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The Clinical journal of pain
02 01, 2021;37 (2): 118-125.

Severity of Chronic Pain in German Adolescent School Students: A Cross-sectional Study.

Anna Könning, Nicola Rosenthal, Donnamay Brown, Lorin Stahlschmidt, Julia Wager
Author Information
  1. Anna Könning: German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln.
  2. Nicola Rosenthal: German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln.
  3. Donnamay Brown: German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln.
  4. Lorin Stahlschmidt: German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln.
  5. Julia Wager: German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln.
PMID: 33165023 DOI: 10.1097/AJP.0000000000000898

Abstract

OBJECTIVES: Prevalence estimates of severe chronic pain in pediatric community samples are rare and inconclusive. This study aimed to (1) examine the prevalence of chronic pain severity grades in school children and (2) investigate differences between pain severity grades for pain-related characteristics, including pain locations, sociodemographic characteristics, emotional functioning, insomnia, school factors, and health care utilization.
MATERIALS AND METHODS: This cross-sectional observational study was conducted with 2220 school students in Germany (52% female individuals, age: M=13.0; SD=1.8; range, 10 to 18 y). Pain severity was assessed using the validated Chronic Pain Grades for adolescents. Comparisons between Chronic Pain Grade subgroups of adolescent characteristics were conducted using χ2 tests, Kruskal-Wallis tests, and 1-way analysis of variance.
RESULTS: In school students, 31.0% had chronic pain with 8.2% categorized as severe. Individuals with higher pain severity tended to be girls and have multisite pain, more symptoms of depression and generalized anxiety, and a higher emotional burden of pain. Individuals with higher pain severity also reported less school satisfaction, lower perceived school performance, and more insomnia. Pain medication intake and physician visits because of pain were more common in those with more severe pain.
DISCUSSION: Severe chronic pain affects nearly 1 in 10 adolescent school students and is associated with several negative health outcomes and increased health care utilization. It is important to ensure that specialized pain treatment programs are available to these students and that they are aware of the different negative health outcomes associated with the pain condition.

References

  1. Gobina I, Villberg J, Valimaa R, et al. Prevalence of self-reported chronic pain among adolescents: evidence from 42 countries and regions. Eur J Pain. 2019;23:316–326.
  2. Tumin D, Drees D, Miller R, et al. Health care utilization and costs associated with pediatric chronic pain. J Pain. 2018;19:973–982.
  3. Wager J, Brown D, Kupitz A, et al. Prevalence and associated psychosocial and health factors of chronic pain in adolescents: differences by sex and age. Eur J Pain. 2020;24:761–772.
  4. King S, Chambers CT, Huguet A, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152:2729–2738.
  5. Von Korff M, Dworkin SF, Le Resche L. Graded chronic pain status: an epidemiologic evaluation. Pain (Amsterdam). 1990;40:279–291.
  6. Von Korff M, DeBar LL, Krebs EE, et al. Graded chronic pain scale revised: mild, bothersome, and high-impact chronic pain. Pain. 2020;161:651–661.
  7. Huguet A, Miro J. The severity of chronic paediatric pain: an epidemiological study. J Pain. 2008;9:226–236.
  8. Vervoort T, Logan DE, Goubert L, et al. Severity of pediatric pain in relation to school-related functioning and teacher support: an epidemiological study among school-aged children and adolescents. Pain. 2014;155:1118–1127.
  9. Wurm M, Anniko M, Tillfors M, et al. Musculoskeletal pain in early adolescence: a longitudinal examination of pain prevalence and the role of peer-related stress, worry, and gender. J Psychosom Res. 2018;111:76–82.
  10. Von Korff M, Ormel J, Keefe FJ, et al. Grading the severity of chronic pain. Pain. 1992;50:133–149.
  11. Stahlschmidt L, Barth F, Zernikow B, et al. Therapy outcome one year after pediatric outpatient chronic pain evaluation: Chronic Pain Grading (CPG) for adolescent pain patients. Schmerz. 2017;31:601–609.
  12. Wager J, Hechler T, Darlington AS, et al. Classifying the severity of paediatric chronic pain - an application of the chronic pain grading. Eur J Pain. 2013;17:1393–1402.
  13. Schwille IJD, Giel KE, Ellert U, et al. A community-based survey of abdominal pain prevalence, characteristics, and health care use among children. Clin Gastroenterol Hepatol. 2009;7:1062–1068.
  14. Long AC, Krishnamurthy V, Palermo TM. Sleep disturbances in school-age children with chronic pain. J Pediatr Psychol. 2008;33:258–268.
  15. Anttila P, Metsähonkala L, Sillanpää M. Long-term trends in the incidence of headache in Finnish school children. Pediatrics. 2006;117:e1197–e1201.
  16. Bandell-Hoekstra IE, Abu-Saad HH, Passchier J, et al. Prevalence and characteristics of headache in Dutch schoolchildren. Eur J Pain. 2001;5:145–153.
  17. Hakala P, Rimpela A, Salminen JJ, et al. Back, neck and shoulder pain in Finnish adolescents: national cross-sectional surveys. Br Med J. 2002;325:743.
  18. Laurell K, Larsson B, Eeg-Olofsson O. Prevalence of headache in Swedish schoolchildren, with a focus on tension-type headache. Cephalalgia. 2004;24:380–388.
  19. Luntamo T, Sourander A, Santalahti P, et al. Prevalence changes of pain, sleep problems and fatigue among 8-year-old children: years 1989, 1999, and 2005. J Pediatr Psychol. 2012;37:307–318.
  20. Torsheim T, Cavallo F, Levin KA, et al. FAS Development Study Group. Psychometric validation of the Revised Family Affluence Scale: a latent variable approach. Child Indic Res. 2016;9:771–784.
  21. Lange M, Kamtsiuris P, Lange C, et al. Messung soziodemographischer Merkmale im Kinder-und Jugendgesundheitssurvey (KiGGS) und ihre Bedeutung am Beispiel der Einschätzung des allgemeinen Gesundheitszustands. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2007;50:578–589.
  22. Castarlenas E, Jensen MP, von Baeyer CL, et al. Psychometric properties of the Numerical Rating Scale to assess self-reported pain intensity in children and adolescents: a systematic review. Clin J Pain. 2017;33:376–383.
  23. Tsze DS, von Baeyer CL, Pahalyants V, et al. Validity and reliability of the verbal numerical rating scale for children aged 4 to 17 years with acute pain. Ann Emerg Med. 2018;71:691–702.e3.
  24. Hübner B, Hechler T, Dobe M, et al. Pain-related disability in adolescents suffering from chronic pain: preliminary examination of the Pediatric Pain Disability Index (P-PDI). Schmerz. 2009;23:20–32.
  25. Stahlschmidt L, Friedrich Y, Zernikow B, et al. Assessment of pain-related disability in pediatric chronic pain: a comparison of the Functional Disability Inventory and the Paediatric Pain Disability Index. Clin J Pain. 2018;34:1173–1179.
  26. Chorpita BF, Yim L, Moffitt C, et al. Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther. 2000;38:835–855.
  27. Stahlschmidt L, Chorpita BF, Wager J. Validating the German version of the Revised Children’s Anxiety and Depression Scale in a sample of pediatric chronic pain patients. J Psychosom Res. 2019;124:109786.
  28. Chorpita BF, Moffitt CE, Gray J. Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behav Res Ther. 2005;43:309–322.
  29. Wager J, Tietze AL, Hamann M, et al. Schmerzempfindung bei Jugendlichen mit chronischen funktionellen Schmerzen: adaptation und psychometrische Überprüfung der Schmerzempfindungs-skala (SES) nach Geissner. Schmerz. 2010;24:236–250.
  30. Ravens-Sieberer U, Nickel J, Bettge S, et al. Gesundheitsverhalten von Kindern und Jugendlichen - Die WHO Jugendgesundheitsstudie für Berlin und Hamburg. Hamburg: Dr. Kovač; 2008.
  31. Cohen J. Statistical Power Analysis for the Behavioral Sciences. New Jersey: Lawrence EarlbaumAssociates; 1988.
  32. Walker LS, Sherman AL, Bruehl S, et al. Functional abdominal pain patient subtypes in childhood predict functional gastrointestinal disorders with chronic pain and psychiatric comorbidities in adolescence and adulthood. Pain. 2012;153:1798–1806.
  33. Skrove M, Romundstad P, Indredavik MS. Chronic multisite pain in adolescent girls and boys with emotional and behavioral problems: the Young-HUNT study. Eur Child Adolesc Psychiatry. 2015;24:503–515.
  34. Hoftun GB, Romundstad PR, Rygg M. Factors associated with adolescent chronic non-specific pain, chronic multisite pain, and chronic pain with high disability: the Young-HUNT Study 2008. J Pain. 2012;13:874–883.
  35. Eccleston C, Crombez G, Scotford A, et al. Adolescent chronic pain: patterns and predictors of emotional distress in adolescents with chronic pain and their parents. Pain. 2004;108:221–229.
  36. Gauntlett-Gilbert J, Eccleston C. Disability in adolescents with chronic pain: patterns and predictors across different domains of functioning. Pain. 2007;131:121–132.
  37. Krause L, Neuhauser H, Hölling H, et al. Kopf-, Bauch-und Rückenschmerzen bei Kindern und Jugendlichen in Deutschland—Aktuelle Prävalenzen und zeitliche Trends. Monatsschrift Kinderheilkunde. 2017;165:416–426.
  38. Knook LME, Konijnenberg AY, van der Hoeven J, et al. Psychiatric disorders in children and adolescents presenting with unexplained chronic pain: what is the prevalence and clinical relevancy? Eur Child Adolesc Psychiatry. 2011;20:39–48.
  39. Zernikow B, Wager J, Hechler T, et al. Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients. BMC Pediatr. 2012;16:54–65.
  40. Valrie CR, Bromberg MH, Palermo T, et al. A systematic review of sleep in pediatric pain populations. J Dev Behav Pediatr. 2013;34:120–128.
  41. Groenewald CB, Essner BS, Wright D, et al. The economic costs of chronic pain among a cohort of treatment-seeking adolescents in the United States. J Pain. 2014;15:925–933.
  42. Stahlschmidt L, Zernikow B, Wager J. Specialized Rehabilitation Programs for children and adolescents with severe disabling chronic pain: indications, treatment and outcomes. Children. 2016;3:33.
  43. Ruhe A, Frosch M, Wager J, et al. Health care utilization and cost in children and adolescents with chronic pain: analysis of health care claims data one year before and after intensive interdisciplinary pain treatment. Clin J Pain. 2017;33:767–776.
  44. Hoftun GB, Romundstad PR, Zwart JA, et al. Chronic idiopathic pain in adolescence-high prevalence and disability: the young HUNT study 2008. Pain. 2011;152:2259–2266.
  45. Lewandowski AS, Palermo TM, Kirchner HL, et al. Comparing diary and retrospective reports of pain and activity restriction in children and adolescents with chronic pain conditions. Clin J Pain. 2009;25:299–306.
  46. Ministerium für Kinder Famile Flüchtlinge und Integration des Landes Nordrhein-Westfalen (MKFFI NRW). Kommentierte Zuwanderungs- und Integrationsstatistik Nordrhein-Westfalen. Düsseldorf: MKFFI NRW; 2017.

MeSH Term

Adolescent
Child
Chronic Pain
Cross-Sectional Studies
Female
Germany
Humans
Male
Prevalence
Schools
Students
Surveys and Questionnaires
Journal Article Observational Study Research Support, Non-U.S. Gov't
Article has an altmetric score of 23

Word Cloud

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