Relationship between Pain Intensity and Frequency
with Psychosocial Risk Factors
Katherine Simon1, Keri R. Hainsworth2, Renee J. Ladwig3, Kristen E. Jastrowski Mano2,
Kimberly Anderson Khan2, W. Hobart Davies1,3, and Steven J. Weisman2,3
University of Wisconsin-Milwaukee1, Medical College of Wisconsin2, & Children’s Hospital of Wisconsin3
Introduction Measures Table II: Correlations
It is estimated that one in five U.S. children are affected by chronic Demographic and Medical Information, including age, gender, ethnicity, Best Pain Worst Pain Usual Pain
pain (Zeltzer & Schlank, 2005). Youth with chronic pain often have diagnosis, and pain intensity (worst, usual, best) and frequency, are r p r p r p
decreased social functioning, increased school absenteeism, and collected upon arrival at the comprehensive pain center. The doctor or nurse
decreased quality of life (Eccleston, Wastell, Crombez, & Jordan, asked the primary caregiver and the youth for this information.
Cumulative Risk .03 (NS) .07 (NS) .16 (.004)***
2008). Research in adults has noted that daily stress is associated with Factors
headache severity (Cathcart & Pritchard, 2008); however, less is Clinician Interviews were conducted during the initial visit with the
known about the relationship between daily stressors and pain in family. The interviews include information regarding mental health history,
pediatric populations. current mental health symptoms, and coping attempts, among other factors. *p < . 10. **p < .05. ***p < .01.
The number of risk factors were totaled and cumulative risk factors were To Note: Best Pain was significantly correlated with Worst Pain (r =
used in subsequent analyses. .14, p = .018) and Usual Pain (r = .30, p = .000). Worst and Usual pain
were also significant related (r = .35, p = .000).
The current study aimed to explore the association between pain
(intensity and frequency) and common psychosocial risk factors Pearson Correlations were used to explore the relationship between pain Table III: T-tests
reported by youth seen in a multidisciplinary pain clinic. intensity, frequency and psychosocial risk factors.
M of Pain M of Pain t(df) p
Hypothesis: Youth with fewer psychosocial risk factors will report Independent t-tests were conducted to further describe the relationship
if Factor if Factor
lower pain intensity and frequency. between pain intensity and frequency with psychosocial risk factors Endorsed Not
See Table I for psychosocial risk factors, Table II for correlations, and Endorsed
Table III for t-tests. Usual Pain
Family Conflict 6.33 5.80 1.91(304) .057*
Methods N = 84 N = 222
Descriptive Statistics Divorce 6.40 5.83 1.85(304) .066*
This study involved patients presenting to a multidisciplinary pain N = 62 N = 244
clinic at a large Midwestern children’s hospital. Pain Locations (Top 3) Abuse 6.89 5.88 1.96(304) .051*
At intake, mothers, fathers, and youth completed a packet of Headache 35.1% N = 19 N = 287
questionnaires that assess clinical, behavioral, and psychosocial Financial Problems 7.11 5.74 4.05(304) .000***
Abdominal Pain 24.7%
variables related to pain. N = 47 N = 259
Lower Extremity Pain 17.1% School Transition 6.39 5.83 1.83(304) .068*
Based on an interview with the family, clinician’s also rate the
Cumulative Risk Factors 2.77 (SD = 2.39; R = 0-11) N = 64 N = 242
occurrence of 23 psychosocial risk factors.
Academic Problems 6.62 5.79 2.63(304) .009**
The current study includes youth 4 - 19 years old with chronic pain
N = 58 N = 248
(e.g., headache, gastrointestinal pain, musculoskeletal pain). Best Pain
Table I: Top 10 Psychosocial Risk Factors School Absenteeism 2.62 1.94 2.06(308) .040**
N = 95 N= 215
Psychosocial Risk Factors % Reported Athletic Achievement 3.45 2.04 2.40(306) .017**
N = 22 N= 286
Participant Demographics School Absenteeism 31.3% Worst Pain
Youth School Absenteeism 8.80 8.37 2.02(314) .044**
Family Conflict 28.5% N = 99 N = 217
N = 351
*p < . 10. **p < .05. ***p < .01.
Gender 67.5% female Divorce 19.9%
Age 13.65 yrs (2.39) School Transition 19.7% The data highlight the importance of assessing potential risk
factors in the treatment of chronic pain in youth, especially
Ethnicity 77.9% Caucasian Feeling Isolated/Not Fitting In 19.4% family and school factors.
These results suggest that there is a relationship between
Best Pain Intensity 2.15 (2.69) Academic or Learning Difficulties 18.8%
pain ratings and identified school (i.e. transition, academic
problems) and family stressors (i.e. divorce, abuse, financial
Worst Pain Intensity 8.49 (1.75) Family Financial Problems 16.2% issues), which may indicate that youth identifying these
Usual Pain Intensity 5.59 (2.19) stressors warrant more specific interventions directed at those
Sibling Behavior Problems 16.0% problematic areas based on the fact that school and family are
important components of development.
Youth as a High Achiever 14.2%
Future research should focus on determining if these
Peer Conflict 9.7% psychosocial risk factors impact treatment strategies or the
need for additional services.
The authors would like to acknowledge the families at the Children’s Hospital of Wisconsin Jane P. Pettit Pain and Palliative Care Center.
For more information, please contact Katherine Simon at email@example.com.