinking about their pain.
We ran logistical and hierarchical linear regressions using baseline predictors for chronic pain onset, pain interference, and physical disability at 3 months. We controlled for baseline pain, interference, or disability in the relevant model. We found depression and fear of pain at baseline independently predicted chronic pain onset at 3 months, parent protectiveness predicted child pain interference at 3 months, and child depression, poor sleep, parent anxiety and pain catastrophising predicted disability.
Conclusions
This is the first study to include parent and child risk factors of developing chronic pain in children and adolescents. Most of our sample recovered from their injury, with low levels of pain and disability at 3 months. However, we found that higher depressive symptoms and fear of pain at baseline were predictive of later chronic pain, and that parent protectiveness predicted pain interference, and child depression, poor sleep, parent anxiety and catastrophising were associated with higher physical disability. These risk factors are malleable, and this study presents important targets for intervention for this population.
References
1.Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: a study using the general practice research database. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 2004;19(12):1976-1981.
2.El-Metwally A, Salminen JJ, Auvinen A, Kautiainen H, Mikkelsson M. Risk factors for traumatic and non-traumatic lower limb pain among preadolescents: a population-based study of Finnish schoolchildren. BMC Musculoskelet Disord 2006;7:3.
3.Lewandowski Holley A, Wilson AC, Palermo TM. Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study. Pain 2016;158(5):794-801.
4.Rosenbloom BN, Khan S, McCartney C, Katz J. Systematic review of persistent pain and psychological outcomes following traumatic musculoskeletal injury. Journal of Pain Research 2013;6:39-51.
Presenting Author
Emma Fisher
Poster Authors
Topics
- Pain in Special Populations: Infants/Children