The Impact of Adolescent Chronic Pain on Functioning: Disentangling the Complex Role of Anxiety

Abstract

A number of adolescents with chronic pain have clinically significant disability across physical, social, and academic activities, and pain severity only explains a portion of the variance in functioning. Thus, it is important to identify therapeutic options to improve adolescents' functioning. In contrast to studies with adults with chronic pain, research in pediatric pain has not consistently found anxiety to be a good predictor of pain-related disability. The present study evaluated pain, anxiety, and functioning in 222 adolescents with chronic pain. Results indicated that pain was consistently and linearly related to disability across measures of physical and social functioning, school attendance, and physician visits. The relation between anxiety and functioning was complex; increased anxiety was related to poorer physical and social functioning and was related to fewer physician visits, although it was not associated with school attendance. Additional analyses revealed that anxiety serves to moderate the relation between pain and functioning. Specifically, at high anxiety, pain was not related to functioning, but at low anxiety pain consistently predicted disability. In other words, highly anxious adolescents were functioning poorly regardless of the level of pain. The moderating role of anxiety highlights a number of research and clinical possibilities to explore with adolescents with chronic painrelated disability.Perspective: Data suggest that high anxiety is associated with poor functioning irrespective of pain intensity. At low anxiety, higher pain predicted greater disability.Anxiety is important to assess when investigating potential reasons for pain-related disability.

Pain-related quality of life related to mental health and sociodemographic indicators in adolescents

“…A study reported that higher anxiety sensitivity correlates with a higher fear of pain, which is associated with increased pain disability 55 . Another study indicated that pain is related to functioning at a low, but not high, level of anxiety 56 . This finding provides an alternative perspective that anxiety may moderate the relationship between pain and QOL.…”

The Influence of Anxiety Reduction on Clinical Response to Pediatric Chronic Pain Rehabilitation

“…in children with CP-regardless of pain intensity. 16 Even if not directly related to pain, measures of anxiety may still predict painassociated disability. 17 Central to the current study, existing research has shown that anxiety can be mitigated in children with CP through psychological interventions.…”

The Role of Peripheral Nerve Blocks in the Interdisciplinary Care of Children with Chronic Pain: A Case Series and Review of the Literature

“…Greater anxiety sensitivity was associated with lower self-esteem and perceived general and mental health, and with more behavioural problems and family disruption, but did not appear to affect physical functioning (Tsao et al, 2007). In a similar study of 222 adolescents aged 11 to 19 years attending two chronic pain clinics in the UK, Cohen et al (2010) found that in children with low anxiety, level of pain was a good predictor of physical and social function, but that high levels of anxiety prompted poorer function regardless of the level of pain.…”