Chronic non-cancer pain in adolescents: a narrative review

Social determinants of health and youth chronic pain

OBJECTIVES

To identify the relationships between social determinants of health (SDOH) and chronic pain among U.S. youth (referring to children and adolescents).

METHODS

Data including a national sample of U.S. youth were retrieved from the 2022 National Survey of Children's Health. Twenty indicators within five SDOH-related domains (e.i., economic stability, social and community context, neighborhood and built environment, health care access and quality, and education access and quality) were included. The presence of chronic pain was assessed using a self-reported question, answered by the main caregiver. Associations of SDOH-related indicators and youth chronic pain were estimated using multi-variable logistic regression models, while adjusting for covariates (e.g., age, sex, ethnicity, weight status, and movement behaviors).

RESULTS

Data from 30,287 U S. youth aged 6-17 years (median [SD] age, 11.59 [3.30] years; 14,582 girls [48.97 %]) were collected. In 7.5 % of the final sample size, caregivers reported that they had chronic pain. Youth grow up in conditions with diverse SDOH profiles, including food insufficiency (OR = 1.46, 95 % CI: 1.01 to 2.10) and parental unemployment (OR = 1.56, 95 % CI: 1.15 to 2.12); low school engagement (OR = 1.48, 95 % CI: 1.14 to 1.92) and low school safety (OR = 1.65, 95 % CI: 1.14 to 2.39); limited access to quality health care (OR = 2.56, 95 % CI: 2.12 to 3.09), a high frequency of hospital visits (OR = 4.76, 95 % CI: 1.82 to 12.44), and alternative health care (OR = 2.57, 95 % CI: 2.07 to 3.20); bullying victimization (OR = 1.37, 95 % CI: 1.11 to 1.68) and community-based adverse childhood experiences (OR = 1.64, 95 % CI: 1.32 to 2.05); and disadvantageous amenity characteristics (OR = 1.38, 95 % CI: 1.05 to 1.79); resulted in higher odds of presenting chronic pain.

CONCLUSIONS

Different indicators included in the SDOH domains were associated with a higher probability of presenting chronic pain in U.S youth. These findings have implied relationships between the SDOH and chronic pain in youth, requiring a comprehensive approach to addressing health equity to prevent and reduce the presence of youth chronic pain.

How Do We Treat Children with Anterior Cutaneous Nerve Entrapment Syndrome and Is the Biopsychosocial Model Also Being Applied? A Scoping Review

Background

Evidence-based guidelines for managing anterior cutaneous nerve entrapment syndrome (ACNES) in children are absent. The primary aim of this review was to scrutinize the evidence supporting currently used treatment interventions. In accordance with the World Health Organization (WHO) guidelines for managing chronic pain in children, these patients and their families and caregivers should be treated within the context of the biopsychosocial model; pain should not be treated purely as a biomedical problem. Therefore, our second aim was to evaluate whether these interventions are applied within the context of the biopsychosocial model, utilizing an inter- or multidisciplinary approach.

Materials and Methods

A scoping review of the literature was conducted to explore treatment strategies for ACNES in children. To ensure a comprehensive overview of published literature on this topic, the search was not restricted based on study type. Two reviewers independently assessed titles and abstracts. After excluding records unrelated to children, full texts were screened for inclusion. Any discrepancies in judgement were resolved through discussion with a third reviewer.

Results

Out of 35 relevant titles, 22 were included in this review. Only 4 articles provided information on long-term outcomes. The overall quality of the review was deemed low. The majority of reports did not address treatment or education within the psychological and social domains. A structural qualitative analysis was not feasible due to the substantial heterogeneity of the data.

Conclusion

The evidence supporting current treatment strategies in children with ACNES is of low quality. More research is needed to establish an evidence-based treatment algorithm for patients with this challenging pain problem. In line with the WHO recommendation, greater emphasis should be placed on a biopsychosocial approach. The ultimate goal should be the development of a generic treatment algorithm outlining an approach to ACNES applicable to all professionals involved.

Differences in chronic pain prevalence between men and women at mid-life: a systematic review protocol

INTRODUCTION

Epidemiological literature shows differences in chronic pain (CP) prevalence in men and women. Women are more likely to develop CP at different points of the life course, such as adolescence and old age. Less is known about the prevalence of CP by sex and the difference in prevalence during mid-life, when changes may predispose to an earlier differentiation in CP distribution. The aim of this study is to describe the difference in prevalence of CP at mid-life (ages 40-60) in men and women in the general population.

METHODS AND ANALYSIS

This systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Appropriate studies will be identified in the following databases: MEDLINE, EMBASE, AMED and PsycINFO. Two reviewers will independently screen each title and abstract. Studies eligible for data extraction will report estimates of CP prevalence for each sex, and/or a measure of the difference in prevalence between sexes. The findings will be reported in a narrative synthesis following the Social Research Council Methods Programme guidelines. A random effects meta-analysis will be conducted where the reviewers can justify combining results.

ETHICS AND DISSEMINATION

This review will summarise the prevalence of CP in men and women at mid-life, based on existing evidence. It is expected that the results will identify gaps in knowledge and areas for further research. The review will be submitted for publication in topic specific journals and disseminated to professional networks. Individual patient data are not included, so ethical approval is not required.

PROSPERO REGISTRATION NUMBER

CRD42021295895.

Lipid signatures of chronic pain in female adolescents with and without obesity

BACKGROUND

Chronic pain in adolescence is associated with diminished outcomes, lower socioeconomic status in later life, and decreased family well-being. Approximately one third of adolescents with chronic pain have obesity compared to the general population. In obesity, lipid signals regulate insulin sensitivity, satiety, and pain sensation. We determined whether there is a distinct lipid signature associated with chronic pain and its co-occurrence with obesity in adolescents.

METHODS

We performed global lipidomics in serum samples from female adolescents (N = 67, 13-17 years old) with no pain/healthy weight (Controls), chronic pain/healthy weight (Pain Non-obese), no pain/obesity (Obese), or chronic pain/obesity (Pain Obese).

RESULTS

The Pain Non-obese group had lipid profiles similar to the Obese and Pain Obese groups. The major difference in these lipids included decreased lysophosphatidylinositol (LPI), lysophosphatidylcholine (LPC), and lysophosphatidylethanolamine (LPE) in the three clinical groups compared to the Control group. Furthermore, ceramides and sphingomyelin were higher in the groups with obesity when compared to the groups with healthy weight, while plasmalogens were elevated in the Pain Obese group only.

CONCLUSIONS

Serum lipid markers are associated with chronic pain and suggest that specific lipid metabolites may be a signaling mechanism for inflammation associated with co-occurring chronic pain and obesity.