ABSTRACT Data are equivocal on the consequences of COVID-19 pandemic on pain and well-being for individuals with chronic pain. Furthermore, little is known regarding its impact on the health of young adults with chronic pain. We conducted a longitudinal study to compare pain, psychological functioning, and substance use before and during the pandemic of 196 young adults with chronic pain. Participants aged 18 to 24 years (M = 21.1 years; 79.6% females) reported on pain, anxiety, depression, and substance use before (October 2018-August 2019) and during the pandemic (October 2020-November 2020), in addition to the assessment of COVID-19 exposure and its impact. Before the pandemic, young adults experienced mild-to-moderate pain intensity (M = 3.75, SD = 2.33) and pain interference (M = 3.44, SD = 2.69). Findings were that pain intensity, pain interference, and depression symptoms remained stable during the pandemic. In contrast, anxiety symptoms increased significantly (M = 8.21, SD = 5.84 vs M = 8.89, SD = 5.95, P = 0.04). Tobacco, alcohol, and cannabis use were unchanged. Mixed linear models revealed that COVID-19 exposure and impact were not associated with changes in pain intensity or interference, with female sex associated with increased pain intensity (β = 0.86, P = 0.02) and pain interference (β = 0.87, P = 0.02). Our findings indicated relative stability of pain symptoms experienced by young adults with chronic pain. However, the increases in anxiety highlight the need to facilitate treatment access for mental health services to mitigate downstream impact.

Children with chronic pain commonly report comorbid sleep deficiency. However, research has been limited in pediatric chronic abdominal pain (CAP) populations. This study sought to characterize the etiology of sleep deficiency in adolescents with CAP and examine the associations between sleep and functioning. The sample included 21 adolescents 14 to 18 years old with CAP (female=85.7%, mean age=16.5 years). CAP is defined by abdominal pain present for two or more months, experienced at least four times per month, and not explained by another condition. Self-reported sleep measures provided information on insomnia symptoms and disability. Adolescents also wore an actigraph for 7 days. The average pain intensity was 5.33 (SD=2.0), and reported disability of 37.8 (SD=17.0), comparable to adolescents with other pain conditions e.g. chronic headaches. Moderately severe insomnia symptoms were reported by 33.4% of adolescents, with night time sleep duration of 7 hours 17 minutes (SD=52 min), with efficiency of 87.3% (SD=5.4%) and wake time after sleep onset of 67 minutes (SD=39 min). We found that greater insomnia symptoms (r=.571, p=0.007), poorer sleep quality (r=-.593, p=0.005) and shorter sleep duration (r=-.464, p=0.03) were associated with greater disability. Regression analyses revealed that more severe insomnia symptoms (t=2.455, p=0.025) and higher pain intensity (t=2.492, p=0.023) were associated with greater pain related disability (F2,18=8.946, p=0.002). Moreover, shorter sleep duration (t=-2.473, p=0.02) and higher pain intensity (t=3.20, p=0.005) were associated with greater disability (F2,18=9.012, p=0.002). Findings highlight that comorbid insomnia symptoms and shorter sleep duration were associated with greater disability in adolescents with CAP, supporting the importance of targeting sleep as core interventions in treatment.

Intensive interdisciplinary pain rehabilitation programs (IIPRP) are typically recommended for youth with chronic pain conditions who do not respond to outpatient pain clinic treatment. A growing body of literature has shown that IIPRP are associated with improvements in functioning, pain, and distress. However, little is known about treatment mechanisms for IIPRP. A few studies have documented improvements in physical functioning within IIPRP, but how these improvements contribute to other areas of functioning remains unexplored. Existing conceptual models (fear-avoidance model of chronic pain, self-efficacy model) suggest that pain-related anxiety and self-efficacy may be important treatment mechanisms for youth undergoing IIPRP. For this study, we hypothesized that improvements in physical functioning (measured via objective measures of gait speed and core and upper strength) would be associated with changes in self-report measures of pain-related anxiety and self-efficacy. For this preliminary analysis, 10 participants, ages 10-16, completed measures prior to and upon completion of an IIPRP where they received physical and occupational therapy, pain psychology, and medical services for 1-3 weeks. Measures included the Fear of Pain Questionnaire, Self-Efficacy Scale, 100-Foot Walk, and the Sit-Up and Push-Up subtests of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition. Regression analyses produced standardized residuals for change scores. Preliminary results indicate improvements in gait speed and core strength were related to improvements in fear of pain (rs > 0.60, ps< 0.05). Similar associations were not found for improvements upper body strength or self-efficacy. This study provides preliminary data to suggest improvements in objective measures of physical functioning are related to improvements in self-reported pain-anxiety but not self-efficacy within a pediatric IIPRP. Recruitment for this study is ongoing. Our long-term goal is to investigate mechanisms of change within IIPRP in order to assist in tailoring treatment to maximize efficacy. Intensive interdisciplinary pain rehabilitation programs (IIPRP) are typically recommended for youth with chronic pain conditions who do not respond to outpatient pain clinic treatment. A growing body of literature has shown that IIPRP are associated with improvements in functioning, pain, and distress. However, little is known about treatment mechanisms for IIPRP. A few studies have documented improvements in physical functioning within IIPRP, but how these improvements contribute to other areas of functioning remains unexplored. Existing conceptual models (fear-avoidance model of chronic pain, self-efficacy model) suggest that pain-related anxiety and self-efficacy may be important treatment mechanisms for youth undergoing IIPRP. For this study, we hypothesized that improvements in physical functioning (measured via objective measures of gait speed and core and upper strength) would be associated with changes in self-report measures of pain-related anxiety and self-efficacy. For this preliminary analysis, 10 participants, ages 10-16, completed measures prior to and upon completion of an IIPRP where they received physical and occupational therapy, pain psychology, and medical services for 1-3 weeks. Measures included the Fear of Pain Questionnaire, Self-Efficacy Scale, 100-Foot Walk, and the Sit-Up and Push-Up subtests of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd Edition. Regression analyses produced standardized residuals for change scores. Preliminary results indicate improvements in gait speed and core strength were related to improvements in fear of pain (rs > 0.60, ps< 0.05). Similar associations were not found for improvements upper body strength or self-efficacy. This study provides preliminary data to suggest improvements in objective measures of physical functioning are related to improvements in self-reported pain-anxiety but not self-efficacy within a pediatric IIPRP. Recruitment for this study is ongoing. Our long-term goal is to investigate mechanisms of change within IIPRP in order to assist in tailoring treatment to maximize efficacy.

Chronic musculoskeletal pain is common in adolescents and young adults, and is associated with physical limitations and poor psychosocial functioning. Prevalence of smoking is highest in this age group, highlighting the importance of interrelations between chronic pain and potentially modifiable health-risk behaviors like smoking. We conducted a secondary data analysis from a large twin cohort to determine if genetics and shared environmental factors affect the association between smoking and chronic musculoskeletal pain. Participants were monozygotic and same-sex dizygotic twins (834 pairs) ages 18-30 years (M=23.2,SD=3.1) who completed measures of current smoking, chronic musculoskeletal pain history, perceived stress, and depression. Generalized estimating equation regressions accounting for clustering of twin pairs were used to model the association between smoking and chronic pain. A history of chronic musculoskeletal pain was reported by 10.7% of participants. These participants also reported higher current pain intensity (p<.001) and higher prevalence of current smoking (p<.001). Current smoking was significantly associated with chronic musculoskeletal pain history after adjusting for age, sex, education, depression, and perceived stress (OR 1.97, 1.35-2.87, p<.01). Specifically, individual twins who smoked had two-fold greater odds of chronic musculoskeletal pain than those who did not smoke. Within-pair analyses that adjust for potential confounding due to genetics and shared environmental factors were conducted using only monozygotic twins (n = 607 pairs). The within-pair association between smoking and chronic musculoskeletal pain remained significant (OR 1.98, 1.20-3.28, p<.01) for the monozygotic sub-sample suggesting that familial factors do not confound this association. Rather, non-shared factors (e.g., attitudes, behaviors) and possibly the direct effects of smoking on pain perception may play a role. Longitudinal studies of these non-shared factors and recruitment of younger participants prior to smoking initiation and chronic pain onset will better identify causal associations.

Recurrent multiple-site pain is common among adolescents, with a prevalence of up to 50%. There has been limited description of the physical or psychosocial impact of multiple-site pain on adolescents; thus it is unknown whether having multiple-site pain has a different impact on youth than having pain at a single site. This study aimed to compare differences in quality of life in youth experiencing single-site or multiple-site pain, and examine the contribution of psychosocial factors. Adolescents, 12-18 years (n = 155, 70.3% female) recruited from community and clinical settings, completed questionnaires on pain, depression, and health-related quality of life. Approximately equal numbers of adolescents reported pain at a single site (n = 54), two sites (n = 55), and three or more sites (n = 46). MANOVA was used to test group differences on pain characteristics (intensity, frequency, and duration) and quality of life (Physical, Psychosocial, and Total subscales). Pain characteristics were similar across the three groups, F(6, 296) = 1.28, p = .266. The three groups differed on quality of life, F(4,294) = 3.97, p = 0.004. Univariate analyses indicated youth with three or more pain sites had lower Psychosocial and Total quality of life scores compared to youth with one or two pain sites (ps < 0.006). Regression analyses controlling for age, gender, body mass index (β = -.094, p = 0.097), and depressive symptoms (β = -.706, p < 0.001) indicated adolescents with three or more pain sites had poorer Total quality of life scores compared to adolescents with two or fewer pain sites (p = 0.05), but not Physical (p = 0.246) or Psychosocial (p = 0.086) subscales. These findings suggest that youth with multiple-site pain may be at risk for poor quality of life and may need more intensive intervention to enhance psychosocial function.