Long-term effect of pain history and experimental pain responses on adolescents’ quality-of-life: A cohort study

Pain has been shown to impact quality-of-life, but less is known on whether adverse pediatric pain profiles predict long-term quality-of-life in non-clinical populations. We aimed to (1) assess the association of multisite and chronic musculoskeletal pain with quality-of-life at age 18, and (2) test whether experimental pain responses at age 13 predict future quality-of-life. We used data from the Generation XXI cohort. Reported pain was assessed using the Luebeck questionnaire at ages 13 and 18. At age 13, a subsample underwent quantitative sensory testing to assess pain sensitivity, and temporal summation of pain effects. At age 18, quality-of-life was assessed in six dimensions using the Kiddo-KINDL questionnaire. Associations were quantified using linear regression or analysis of covariance models, adjusted for adverse childhood experiences reported at age 13. No associations between multisite pain at 13 and scores in any quality-of-life dimensions at 18 were observed in either sex. Females with chronic musculoskeletal pain at 13 reported lower quality-of-life scores at 18 for self-esteem (linear regression coefficient: 12.73 [95% confidence interval: 4.18, 21.27]), friends (8.59 [1.76, 15.41]), school (6.05 [0.24, 11.86]) and overall quality-of-life (6.25 [1.47, 11.02]). Temporal summation of pain at 13 was associated with overall quality-of-life at 18 (-2.17 [-3.81, 0.54]). Participants who did not report multisite pain at either age showed higher quality-of-life scores at 18 across most dimensions. Quality-of-life scores were lower among participants reporting chronic musculoskeletal pain at both ages. Our findings underline the implications of pediatric pain management in shaping future psychosocial well-being.

Perspective

We found that: 1) experiencing pain throughout adolescence is associated with lower quality-of-life in late adolescence, particularly in females; 2) early enhanced temporal summation of pain may indicate future quality-of-life impairments; and 3) persistent pain from 13 to 18 seems to have a cumulative effect, especially for multisite pain.