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The Co-occurrence of Pediatric Chronic Pain and Anxiety

A Theoretical Review of a Developmentally Informed Shared Vulnerability Model

Jastrowski Mano, Kristen E. PhD; O’Bryan, Emily M. MA; Gibler, Robert C. MA; Beckmann, Emily BS

doi: 10.1097/AJP.0000000000000763
Review Article

The development and maintenance of pediatric chronic pain and anxiety are complex, underscoring the need to better understand the interactive forces contributing to their co-occurrence. The shared vulnerability model (SVM) was developed to explain the co-occurrence of chronic pain and posttraumatic stress disorder in adults. Although many core tenets have been well supported by pediatric research, the SVM has yet to be extended to pediatric pain populations. We propose a developmentally informed pediatric SVM for advancing our understanding of the co-occurrence of pediatric chronic pain and anxiety disorders. The proposed SVM postulates that youth at increased risk for the development of chronic pain and/or anxiety share predisposing vulnerabilities, including anxiety sensitivity, and that these shared vulnerabilities give rise to negative emotional responses (child and parent) in the context of stressful events. Consequences of fear and anxiety, including avoidance behavior, further contribute to the development of chronic pain, anxiety, and their co-occurrence. The parental, school, and peer contexts in which these problems develop and are maintained in youth are pertinent to integrate into a SVM, as pediatric chronic pain and anxiety disorders share several social-contextual risk and maintenance factors. We also highlight new areas of inquiry.

Department of Psychology, University of Cincinnati, Cincinnati, OH

The authors declare no conflict of interest.

Reprints: Kristen E. Jastrowski Mano, PhD, Department of Psychology, University of Cincinnati, 5130D Edwards One, ML 0376, Cincinnati, OH 45221-0376 (e-mail:

Received March 13, 2019

Received in revised form August 10, 2019

Accepted August 27, 2019

Online date: September 10, 2019

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