Anxiety and depression linked to chronic pain in children, finds JAMA study

Young people with chronic pain are three times more likely than their peers to also have clinical anxiety or depression, a new review has found.

Led by researchers at Macquarie University, the study suggests a third of children under the age of 18 who have chronic pain also meet the criteria for anxiety disorder, while one in eight meets the criteria for a depressive disorder.

The results are published in the latest edition of JAMA Paediatrics and comprise a metareview of 79 studies that covered nearly 23,000 children and youths under the age of 18, including more than 12,000 with chronic pain.

It included conditions where pain is the primary symptom, such as juvenile idiopathic arthritis and fibromyalgia, chronic diseases where pain is a secondary symptom, such as Crohn’s disease and colitis, and cases where the pain has no known cause.

Lead author, Dr Joanne Dudeney, is a clinical psychologist and a Macquarie University Research Fellow in the School of Psychological Sciences.

“The findings indicate we risk doing young people a disservice if we’re not considering comorbid anxiety and depression when they’re presenting with chronic pain,” she says.

“Clinically, I was seeing a lot of young people with chronic pain who were also being diagnosed with anxiety and depression, but those comorbid psychological conditions weren’t showing up in the body of research on pain.

“The research mostly related to fear of pain, pain anxiety and pain catastrophisation, which centres on the concern that the pain will never get better.

“I thought there was a gap in our understanding, and these kids were presenting with general symptoms of anxiety and depression, but because these weren’t being considered in the research for managing chronic pain, they weren’t making it into clinical practice.”

Dr Dudeney says one key takeaway is the need for parents to be aware of the prevalence of anxiety and depression with chronic pain so they can advocate for their children to be assessed.

It is also vital for clinicians such as GPs, rheumatologists and pain practitioners to be aware of the link, with a view to establishing a more multidisciplinary approach that treats pain, anxiety and depression together, if needed.

“A simple way to put this into practice would be for pain practitioners to consider a short screening assessment for symptoms of anxiety and depression in young patients,” Dr Dudeney says.

“This is a vulnerable population, and if we’re not considering the mental health component, it’s likely we’re also not going to achieve the clinical improvements we want to see.”

She and her colleagues are currently developing an online program for adolescents with chronic pain to be delivered by Macquarie University’s eCentreClinic. It is similar to the adult pain course already on offer, which has been shown to be effective in reducing pain intensity and improving quality of life.

Reference:

Dudeney J, Aaron RV, Hathway T, et al. Anxiety and Depression in Youth With Chronic Pain: A Systematic Review and Meta-Analysis. JAMA Pediatr. Published online September 09, 2024. doi:10.1001/jamapediatrics.2024.3039