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Stress-system activation in children with chronic pain: A focus for clinical intervention

Peter M McInnis1, Taylor A Braund2,3,4, Zhi Kai Chua1

  • 1Department of Psychological Medicine, The Children's Hospital at Westmead, Australia.

Clinical Child Psychology and Psychiatry
|August 1, 2019
PubMed

Insights

Children and adolescents with chronic pain exhibit heightened early-life stress, psychological distress, and stress system activation, including autonomic and immune markers. These findings highlight the need for integrated mind-body interventions addressing both psychological and physiological factors.

Area of Science:

  • Psychoneuroimmunology
  • Pediatric Pain Research
  • Stress Physiology

Background:

  • Psychological and neurophysiological processes are increasingly recognized for their role in activating the body's stress system and influencing functional somatic symptoms.
  • Chronic pain in children and adolescents is often associated with significant psychological distress and may involve complex interactions with the stress response system.

Purpose of the Study:

  • To investigate the relationship between childhood adversity, psychological distress, and physiological stress-system activation in children and adolescents with chronic pain.
  • To compare these factors in a cohort of children with chronic pain against healthy controls.

Main Methods:

  • Utilized the Early Life Stress Questionnaire and Depression Anxiety Stress Scales to assess psychological factors.
  • Measured biological markers including heart rate, heart rate variability, skin conductance, C-reactive protein (CRP) titre, and respiratory rate.
  • Included an emotion-face identification task to assess cognitive processing, alongside comparisons with age- and sex-matched healthy controls.

Main Results:

  • Patients with chronic pain reported significantly higher levels of early-life stress and psychological distress compared to controls.
  • Demonstrated evidence of autonomic system activation in the patient group, including elevated heart rate, electrodermal activity, and reduced heart rate variability.
  • Observed an upward shift in C-reactive protein (CRP) titres, indicating immune-inflammatory system activation, with elevated CRP associated with increased heart rate.

Conclusions:

  • Children and adolescents with chronic pain exhibit a dysregulated stress system involving psychological, autonomic, and immune components.
  • Findings underscore the necessity of multidisciplinary, mind-body interventions for managing chronic pain in pediatric populations.
  • Interventions should concurrently address psychological distress, physical impairment, and stress system dysregulation for optimal outcomes.

Keywords:
Chronic paindisorders of adaptationfunctional somatic symptomsstress system

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