Chronic Pain May Be Common Among School-Aged Children

In a community sample of children in Spain, the prevalence of chronic pain neared 50%, according to results of a study published in the Journal of Pain.

Data for this study were sourced from the EPIDOL Project, which was a longitudinal epidemiological study of pain among children and adolescents living in Spain. Students from 4 primary schools, 3 secondary schools, and 3 combined schools received a letter in the mail describing the project and inviting the children to participate. A total of 1142 parents and 1115 children responded to a questionnaire about demographics, pain, and function. Chronic pain was defined as at least weekly pain for at least 3 months, and high-impact chronic pain was defined as pain that limited life or work activities most or every day in the previous 3 months. 

Study authors comment, “The concept of high impact chronic pain (HICP) has been proposed to better identify individuals with significant levels of life interference due to chronic pain. Moreover, individuals with HICP account for the largest share of the economic costs of chronic pain.”

The mean age of children participating in the study was 11.67 (standard deviation [SD], 2.47) years, and 27% reported an illness in the past 3 months.

Most children (89%) reported pain in the past 3 months. The most common pain locations were the head (53%), belly or pelvis (36%), legs (32%), and back (32%). On a 12-point scale, 30% of children rated their pain as 4 or higher. More than half of the children (57%) described experiencing pain that resulted in school absence.

Chronic pain was reported by 46% of children, with 18% describing head pain, 16% experiencing back pain, and 11% reporting pain in the legs. The level of chronic pain was rated as 4 or higher by 7% of children, and the average pain intensity in the prior week was 6.06 (SD, 2.37) points.

The subgroups with no chronic pain (n=558), those with no high-impact chronic pain (n=431), and those with high-impact chronic pain (n=52) differed on the basis of gender (χ², 29.46; P <.001), age (F_[2,1037], 54.92; P <.001), severity of depressive symptoms (F_[2,1008], 82.15; P <.001), fatigue (F_[2,1002], 64.72; P <.001), anxiety (F_[2,1004], 64.05; P <.001), sleep quality (F_[2,1001], 39.92; P <.001), cognitive function (F_[2,995], 31.54; P <.001), pain-related school absences (F_[2,994], 20.63; P <.001), mobility (F_[2,1008], 15.13; P <.001), and perceived school performance (χ², 10.42; P =.005).

Among children with chronic pain, the subset with high-impact chronic pain reported greater pain intensity (t_[413], -4.43; P <.001) and pain frequency (χ², 10.59; P =.001) than those reporting nonhigh impact chronic pain.

This study may be limited by the inclusion of selection bias, as only 36% of invited children participated in the study.

These data add to the understanding about the prevalence of chronic pain among children and should be used to inform future studies about effective interventions for pediatric pain management.