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Review
. 2016 Dec 2;3(4):40.
doi: 10.3390/children3040040.

Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment

Jillian Vinall  1 , Maria Pavlova  2 , Gordon J G Asmundson  3 , Nivez Rasic  4 , Melanie Noel  5   6
Affiliations
Review

Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment

Jillian Vinall et al. Children (Basel). .

Abstract

Chronic pain during childhood and adolescence can lead to persistent pain problems and mental health disorders into adulthood. Posttraumatic stress disorders and depressive and anxiety disorders are mental health conditions that co-occur at high rates in both adolescent and adult samples, and are linked to heightened impairment and disability. Comorbid chronic pain and psychopathology has been explained by the presence of shared neurobiology and mutually maintaining cognitive-affective and behavioral factors that lead to the development and/or maintenance of both conditions. Particularly within the pediatric chronic pain population, these factors are embedded within the broader context of the parent-child relationship. In this review, we will explore the epidemiology of, and current working models explaining, these comorbidities. Particular emphasis will be made on shared neurobiological mechanisms, given that the majority of previous research to date has centered on cognitive, affective, and behavioral mechanisms. Parental contributions to co-occurring chronic pain and psychopathology in childhood and adolescence will be discussed. Moreover, we will review current treatment recommendations and future directions for both research and practice. We argue that the integration of biological and behavioral approaches will be critical to sufficiently address why these comorbidities exist and how they can best be targeted in treatment.

Keywords: anxiety; brain; chronic pain; comorbidity; depression; intervention; neurobiology; parent; posttraumatic stress disorder; stress.

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Conflict of interest statement

The authors declare no conflict of interest. The founding sponsors had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, and in the decision to publish the results.

Figures

Figure 1
Figure 1
Possible mechanisms underlying the shared vulnerability and mutual maintenance of pediatric chronic pain and internalizing mental health disorders. 5-HTTLPR: Serotonin-transporter-linked polymorphic region; BDNF: Brain-derived neurotrophic factor; HPA: hypothalamic–pituitary–adrenal; S allele: Short allele.
See this image and copyright information in PMC

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