Pain, Fatigue, and Health-related Quality of Life in Children and Adolescents With Chronic Pain

Abstract

OBJECTIVES-Chronic pain and fatigue are common physical complaints among children and adolescents. Both symptoms can interfere considerably with daily life by affecting sleep and eating habits, engagement in physical and social activities, and school participation. The aim of this study was to examine the potential mediational role of fatigue in the relationship between pain and children's school functioning and overall health-related quality of life (HRQOL). METHODS: Children seeking outpatient pain management services at two urban children's hospitals were recruited for this study. The combined sample includes 80 children and adolescents between the ages of 8 and 18 (M = 13.89, SD = 2.57), 72.5% female, and their caregivers. The Pediatric Quality of Life Inventory (PedsQL ™ 4.0) was used to assess HRQOL and the related PedsQL ™ Multidimensional Fatigue Scale provided a comprehensive measure of fatigue. (2004), fatigue functioned as a mediator between pain and overall HRQOL based on both self and proxy reports. Fatigue functioned as a mediator between pain and school functioning based on the caregiver proxy report only. Additionally, moderate relationships were found between self and caregiver proxy reports of HRQOL and fatigue, although children self-reported less fatigue, better school functioning, and greater quality of life than did their caregivers via proxy report. RESULTS-Based on Preacher and Hayes' mediation modelDISCUSSION-Findings demonstrated that fatigue is a significant problem for many youth with chronic pain and may be an important target for clinical intervention.

Understanding fatigue in paediatric multiple sclerosis: a systematic review of clinical and psychosocial factors

“…[12][13][14][15][16][17] Recent evidence of fatigue in children and adolescents with multiple sclerosis (caMS) reflects these findings, with over half reporting at least mild fatigue and approximately 40% reporting fatigue severe enough to impact on school performance and recreational activities. 2,18 Fatigue in caMS is also associated with physical and emotional difficulties, sleep problems, and reduced quality of life.…”

A Review of Intravenous Lidocaine Infusion Therapy for Paediatric Acute and Chronic Pain Management

“…This includes loss of mobility with inability to participate in physical or sporting activities, poor sleep, difficulty concentrating on school work, school absenteeism, social isolation and family stress [240]. As chronic pain persists, the child can experience increased pain intensity, distress, sadness, anxiety, depression resulting in very poor quality of life [241]. The impact of chronic pain on the family matches the adverse impact experienced by families caring for children at home with severe cerebral palsy or birth defects [242][243][244].…”

The Role of Peripheral Nerve Blocks in the Interdisciplinary Care of Children with Chronic Pain: A Case Series and Review of the Literature

“…Firstly, the specific effects of chronic pain are not easily isolated from one another. For example, fatigue may be a mediating factor between pain and school functioning (Gold et al, 2009). Anxiety also plays a complex role in moderating the relationship between pain and function.…”

“…School functioning has received perhaps the most attention (Palermo, 2000). It demonstrates the most marked detriment of all the psychosocial dimensions of the PedsQL scale (Vetter, 2008;Gold et al, 2009) and clearly illustrates the complex effects of chronic pain on quality of life. A child with chronic pain may experience a range of problems which impact on their schooling: fatigue and/or poor sleep profile prevents early morning waking; pain inhibits physical ability to get to school, to sit in a classroom for long periods or to participate in physical activities; fear of pain by accidentally being knocked during recess times inhibits social interaction and imparts a sense of isolation, difference and not being involved with peers; poor memory and concentration affects schoolwork; as school work becomes missed or incomplete these unfinished projects become a barrier to return to school if workload is not controlled; and the school may represent an environment where their pain condition is not properly understood or tolerated.…”

“…An understanding of the range and interaction of all these different effects is crucial to the effective recognition and treatment of chronic pain in children. These impacts on daily living can be bundled into the notion of Health-Related Quality of Life (HRQoL), which may be defined as "an individual's subjective assessment of his or her functioning and emotional state" (Gold et al, 2009) and can be used for comparative purposes. One such measurement instrument is the Pediatric Quality of Life Inventory (PedsQL), which contains items relating specifically to both physical and psychosocial function (the latter comprising emotional, social and school function) and can be completed by self-report or parent-proxy (Varni et al, 2001).…”