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Common Pediatric Pain Disorders and Their Clinical Associations

Donnelly, Theresa J. BAPsych (Hons), LLB*; Bott, Aneeka BPsych (Hons)*; Bui, Minh PhD; Goh, Shuxiang MBBS*; Jaaniste, Tiina PhD*,‡; Chapman, Cindy BPsych (Hons)*; Crawford, Matthew MBBS*; Hopper, John L. PhD; Champion, David MD*,‡

doi: 10.1097/AJP.0000000000000496
Review Articles

Background: Common childhood pain conditions (nonmigraine headache, migraine, recurrent abdominal pain, growing pains, low back pain) and persistent pains are often associated with each other and have significant implications in later life. Emerging evidence suggests additional associations between these pain conditions and restless legs syndrome, iron deficiency, anxiety, and depression. The aim of this cross-sectional study in pediatric twin individuals and their siblings was to investigate these associations.

Materials and Methods: Surveys were sent to Australian twin families via the Australian Twin Registry, yielding responses from 2530 pediatric individuals. The lifetime prevalence of the common pain disorders of childhood and of other persistent pains, restless legs syndrome and iron deficiency, and anxious/depressed score were determined by questionnaires. Random-effects logistic regression modeling was used to investigate univariate and multivariate associations between conditions.

Results: Univariate associations were found between each of the pain conditions and persistent pain, and between the pain conditions with restless legs syndrome, iron deficiency, and anxious/depressed score. Derivative multivariate analyses retained statistically significant associations between each of the pain disorders included in the respective models (odds ratios [OR], 1.69-7.04) with the exception of growing pains with persistent pain. Of the nonpain conditions included in the multivariate analyses, restless legs syndrome remained associated with growing pains (OR, 8.50) and persistent pain (OR, 2.01). Iron deficiency remained significantly associated with migraine (OR, 2.38), persistent pain (OR, 3.70), and restless legs syndrome (OR, 5.10).

Conclusions: In light of their extensive associations, the common pain conditions, persistent pain, restless legs syndrome, iron deficiency, anxiety and depression, are likely to involve common etiological mechanisms that warrant further investigation.

*Department of Anaesthesia and Pain Medicine, Sydney Children’s Hospital, Randwick

Melbourne School of Population and Global Health, The University of Melbourne, Carlton

School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW, Australia

T.J.D. and A.B. are equal first authors.

Supported by Independent Learning Project Scheme, School of Women’s and Children’s Health, University of New South Wales, Kensington, NSW, Australia. The authors declare no conflict of interest.

Reprints: David Champion, MD, Department of Anaesthesia and Pain Medicine, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia (e-mail:

Received May 8, 2016

Received in revised form January 29, 2017

Accepted February 18, 2017

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