Anxiety and Functional Disability in a Large Sample of Children and Adolescents with Chronic Pain

Laura E Simons,Christine B Sieberg,Robyn Lewis Claar

doi:10.1155/2012/420676

Abstract

Anxiety is the most common psychiatric condition in children and adolescents, and is linked to significant disruptions across domains of function. Due to the avoidant nature of anxiety and pain-related disability, studying anxiety symptoms in children with chronic and recurrent pain conditions is important. To examine anxiety symptoms in a large cohort of children and adolescents evaluated for complex chronic and recurrent pain conditions. Through retrospective chart review, data on anxiety, pain and functional disability were collected from 655 children evaluated at a multidisciplinary pain clinic over a three-year period. Approximately 11% of children and adolescents reported clinically elevated anxiety symptoms, with elevated levels across dimensions of anxiety ranging from 14% (social anxiety, worry) to 27% (physiological). In addition, a notable 31% of the sample potentially minimized their anxiety by responding in a socially desirable manner. Anxiety was linearly associated with greater pain-related functional disability, but was not directly correlated with pain. Moderation analyses revealed that at low levels of worry, higher levels of pain were associated with greater functional disability, whereas at high levels of worry, pain no longer predicted the level of functional disability. These findings document the prevalence of anxiety in children and adolescents with chronic pain, and also extend recent studies examining the complex relationships among pain, anxiety and pain-related disability.

Highlights

BACkgRound: Anxiety is the most common psychiatric condition in children and adolescents, and is linked to significant disruptions across domains of function
Elevated levels of anxiety vary widely across pain conditions, with high rates found among children with noncardiac chest pain (56% to 81%) [3,4], abdominal pain (45%) [5] and fibromyalgia (58%) [6], while more moderate to low rates have been found among children with complex regional pain syndrome (20%) [7], unexplained pain (18%) [8] and headache (6%) [9]
Studies examining anxiety symptoms in tertiary care chronic pain clinics that serve a broad range of patients have found that overall these patients report higher levels of anxiety symptoms than nonclinical samples of children, but as a group, these patients do not report levels equivalent to youth with anxiety disorders [10,11]

Summary

Introduction

BACkgRound: Anxiety is the most common psychiatric condition in children and adolescents, and is linked to significant disruptions across domains of function. We hypothesized that children and adolescents with abdominal pain [20] and diffuse pain [6] would report higher levels of anxiety than patients with other chronic pain conditions.

Results

Conclusion