Background: Developmental life stage at chronic pain onset differs among chronic pain patients. Although pain affects multiple life domains, it is unknown whether the timing of chronic pain onset relates to pain characteristics and psychosocial outcomes. The purpose of this retrospective study was to investigate differences in pain characteristics and psychosocial outcomes in patients at different developmental life stages at chronic pain onset.

Methods: Cross-sectional baseline data from the Swedish Quality Registry for Pain Rehabilitation (2009 to 2016) were used, selecting the middle-aged patients (45-65 years, n=6225) reporting chronic nonmalignant pain. Patients were categorized into three groups, depending on their developmental life stage at chronic pain onset: early onset (age ≤30 years), intermediate onset (age 31-45 years), and late onset (age ≥46 years). Pain characteristics and psychosocial outcomes were assessed with validated self-reported measures.

Results: One-way MANCOVA indicated differences in number of pain locations and psychosocial outcomes among the groups. Post hoc analysis showed differences in the trends for how groups differed on outcome domains. Overall, patients with earlier chronic pain onset showed significantly poorer psychosocial outcomes and more spreading of pain.

Conclusion: Developmental life stage at chronic pain onset is associated with different pain outcomes. Pain onset early in life is linked to worse outcomes in multiple domains, pointing to a need for identifying these patients early.

BACKGROUND: Adolescents with recurrent pain miss out from school more often than pain-free peers. Research has so far used cross-sectional designs, focusing on non-specific absenteeism in clinical samples. Hence, it is unknown whether estimates of absenteeism are specifically linked to the pain itself or reflects the characteristics of clinical samples. This study aimed to prospectively explore pain-related school absenteeism in a non-clinical sample, its variance and potential risk factors.

METHODS: This prospective study followed a cohort of 1300 Sweden-based adolescents (mean age =16.9; 17.2% immigrants; 62.7% girls) with recurrent pain (headache, abdominal and/or musculoskeletal pain) through self-reports at two assessment points 12 months apart. RESULTS: Overall, 64.2% reported any absenteeism at follow-up and about half of these (26.2%) reported frequent absenteeism. Adolescents who indicated missing school were more often girls, slightly older, and had a higher overall pain burden and stressor levels. Yet, after adjusting for previous absenteeism, independent predictors were age, pain intensity, medication use, and stress associated with school attendance. Further to this, immigrant status predicted frequent absenteeism.

CONCLUSIONS: Many adolescents with pain frequently miss out from school due to pain. Identified risk factors points at pain characteristics and coping, stressors associated with participation and advancing age. Taken together, the burden of pain and its correlates emerge earlier and escalate with increasing age hence, early interventions targeting broader domains are needed.

Introduction: A sizeable number of adolescents with recurrent pain frequently miss school, yet the trajectories of absenteeism and their correlates remain unclear. We aimed to explore trajectories of school absenteeism due to pain among adolescents with recurrent pain, and predictors and correlates of the trajectories.

Methods: A prospective cohort design with 3 yearly measurement points between 2016 and 2018 was used. The sample included 873 Swedish upper secondary school adolescents (mean age = 16.5 years; 60.8% girls; 11.7% immigrants) with recurrent pain (headache, abdominal and/or musculoskeletal pain ≥1/wk for 6 months). Predictors were sociodemographic variables, pain characteristics, depressive symptoms, and stressors in the school context. Distal outcomes were perceived future work ability and overall future expectancy.

Results: We identified 3 trajectories of absenteeism through latent class growth analysis: persistently high absenteeism (18.1%), persistently low absenteeism (49.4%), and persistently no absenteeism (32.5%). Pain intensity and school-related stressors independently predicted absenteeism trajectories. Compared with the other trajectories, the persistently high absenteeism subgroup had more negative perceived future work ability and overall future expectancy.

Conclusion: A substantial subgroup of adolescents showed a stable pattern of high absenteeism across their upper secondary education, which was associated with overall negative expectancies for the future and specifically future work ability. Therefore, there is a need to identify this subgroup and intervene early in the life course to prevent long-term disadvantages in education, employment, and overall well-being.