Longitudinal Associations Among Pain Catastrophizing, Pain Interference, and Pain Medication Use in Adolescents With...

Cross-sectional studies have reported associations between pain catastrophizing and pain medication use in youth with chronic pain; however, the factors underlying this association remain unclear. Guided by the paediatric Fear-Avoidance model, this cohort study examined whether pain interference played a role in the longitudinal association between pain catastrophizing and subsequent pain medication use.

Participants were drawn from the EPIDOL project and included 180 adolescents (mean age = 13.56 years; 78% female) with chronic pain at both first assessment (T1) and 12-month follow-up (T2). Self-report measures assessed demographics (birth sex and age), pain characteristics (location, extent, and intensity), pain interference, pain catastrophizing, and pain medication use. Generalized structural equation models tested theory-guided autoregressive and cross-lagged panel specifications. Models adjusted for age, birth sex, and pain intensity and accounted for temporal stability.

Pain catastrophizing and pain medication use showed moderate to high temporal stability. No significant association was observed between pain catastrophizing at T1 and pain medication use at T2. In contrast, pain interference at T1 was significantly associated with pain medication use at T2, even when controlling for pain catastrophizing at T1. Findings were consistent across model specifications.

The findings suggest that pain interference may represent a functional factor prospectively associated with subsequent pain medication use. Future research should examine its potential role in linking pain catastrophizing and pain medication use when such associations are observed. Overall, the results support assessing both cognitive and functional dimensions when evaluating pain-related management patterns in youth with chronic pain.

This longitudinal study found that the association between pain catastrophizing and pain medication use inadolescents with chronic pain was accounted for indirectly by pain interference. These findings highlight theimportance of addressing both functional interference and pain-related cognitions in paediatric pain management.