Background Chronic pain is a common issue in adolescents. Prevalence of pain and associated factors present differently in sex and age subgroups; however, the interaction of sex and age combined has not been thoroughly assessed. This study aimed to identify psychosocial and health factors associated with chronic pain in younger and older adolescent girls and boys. Methods Students from five schools in grades 5–10 self‐completed a pain survey. Participants were 2,280 adolescents (52% girls) aged 10–18 years (M = 12.95, SD = 1.84). Data were analysed using multivariate logistic regression models. Results Chronic pain was present in 33% of participants. The risk of chronic pain increased by 29% in girls, compared to 16% in boys, per year of age (p = .039). Overall, depression (OR = 2.05, p < .001), anxiety (OR = 1.51, p < .001), lower school satisfaction (OR = 1.41, p = .034) and sleep issues (OR = 2.34, p < .001) were associated with chronic pain. Stratified analyses identified unique significant associations between chronic pain and psychosocial factors. In boys aged 10–13 years, higher socioeconomic status (OR = 1.76, p = .024) and poorer school performance (OR = 1.60, p = .027) were uniquely important; in girls aged 10–13 years, lower school satisfaction (OR = 2.92, p = .003) was associated with pain, and in older girls aged 14–18 years, anxiety (OR = 1.74, p = .009) was significantly associated with pain. When these differences were assessed statistically, only lower school satisfaction had significant differences between subgroups (p = .049). Conclusions Many psychosocial and health factors are similarly important, with few differences, for chronic pain in girls and boys at different stages of adolescence. Significance We report evidence that negative psychosocial and health factors are related to a higher prevalence of chronic pain in adolescents. Furthermore, the relationships between anxiety, socioeconomic status, lower school satisfaction and lower school performance with pain may vary between adolescents of differing sexes and ages. Understanding how possible risk factors for chronic pain contribute differently to the pain experience of adolescent girls and boys is an important step towards lowering the prevalence of this common health condition.

Objectives: Prevalence estimates of severe chronic pain in pediatric community samples are rare and inconclusive. This study aimed to (1) examine the prevalence of chronic pain severity grades in school children and (2) investigate differences between pain severity grades for pain-related characteristics, including pain locations, sociodemographic characteristics, emotional functioning, insomnia, school factors, and health care utilization. Materials and Methods: This cross-sectional observational study was conducted with 2220 school students in Germany (52% female individuals, age: M=13.0; SD=1.8; range, 10 to 18 y). Pain severity was assessed using the validated Chronic Pain Grades for adolescents. Comparisons between Chronic Pain Grade subgroups of adolescent characteristics were conducted using χ2 tests, Kruskal-Wallis tests, and 1-way analysis of variance. Results: In school students, 31.0% had chronic pain with 8.2% categorized as severe. Individuals with higher pain severity tended to be girls and have multisite pain, more symptoms of depression and generalized anxiety, and a higher emotional burden of pain. Individuals with higher pain severity also reported less school satisfaction, lower perceived school performance, and more insomnia. Pain medication intake and physician visits because of pain were more common in those with more severe pain. Discussion: Severe chronic pain affects nearly 1 in 10 adolescent school students and is associated with several negative health outcomes and increased health care utilization. It is important to ensure that specialized pain treatment programs are available to these students and that they are aware of the different negative health outcomes associated with the pain condition.

Background: Although paediatric chronic pain is common, it is not yet clear which individuals with chronic pain are likely to seek health care for their pain. The aims of this study were to summarize the current evidence of the characteristics of children and adolescents with chronic pain who consult a physician or use medication for their pain. Additionally, we aimed to expand knowledge by further investigating key and promising, factors in a large community sample of adolescents. Methods: First, using scoping review methodology, studies on health care utilisation in paediatric chronic pain were identified by the systematic literature search. Out of 1,158 articles, 12 were included for data extraction. Second, in a population-based cross-sectional survey, data of N = 2,280 adolescents (10-18 years) and their parents (N = 1,464), were analysed. Univariable logistic and multivariable LASSO regression models were calculated for adolescents with chronic pain (n = 749) to identify predictors of physician visits or analgesics intake due to pain, controlling for acute illness and injury. Results: The scoping review identified higher pain intensity, frequency, severity and pain-related disability as significant individual factors associated with physician consultation. Female sex and higher pain intensity were associated with medication consumption. Multivariable analyses with cross-sectional data revealed only painrelated school absence to be associated with physician consultation; analgesic medication use was associated with school absence and higher pain intensity. Conclusion: Original data from this study support prior findings. School absence and pain intensity, plausible surrogates for pain severity, are the most relevant factors in health care utilisation due to chronic pain. Significance: A scoping summary of existing research on predictors for physician consultation and medication use in children and adolescents with chronic pain is provided. Furthermore, the role of potential predictors for health care utilisationsociodemographic, pain, school, psychological and parent-related characteristics-is analysed in a population-based cross-sectional survey. Controlling for illness and injuries, and using a strict chronic pain definition, the cross-sectional survey allows conclusions on healthcare utilisation specific to chronic pain in adolescents.