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

Abstract

Chronic pain during childhood and adolescence can lead to persistent pain problems and mental health disorders into adulthood. Posttraumatic stress disorders and depressive and anxiety disorders are mental health conditions that co-occur at high rates in both adolescent and adult samples, and are linked to heightened impairment and disability. Comorbid chronic pain and psychopathology has been explained by the presence of shared neurobiology and mutually maintaining cognitive-affective and behavioral factors that lead to the development and/or maintenance of both conditions. Particularly within the pediatric chronic pain population, these factors are embedded within the broader context of the parent–child relationship. In this review, we will explore the epidemiology of, and current working models explaining, these comorbidities. Particular emphasis will be made on shared neurobiological mechanisms, given that the majority of previous research to date has centered on cognitive, affective, and behavioral mechanisms. Parental contributions to co-occurring chronic pain and psychopathology in childhood and adolescence will be discussed. Moreover, we will review current treatment recommendations and future directions for both research and practice. We argue that the integration of biological and behavioral approaches will be critical to sufficiently address why these comorbidities exist and how they can best be targeted in treatment.

Interventional procedures in children and adolescents with chronic non‐cancer pain as part of a multidisciplinary pain treatment program

“…In our study, older age and psychiatric comorbidity were the two prognostic factors associated with an adverse outcome (ie, not having full recovery). The prevalence of psychiatric comorbidity in our study is similar to previous reports in youth patients with chronic pain . The Axis I psychiatric diagnoses (eg, depression, anxiety, post‐traumatic stress disorder and panic disorder) are the most common psychiatric conditions found in children and adolescents with chronic pain.…”

“…The Axis I psychiatric diagnoses (eg, depression, anxiety, post‐traumatic stress disorder and panic disorder) are the most common psychiatric conditions found in children and adolescents with chronic pain. Psychiatric comorbidity during childhood was identified as a negative factor in having a good outcome in our population, and it has been described as a predicting factor for experiencing chronic pain during adulthood . In terms of mental health support, our MPTP is comparable to other pediatric chronic pain facilities across Canada, being the psychologist a permanent team member having the psychiatrist a consultant for specific cases …”

“…The prevalence of psychiatric comorbidity in our study is similar to previous reports in youth patients with chronic pain. 24 The Axis I psychiatric diagnoses (eg, depression, anxiety, post-traumatic stress disorder and panic disorder) are the most common psychiatric conditions found in children and adolescents with chronic pain. Psychiatric comorbidity during childhood was identified as a negative factor in having a good outcome in our population, and it has been described as a predicting factor for experiencing chronic pain during adulthood.…”

“…Psychiatric comorbidity during childhood was identified as a negative factor in having a good outcome in our population, and it has been described as a predicting factor for experiencing chronic pain during adulthood. 24,25 In terms of mental health support, our MPTP is comparable to other pediatric chronic pain facilities across Canada, being the psychologist a permanent team member having the psychiatrist a consultant for specific cases. 9 This study presents several limitations including the fact that is a retrospective analysis of prospectively collected data.…”

Utilization of a rodent model to examine the neurological effects of early life adversity on adolescent pain sensitivity

“…Presently missing from the literature are prospective studies demonstrating that early life adversity precedes the development of chronic pain in youth. Furthermore, while neurobiological mechanisms (e.g., inflammation, genetic factors) have been posited to be critically important in conceptual models of trauma and pediatric pain, empirical research has not yet examined the neurobiological underpinnings of the trauma‐pain relationship in youth (Vinall, Pavlova, Asmundson, Rasic, & Noel, ).…”