A systematic review of the psychosocial factors associated with pain in children with juvenile idiopathic arthritis

Abstract

Background Pain is one of the most frequently reported experiences amongst children with Juvenile Idiopathic Arthritis (JIA); however, the management of JIA pain remains challenging. As pain is a multidimensional experience that is influenced by biological, psychological, and social factors, the key to effective pain management lies in understanding these complex relationships. The objective of this study is to systematically review the literature on psychosocial factors of children with JIA and their caregivers 1) associated with and 2) predictive of later JIA pain intensity, frequency, and sensitivity in children 0–17 years of age. Methods The Joanna Briggs Institute methodology for etiology and risk and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. Terms related to pain and JIA were searched in English without date restrictions across various databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Central Register of Controlled Trials) in September 2021. Two independent reviewers identified, extracted data from, and critically appraised the included studies. Conflicts were resolved via consensus. Results Of the 9,929 unique studies identified, 61 were included in this review and reported on 516 associations. Results were heterogeneous, likely due to methodological differences and moderate study quality. Results identified predominantly significant associations between pain and primary and secondary appraisals (e.g., more child pain beliefs, lower parent/child self-efficacy, lower child social functioning), parent/child internalizing symptoms, and lower child well-being and health-related quality of life. Prognostically, studies had 1-to-60-month follow-up periods. Fewer beliefs of harm, disability, and no control were associated with lower pain at follow-up, whereas internalizing symptoms and lower well-being were predictive of higher pain at follow-up (bidirectional relationships were also identified). Conclusions Despite the heterogeneous results, this review highlights important associations between psychosocial factors and JIA pain. Clinically, this information supports an interdisciplinary approach to pain management, informs the role of psychosocial supports, and provides information to better optimize JIA pain assessments and interventions. It also identifies a need for high quality studies with larger samples and more complex and longitudinal analyses to understand factors that impact the pain experience in children with JIA. Trial registration PROSPERO CRD42021266716.

Significant pain decrease in children with non-systemic Juvenile Idiopathic Arthritis treated to target: results over 24 months of follow up

“…Further research should focus on how to identify patients who are at risk for chronic pain even after the inflammation is abrogated. When we are able to recognize children with chronic pain in an early stage, they might benefit from education about the cause of their pain, relevant pain mechanisms, and the role of psychosocial and physical factors in precipitating and maintaining chronic pain [39,40].…”

“…The sample size of our study was limited, therefore more subtle differences might have been found in a larger study cohort. Second, pain is multifactorial in nature and affected by many psychosocial patient factors [ 39 ]. This study only looked at pain intensity and did not take a possible response shift during the study period into consideration [ 49 ].…”

Increase in stress contributes to impaired jaw function in juvenile idiopathic arthritis: a two-year prospective study

“…The disease is also associated to a variety of negative outcomes (pain interference with physical, educational, emotional and social activities) [ 8 – 10 ]. JIA pain also affects patients psychosocially (sense of being misunderstood and stigmatize, overwhelming pain and despair, quality of life and mental health challenges) [ 11 – 13 ].…”