The role of pain-related anxiety in adolescents' disability and social impairment: ALSPAC data

BACKGROUND: Anxiety, in particular pain-related anxiety, plays an important role in explaining the severity of pain complaints and pain-related disability in both adults and children with chronic pain. The fear-avoidance model (FAM) describes how pain-related anxiety plays a critical role in the maintenance of pain-avoidance behaviour, which in turn influences pain-related disability. However, the FAM does not take into account broader aspects of adolescence, such as social functioning, which could be negatively impacted by anxiety. In addition, most studies examining the role of anxiety in pain have used small convenience or clinical samples. By using a large UK epidemiological database, this study investigated the associations between pain-related anxiety, disability and judgements of social impairment.

METHODS: Participants (n = 856) with recurrent pain were selected from a larger epidemiological study (Avon Longitudinal Study of Parents and Children) of adolescents attending a research clinic at the age of 17 (n = 5170). Adolescents completed a self-report questionnaire on pain-related anxiety, disability and perceived social impairment.

RESULTS: High levels of pain-related anxiety were associated with more disability. In girls, higher levels of pain-related anxiety were also related to the self-perception of greater impairment in social functioning compared with their peers.

CONCLUSIONS: Pain-related anxiety was associated with greater pain-related disability and impaired social functioning. Social functioning should be explored as an integral part of fear-avoidance models of adolescent chronic pain.