Paediatric pain: Overview

Abstract
Introduction: Pediatric chronic pain is linked to higher school absenteeism, academic struggles, and social stressors, which may further exacerbate pain. Stress is thought to be a key mechanism in this relationship. This study tested whether psychological stress mediates the association between chronic pain and school functioning.

Methods: Adolescents with chronic pain (ACP) at a tertiary hospital in the northeastern United States and adolescents without chronic pain (AWCP) completed self-report measures of psychological stress and school functioning. Analyses included t-tests, Spearman's correlations, and mediation models controlling for age, gender and race.

Results: The sample comprised 488 adolescents (63.11% female, Mage=16.05, SD=1.23): 274 (56.14%) ACP and 214 (43.85%) AWCP. ACP reported significantly higher psychological stress (P<0.001) and greater school related interpersonal discomfort (P=0.013) compared to AWCP. After covariate adjustment, the difference in interpersonal discomfort was no longer significant. Psychological stress correlated with poorer school functioning across all subscales (rs=0.4-0.52, ps< 0.05). In the mediation model, chronic pain strongly predicted higher stress (a=9.70, P<0.001), stress predicted poorer school functioning (b=0.99, P<0.001), and the indirect effect was large and significant (ab=9.62, 95%CI [7.06,12.45], P<0.001). After accounting for stress, the direct link between chronic pain and school functioning became negative and statistically significant (c'=-12.61, 95% CI [-16.09,-9.13], P<0.001), while the total effect remained nonsignificant (c=-2.99, P=0.14), consistent with a suppression pattern.

Discussion: Psychological stress mediates the relationship between chronic pain and school functioning. Interventions targeting stress may improve school outcomes for adolescents with chronic pain even if pain symptoms persist.

Abstract
Objectives: The current study assessed health care utilization (HCU) in pediatric patients with Functional Abdominal Pain Disorder (FAPD) and compared rates of HCU between youth who received cognitive behavioral therapy (CBT) as part of a randomized clinical trial and those that received medical treatment as usual (TAU).

Methods: Participants between the ages of 9-14 were randomly assigned to receive either CBT (n=39) or TAU (n=39). Participants in the active arm received the Aim to Decrease Anxiety and Pain Treatment (ADAPT), an evidence-based CBT intervention targeting abdominal pain and mental health symptoms. Frequency of HCU 12 months post intervention was examined using objective data via the electronic medical record (EMR). HCU variables included outpatient gastroenterology (GI) clinic visits, outpatient psychology/psychiatry visits, ED visits, and hospitalizations. Count regression models tested the effect of ADAPT on HCU.

Results: In the total sample, HCU of subspecialty and emergency treatment services was overall low. ADAPT participants may have had fewer GI clinic visits (IRR=0.86, CI=[0.45, 1.68]), psychology/psychiatry visits (IRR=0.84, CI=[0.10, 6.88]) and hospitalizations (IRR=0.37, CI=[0.04, 3.68]) than TAU participants, though wide confidence intervals were noted.

Discussion: Findings suggest variation in HCU between youth with FAPD who received CBT compared to those that received TAU. More work is needed to examine how cognitive behavioral interventions may impact HCU in pediatric patients with FAPD and related Disorders of Gut-Brain Interaction (DGBI).