Trajectories of Pain Symptoms From Early Childhood to Adolescence Impacted by Certain Distinct Life Experiences

Childhood problems - Child abuse
young girl sitting down alone in the dark.
One of the objectives of this study was to examine how early childhood factors at the individual-, parental-, and family-level predict pain trajectories.

Adolescent pain symptoms may be mitigated by reducing sleep disturbances and harsh parenting during early childhood, according to results of a multicenter, 14-year longitudinal study published in Pain Medicine.

This study is a secondary analysis of the Early Steps Multisite Study, which evaluated the Family Check-Up’s preventive effects on problem behaviors of youth. Families (N=731) with children aged 2 years were recruited from Women, Infants, and Children Nutritional Supplement Centers in Pittsburgh, Pennsylvania; Eugene, Oregon; and Charlottesville, Virginia, beginning in 2003. All participants met 2 of the 3 criteria of problematic child behavior, family problems (ie, maternal depression, parental substance use, teen parent, challenges in daily parenting), or sociodemographic risk. Children were evaluated for pain over the 14-year follow-up.

The participating families comprised 46.6% White, 27.6% Black, 13.4% Hispanic, and 9.8% biracial individuals. The primary caregivers had received less than a high school education (23.6%), high school or equivalent diploma (41%), or post-high school training (35.4%). Household income was less than $20,000 for more than 60% of families. The average number of family members was 4.5 (SD, 1.63) per household.

At baseline, the focal children were 49% girls with a mean age of 29.9 (SD, 3.2) months. Follow-up through age 16 was available for 80% of the-participants.

Pain trajectories were characterized as low pain (n=572), increasing pain (n=106), and U-shaped pain (n=53). Significant differences among the pain trajectories were observed for childhood anxiety and depression (F[2,727], 13.98; P <.001), childhood sleep disturbance (F[2,727], 8.78; P <.001), childhood withdrawal and depression (F[2,727], 7.54; P =.001), primary caregiver depression (F[2,726], 6.86; P =.001), and harsh parenting (F[2,715], 5.86; P =.003).

Youth with an increasing pain trajectory were more likely to grow up in a family with harsh parenting (odds ratio [OR], 1.42; 95% CI, 1.045-1.923; P <.05) and to experience sleep disturbances (OR, 1.03; 95% CI, 1.007-1.062; P <.05) compared with the low-pain trajectory.

Youth with a U-shaped pain trajectory were more likely to be anxious and depressed during early childhood (OR, 1.07; 95% CI, 1.025-1.120; P <.001) compared with the low-pain trajectory youth.

Youth with a U-shaped trajectory were more likely to be withdrawn and depressed during early childhood (OR, 1.05; 95% CI, 1.003-1.108; P <.05) compared with youth who had an increasing pain trajectory.

The increasing pain trajectory was associated with symptoms of anxiety at 16 years of age (b, 0.23; 95% CI, 0.060-0.399; P <.01).

This study was likely limited by the assessment of pain, which was based on the caregiver’s perception of the child’s pain.

The study authors concluded that distinct experiences during early childhood to middle adolescence associated with distinct pain trajectories. Harsh parenting and sleep disturbances during early childhood may be possible interventional targets to reduce future adolescent pain symptoms.


Mun CJ, Lemery-Chalfant K, Wilson M, Shaw DS. Predictors and consequences of pediatric pain symptom trajectories: a 14-year longitudinal study. Pain Med. 2021. Published online may 27, 2021. doi:10.1093/pm/pnab173