Childeren growing up with chronic pain: Psychiatric comorbidity, quality of life & familial illness

Abstract

Background: Chronic pain is common in childhood and often co-occurs with psychiatric disorders. It frequently influences daily activities, undermines the child’s confidence in one's health, and affects general well-being. Parents of children with chronic pain often suffer from chronic illness themselves. This thesis aimed to advance our understanding of the high prevalence of psychiatric comorbidity by investigating its clinical relevance in daily practice and its impact on long-term clinical and quality of life outcome ( QoL) of children confronted with chronic pain. In addition, the impact of parental illness on functioning of children with chronic pain with and without psychiatric comorbidity was explored. Methods: Children and adolescents (aged 8-17) with chronic pain and their parents referred to the pediatric out-patient clinic of the University Medical Centre in Utrecht were assessed and re-assessed 6 years later in adolescence and young adulthood (aged 13-24). Results: Psychiatric assessment at referral and 6 years later revealed that one third of the participants suffered a psychiatric disorder. New onset and persistent psychiatric disorders diagnosed at follow-up included internalizing, externalizing psychiatric disorders (ADHD), and substance use disorders. Overall, merely 15 % of all children referred were free of pain and psychiatric symptoms 6 years after referral. Despite this poor clinical prognosis, health-related Quality of Life (HRQOL) was comparable with peers and academic functioning improved when children grew up. In line with other studies showing a different impact of fathers and mothers on child chronic pain, this thesis showed a different relation between maternal and paternal chronic illness and functioning of children with chronic pain. Whereas maternal chronic illness was not related to the daily functioning of children with chronic pain, paternal chronic illness was related to better physical, school, and social functioning. Psychiatric comorbidity at referral was an important predictor of persistent psychopathology 6 years later, but did not predict pain persistence and HRQOL outcome. A poor perception of one’s own health at referral seemed to be the best predictor of poor HRQOL outcome in adolescence and young adulthood. Conclusion: This thesis provides evidence for the co-occurrence of treatable child psychiatric disorders and chronic pain in the transition from childhood to young adulthood. Despite a poor clinical prognosis in children referred for chronic pain, HRQOL and academic functioning may improve when these children grow up. Results of this thesis suggest that child psychiatric care and HRQOL assessment should be included in the care of children referred for chronic pain.