New models of therapy in the treatment of chronic pain conditions such rheumatoid arthritis (RA) and fibromyalgia now target psychosocial function to improve the efficacy of therapeutic interventions in adolescents by reducing negative attitudes toward pain and strengthening engagement in physical and social activity.
Chronic pain syndromes have broadly negative effects on the quality of life in children and adolescents, having a significant impact on psychosocial status and impairing daily function. In recent years, studies in children and adolescents with chronic pain have indicated that they miss a significant number of school days, have greater problems with concentration, lower grades, and perceive their pain to have a negative impact on their grades and social experiences.1-3 They also frequently report sleep problems (53.6%), inability to pursue hobbies (53.3%), eating problems (51.1%), school absence (48.8%), and inability to meet friends (46.7%).2
How Children Cope with Pain
Children’s ability to cope with pain differs from adults and until recently was not studied separately. Anxiety appears to contribute significantly to the distress caused by chronic pain conditions in adolescents, with reported rates of 57.5%.1 A 2015 study by Cunningham, et al4 found that current anxiety in young adults with juvenile fibromyalgia was likely to produce significantly more impairment in physical function.4,5 Symptoms of fibromyalgia were still present in more than 80% of the adolescents at 6-year follow-up, at which time greater than 60% continued to report anxiety symptoms and nearly 27% reported mild-to-moderate depression.6
Catastrophizing involves both negative attitudes toward pain-related outcomes and the magnification and rumination on the pain itself.7 A 2006 review by Edwards et al 7 showed a significant impact from catastrophizing on perceptions of pain severity and sensitivity (measured by tender-point counts) that was associated with particularly high levels of emotional distress in patients with fibromyalgia.8-11 The review found that in patients with RA, high-catastrophizers also showed more attention to their pain in daily diaries than low-catastrophizers.12,13
High-Yield Data Summary
- Psychosocial impact therapies such as CBT are effective in the treatment of chronic pain conditions, including fibromyalgia; however, the addition of a neuromuscular training component significantly enhances adherence and efficacy.
The consequences of catastrophizing are that pain signals traveling within the central nervous system (CNS) appear to be magnified over time, although the mechanisms of this are not well understood.7 Expressions of catastrophizing also appear to have a negative impact on social function as the person seeks sympathy from others who reflect pain back and are likely to perceive catastrophizers as less able to cope with pain.14-17
Impact of Family Environment on Catastrophizing
A study by Sil et al18 investigated the separate impacts of a negative home environment and highly controlled, protective environment on long-term outcomes in juvenile fibromyalgia. The researchers found that adolescents with fibromyalgia who came from homes with a high degree of family conflict were no more likely than healthy adolescents to show distress, and that this had little effect on the outcomes of their chronic pain syndrome. Of more importance, adolescents with fibromyalgia whose parents showed a high degree of concern and protective parenting had higher levels of both disability and depression associated with their pain, which was consistent with results from earlier studies.19,20