Pain Trajectories in Pediatric Inflammatory Bowel Disease: Disease Severity, Optimism, and Pain Self-efficacy.

Abstract

Objectives: This study aimed to characterize pain intensity (average, worst) and disease severity in youth with inflammatory bowel disease in the 12-months post-diagnosis, and to examine the relation between pain and risk (disease severity) and resilience (optimism, pain self-efficacy) factors over time.

Methods: Data collection ran from February 2019 to March 2022. Newly diagnosed youth aged 8-17 with IBD completed numerical rating scales for average and worst pain intensity, Youth Life Orientation Test for optimism, and Pain Self-Efficacy Scale for pain self-efficacy via REDCap; weighted Pediatric Crohn's Disease Activity Index and the Pediatric Ulcerative Colitis Activity Index were used as indicators of disease severity. Descriptive statistics characterized pain and disease severity. Multilevel modeling explored relations between variables over time, including moderation effects of optimism and pain self-efficacy.

Results: At baseline, 83 youth (Mage=13.9, SD=2.6; 60.2% Crohn's disease; 39.8% female) were included. Attrition rates at 4 and 12 months were 6.0% and 9.6%, respectively. Across time, at least 52% of participants reported pain. Participants in disease remission increased from 4% to 70% over 12-months. Higher disease severity predicted higher worst pain, regardless of time since diagnosis. Higher pain self-efficacy: (a) predicted lower average and worst pain, especially at later time points; and (b) attenuated the association between disease severity and worst pain when included as a moderator. Higher optimism predicted lower worst pain.

Discussion: Pain is prevalent in pediatric inflammatory bowel disease and impacted by disease severity, pain self-efficacy, and optimism. Findings highlight modifiable intervention targets.