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The Co-occurrence of Pediatric Chronic Pain and Depression

A Narrative Review and Conceptualization of Mutual Maintenance

Soltani, Sabine, MA*; Kopala-Sibley, Daniel C., PhD†,‡,§,∥; Noel, Melanie, PhD*,‡,§,∥

The Clinical Journal of Pain: July 2019 - Volume 35 - Issue 7 - p 633–643
doi: 10.1097/AJP.0000000000000723
Original Articles

Objectives: Internalizing mental health issues co-occur with pediatric chronic pain at high rates and are linked to worse pain and functioning. Although the field has prioritized anxiety and posttraumatic stress disorder, little is known about co-occurring depression and chronic pain in youth, despite its high prevalence. The purpose of this narrative review was to examine the existing literature on the co-occurrence of pediatric chronic pain and depressive disorders and symptoms and propose a conceptual model of mutual maintenance to guide future research.

Methods: The literature from both fields of pediatric pain and developmental psychology were searched to review the evidence for the co-occurrence of pediatric chronic pain and depression. Conceptual models of co-occurring mental health issues and chronic pain, as well as child depression, were reviewed. From both literatures, we provide evidence for a number of proposed child, parent, and neurobiological factors that may serve to mutually maintain both conditions over time. On the basis of this evidence, we propose a conceptual model of mutual maintenance and highlight several areas for future research in this area.

Results: Evidence was found for the prevalence of depression in pediatric chronic pain as well as the co-occurrence of both conditions. The key mutually maintaining factors identified and proposed included neurobiological, intrapersonal (eg, cognitive biases, sleep disturbances, emotion regulation, and behavioral inactivation), and interpersonal (eg, parent mental health and pain, genes, and parenting) factors.

Discussion: Given the dearth of research on mutual maintenance in this area, this review and conceptual model could drive future research in this area. We argue for the development of tailored treatments for this unique population of youth to improve outcomes.

Departments of *Psychology

Psychiatry, University of Calgary

Alberta Children’s Hospital Research Institute, Behaviour & the Developing Brain Theme

§Hotchkiss Brain Institute

Mathison Centre for Mental Health Research & Education, Calgary, AB, Canada

The authors declare no conflict of interest.

Reprints: Melanie Noel, PhD, Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada T2N 1N4 (e-mail:

Received April 18, 2019

Received in revised form April 29, 2019

Accepted April 22, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.