All ETDs from UAB

Advisory Committee Chair

Burel R Goodin

Advisory Committee Members

Aaron Fobian

Matthew Stoll

Peter Weiser

David Schwebel

Document Type

Dissertation

Date of Award

2022

Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences

Abstract

Background: Chronic pain is a prominent feature of many pediatric rheumatic conditions. However, the diagnosis, experience, and treatment of musculoskeletal pain varies by condition. Therefore, the overall aim of the present study is to elucidate group differences and examine biopsychosocial correlates of pain in children with juvenile idiopathic arthritis (JIA), juvenile primary fibromyalgia syndrome (JPFS), non-specific chronic pain (NSCP), and pain-free controls.Methods: We recruited 117 (66% female, 73% White) school-aged children from Children’s of Alabama Rheumatology and Allergy Clinics and the community. Participants self-reported their pain, physical function, sleep, pain-related stigma, and somatic symptoms and underwent experimental pain tasks. Caregivers reported demographic information for themselves and their child (e.g., age, race, sex) and information on their pain and somatization. Participants wore an Actiwatch and filled out a sleep diary for seven days following their research appointment. Results: Results suggest that children with medically unexplained musculoskeletal pain (i.e., JPFS) report greater pain (F[3,112] = 21.56, p <.001), poorer physical function (F[3,110] = 22.59, p <.001), greater pain interference (F[3,112] = 27.45, p <.001), poorer sleep (F[3,107] = 7.75, p < .001; F[3,74] = 7.04, p < .001), and greater pain-related stigma (F[3,112] = 15.45, p < .001) than their counterparts with medically explained pain. Interestingly, children with JIA were the most susceptible to the negative effects of sleep (z=1.77, p=.039) and stigma (z=1.93, p=.027) on pain. Finally, the present study demonstrated greater caregiver pain and somatization were related to greater child pain and somatization (all p’s<.05). Specifically, caregiver pain behavior and somatization was associated with child endogenous pain amplification in children with JIA (z=1.79, p=.037; z=1.92, p= 027) and pain-free controls (z=1.97, p=.025). Conclusions: Although children with medically unexplained pain report more pain, poorer sleep, and greater pain-related stigma, children with medically explained pain may be more susceptible to the deleterious effects of stigma and sleep on pain outcomes. Therefore, it is equally important for all children with rheumatic conditions to receive interventions focused on bolstering coping skills to combat stigma and poor sleep hygiene to improve pain related outcomes.

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