Long-term effect of pain history and experimental pain responses on adolescents' quality of life: a cohort study

Abstract

Introduction: Chronic pain conditions are the major cause of disability worldwide and interfere significantly with the quality of life of individuals from early ages. Little is known on whether adverse pain profiles in pediatric ages, including pain reports and somatosensory responses to painful stimuli, may also have a long-term effect on quality of life, particularly in non-clinical settings. We aimed to (1) assess the association between reported pain history (multisite and chronic musculoskeletal pain) and quality of life at age 18, and (2) Test whether experimental pain responses at age 13 years predict quality of life five years later. Methods: We used data from Generation XXI, a population-based birth cohort established in 2005/6, in Porto, Portugal. After recruitment at birth, the whole cohort was invited to attend follow-up evaluation waves, including at ages 13 (49% of participation) and 18 (13.4% of participation) years. The Luebeck pain questionnaire was used to collect data on pain history at age 13 and 18 years. We used as exposures multisite pain (two or more pain sites) and chronic musculoskeletal pain (principal pain in lower/mid back, neck/shoulders, upper and lower limbs, hips, unspecified musculoskeletal, or generalized pain lasting over 3 months). Additionally, a subsample underwent quantitative sensory testing using computerized cuff pressure algometry. To assess pressure pain sensitivity, pain detection (PDT) and tolerance thresholds (PTT) were collected. Participants also underwent 10 sequential PTT pressure stimuli, which they rated using a visual analogue scale (VAS) for intensity. Average scores for stimuli 1-4 (VAS-I) and 8-10 (VAS-II) were computed and temporal summation of pain effect was defined as VAS-II minus VAS-I. At age 18, due to COVID-19-related restrictions, a remote evaluation was conducted where participants answered questionnaires via a dedicated mobile app (ispup.up.pt/sepia). Quality of life was assessed in six subscales (physical well-being, emotional well-being, self-esteem, family, friends and school) using the validated Kiddo-KINDL questionnaire. The overall quality of life was quantified as the sum of subscale scores. Comparative analysis was conducted using t-tests. Associations between experimental pain responses and quality of life were quantified using linear regression. To explore the association between pain at both time points and quality of life at age 18 we conducted a two-way analysis of variance (ANOVA). Results: Both multisite and chronic musculoskeletal pain at age 13 were found to be significantly associated with lower quality of life scores for the physical well-being (p=0.005 and p=0.002, respectively), emotional well-being (p=0.041 and p=0.036) and friends (p=0.040 and p=0.020) dimensions. As for experimental pain responses, there were no clear associations between pressure pain detection or tolerance thresholds at 13 and quality of life at 18 but temporal summation of pain was associated with physical well-being (mean -2.24, 95%CI -4.31 to -0.18), emotional well-being (-3.77, -6.05 to -1.48), friends (-3.03, -5.22 to -0.84) and overall quality of life (-2.23, -3.86 to -0.60). Participants who did not report multisite pain at either age 13 or 18 years reported higher quality of life scores across all dimensions, while those who reported multisite pain at both ages showed lower quality of life scores at 18 for physical well-being, emotional well-being and 'friends' dimensions. Similarly, results on quality of life scores were found to be the lowest in adolescents reporting chronic musculoskeletal pain at both ages 13 and 18 across most dimensions, except for the family dimension. Conclusion: An history of multisite or chronic musculoskeletal pain throughout adolescence is associated with lower quality of life at the beginning of adult life. Our findings underline the long-term implications of pediatric pain and the importance of considering pain perception dynamics in shaping future psychosocial well-being.