From One Pain to Many

Logan, Deirdre E.; Donado, Carolina; Kaczynski, Karen J.; Lebel, Alyssa; Schechter, Neil L.

doi:10.1097/ajp.0000000000000939

Cited by 9 publications

(9 citation statements)

References 56 publications

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“…44 Various body map instruments, both paper/pencil and electronic versions, have been reliably used to indicate pain location in clinical samples of children aged 8 and older. 2,11,[45][46][47] Similar to most body maps, the CHOIR instrument depicts both anterior and posterior body sites (38 and 36 sites, respectively). The instrument's criterion validity and test-retest reliability (intraclass correlation coefficient = 0.93) were recently established in a large sample of adults with chronic pain.…”

Section: Multi-region Painmentioning

confidence: 99%

“…Body map data were used to code pain as none, singleregion, or multi-region as recently defined by Logan et al 2 Single-region pain was defined as pain documented in 1 major region only (ie, head/neck/face, abdomen/pelvic, or musculoskeletal [ie, extremities/back/chest]). Multi-region pain included pain in 2 or more of these major regions, pain in multiple noncontiguous regions, or whole-body pain (ie, pain identified across 2 or more of the following distinct regions: head/neck, abdomen/pelvis, chest, back, right upper extremity, left upper extremity, right lower extremity, left lower extremity).…”

Section: Multi-region Painmentioning

confidence: 99%

“…This gap may impede the ability to identify the most salient and, perhaps, progressive targets for treating single-region or multi-region pain in young adolescents. Since a significant number of teens present to pain clinics with established multi-region, persistent pain, 2 teasing out relevant risk factors in healthy young adolescents may be particularly germane to understanding the pain continuum and could guide the development of unique treatment pathways. The purpose of this cross-sectional analyses was, therefore, to examine how biological, psychological, and sociocultural attributes help explain single-region or multi-region pain in healthy young adolescents.…”

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confidence: 99%

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Biopsychosocial Attributes of Single-region and Multi-region Body Pain During Early Adolescence

Senger-Carpenter¹,

Scott

Isaman³

et al. 2022

The Clinical Journal of Pain

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Objectives: Multi-region pain during adolescence is associated with a higher symptom burden and lower quality of life. The purpose of this study was to describe and compare the biopsychosocial attributes of single-region and multi-region pain among healthy young adolescents. Materials and Methods: We analyzed data from 10,320 children aged 10.6 to 14 years who self-reported pain in the Adolescent Brain and Cognitive Development Study. Pain was coded as single-region or multi-region based on body map data. Results: One in 5 young adolescents indicated recent multi-region pain. Sequential regression supported improved model fit when psychological and sociocultural factors were added to a biological model of pain; however, these models improved the classification of multi-region but not single-region pain. A significant interaction effect of sex and puberty remained constant across models with increased odds of pain at each advancing pubertal stage for both sexes compared with prepuberty, but no difference between girls and boys at late puberty (adjusted odds ratio [OR]=2.45 [1.72, 3.49] and adjusted OR=1.63 [1.20, 2.23], respectively). Psychological factors improved the classification of multi-region pain with significant effects of anxiety, somatic symptoms, and somnolence. Finally, compared with White and non-Hispanic children, Black and Hispanic children were less likely to report pain (adjusted OR=0.70 [0.61, 0.80]; adjusted OR=0.88 [0.78, 0.99], respectively) but had significantly higher pain interference when pain was present (adjusted OR=1.49 [1.29, 1.73] and adjusted OR=1.20 [1.06, 1.35], respectively). Discussion: Pain is a biopsychosocial phenomenon, but psychological and sociocultural features may be more relevant for multi-region compared with single-region pain during early adolescence.

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Section: Multi-region Painmentioning

confidence: 99%

Section: Multi-region Painmentioning

confidence: 99%

mentioning

confidence: 99%

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Biopsychosocial Attributes of Single-region and Multi-region Body Pain During Early Adolescence

Senger-Carpenter¹,

Scott

Isaman³

et al. 2022

The Clinical Journal of Pain

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“…Development of overlapping pain may require many months after the onset of the first pain ( 205 ). This is in line with the introduced concept, because development of an established cPNL obviously takes time, especially when there is no initial proximal neural injury.…”

Section: Application Of the Cpnl Hypothesis To Chronic Pain In Generalmentioning

confidence: 99%

Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion

Macionis¹

2023

Front. Pain Res.

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It has been unexplained why chronic pain does not invariably accompany chronic pain-prone disorders. This question-driven, hypothesis-based article suggests that the reason may be varying occurrence of concomitant peripheral compressive proximal neural lesion (cPNL), e.g., radiculopathy and entrapment plexopathies. Transition of acute to chronic pain may involve development or aggravation of cPNL. Nociceptive hypersensitivity induced and/or maintained by cPNL may be responsible for all types of general chronic pain as well as for pain in isolated tissue conditions that are usually painless, e.g., neuroma, scar, and Dupuytren's fibromatosis. Compressive PNL induces focal neuroinflammation, which can maintain dorsal root ganglion neuron (DRGn) hyperexcitability (i.e., peripheral sensitization) and thus fuel central sensitization (i.e., hyperexcitability of central nociceptive pathways) and a vicious cycle of chronic pain. DRGn hyperexcitability and cPNL may reciprocally maintain each other, because cPNL can result from reflexive myospasm-induced myofascial tension, muscle weakness, and consequent muscle imbalance- and/or pain-provoked compensatory overuse. Because of pain and motor fiber damage, cPNL can worsen the causative musculoskeletal dysfunction, which further accounts for the reciprocity between the latter two factors. Sensitization increases nerve vulnerability and thus catalyzes this cycle. Because of these mechanisms and relatively greater number of neurons involved, cPNL is more likely to maintain DRGn hyperexcitability in comparison to distal neural and non-neural lesions. Compressive PNL is associated with restricted neural mobility. Intermittent (dynamic) nature of cPNL may be essential in chronic pain, because healed (i.e., fibrotic) lesions are physiologically silent and, consequently, cannot provide nociceptive input. Not all patients may be equally susceptible to develop cPNL, because occurrence of cPNL may vary as vary patients' predisposition to musculoskeletal impairment. Sensitization is accompanied by pressure pain threshold decrease and consequent mechanical allodynia and hyperalgesia, which can cause unusual local pain via natural pressure exerted by space occupying lesions or by their examination. Worsening of local pain is similarly explainable. Neuroma pain may be due to cPNL-induced axonal mechanical sensitivity and hypersensitivity of the nociceptive nervi nervorum of the nerve trunk and its stump. Intermittence and symptomatic complexity of cPNL may be the cause of frequent misdiagnosis of chronic pain.

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“…We also report the child's self-reported pain location as single region vs multiregion (Ն2 body regions; eg, head and neck, abdomen and pelvis, chest, back). 37,38 Children also self-reported their past-month pain intensity (0, no pain, to 10, worst pain) and pain interference with normal activities (0, not at all, to 10, stopped me from doing anything).…”

Section: Self-reported Painmentioning

confidence: 99%

Associations of Co-occurring Symptom Trajectories With Sex, Race, Ethnicity, and Health Care Utilization in Children

et al. 2023

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ImportanceCo-occurring physical and psychological symptoms during childhood and early adolescence may increase risk of symptom persistence into adulthood.ObjectiveTo describe co-occurring pain, psychological, and sleep disturbance symptom (pain-PSS) trajectories in a diverse cohort of children and the association of symptom trajectory with health care utilization.Design, Setting, and ParticipantsThis cohort study was a secondary analysis of longitudinal data from the Adolescent Brain Cognitive Development (ABCD) Study, collected between 2016 and 2022 at 21 research sites across the US. Participants included children with 2 to 4 complete annual symptom assessments. Data were analyzed from November 2022 to March 2023.Main Outcomes and MeasuresFour-year symptom trajectories were derived from multivariate latent growth curve analyses. Pain-PSS scores, including depression and anxiety, were measured using subscales from the Child Behavior Checklist and the Sleep Disturbance Scale of Childhood. Nonroutine medical care and mental health care utilization were measured using medical history and Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) items.ResultsA total of 11 473 children (6018 [52.5%] male; mean [SD] age at baseline, 9.91 [0.63] years) were included in analyses. Four no pain-PSS and 5 pain-PSS trajectories were supported with good or excellent model fit (predicted probabilities, 0.87-0.96). Most children (9327 [81.3%]) had asymptomatic or low, intermittent, or single symptom trajectories. Approximately 1 in 5 children (2146 [18.7%]) had moderate to high co-occurring symptom trajectories that persisted or worsened. Compared with White children, there was a lower relative risk of having moderate to high co-occurring symptom trajectories among Black children (adjusted relative risk ratio [aRRR] range, 0.15-0.38), Hispanic children (aRRR range, 0.58-0.67), and children who identified as another race (including American Indian, Asian, Native Hawaiian, and other Pacific Islader; aRRR range, 0.43-0.59). Less than half of children with moderate to high co-occurring symptom trajectories used nonroutine health care, despite higher utilization compared with asymptomatic children (nonroutine medical care: adjusted odds ratio [aOR], 2.43 [95% CI, 1.97-2.99]; mental health services: aOR, 26.84 [95% CI, 17.89-40.29]). Black children were less likely to report nonroutine medical care (aOR, 0.61 [95% CI, 0.52-0.71]) or mental health care (aOR, 0.68 [95% CI, 0.54-0.87]) than White children, while Hispanic children were less likely to have used mental health care (aOR, 0.59 [95% CI, 0.47-0.73]) than non-Hispanic children. Lower household income was associated with lower odds of nonroutine medical care (aOR, 0.87 [95% CI, 0.77-0.99]) but not mental health care.Conclusions and RelevanceThese findings suggest there is a need for innovative and equitable intervention approaches to decrease the potential for symptom persistence during adolescence.

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From One Pain to Many

Cited by 9 publications

References 56 publications

Biopsychosocial Attributes of Single-region and Multi-region Body Pain During Early Adolescence

Biopsychosocial Attributes of Single-region and Multi-region Body Pain During Early Adolescence

Chronic pain and local pain in usually painless conditions including neuroma may be due to compressive proximal neural lesion

Associations of Co-occurring Symptom Trajectories With Sex, Race, Ethnicity, and Health Care Utilization in Children

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