Background/Purpose: Pain intensity has been shown to be important in understanding pain related functional disability in adolescents.  Additional factors may affect other critical outcomes including functional disability and quality of life.  Findings from adult-based studies indicate that contextual factors (e.g. demographics and other patient centered characteristics) may contribute to functional disability beyond that of pain intensity but are less documented in pediatric populations. The purpose of this study was to describe pain distribution and characteristics in adolescents with chronic pain and to explore predictors of functional disability.

Methods: Data were collected from electronic medical records review in a consecutive series of 314 new pediatric pain patients in an academic pain clinic. Available variables included demographics, pain intensity, location, history and frequency, child optimism, anxiety and depression, and the Children’s Activity Limitations Interview (CALI) a 21-item measure designed to assess pain-related activity limitations and is a proxy for functional disability in children and adolescents.

Results: The mean (±SD) age at presentation was 15.9±3.27. Participants reported high levels of pain with a typical pain intensity of 5.82 ± 1.98 and worst pain intensity of 8.95 ± 1.33. 42.3% of participants reported experiencing pain in three or greater locations. The most commonly reported pain location included the head (28.5%), abdomen (23.4%), leg (13.6%) and lower back (11.2%) with 78.5% of participants reported experiencing pain at least daily within the last month. 87.6% of participants reported difficulty sleeping related to their pain. The CALI sum scores had a mean of 43.86 ± 17.89. Child/adolescent perception of their ability to cope or deal with their pain was a mean of 4.86. Regression analysis conducted with CALI as independent variable. Stage 1, pain characteristics, contributed significantly to the model and accounted for 18.3% of variance in functional disability. Stage 2, psychological function, explained an additional 10% of variation in functional disability. Stage 3, physical variables, accounted for an additional 3.2% of variance. Stage 4, sleep problems, explained an additional 1.5% of the variance in functional disability. Significant predictors of functional disability included “worst” pain intensity levels, depressive symptoms, physical activity and sleep problems.  Together, all independent variables accounted for 32.8% of the variance in functional disability.

Conclusion: In line with previous research, pain characteristics were found to be a significant predictor of functional disability.  Novel factors (depressive symptoms, engagement in physical activity and sleep problems) also significantly predicted functional disability after controlling for pain characteristics. Understanding a more comprehensive set of variables that contribute to adolescents’ functional disability is an important step in tailoring interventions in adolescents with chronic pain.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/functional-disability-in-adolescents-is-predicted-by-self-report-of-sleep-problems-depressive-symptoms-low-physical-activity-and-worst-pain-intensity-levels/