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Elevated Reports of Anxiety Symptoms among Pediatric Chronic Pain Patients:
A Need for Routine Screening?
Susan T. Heinze¹, B.A., Kim Anderson Khan², ³, Psy.D., Keri R. Hainsworth², Ph.D., Steven J. Weisman², ³, M.D., & W. Hobart Davies¹
¹University of Wisconsin-Milwaukee, ²Medical College of Wisconsin, & ³Children’s Hospital of Wisconsin
PURPOSE/BACKGROUND
•
•
Children with chronic pain report more symptoms of anxiety
than non-clinical controls (Tsao et al., 2009).
• This is especially true for those with recurrent abdominal
pain (Campo et al., 2004).
Although recommended for adults with chronic pain, little
attention has been paid to routine screening for anxiety
disorders in pediatric chronic pain populations.
To quantify the prevalence of clinical and sub-clinical
levels of anxiety in a pediatric chronic pain population.
To examine differences in anxiety symptoms in children
with headache and abdominal pain.
•
MEASURES
•
•
RESULTS (CONTINUED)
General Findings
• Based on clinical cutoff scores, 35% of children and adolescents had total
scores indicating a possible anxiety disorder; 22% of the total sample scored
above the more stringent cutoff.
• See Table 2 for prevalence of elevated total and subscale scores.
• Nearly half of our sample endorsed significant school avoidance symptoms
(See Figure 1 for items).
Pain Location
• The two most common primary pain locations reported were head
and abdomen. These two groups did not differ in age or gender.
• Children with abdominal pain reported higher overall anxiety, panic
and somatic complaints, and school avoidance than children
reporting headaches (See Table 3).
• Youth grouped by location did not differ in their reports of pain
intensity, however, those with abdominal pain reported
experiencing pain for a longer duration than those with headache
(t (47) = 2.12, p < .05).
TABLE 2: Youth with Elevated Scores across Subscales
STUDY GOALS
•
RESULTS
Children and adolescents (See Table 1) completed
demographic measures before beginning treatment at a
multidisciplinary pain clinic.
Youth also completed the Screen for Child Anxiety Related
Disorders (SCARED).
• Includes 5 factors with clinical cutoffs and a total score
(Birmaher et al., 1999).
• Cutoff score of 25 may indicate the presence of an
anxiety disorder, with a cutoff of 30 being more
stringent.
Percentage of youth elevated
≥ 25 Overall Anxiety
≥ 30 Overall Anxiety
35%
22%
(n = 30)
(n = 18)
≥ 7 Panic and Somatic
22%
(n = 18)
≥ 9 GAD
24%
(n = 20)
≥ 5 Separation
20%
(n = 16)
≥ 8 Social
10%
(n = 8)
≥ 3 School Avoidance
48%
(n = 39)
TABLE 3: Reports of Anxiety Compared by Pain Location
Total
N = 92
Worst pain
M = 8.6
SD = 1.37
Gender
73.9%
female
Best pain
M = 2.82
SD = 2.70
Ethnicity
79.6%
Caucasian
Pain
duration
Age
M = 14.1
SD = 2.56
Pain location 40% Head
18.9% Abdomen
< 1 year 55.6%
> 1 year 44.4%
Group with
Abdominal
Pain
Overall Anxiety
M = 17.31
SD = 9.22
M = 25.53
SD = 12.86
-2.51
(45)
.016*
Panic and
Somatic
M = 2.63
SD = 2.34
M = 6.53
SD = 6.05
-3.21
(45)
.002**
GAD
M = 5.06
SD = 3.60
M = 6.13
SD = 3.56
-0.95
(45)
.345
FIGURE 1: SCARED School Avoidance Items
t (df)
p
I get headaches when I am at school.
I worry about going to school
Separation
M = 2.66
SD = 2.21
M = 3.60
SD = 3.16
-1.19
(45)
.242
I get stomachaches at school.
I am scared to go to school.
Social
M = 3.94
SD = 3.02
M = 5.00
SD = 4.14
-1.00
(45)
.324
School
Avoidance
M = 3.03
SD = 1.62
M = 4.27
SD = 2.09
-2.22
(45)
.031*
RESULTS (CONTINUED)
TABLE 1: Participant Characteristics
Group with
Head Pain
Exploratory Analyses
• Many youth endorsed symptoms of anxiety, but fell just below the clinical
cutoff score. Including all youth who scored greater than or equal to 20,
43.4% (n = 42) of our sample warrant further assessment of anxiety
symptoms.
Pain Intensity
• Worst pain level was positively correlated with child report of total anxiety (r
= .26, p < .05) and generalized anxiety symptoms (r = .24, p < .05).
• Best pain level was positively correlated with child report of total anxiety,
separation anxiety and social anxiety (r range = .24 - .29, p < .05).
For more information, please contact:
Susan T. Heinze, [email protected]
* p < .05, ** p < .01
CONCLUSION
•
•
•
A significant number of youth (35%) with complex chronic pain have
elevated anxiety symptoms. Additionally, youth reported anxiety
across several domains, with notable endorsement of school avoidance
(48%).
Children reporting abdominal pain experienced more overall anxiety,
panic and somatic complaints, and school avoidance than those who
reported headache pain, suggesting possible differences in patterns of
comorbidity or etiology.
Given these findings, anxiety symptoms should be assessed when
treating children with chronic pain.