Abstract
BackgroundTo promote health-related quality of life (HRQOL) in adolescents with pain, it is important to study factors associated with pain. This study aimed to describe selected factors and pain in 14–15-year-old adolescents and their parents, to assess how these factors are associated with adolescent pain groups, and to explore whether the relationship between pain intensity and HRQOL in adolescents with persistent pain is mediated by self-esteem and self-efficacy.MethodsA cross-sectional study was performed among 508 dyads of adolescents (14–15 years) and parents in a school-based setting. Among these, 148 adolescents had persistent pain. We explored the following variables: HRQOL, pain, self-efficacy, self-esteem, sleep, loneliness, stress and sociodemographic variables. All variables were assessed with well-validated instruments. HRQOL was measured with KIDSCREEN-27. Analyses included Chi-square, ANOVA, Mann–Whitney U tests, Kruskal–Wallis and the PROCESS macro method for mediation analyses.ResultsAdolescents with pain reported significantly higher levels of stress, loneliness and lack of sleep and lower levels of self-efficacy, self-esteem and HRQOL compared to adolescents without pain. More girls than boys reported pain. Adolescents with persistent pain scored significantly worse on self-esteem, stress, loneliness, lack of sleep, school absence, pain and HRQOL compared to adolescents with shorter pain duration. Adolescent pain groups did not differ significantly considering parental factors. However, more adolescents with persistent pain reported that someone in their family had pain. The associations between pain intensity and the HRQOL subscales in adolescents with persistent pain were completely mediated by self-esteem, but not by self-efficacy. The highest degree of mediation was estimated for the HRQOL subscale school environment (indirect effect = 73.5%).ConclusionsOur findings highlight the complexity within adolescent pain, demonstrating that adolescents with pain differ from adolescents without pain when it comes to gender, school absence, factors within-person and between-persons. Longer pain duration makes adolescents more vulnerable. We confirm the importance of resilience factors for HRQOL but indicate that self-esteem is more important than self-efficacy. To promote HRQOL in adolescents with persistent pain, a strengthening of both their self-esteem and self-efficacy is recommended. We highlight the need for an individual, holistic approach to adolescent pain.
Highlights
Pain problems in adolescents have increased during the last 2 decades and is recognized as a substantial public health challenge in industrialized countries [1, 2]
We highlight the need for an individual, holistic approach to adolescent pain
We found that adolescents with pain differ from adolescents without pain when it comes to gender and school absence and factors within-person and between-persons
Summary
Pain problems in adolescents have increased during the last 2 decades and is recognized as a substantial public health challenge in industrialized countries [1, 2]. Negative consequences of adolescent pain include peer relationship problems, sleeping problems, avoidance of activities and sports, school absenteeism, an increased risk of recurrent pain in adulthood and a decreased health-related quality of life (HRQOL) [3,4,5,6,7,8,9]. Sociodemographic factors [e.g. age, gender, ethnicity, socioeconomic status (SES)] and factors within-person (e.g. stress, self-efficacy, self-esteem, sleeping problems) and between-persons (e.g. parents/family, loneliness, the school situation) contribute to and affect adolescent pain from both a resilience perspective and a risk perspective [2, 4, 8, 13,14,15,16,17,18,19,20,21,22]. This study aimed to describe selected factors and pain in 14–15-year-old adolescents and their parents, to assess how these factors are associated with adolescent pain groups, and to explore whether the relationship between pain intensity and HRQOL in adolescents with persistent pain is mediated by self-esteem and self-efficacy
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