番茄社区

ANAHEIM, Calif. -- Adverse events in childhood may strongly predict poorer school performance in kids with chronic pain, researchers reported here.

Among children and youth with a history of chronic pain, the vast majority reported having ever had an adverse experience in childhood (81.5%), according to Sarah Nelson, PhD, and Deirdre Logan, PhD, of Boston Children's Hospital and Harvard Medical School.

Factors linked with poorer school functioning -- including missing school due to not feeling well, missing school to get medical treatment, and having a difficult time paying attention in class and keeping up with school activities -- were all significantly higher among kids with chronic pain and a history of adverse childhood experiences (ACEs).

The study, which was presented at the American Pain Society's Scientific Summit, also found a trend toward a higher occurrence of forgetting things in school.

"Up until recently, little research has been performed looking at the incidence rates and associated impairment of ACEs in youth with chronic pain," Nelson told 番茄社区. "This disparity in research is particularly notable given the evidence found in adult populations that a history of ACEs is significantly associated with greater health-related impairment, including increased issues with pain."

She pointed to prior research by her team that identified higher incidence rates of ACES in youth with chronic pain tied to increased psychosocial impairment, including anxiety and depression. Prior to this analysis, "no research has been done examining the role that ACES may play in school impairment, despite the high incident rates of these issues in pediatric chronic pain," Nelson said.

A total of 141 young people between the ages of 9 and 19 with a history of chronic pain were included in the new analysis, the majority of whom were female. The types of ACEs included in the study were divorce or separation of parents; familial mental illness; a violent home environment; neglect; and physical, sexual, or emotional abuse. The most commonly reported problem was family mental illness, which was mentioned by 44.7% of participants.

In a post-hoc analysis, the researchers reported that kids with more adverse experiences, particularly three or more, had an even greater extent of school impairment across all outcomes -- a finding Nelson said was unsurprising and consistent with previous research.

These findings are an "important first step" and can be used to better identify certain risk factors for school impairment in kids, she said.

"As these studies are cross-sectional and without a control group, in the future I plan to solidify my findings by examining how they may develop or change over time in youth with chronic pain versus healthy controls. Additionally, given the high incidence rates of ACEs found in youth with pain, I am currently in the process of examining potential neuroendocrine mechanisms common to both phenomena that may be implicated in compounded pain-related and psychosocial impairment.

"Depending on what these studies find, I also plan to examine future intervention and prevention efforts in this context."

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