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The prevalence, trajectories and predictors of recurrent pain among adolescents : a population-based approach Stanford, Elizabeth Ann


Recurrent pains are a complex set of conditions that cause great discomfort and impairment to children, adolescents, and adults. The objectives of this study were to (a) determine the prevalence of headache, stomachache, and backache in a nationally representative adolescent sample and (b) evaluate a psychosocial model for the development of adolescent recurrent pain that included underlying vulnerability factors (i.e., gender, pubertal development and the presence of parent chronic pain), precipitating stimuli (i.e., illness, injury/hospitalization, and stressful life events), and psychological factors (i.e., anxiety/depression, and self-esteem). Statistics Canada's National Longitudinal Survey of Children and Youth, a large longitudinal population-level database, was used to assess a cohort of 2,488 10- to 11-year-old adolescents five times, every 2 years. Results showed that, across 12-19 years of age, weekly rates ranged from 26.2-31.8% for headache, 13.5-22.2% for stomachache, and 17.6-25.8% for backache. Across 12-19 years, 3.6-8.6% adolescents experienced multiple types of weekly recurrent pain. Chi-square tests indicated that girls had higher rates of pain than boys for all types of pain, at all time points. Structural equation modeling using latent growth curves considered psychosocial factors predictive of stable trajectories (i.e., predictors of both start- and end-point intercepts), as well as increasing recurrent pain trajectories over time (i.e., predictors of slopes). Gender and anxiety/depression were predictive of the start- and end-point intercepts and/or slopes for all three types of pain. Some factors were predictive of only certain pain types, for example parent headache was predictive of stable, high frequencies of headache, while fewer injuries and lower pubertal development were predictive of increasing frequencies of stomachache. Some factors were only predictive of certain trajectories types, for example low self-esteem was predictive of stable, high frequencies of recurrent pain, but not increasing frequencies of recurrent pain. Finally, many factors, such as parent chronic pain, illness/hospitalization, and stressful life events, were not found to be predictive in any analyses. The results of this study suggest that adolescent recurrent pain is very common and that psychosocial factors, such as gender and anxiety/depression, predict trajectories of recurrent pain across adolescence.

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