# School Attendance Pre- and Post-Pandemic in Adolescents with Chronic Pain

## TL;DR

After the pandemic, teens with chronic pain are more likely to attend online or home school, which increases their risk of missing school and facing greater disability.

## Contribution

The study reveals that post-pandemic shifts in schooling for adolescents with chronic pain correlate with increased absenteeism and disability.

## Key findings

- Post-pandemic youth with chronic pain are more likely to attend online or home school than before the pandemic.
- Youth attending online school are at greater risk of chronic school absenteeism and functional disability compared to in-person attendees.
- Post-pandemic students attending online school missed more school days and experienced greater disability than in-person attendees.

## Abstract

What are the main findings?
In the post-pandemic era, youth with high-impact chronic pain are more likely to attend online or home-school than prior to the pandemic.Youth who attend online school are at greater risk of chronic school absenteeism and functional disability than those who attend school in person.

In the post-pandemic era, youth with high-impact chronic pain are more likely to attend online or home-school than prior to the pandemic.

Youth who attend online school are at greater risk of chronic school absenteeism and functional disability than those who attend school in person.

What are the implications of the main findings?
Though the shift to online school may have helped students with high-impact chronic pain access schooling, it also increases the risk of school absence and greater disability.The results support evidence-based treatment for pediatric chronic pain, which emphasizes return to full functioning, including return to in-person schooling.

Though the shift to online school may have helped students with high-impact chronic pain access schooling, it also increases the risk of school absence and greater disability.

The results support evidence-based treatment for pediatric chronic pain, which emphasizes return to full functioning, including return to in-person schooling.

Background/Objective: The COVID-19 pandemic led to a widespread transition to online learning. Yet, it is unclear how this shift in learning format impacted school attendance in adolescents with chronic pain, a group that struggles with school absenteeism. This study compared school attendance and format (e.g., in-person, online) in patients with chronic pain attending an Intensive Interdisciplinary Pain Treatment Program (IIPT) before the pandemic to an age- and gender-matched sample of youth attending the program after the pandemic. Methods: Participants were 226 school aged adolescents (13–18 years; M age = 15.89, SD = 1.46) enrolled in an IIPT before and after the COVID-19 pandemic. Patients admitted before March 2020 (pre-pandemic group; n = 113) were compared to an age- and gender-matched group of patients who were admitted to the IIPT from November 2021 to November 2023 (post-pandemic group = 113). Upon admission to the program, participants completed validated measures of internalizing symptoms and functional disability. They also completed structured questions related to pain and school history. Results: Significantly more patients in the post-pandemic group were attending school through online and home-schooling options (p < 0.01). Youth who attended the IIPT after the pandemic missed fewer school days (p < 0.05) than those who attended before the pandemic. The groups did not differ in functional disability or internalizing symptoms. However, participants in the post-pandemic group who attended online school missed more school days (p < 0.01) and experienced greater functional disability (p < 0.05) than those who attended in person. Conclusions: The findings highlight how the COVID-19 pandemic may lead to sustained changes in the way adolescents with chronic pain attend school, with implications for increased functional disability and school dropout among this vulnerable population.