Chronic Pain in Adolescents and Alexithymia

Adolescent patients with chronic pain may be more likely to suffer from alexithymia — in particular, they may have difficulties identifying feelings — according to a study presented at the 2018 American Pain Society Annual Scientific Meeting, held March 4-6 in Anaheim, California.

“Alexithymia refers to a deficit in emotional awareness and is elevated in adults with chronic pain and [is] associated with greater pain interference and pain-related affective distress,” noted the investigators. “Prior studies demonstrate that depression and anxiety symptoms partially account for elevated levels of alexithymia in adults with [chronic pain] compared to [patient] without chronic pain.

However, limited research has examined alexithymia in adolescents with chronic pain compared to healthy adolescents, or how alexithymia relates to pain characteristics.”

Adolescent patients with alexithymia and chronic pain (n=22) or no chronic pain (n=22) were enrolled in this study. The investigators evaluated levels of anxiety and depression in both groups, as well as associations between alexithymia and several pain characteristics.

To assess for alexithymia-related symptoms, the investigators had participants complete the Toronto Alexithymia Scale (TAS-20), which is comprised of 3 subscales:difficulty identifying feelings (7 items), difficulty describing feelings (5 items), and externally oriented thinking (8 items). In addition, the investigators used the Patient-Reported Outcomes Measurement Information System (PROMIS) depression and anxiety scales to examine the occurrence of anxiety and depression and rated participants’ pain intensity, pain bothersomeness, and pain interference using a 0 to 10 numeric rating scale (NRS).

Compared with healthy controls, participants with chronic pain had higher total TAS-20 scores (F(1, 42) = 4.54; P =.039) and DIF (F(1, 42) = 12.33; P =.001). Anxiety, depression, or age showed no effect on group differences in an ANCOVA analysis. Pain bothersomeness and pain interference were both positively correlated with difficulty identifying feelings (r=.56; P =.001 and r=.56; P <.001, respectively). TAS-20 total and pain interference also showed a positive correlation (r=.41; P =.03). No associations were found between pain intensity and TAS-20 scores.

“The current study suggests adolescents with chronic pain have elevated alexithymia, particularly difficulty identifying feelings, even when accounting for depression and anxiety symptoms,” concluded the investigators. “Consistent with adult literature, alexithymia (particularly [difficulty identifying feelings]) was associated with greater pain interference and bothersomeness, but not with pain intensity. Future research is needed on larger samples and using longitudinal designs to better understand relationships between alexithymia, depression, and anxiety in adolescents with chronic pain.”

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Reference

Aaron R, Fisher E, and Palermo T. Alexithymia in adolescents with and without chronic pain. Presented at: 2018 American Pain Society Annual Meeting, March 4-6, 2018, Anaheim, California. Abstract 163.