Clinician perspectives concerning the treatment of adolescents with co-occurring chronic pain and mental health symptoms.

Pain and mental health symptoms frequently co-occur in adolescents, often posing physical, social, and emotional challenges. While previous research has focused on clinician perspectives on chronic pain in isolation, limited knowledge exists on the potential unique challenges these co-occurring symptoms’ present to clinicians in providing appropriate support to adolescents. This study examined clinician perspectives on the challenges and barriers to treating adolescents who experience co-occurring pain and mental health symptoms. Using a cross-sectional qualitative online vignette survey, responses were collected from 40 clinicians, including psychologists, physiotherapists, and doctors involved in treating adolescents (11-19 years) who experience co-occurring chronic pain and mental health symptoms. Participants, recruited from several countries, were asked about their perceived challenges to treating adolescents with co-occurring chronic pain and mental health symptoms. Vignettes were analyzed using reflexive thematic analysis. The analysis generated two themes. The first, ‘tangled threads’, describes how clinicians perceive mistrust from the adolescents based on previous negative clinician encounters and a perceived need to ‘undo’ this anticipated harm. The second theme ‘the difficult-to-pursue integrated approach’ depicts how fragmentation and siloed services for pain and mental health hinder effective treatment for adolescents who experience both symptoms. Co-occurring pain and mental health symptoms in adolescents are often initially mismanaged because they do not fit the mould of the services available to treat them, resulting in a more complex presentation to clinicians. The development of a more integrated clinical approach to treating adolescents with co-occurring pain and mental health symptoms is needed.