Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Harvard Medical School.
Department of Psychiatry, Harvard Medical School, Boston, MA.
Clin J Pain. 2021 Jun 1;37(6):404-412. doi: 10.1097/AJP.0000000000000939.
The objective of this study was to compare children and adolescents with overlapping chronic pains (OCP) to those with single chronic pains (SCP) among youth presenting in specialized clinical settings, in an effort to identify potential risk factors for developing overlapping pains.
A total of 1235 youth ages 8 to 18 seen in a tertiary care multidisciplinary pain clinic or a multidisciplinary headache clinic completed self-report measures of pain, disability, psychological functioning and clinical history and characteristics at the time of initial clinic visit. Information was captured in a chronic pain data repository and accessed for the current study.
Subsequent pain symptoms developed on average 11.9 months (SD=24.5 mo) after onset of the first pain symptom. Compared with patients with SCP, patients with OCP report more medical comorbidity, more developmental issues, and poorer current sleep and school functioning. They also scored significantly higher than patients with SCP on self-reported functional disability, pain catastrophizing, fear of pain, depression, anxiety, and psychological stress and lower quality of life (all Ps<0.001). In multivariate analysis, variables most strongly associated with presenting with OCP were age (odds ratio [OR]: 1.1, P<0.001), having a clinically significant high functional disability (OR: 1.4, P=0.3), and low quality of life (OR: 2.5, P<0.001).
Given their tendency toward more psychological and medical comorbidities, patients with OCP may require more intense and diverse treatment approaches. Some early life experiences may be a risk factor for development of OCP. Longitudinal studies are needed to fully evaluate the heightened risk for OCP associated with some of these factors.
本研究旨在比较就诊于专科临床科室的同时患有多种慢性疼痛（OCP）和单一慢性疼痛（SCP）的儿童和青少年，以确定发展为重叠性疼痛的潜在风险因素。
共有 1235 名 8 至 18 岁的青少年在一家三级保健多学科疼痛诊所或多学科头痛诊所就诊，他们在首次就诊时完成了疼痛、残疾、心理功能以及临床病史和特征的自我报告测量。信息在慢性疼痛数据存储库中捕获，并可用于当前的研究。
后续疼痛症状平均在首次疼痛症状出现后 11.9 个月（SD=24.5mo）后发展。与 SCP 患者相比，OCP 患者报告了更多的合并症、更多的发育问题以及更差的当前睡眠和学校功能。他们在自我报告的功能残疾、疼痛灾难化、疼痛恐惧、抑郁、焦虑和心理压力以及生活质量方面的评分也显著高于 SCP 患者（均 P<0.001）。在多变量分析中，与出现 OCP 最相关的变量是年龄（比值比[OR]：1.1，P<0.001）、存在临床显著的高功能残疾（OR：1.4，P=0.3）和生活质量低（OR：2.5，P<0.001）。
鉴于他们存在更多心理和医疗合并症的倾向，OCP 患者可能需要更强烈和多样化的治疗方法。一些早期的生活经历可能是发生 OCP 的风险因素。需要进行纵向研究，以充分评估与其中一些因素相关的 OCP 发生风险增加。
