Scaini Simona, Michelini Giorgia, De Francesco Stefano, Fagnani Corrado, Medda Emanuela, Stazi Maria Antonietta, Battaglia Marco
Child and Youth Lab, Sigmund Freud University, Milan, Italy.
Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States.
Pain. 2022 Mar 1;163(3):e488-e494. doi: 10.1097/j.pain.0000000000002400.
Data on the etiological factors underlying the co-occurrence of common adolescent pain with anxiety and depression symptoms are very limited. Opioid prescriptions for adolescent pain problems are on the rise in North America and constitute a risk factor for diversion, misuse, and substance use. In this study, we aimed to investigate the phenotypic and etiological association among pain, depression, and anxiety and to test their link to substance use in adolescents. By taking advantage of the Italian National Twin Registry and of the relatively low incidence of opioid prescriptions in Italy, we applied multivariate modelling analyses to 748 Italian adolescent twins (374 pairs, mean age 16 ± 1.24 years). Twins' responses to the Achenbach Youth Self-Report questionnaire were used to build a composite adolescent pain index and to measure anxiety, depression, and substance use. All monozygotic within-pair correlations were higher than the dizygotic correlations, indicating genetic influences for adolescent pain, anxiety, and depressive problems. A common latent liability factor influenced by genetic and environmental elements shared among pain, depression, and anxiety provided the best fit to explain the co-occurrence of adolescent pain, anxiety, and depression problems. A common phenotypic factor capturing all 3 phenotypes was positively associated (β = 0.19, P < 0.001, confidence interval: 0.10-0.27) with substance use. These findings indicate that several intertwined mechanisms, including genetic factors, can explain a shared liability to common adolescent pain, anxiety, and depression problems. Their association with substance use remains traceable even in societies with relatively low prevalence of opioid prescriptions.
关于青少年常见疼痛与焦虑和抑郁症状同时出现的潜在病因的数据非常有限。在北美，用于青少年疼痛问题的阿片类药物处方正在增加，这构成了药物转移、滥用和物质使用的一个风险因素。在本研究中，我们旨在调查疼痛、抑郁和焦虑之间的表型和病因关联，并测试它们与青少年物质使用的联系。利用意大利国家双胞胎登记处以及意大利阿片类药物处方相对较低的发病率，我们对748名意大利青少年双胞胎（374对，平均年龄16±1.24岁）进行了多变量建模分析。双胞胎对阿chenbach青少年自我报告问卷的回答被用于构建一个综合青少年疼痛指数，并测量焦虑、抑郁和物质使用情况。所有同卵双胞胎对内的相关性均高于异卵双胞胎的相关性，表明遗传因素对青少年疼痛、焦虑和抑郁问题有影响。一个受疼痛、抑郁和焦虑之间共享的遗传和环境因素影响的共同潜在易感性因素最能解释青少年疼痛、焦虑和抑郁问题的同时出现。一个涵盖所有三种表型的共同表型因素与物质使用呈正相关（β = 0.19，P < 0.001，置信区间：0.10 - 0.27）。这些发现表明，包括遗传因素在内的几种相互交织的机制可以解释青少年常见疼痛、焦虑和抑郁问题的共同易感性。即使在阿片类药物处方患病率相对较低的社会中，它们与物质使用的关联仍然可以追溯。
