Predictors of the transition from acute to persistent musculoskeletal pain in children and adolescents: a prospective study

Abstract

Strategies directed at the prevention of disabling pain have been suggested as a public health priority, making early identification of youth at risk for poor outcomes critical. At present limited information is available to predict which youth presenting with acute pain are at risk for persistence. The aims of this prospective longitudinal study were to identify biopsychosocial factors in the acute period that predict the transition to persistent pain in youth with new-onset musculoskeletal (MSK) pain complaints. Participants were 88 children and adolescents (age 10–17 years) presenting to the emergency department (n=47) or orthopedic clinic (n=41) for evaluation of a new MSK pain complaint (< 1 month duration). Youth presented for two study visits (T1 = <1 month post pain onset; T2 = 4 month follow-up) during which they completed questionnaires (assessing pain characteristics, psychological factors, sleep quality) and participated in a lab task assessing conditioned pain modulation (CPM). Regression analyses tested T1 predictors of longitudinal pain outcomes (pain persistence, pain-related disability, quality of life). Results revealed approximately 35% of youth had persistent pain at 4-month follow-up, with persistent pain predicted by poorer CPM and female sex. Higher depressive symptoms at T1 were associated with higher pain-related disability and poorer quality of life at T2. Findings highlight the roles of depressive symptoms and pain modulation in longitudinally predicting pain persistence in treatment-seeking youth with acute MSK pain, and suggest potential mechanisms in the transition from acute to chronic MSK pain in children and adolescents.

Adverse childhood experiences in parents of youth with chronic pain: prevalence and comparison with a community-based sample

“…Although speculative, parent ACEs may impact parents' health which could, in turn, increase children's risk of chronic pain through parent (eg, chronic pain) and child (eg, depressive symptoms) risk factors. 18 , 26 , 27 To the best of our knowledge, only 1 study has examined parent ACEs in the context of chronic pain. Dennis et al examined mothers with chronic pain and their children and found that maternal ACEs were not related to child pain but were indirectly related to child depressive symptoms through maternal depressive symptoms.…”

Mechanisms that drive bone pain across the lifespan

“…Whether significant and unwanted sprouting of sensory and sympathetic nerve fibres also occurs in patients with genetic disorders of the skeleton, has yet to be determined. However, if ectopic nerve sprouting in bone does occur in these conditions, it may provide insight into the mechanisms that drive the transition from acute to chronic skeletal pain in these patients .…”

Influencia de los factores psicosociales en la experiencia de dolor músculo-esquelético: Una revisión de la literatura

“…Una reciente revisión sistemática (87) demostró que la depresión es un factor predictor del desarrollo de dolor crónico no oncológico en personas mayores de 18 años. De los estudios incluidos en esta revisión, el catastrofismo y la depresión fueron los factores cognitivo-afectivos más estudiados y que presentaron mayor correlación con el dolor musculoesquelético (25,27,28,31,37,38).…”

“…La relación entre el dolor y la depresión se ha estudiado bastante. Desde esta perspectiva se ha descubierto cierta relación lineal entre síntomas depresivos, discapacidad y dolor, la cual se traduce en una menor calidad de vida (37,38). La depresión ha sido identificada como un factor predictor de dolor crónico en muñecas, manos, hombros y columna cervical (39-41).…”