What happens to pediatric chronic pain over time?
We all want to know, what will happen next?
With pediatric chronic pain, those answers can be difficult to come by. As a heterogenous category encompassing many diagnoses, it can be difficult for clinicians to help families make evidence-based predictions. Furthermore, research in children sadly usually lags behind knowledge of health outcomes in adults.
Still, children, parents, and families often want to know- what will happen to my pain?
Researchers have also struggled with this question, with many challenges to this type of longitudinal research. However, recently, a group out of Germany published interesting findings that may help families make decisions about their healthcare.
Research Updates in Pediatric Chronic Pain Trajectories
The article by Hamburg et al., published in the spring of 2024 in The Journal of Pain, outlines how they completed their study and what they found.
Specifically, the researchers examined data collected from over 2000 school-age children as part of a larger study. Using this large dataset, they were able to identify almost 700 children who had some type of chronic pain. They found that over the course of the year, these children followed one of 3 common patterns.
Common Patterns of Pediatric Chronic Pain Over 1 Year
Pain Recovery: These children had moderate pain at the beginning of the year, that rapidly and consistently reduced to pain-free levels at the end of the year.
Continuous Moderate Pain: This group had high levels of pain, that stayed stable or reduced to moderate levels over the year.
Continuous Low Pain: This group started with moderate pain, that stayed stable or only slightly declined.
Well, how can you know which group your child will be in? How can you know if your child will naturally recover from pain?
Frustratingly, we cannot yet make accurate predictions. However, when the researchers compared the children in these groups, they found some interesting patterns here as well:
The Continuous Moderate Pain group had higher anxiety, depression, and affective pain perception than the Pain Recovery group
Both the Continuous Moderate Pain group and the Continuous Low Pain group had more females than the Pain Recovery group
Sadly, despite the high rates of anxiety and depression, only a small fraction consulted with a psychiatrist or a psychologist.
Why does anxiety and mood play such a role in pediatric chronic pain?
The authors noted a large history of research demonstrating the connection between fear, avoidance, pain, and pain-related disability. In this Fear-Avoidance model, anxiety leads to avoidance of certain behaviors or activities, which then leads to more disability, and resulting in more pain. This increase in pain, understandably, contributes to even more anxiety.
Similarly, pain and depression are thought to be bidirectional- each can worsen each other.
What can parents do to create a positive trajectory?
Here are some ideas you can start to implement today:
Recognize that your child is unique. Research is driven by averages across groups, but your child is certainly individual.
Consider your child as a whole- they are not just their pain score, or even a collection of symptoms. They are their lifestyle, their feelings, their beliefs, their history, their family, their dreams, and so much more.
Ask your pediatrician or medical specialist to track more than just their pain - they can also measure their mood, anxiety, and affective pain perception.
Value the role of your child’s mental health and seek support- growing evidence is suggesting that pediatric pain psychology can help your child’s pain intensity, functioning in everyday activities, and resilience to thrive in life. A trained pediatric pain psychologist can help you and your family take feasible steps in line with your values toward sustainable progress and disentangle the deep connections between anxiety, depression, and pain.
If you don’t know where to start, click the Get Started button at the top right of your screen. You can name a time for Dr. Foxen-Craft, pediatric pain psychologist, to call you and provide a free individualized consultation for your unique child.
Reference:
Humberg, C., Rau, L. M., Claus, B. B., Könning, A., Stahlschmidt, L., & Wager, J. (2024). Risk of Unfavorable Trajectories of Chronic Pain Severity—Results of a Longitudinal Study in School Children. The Journal of Pain, 104528.