Multiple Pain Sites May Increase Risk for Poor Physical Function in Children

A physician examining a child
A physician examining a child
Youths between the ages of 8 and 17 who suffer from multiple pain sites may be at risk for poorer emotional, physical, and educational functioning compared with youths who experience pain at a single site.

Children and adolescents between the ages of 8 and 17 who have multiple pain sites may be at risk for poorer emotional, physical, and educational functioning compared with those who have pain at a single site, according to study findings published in the European Journal of Pain.

Patients age 8 to 17 years attending an outpatient multidisciplinary pain clinic (n=195) were included in this analysis. Parents and patients completed pain measures as part of a standard clinic battery that evaluated patients’ pain-related distress and functioning at the initial clinic evaluation and at 4-month follow-up.

Demographic and pain-related variables (eg, age, sex, and pain duration), pain sites, depressive symptoms, general anxiety, school functioning, and functional disability were all recorded and assessed.

A majority of study participants (63%) had multiple pain sites at the initial evaluation, with approximately one-quarter of patients reporting pain in ≥5 locations. Participants with headache (F [4, 189] =12.738, P <.001) and diffuse musculoskeletal (F [4, 190] = 31.625, P <.001) pain were more likely to report more pain sites than participants with other primary pain issues. In addition, higher anxiety symptoms (correlation factor, r =.16; P <.05), older age (r =.16; P <.05), longer pain duration (r =.24; P <.01), and lower school functioning (r =-.19; P <.01) at the initial assessment were associated with more pain sites.

Depressive symptoms (β =.27; P <.01) and pain duration (β =-.19; P <.01) were associated with functional disability in patients with multiple pain sites. The number of pain sites (E =-.16; P <.05) and the presence of depressive symptoms (β =-.30; P <.01) were predictors of school functioning at the initial assessment. The number of pain sites (β =.15; P <.05) and functional disability at initial evaluation (β =.30; P <.01) were also found to be predictors of functional disability at follow-up.

The 4-month duration of this study was too short to determine longitudinal associations between multiple pain sites and mental and physical function in young patients. The findings from this study may not generalize to older patient groups.

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“It appears that the mechanisms driving these associations between [multiple pain sites] with disability and school functioning are unique and may extend beyond the examined pain-related demographic and psychological/emotional factors,” concluded the study authors.

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Basch MC, Chow ET, Logan DE, Borsook D, Schechter NL, Simons LE. Cumulative effects of multiple pain sites in youth with chronic pain [published online February 13, 2018]. Eur J Pain. doi: 10.1002/ejp.1201