Murphy Lexa K, Rights Jason D, Ricciuto Amanda, Church Peter C, Ahola Kohut Sara
Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.
Department of Psychology, University of British Columbia, Vancouver, BC, United States.
Front Pediatr. 2020 Sep 8;8:559. doi: 10.3389/fped.2020.00559. eCollection 2020.
There is growing consensus that pain in pediatric inflammatory bowel disease (IBD) is not fully explained by disease-related processes. However, previous studies have largely measured individual biological, psychological, or social risk factors for pain in isolation. Further, not all youth with IBD presenting to clinic will report presence of pain, and those who do vary in their reports of pain intensity. This study therefore extends prior research by determining biopsychosocial correlates of both presence and intensity of pain in adolescents with IBD, in order to inform targeted pain management intervention approaches. Adolescents with IBD followed at SickKids, Toronto, and their parents were consecutively enrolled from outpatient clinic. IBD characteristics (diagnosis, time since diagnosis, patient-reported disease activity) were collected. Adolescents reported on current pain (NRS-10), internalizing symptoms (Strengths and Difficulties Questionnaire), and pain catastrophizing (Pain Catastrophizing Scale-Child). Parents reported on protective responses to child pain (Adult Responses to Child Pain) and pain catastrophizing (Pain Catastrophizing Scale-Child). Hurdle models were conducted to examine predictors of presence and intensity of pain in the same model. Biological (patient-reported disease activity, IBD diagnosis subtype, illness duration), psychological (internalizing symptoms, pain catastrophizing), and social (parent pain catastrophizing, parent protective responses) factors were entered as predictors, adjusting for age and sex. Participants included 100 adolescents (12-18; = 15 years) with IBD (60% Crohn's Disease, 40% Ulcerative Colitis or IBD-unclassified) and 76 parents. The majority of the sample was in clinical remission or reported minimal symptoms. Half of participants reported no current pain; for those reporting pain, intensity ranged 1-7 ( = 3.43, SD = 1.98). Disease activity (OR = 53.91, < 0.001) and adolescent internalizing symptoms (OR = 7.62, = 0.03) were significant predictors of presence of pain. Disease activity (RR = 1.37, = 0.03) and parent protective responses (RR = 1.45, = 0.02) were significant predictors of intensity of pain. Results suggest that the experience of pain in pediatric IBD is biopsychosocially determined. Patient-reported disease activity and internalizing symptoms predicted presence of pain, while disease activity and parent protective responses predicted intensity of pain. While medical intervention in pediatric IBD is focused on disease management, results suggest that depression/anxiety symptoms as well as parent protective responses may be important targets of pain management interventions in pediatric IBD.
越来越多的共识认为，儿童炎症性肠病（IBD）中的疼痛不能完全用与疾病相关的过程来解释。然而，先前的研究大多孤立地测量了疼痛的个体生物学、心理或社会风险因素。此外，并非所有到诊所就诊的IBD青少年都会报告疼痛的存在，而且报告疼痛强度的青少年也各不相同。因此，本研究通过确定IBD青少年疼痛存在和强度的生物心理社会相关因素，扩展了先前的研究，以便为有针对性的疼痛管理干预方法提供信息。在多伦多病童医院接受随访的IBD青少年及其父母从门诊连续招募。收集了IBD特征（诊断、诊断后的时间、患者报告的疾病活动度）。青少年报告了当前的疼痛（数字评定量表-10）、内化症状（长处与困难问卷）和疼痛灾难化（儿童疼痛灾难化量表）。父母报告了对孩子疼痛的保护性反应（成人对儿童疼痛的反应）和疼痛灾难化（儿童疼痛灾难化量表）。进行了障碍模型分析，以在同一模型中检验疼痛存在和强度的预测因素。将生物学因素（患者报告的疾病活动度、IBD诊断亚型、病程）、心理因素（内化症状、疼痛灾难化）和社会因素（父母疼痛灾难化、父母保护性反应）作为预测因素，并对年龄和性别进行了调整。参与者包括100名IBD青少年（12 - 18岁；平均年龄 = 15岁）（60%为克罗恩病，40%为溃疡性结肠炎或未分类的IBD）和76名父母。大多数样本处于临床缓解期或报告症状轻微。一半的参与者报告目前没有疼痛；对于报告疼痛的人，疼痛强度范围为1 - 7（平均 = 3.43，标准差 = 1.98）。疾病活动度（比值比 = 53.91，P < 0.001）和青少年内化症状（比值比 = 7.62，P = 0.03）是疼痛存在的显著预测因素。疾病活动度（相对危险度 = 1.37，P = 0.03）和父母保护性反应（相对危险度 = 1.45，P = 0.02）是疼痛强度的显著预测因素。结果表明，儿童IBD中的疼痛体验是由生物心理社会因素决定的。患者报告的疾病活动度和内化症状预测了疼痛的存在，而疾病活动度和父母保护性反应预测了疼痛的强度。虽然儿童IBD的医学干预侧重于疾病管理，但结果表明，抑郁/焦虑症状以及父母保护性反应可能是儿童IBD疼痛管理干预的重要目标。
