Posttraumatic stress disorder symptoms in youth with vs without chronic pain

Abstract

Chronic pain and posttraumatic stress disorder (PTSD) symptoms have been found to co-occur in adults; however, research has not examined this co-occurrence in adolescence, when pediatric chronic pain often first emerges. The aims of this study were to compare the frequency and intensity of PTSD symptoms and stressful life events in cohorts of youth with (n = 95) and without (n = 100) chronic pain and their parents and to determine the association between PTSD symptoms, health-related quality of life, and pain symptoms within the chronic pain sample. All participants completed questionnaire measures through an online survey. Findings revealed that youth with chronic pain and their parents had significantly higher levels of PTSD symptoms as compared with pain-free peers. More youth with chronic pain (32%) and their parents (20%) reported clinically significant elevations in PTSD symptoms than youth without chronic pain (8%) and their parents (1%). Youth with chronic pain also reported a greater number of stressful life events than those without chronic pain, and this was associated with higher PTSD symptoms. Among the chronic pain cohort, higher levels of PTSD symptoms were predictive of worse health-related quality of life and were associated with higher pain intensity, unpleasantness, and interference. Results suggest that elevated PTSD symptoms are common and linked to reduced functioning among youth with chronic pain. Future research is needed to examine PTSD at the diagnostic level and the underlying mechanisms that may explain why this co-occurrence exists.

The biopsychosocial model of pain in the context of pediatric burn injuries

“…Accordingly, post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) are common in youth following burn injury (18%-25%; Corry et al, 2010;De Young, Kenardy, Cobham, & Kimble, 2012;Landolt, Buehlmann, Maag, & Schiestl, 2007) and can be observed in children as young as 12 months old (Stoddard et al, 2006). Consistent with this line of research, evidence suggests that youth with chronic pain report high exposure to psychological trauma or adverse childhood experiences (Nelson, Simons, & Logan, 2017;Walker et al, 1997) and many report experiencing PTSS Noel et al, 2016). Similar to other psychological symptoms, the relationship between the experience of pain and trauma or post-traumatic stress may be bidirectional.…”

Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment

“…Children with diffuse pain reported significantly higher levels of anxiety as compared to youth with musculoskeletal, abdominal or neuropathic pain [23]. Recently, Noel et al [25] compared prevalence of PTSD symptoms in a sample of youth with chronic pain and their parents to pain-free peers. Findings revealed significantly higher levels of PTSD symptoms (including clinically significant symptoms) in youth with chronic pain and their parents [25].…”

“…Recently, Noel et al [25] compared prevalence of PTSD symptoms in a sample of youth with chronic pain and their parents to pain-free peers. Findings revealed significantly higher levels of PTSD symptoms (including clinically significant symptoms) in youth with chronic pain and their parents [25]. …”

“…Youth with chronic pain report having a greater number of stressful life events compared to those without chronic pain, and cumulative trauma was associated with higher PTSD symptoms [25]. The timing and duration of traumatic events appears to largely influence glucocorticoid and behavioral responses to trauma.…”

“…Certainly, parenting a child with chronic pain is associated with high emotional burden to the parent and the broader family system, and recent efforts have been made to directly target parental distress in pediatric chronic pain for this very reason [180]. Twenty percent of parents of youth with chronic pain (versus 1% of parents of pain free peers) have been found to experience clinically significant levels of PTSD [25], however, their PTSD symptoms were not related to those of their child [25]. …”