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Pain and learning in primary school: a population-based study

Kosola, Siljaa,b,c,d,*; Mundy, Lisa K.a,b,e; Sawyer, Susan M.a,b,e; Canterford, Louisea,b; van der Windt, Danielle A.f; Dunn, Kate M.f; Patton, George C.a,b,e

doi: 10.1097/j.pain.0000000000000984
Research Paper

Despite the frequency of pain among children, little is known about its effects on learning and school outcomes. The objective of this study was to quantify the association of pain and academic achievement while taking into account the presence of co-occurring emotional symptoms. A population-based stratified random sample of 1239 students aged 8 to 9 years from primary schools in Melbourne, Australia, was recruited for the Childhood to Adolescence Transition Study. Children indicated sites of pain that had lasted for a day or longer in the past month using a pain manikin. Depressive- and anxiety-related symptoms were assessed using child-reported items. National assessment results for reading and numeracy were used to measure academic achievement. Sixty-five percent of children reported pain in at least 1 body site and 16% reported chronic pain. Increasing number of pain sites was associated with poorer reading scores in a dose–response fashion (β = −3.1; 95% confidence interval −4.9 to −1.3; P < 0.001). The association was only partly attenuated when adjusting for emotional symptoms (β = −2.6; 95% confidence interval −4.5 to −0.8; P < 0.001) and was not moderated by emotional symptoms. Children with chronic pain were a year behind their peers in both reading and numeracy. Among primary school students, pain was associated with lower reading scores even after adjusting for the presence of emotional symptoms. Although population-based longitudinal studies will be required to ascertain consistency and possible causality, grounds exist for considering pain and emotional symptoms in the assessment of children with reading difficulties.

Among a population-based sample of grade 3 students, a greater number of pain sites were associated with decreasing reading scores. This association appeared independent of concurrent emotional symptoms.

aCentre for Adolescent Health, The Royal Children's Hospital, Melbourne, Victoria, Australia

bMurdoch Children's Research Institute, Melbourne, Victoria, Australia

cSchool and Student Healthcare, City of Helsinki, Finland

dChildren's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland

eDepartment of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia

fArthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Staffordshire, United Kingdom

Corresponding author. Address: Researchers of the Helsinki Children's Hospital, Biomedicum 2 C, 6th floor, Tukholmankatu 8, 00029 HUS, Finland. Tel.: +358 9 4717 5725. E-mail address: silja.kosola@fimnet.fi (S. Kosola).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received February 27, 2017

Received in revised form May 26, 2017

Accepted June 13, 2017

© 2017 International Association for the Study of Pain
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