Sex Differences in Pain-Related Central Nervous System-Mediated Symptom Clusters in Children with Multisite Pain

Pain in children is often accompanied by symptoms of negative affect, cognitive problems, and sleep disturbances. Although female preponderance in pain prevalence emerges around age 12 and persists across the lifespan, the pattern of sex differences in pediatric symptom comorbidities is unclear. The present study investigates sex differences in children with multisite pain using data from the Adolescent Brain Cognitive Development study. 1,254 participants, aged 11-12, were classified by their number of self-reported painful regions: multisite pain (3+), regional pain (1-2), and no pain (0). Participants were matched on pubertal status, race/ethnicity, and handedness. Multinomial logistic regression was used to assess associations between symptom domains and pain separately for boys and girls to examine sex-stratified patterns. Greater internalizing, externalizing, and attention problems were associated with multisite pain in both boys and girls (all p<0.001). However, in girls only, excessive somnolence (OR:1.10; 95%CI:1.02-1.19), sleep-wake transition disorders (OR:1.12; 95%CI:1.02-1.22), disorders of initiating and maintaining sleep (OR:1.10; 95%CI:1.05-1.16), and total sleep disturbances (OR:1.05; 95%CI:1.03-1.08) were associated with multisite pain; the latter two statistically differed from boys. These results suggest that there are sex-specific behavioral processes underlying multisite pain in children, with sleep problems potentially being key to the pathogenesis of multisite pain in girls. Funded by the National Institute of Nursing Research, NIH (R01NR020013).