# High impact chronic pain in children: exploration of associated characteristics and clinical factors in children and parents

## TL;DR

This study explores factors linked to high impact chronic pain in children, emphasizing the role of depression, psychological inflexibility, and parental pain reactivity.

## Contribution

The study introduces a biopsychosocial definition of High Impact Chronic Pain (HICP) in children and identifies key clinical factors.

## Key findings

- 60% of children met the criteria for High Impact Chronic Pain (HICP).
- Depression and psychological inflexibility in children were strongly associated with HICP.
- Parental pain reactivity was also significantly linked to HICP in children.

## Abstract

Chronic pain in children can significantly impact daily functioning. While interdisciplinary pain rehabilitation is the recommended treatment, it is resource-intensive and limited in availability. Therefore, children with more complex symptoms, classified as High Impact Chronic Pain (HICP), need to be prioritized for interdisciplinary pain rehabilitation. However, HICP in children has been incompletely defined in previous literature, and associated factors remain underexplored. This study aimed to explore a broader biopsychosocial definition of HICP in children and to investigate characteristics and clinical factors in children and parents associated with HICP.

This exploratory retrospective cross-sectional registry study included 484 children with chronic pain and their parents, referred to a tertiary pediatric pain clinic in Sweden. HICP was defined using five variables: pain intensity, pain interference, overall well-being, insomnia, and school absence. Children who met thresholds in at least three of these variables were classified as having HICP. Multivariable logistic regression models were used to identify factors in children and parents associated with HICP.

A total of 60% of the participants met the criteria for HICP. Variables significantly associated with HICP included symptoms of depression (OR 1.10, p = 0.001) and psychological inflexibility (OR 1.06, p = 0.001) in children, as well as pain reactivity in parents (OR 1.05, p = 0.018).

Psychiatric comorbidity and behavioral aspects, including psychological inflexibility and parental pain reactivity, play key roles in pediatric HICP and should be considered when assessing and planning interventions. Addressing these factors may improve treatment outcomes and reduce long-term challenges.