Initial Adjustment to the COVID-19 Pandemic and the Associated Shutdown in Children and Adolescents With Chronic Pain and Their Families

Abstract

Objectives: Youth with chronic pain often struggle to function in multiple domains due to pain and associated psychosocial distress. In 2020, schools and businesses shut down and people were encouraged to remain at home due to the COVID-19 pandemic, eliminating or reducing stress due to functional difficulties. This study assessed whether pain and associated psychosocial outcomes improved in youth with chronic pain during the shutdown, compared with before the pandemic.Methods: Patients who completed clinical outcome measures during a multidisciplinary evaluation before the pandemic were readministered the same measures (PROMIS Anxiety, Depression, Sleep Disturbance, PCS, PedsQL) during the shutdown. At follow-up, patients also completed measures of adjustment to COVID-19 and their parents completed a measure of pandemic effects.Results: Participants included 47 patients ages 8–18 and a parent/guardian. The pandemic impacted families in both positive (e.g., more quality time with family) and negative ways (e.g., social isolation, disruption in care). Pain intensity and pain catastrophizing significantly decreased during the shutdown (ps <0.01). Change in pain catastrophizing was correlated positively with change in psychological stress (p = 0.004) and anxiety (p = 0.005) and negatively with change in quality of life (p = 0.024).Discussion: Pain and pain catastrophizing decreased initially during the shutdown related to the COVID-19 pandemic. Change in catastrophizing was associated with change in stress and anxiety. It may be that the reduction in functional demands contributed to this change. Functional difficulties should be addressed in treatment, including pain coping and also environmental modification to support optimal functioning in youth with chronic pain.

A Parent-Targeted Group Intervention for Pediatric Pain Delivered In-Person or Virtually

“…For example, the deleterious impact of the COVID-19 pandemic on parent mental health 26 may have understandably made it more difficult for some parents to participate. Further, the challenges related to screen/virtual fatigue has impacted enrolment in other forms of pediatric chronic pain research during the pandemic, 27 demonstrating that easier intervention access may not necessarily increase enrolment. Based on a content analysis of open-ended written feedback from parents posttreatment, there appears to be strong support for the group-based nature of the intervention, given that the social support and the validation/normalization that parents experienced were noted as their most liked components.…”

“…However, preliminary results demonstrated a nonsignificant change in school attendance for inperson groups and a significant improvement in school functioning for the virtual groups from baseline to posttreatment, which was maintained at follow-up. Research on the impact of COVID-19 on school functioning in youth with chronic pain is very limited; 1 study reported that many youths with chronic pain endorsed difficulties with school functioning during the initial shutdowns of the pandemic, 27 although longitudinal or comparative data were not reported. Thus, it is not yet clear how/whether the Covid-19 pandemic impacted school functioning in youth with chronic pain.…”

Comparing the prevalence of chronic pain in school-aged children in the United States from 2019 to 2020: a nationally representative study examining differences associated with the COVID-19 pandemic

“…Among youth with prepandemic chronic pain, researchers predominantly found stable or improved pain symptoms during the first few months of the pandemic. 15,21,24,38,47,50 In addition, a longitudinal study conducted in a German school–based sample (n = 777, age 9-17 years) found a prevalence of chronic pain 22% lower in October or November 2019 relative to June or July 2020. 42 Studies among adults with chronic pain, including clinical and online survey samples, also reported predominant stability or improvement in pain outcomes during the early pandemic.…”

“…7,8,43 Studies with youth who had received care for chronic pain before the pandemic suggest an overall stability or improvement in pain-related symptoms during the early stages of the pandemic. 21,24,33,38,47,50 A study from Germany also found an overall decrease in chronic pain prevalence in a school-based sample from October or November 2019 to June or July 2020. 42 However, these studies are limited to clinical or regional samples which may differ from the US general population in underlying risk and protective factors for pediatric chronic pain, as well as in the pandemic experience.…”

“We survived the pandemic together”: The impact of the COVID-19 pandemic on Canadian families living with chronic pain

“… 20 Despite the onset of both new symptoms as well as exacerbations of preexisting pain, many youth and families experienced reduced access to both medical and mental health care during the pandemic. 23 , 24 These circumstances contributed to patients reporting increased anxiety, fear, and helplessness and, in some cases, resulted in delayed diagnoses and higher complication rates. 25 Prior to the COVID-19 pandemic, the role of family had been shown to be especially influential on pediatric pain experiences as well as quality of life.…”