If you were to ask how many children are experiencing ongoing (chronic) pain on this day (or during a particular period of time) across the country, you would have determined the prevalence rate. That’s what this study does for pain in children and adolescents.
Understanding persistent, recurrent (chronic) pain in children and teens is important. Symptoms of this type can cause them to miss school, become withdrawn and/or depressed, and even develop more symptoms or problems.
If risk factors or causative factors can be identified, it might be possible to either prevent chronic pain from developing or stop acute pain from turning into chronic, lingering pain. And this information might help us better understand what causes chronic pain in adults. Does it begin earlier in childhood or adolescence?
Because of the difficulty of calling up every family in the nation to find out who is in pain and who isn’t, a systematic review was performed instead. A systematic review refers to a search (and analysis) of all published studies on this topic.
Using predetermined criteria for what would qualify as a high-quality, appropriate study, the researchers sorted through 185 published papers from around the world. They ended up with 41 that could be included. The difference in the number of studies available and the number included gives you some idea of how many studies don’t meet quality standards. That’s a problem in itself.
Looking at the studies that are available, here’s what they found. The first thing they noticed was the wide range of prevalence reported. For example, studies of headache in children showed a range from 23 to 51 per cent. That broad of a range was also reported for stomach pain, back pain, musculoskeletal pain, and pain from other sources (including multiple pains).
How do we explain these differences in prevalence? The first factor discussed was the studies themselves. Not every research study defines pain the same way so children may be included in one study in the chronic pain group where they might not be included in other studies. That’s what is called a design feature of studies that makes it difficult to compare one study to another.
What factors are linked with chronic pain? The data was analyzed to see if age, sex (male versus female), socioeconomic or psychosocial factors made a difference. In fact, they found that pain was more often reported in girls (in all countries) and in older children/teens. Children in families with lower socioeconomic circumstances were also more likely to report chronic pain. Headache pain was the top of the list for this group.
Let’s take a closer look at the data on headache. Tension headaches were reported much more often than migraines with an obvious increase starting in second grade. Children in families with low levels of education and children who attend daycare are more likely to develop headaches. There is a worldwide trend of increasing prevalence of headache over a long period of time. The reason(s) for this trend remain a mystery at the present time. Future research is needed to further explore this finding.
Abdominal pain studies involving a combined total of more than 27,500 children showed inconsistent patterns. In some studies, repeated stomach pain was reportedly higher in older age groups while some showed a trend toward more abdominal pain in younger children. Other studies found no relationship between age and recurrent abdominal pain.
Once again, girls were more likely to suffer chronic stomach or abdominal pain compared with boys. This was true for all age groups. Likewise, the role of socioeconomic and psychosocial factors in relation to stomach/abdominal pain varied from study to study with no clear pattern identified.
Back pain seems to have a more predictable pattern. Pain present at least once a week was observed in older children in rural areas with less difference between boys and girls than with headache and stomach pain. Anxiety and depression may have a role in back pain but social class did not appear to be related.
General musculoskeletal and/or limb pain studies of multiple pain were difficult to really analyze. There were just too many symptoms reported in each study. In this category, the role of sports participation was a key factor that wasn’t always present in the other pain areas. As with other bodily pain, general musculoskeletal pain increased with age and was more common in girls compared with boys.
Other discoveries from this systematic review on the prevalence of chronic, persistent, or recurring pain in children and teens included: lower quality of life and greater use of medications among the pain groups. Marital status of the children’s’ parents was only reported in one (Spanish) study but it did not appear to be a factor.
What was the final conclusion from this study? The authors say we should realize that persistent (chronic) pain in children and teens is a major health concern. Studies of health must shift focus to include children in this area and look for ways to reduce risks. Treatment to intervene as early as possible should be established and results studied to look for evidence-based success.
And finally, studies across the developmental life cycles (children to adults) may help reduce the numbers of adults who end up with chronic pain problems. Better designed, higher-quality studies are needed to make this research relevant and accurate. The authors also suggest that understanding why girls suffer more pain than boys across the years should be a focus of future studies as well.