Researchers explore interplay between pain and anxiety

Disability from chronic pain in adolescents can be exacerbated by high levels of anxiety, according to research reported The Journal of Pain, the peer review publication of the American Pain Society.

Although pain severity and duration is a reliable predictor of impaired function and quality of life, some research suggests that psychological variables can influence disability beyond the pain itself. Anxiety and depression have been identified in many studies as factors that can worsen functional disability in adolescents with chronic pain.

Researchers from Georgia State University and the University of Bath (UK) explored the interplay between pain and anxiety and its potential negative influence on physical and social functioning. They hypothesized that for adolescents with high levels of anxiety, pain would not be the main cause of physical and social disability.

Two hundred twenty-two adolescents treated in British pain clinics and their parents participated in the study. The adolescents were assessed for pain intensity using the 10-cm visual analogue scale and, to measure anxiety, they completed the Spense Children's Anxiety Scale. Parents provided reports of their perceptions of their children's disability.

Results showed that for study subjects with high anxiety levels, pain severity was not related to functioning. Highly anxious adolescents, therefore, reported poor physical functioning, high school absences and frequent doctor's office visits. The authors explained that a reinforcing cycle of behaviors occurs in these adolescents in which anxiety drives avoidance of physical and social activities and further heightens anxiety.

Conversely, in study subjects with low anxiety, pain severity seemed to be the driving force of disability. The authors noted that in the absence of high anxiety, the levels of engagement or avoidance of physical and social activity in adolescents might be governed by pain severity levels.