Decoding pain and mental health patterns in youth with chronic pain during COVID-19

The COVID-19 pandemic led to major disruptions in healthcare services, resulting in increased pain and co-occurring mental health issues among youth with chronic pain. However, heterogeneity in these symptoms has not been explored, overlooking the possibility of distinct subgroups. This study aimed to: (1) identify latent profiles of youth based on pain and mental health symptoms; and (2) examine whether sociodemographic and pandemic-related factors were associated with profile membership.

A cross-sectional study of 357 youth aged 8-18 years with chronic pain was conducted during the first three waves of the COVID-19 pandemic (August 2020-April 2021) in Canada. Data on pain, mental health (anxiety, depression, post-traumatic stress disorder, insomnia), and COVID-19 impact were collected using validated questionnaires, alongside self-reported age, sex, and ethnic identity. Latent profile analysis was used to identify unobserved subgroups based on pain and mental health symptoms, and the optimal model was selected based on statistical fit and clinical interpretability. Multinomial logistic regression examined associations between profile membership and covariates.

Five distinct subgroups of youth with chronic pain based on co-occurring mental health symptoms were found. The largest group (42.2%) reported sub-clinical mental health symptoms with the lowest pain, while 12.5% fell into a "sub-clinical mental health symptoms/high pain" group. About one-third (34.6%) were in a "moderate mental health symptoms/moderate pain" profile. Two smaller but clinically concerning groups emerged: "high mental health symptoms/high pain without clinical PTSD" (6.6%) and "high mental health symptoms/high pain" (4.1%). Multinomial logistic regression showed that older youth, female youth and higher perceived COVID-19 impact were associated with membership in nearly all elevated mental health symptom/pain profiles.

Youth with chronic pain showed heterogeneous experiences of mental health during the first three pandemic waves, shaped by sociodemographic and contextual factors. Findings underscore the need for person-centered approaches to pain management, particularly in periods of acute stress, that address both individual vulnerabilities and broader contextual stressors.