The authors would like to acknowledge the families at the Children’s Hospital of Wisconsin Jane P. Pettit Pain and Palliative Care Center.

For more information, please contact Katherine Simon at simon@uwm.edu.

Relationship between Pain Intensity and Frequency with Psychosocial Risk Factors

Katherine Simon1, Keri R. Hainsworth2, Renee J. Ladwig3, Kristen E. Jastrowski Mano2, Kimberly Anderson Khan2, W. Hobart Davies1,3, and Steven J. Weisman2,3 

University of Wisconsin-Milwaukee1, Medical College of Wisconsin2, & Children’s Hospital of Wisconsin3

IntroductionIntroductionIt is estimated that one in five U.S. children are affected by chronic pain (Zeltzer & Schlank, 2005). Youth with chronic pain often have decreased social functioning, increased school absenteeism, and decreased quality of life (Eccleston, Wastell, Crombez, & Jordan, 2008). Research in adults has noted that daily stress is associated with headache severity (Cathcart & Pritchard, 2008); however, less is known about the relationship between daily stressors and pain in pediatric populations.

MethodsMethods This study involved patients presenting to a multidisciplinary pain clinic at a large Midwestern children’s hospital. At intake, mothers, fathers, and youth completed a packet of questionnaires that assess clinical, behavioral, and psychosocial variables related to pain. Based on an interview with the family, clinician’s also rate the occurrence of 23 psychosocial risk factors. The current study includes youth 4 - 19 years old with chronic pain (e.g., headache, gastrointestinal pain, musculoskeletal pain).

Table II: CorrelationsTable II: Correlations

HypothesisHypothesis The current study aimed to explore the association between pain (intensity and frequency) and common psychosocial risk factors reported by youth seen in a multidisciplinary pain clinic. Hypothesis: Youth with fewer psychosocial risk factors will report lower pain intensity and frequency.

MeasuresMeasures Demographic and Medical Information, including age, gender, ethnicity, diagnosis, and pain intensity (worst, usual, best) and frequency, are collected upon arrival at the comprehensive pain center. The doctor or nurse asked the primary caregiver and the youth for this information.

Clinician Interviews were conducted during the initial visit with the family. The interviews include information regarding mental health history, current mental health symptoms, and coping attempts, among other factors. The number of risk factors were totaled and cumulative risk factors were used in subsequent analyses.

Participant DemographicsParticipant Demographics

ResultsResults

ConclusionsConclusions

Pearson Correlations were used to explore the relationship between pain intensity, frequency and psychosocial risk factors. Independent t-tests were conducted to further describe the relationship between pain intensity and frequency with psychosocial risk factors See Table I for psychosocial risk factors, Table II for correlations, and Table III for t-tests.

The data highlight the importance of assessing potential risk factors in the treatment of chronic pain in youth, especially family and school factors.

These results suggest that there is a relationship between pain ratings and identified school (i.e. transition, academic problems) and family stressors (i.e. divorce, abuse, financial issues), which may indicate that youth identifying these stressors warrant more specific interventions directed at those problematic areas based on the fact that school and family are important components of development.

Future research should focus on determining if these psychosocial risk factors impact treatment strategies or the need for additional services.

Table I: Top 10 Psychosocial Risk FactorsTable I: Top 10 Psychosocial Risk Factors

*p < . 10. **p < .05. ***p < .01.

Table III: T-testsTable III: T-tests

*p < . 10. **p < .05. ***p < .01.

YouthN = 351

Gender 67.5% female

Age 13.65 yrs (2.39)

Ethnicity 77.9% Caucasian

Best Pain Intensity 2.15 (2.69)

Worst Pain Intensity 8.49 (1.75)

Usual Pain Intensity 5.59 (2.19)

Psychosocial Risk Factors % Reported

School Absenteeism 31.3%

Family Conflict 28.5%

Divorce 19.9%

School Transition 19.7%

Feeling Isolated/Not Fitting In 19.4%

Academic or Learning Difficulties 18.8%

Family Financial Problems 16.2%

Sibling Behavior Problems 16.0%

Youth as a High Achiever 14.2%

Peer Conflict 9.7%

Descriptive StatisticsDescriptive StatisticsPain Locations (Top 3)

Headache 35.1%Abdominal Pain 24.7%

Lower Extremity Pain 17.1%

Cumulative Risk Factors 2.77 (SD = 2.39; R = 0-11)

M of Pain if Factor Endorsed

M of Pain if Factor

Not Endorsed

t(df) p

Usual PainFamily Conflict 6.33

N = 845.80

N = 2221.91(304) .057*

Divorce 6.40N = 62

5.83N = 244

1.85(304) .066*

Abuse 6.89N = 19

5.88N = 287

1.96(304) .051*

Financial Problems 7.11N = 47

5.74N = 259

4.05(304) .000***

School Transition 6.39N = 64

5.83N = 242

1.83(304) .068*

Academic Problems 6.62N = 58

5.79N = 248

2.63(304) .009**

Best PainSchool Absenteeism 2.62

N = 951.94

N= 2152.06(308) .040**

Athletic Achievement 3.45N = 22

2.04N= 286

2.40(306) .017**

Worst PainSchool Absenteeism 8.80

N = 998.37

N = 2172.02(314) .044**

Best Painr p

Worst Painr p

Usual Painr p

Cumulative Risk Factors

.03 (NS) .07 (NS) .16 (.004)***

To Note: Best Pain was significantly correlated with Worst Pain (r = .14, p = .018) and Usual Pain (r = .30, p = .000). Worst and Usual pain were also significant related (r = .35, p = .000).