Investigating Depressive Symptoms, Stress, and Basal Cortisol Risk in Pediatric Chronic Pain Patients

Abstract

Up to 25% of youth experience chronic pain (pain >3 months). Despite this, mechanisms underlying pediatric chronic pain remain poorly understood. Psychological stress and associated cortisol dysregulation are factors known to influence pain chronicity. While depression has been identified as a catalyst for poorer long-term functioning in addition to being associated with increased cortisol response in youth, few studies have provided concrete evidence of these associations in youth with chronic pain. Accordingly, the current pilot study aimed to investigate basal cortisol, a mechanism of physiological stress, in relation to pediatric pain outcomes. Youth (N = 62; Mage=14.47 years) presenting to a chronic pain clinic appointment provided two saliva samples [(1) immediately upon awakening, (2) 30 minutes later] for cortisol assaying, and completed self report questionnaires of psychological (i.e., stress, anxiety, depression) and pain-related (i.e., pain intensity, functional disability) functioning. Depressive symptoms were significantly correlated with anxiety (r =.707, p <.001), stress (r = 0.786, p <.001), and functional disability (r =.395, p <.001). Participants with low basal cortisol risk relative to the rest of the sample (0, 1) tended to report higher typical pain levels (F (57) = 2.192, p =.033) but not depressive symptoms. Typical pain was significantly correlated with functional disability (r =.525, p <.001) but not depressive symptoms. This pilot investigation provides preliminary evidence for a potential indirect association between cortisol risk and psychological and physical outcomes in pediatric CP patients.