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School Absence Associated With Childhood Pain in the United States

Groenewald, Cornelius B., MB, ChB*; Giles, Marian, MBBS*; Palermo, Tonya M., PhD*,†,‡

The Clinical Journal of Pain: June 2019 - Volume 35 - Issue 6 - p 525–531
doi: 10.1097/AJP.0000000000000701
Original Article

Objective: The objective of this study was to estimate the national burden of school absenteeism associated with pain among 6 to 17-year-old children in the United States.

Methods: Data were analyzed from a large, nationally representative sample from the 2012 National Health Interview Survey. Associations between pain and school absence were analyzed using multivariate negative binomial models controlling for sociodemographic and clinical characteristics.

Results: The sample contained 8641 participants, of whom 30.3% reported pain over the preceding 12 months. Mean number of parent-reported school days missed across the entire sample was 3 per child; however pain was associated with an additional 1.5 reported missed school days per child. Furthermore, pain was associated with higher rates of chronic absenteeism (missing >15 d of school): 6.1% of children with pain was chronically absent as compared with 1.3% of children without pain. Extrapolated to the nation, childhood pain in the United States was associated with 22.2 million additional days of missed school, whereas childhood asthma, in comparison, was associated with 8 million additional days of school missed.

Discussion: Associations between pain and school absenteeism highlight the need for interventions aimed at improving school attendance among children with pain.

Departments of *Anesthesiology and Pain Medicine


Psychiatry, University of Washington School of Medicine, Seattle, WA

This work was partially funded by a grants from the National Institutes of Health: (grant number K23HL138155 PI:CBG), Bethesda, Maryland and (grant number K24HD060068 PI:TMP). The authors declare no conflict of interest.

Reprints: Cornelius B. Groenewald, MB, ChB, Anesthesiology and Pain Medicine, Seattle Children’s Hospital, M/S MB.11.500.3, 4800 Sand Point Way NE, Seattle, WA 98105 (

Received October 5, 2018

Received in revised form February 15, 2019

Accepted February 22, 2019

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