Background & Aims

Altered interoception – the sensing, processing, and integration of internal bodily sensations – has been implicated in mental health and chronic pain conditions and is theorized to contribute to their co-occurrence, including in pediatric populations (Hechler, 2021). Within a predictive processing framework, interoceptive threat monitoring holds promise in explaining emotional, functional, and quality-of-life interference of pain. For example, interoceptive threat monitoring may affect the precision assigned to sensory predictions, up-weighting innocuous sensory information as a valid signal that warrants emotional resources and functional accommodations (Harris et al., 2023; Hechler et al., 2016). This cross-sectional study evaluated interoceptive threat monitoring and its association with pain interference, pain-related functioning, quality of life, and co-occurring mental health problems in adolescents with chronic musculoskeletal (MSK) pain.

Methods

Data from adolescents presenting to multidisciplinary pain clinics across Stanford Medicine Children’s Health, the Toronto Hospital for Sick Children, and Cincinnati Children’s Hospital Medical Center (N=152; age, 12-18 years) were included in the study. These data were collected as part of a larger multisite biomarker discovery study (Simons et al., 2022). Participants completed the Bodily Threat Monitoring Scale (BTMS), a transdiagnostic measure of interoceptive threat monitoring which captures the tendency to monitor and appraise bodily sensations as threatening (Heathcote et al., 2023), and other standardized measures, including the PROMIS Pediatric Anxiety and Depression tools to capture co-occurring mental health problems.

Results

Among youth with chronic MSK pain, the BTMS yielded strong internal consistency (? = .95), and its two-factor structure (1: bodily monitoring, 2: bodily threat appraisals) was replicated. Greater interoceptive threat monitoring was associated with more pain-related interference (r(144) = .19, p = .024), worse physical functioning (r(143) = .28, p = <.001), and poorer quality of life (r(144) = -.39, p = <.001). Interoceptive threat monitoring was also strongly associated yet distinct from cognitive-emotional responses to pain, including pain-related fear (r(144) = .58, p = <.001) and catastrophizing (r(144) = .56, p = <.001). Greater interoceptive threat monitoring was associated with elevated anxiety (r(144) = .46 p = <.001) and depressive symptoms (r(144) = .36, p = <.001), and was significantly higher (t(144) = -4.1, p = <.001) in those with (N = 76; M = 29.855, SD = 17.87) versus without (N = 70; M = 19.14, SD = 12.8) clinically elevated symptoms of anxiety and depression.

Conclusions

Interoceptive threat monitoring is a transdiagnostic factor that is elevated in children with co-occurring chronic pain and mental health problems and is associated with greater pain interference, poorer functioning, and worse quality of life. It warrants further investigation to elucidate its mechanistic role within a predictive processing framework and the multifaceted interplay between interoception, chronic pain, and overall well-being in adolescents.

References

Harris, D. J., Wilkinson, S., & Ellmers, T. J. (2023). From fear of falling to choking under pressure: A predictive processing perspective of disrupted motor control under anxiety. Neuroscience and biobehavioral reviews, 148, 105115. https://doi.org/10.1016/j.neubiorev.2023.105115

Heathcote, L. C., Webster, S. N., Loecher, N., Spunt, S. L., Simon, P., Pradhan, P., Coutts-Bain, D., Sharpe, L., Tutelman, P. R., & Simons, L. E. (2023). The bodily threat monitoring scale: Development and preliminary validation in adult and childhood cancer survivors. Psycho-oncology, 32(12), 1885–1894. https://doi.org/10.1002/pon.6236.

Hechler, T., Endres, D., & Thorwart, A. (2016). Why Harmless Sensations Might Hurt in Individuals with Chronic Pain: About Heightened Prediction and Perception of Pain in the Mind. Frontiers in psychology, 7, 1638. https://doi.org/10.3389/fpsyg.2016.01638.

Hechler T. (2021). Altered interoception and its role for the co-occurrence of chronic primary pain and mental health problems in children. Pain, 162(3), 665–671. https://doi.org/10.1097/j.pain.0000000000002099.

Simons, L., Moayedi, M., Coghill, R. C., Stinson, J., Angst, M. S., Aghaeepour, N., Gaudilliere, B., King, C. D., López-Solà, M., Hoeppli, M. E., Biggs, E., Ganio, E., Williams, S. E., Goldschneider, K. R., Campbell, F., Ruskin, D., Krane, E. J., Walker, S., Rush, G., & Heirich, M. (2022). Signature for Pain Recovery IN Teens (SPRINT): protocol for a multisite prospective signature study in chronic musculoskeletal pain. BMJ open, 12(6), e061548. https://doi.org/10.1136/bmjopen-2022-061548.

Presenting Author

Georgina Lockwood-Taylor

Poster Authors

Georgina Lockwood-Taylor

MSc

King's College London

Lead Author

E-mail

Emma E. Biggs

PhD

Maastricht University

Lead Author

E-mail

Marina López-Sola

Phd

University of Barcelona

Lead Author

E-mail

Massieh Moayedi

University of Toronto

Lead Author

E-mail

Jennifer Stinson

PhD

SickKids and University of Toronto

Lead Author

E-mail

Robert Coghill

Cincinnati Children's Hospital Med. Ctr.

Lead Author

E-mail

Christopher King

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

Lead Author

E-mail

Brice Gauilliere

MD-PhD

Stanford University School of Medicine

Lead Author

E-mail

Nima Aghaeepour

PhD

Stanford University School of Medicine

Lead Author

E-mail

Martin S. Angst

MD

Stanford University School of Medicine

Lead Author

E-mail

Toby J. Ellmers

PhD

Imperial College London

Lead Author

E-mail

Laura Simons

PhD

Stanford University School of Medicine

Lead Author

E-mail

Lauren Heathcote

King's College London

Lead Author

E-mail

Topics

  • Pain in Special Populations: Adolescents