Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, United States.
Pain. 2020 Sep;161 Suppl 1(Suppl):S114-S121. doi: 10.1097/j.pain.0000000000001862.
Pain conditions in childhood often continue into adulthood. Childhood chronic pain is related to a range of vulnerabilities that may have contributed to the onset of childhood pain or that may co-occur as a consequence of childhood pain. These vulnerabilities have been shown to maintain pain and disability during childhood but may also contribute to long-term developmental and health impairments that affect adult life. If progress is to be made in reducing the impact of pain and disability through the lifespan, greater efforts need to be directed toward understanding why, for whom, and how pain occurring in childhood affects subsequent adult pain and health. In this review, a developmental framework is applied to link childhood pain to adult pain highlighting childhood vulnerabilities (emotional, health behavior, social/family, and neurobiological) that may represent pathways for interventions in childhood to interrupt this trajectory. Psychological interventions can play a key role in addressing childhood pain and vulnerabilities associated with risk for maladaptive adult outcomes. The review summarizes the evidence base for the effectiveness of psychological interventions for childhood chronic pain and identifies gaps and opportunities to further develop and test early targeted interventions in childhood to reduce childhood chronic pain as well as build resiliency to promote positive adult outcomes. A future research agenda is delineated including the need for longitudinal cohort studies from childhood into adulthood and testing of both targeted early intervention to reduce risk and build resiliency to enhance long-term adult pain, health, developmental, and social outcomes.
儿童时期的疼痛状况常常会持续到成年期。儿童期慢性疼痛与一系列易感性有关，这些易感性可能导致儿童期疼痛的发生，也可能是儿童期疼痛的后果。这些易感性已被证明在儿童期维持疼痛和残疾，但也可能导致长期的发育和健康损害，影响成年生活。如果要通过整个生命周期减轻疼痛和残疾的影响，就需要加大努力，了解为什么、对谁以及儿童时期的疼痛如何影响随后的成人疼痛和健康。在这篇综述中，应用发展框架将儿童时期的疼痛与成人疼痛联系起来，强调可能代表干预途径的儿童时期的脆弱性（情感、健康行为、社会/家庭和神经生物学），以中断这一轨迹。心理干预可以在解决儿童时期的疼痛和与适应不良的成人结果相关的脆弱性方面发挥关键作用。该综述总结了心理干预治疗儿童慢性疼痛的有效性证据，并确定了差距和机会，以进一步开发和测试儿童时期的早期针对性干预措施，以减轻儿童慢性疼痛，并增强适应能力，促进积极的成人结果。概述了未来的研究议程，包括从儿童期到成年期进行纵向队列研究的必要性，以及测试针对风险的早期干预措施以减轻风险和增强适应能力，从而改善长期成人疼痛、健康、发育和社会结果的必要性。
