Adolescent developmental trajectories can be significantly impacted by chronic pain. This can negatively influence later health and social and educational outcomes (Murray et al 2020). In particular, pain can interrupt engagement and achievement in schooling. There is also evidence that adolescents with chronic pain are less likely to access healthcare (Farrant et al 2023). 

 

There has been limited population level descriptions of young people with chronic and severe pain, and the subsequent impacts on their access to healthcare and schooling (Gorodzinsky et al 2011). 

 

This study aims to describe the associations between self-reported chronic and severe pain among adolescents, educational engagement and healthcare access. 

 

The prevalence of self-reported chronic pain frequency and severity are reported as part of a broader anonymous self-administered health and well-being questionnaire completed by a representative cross-section of students aged 12–18 years in New Zealand secondary schools (Fleming et al 2020). Multivariable models were used to explore chronic pain and health care access and school engagement (self-reported achievement, feeling part of school and importance of attendance); controlling for age, sex, ethnicity, socio-economic status, disability and history of sexual abuse. 

 

 

Overall, 22.8% of young people reported chronic pain for 6 months or more, with 3.2% reporting severe pain weekly or more often. This was greater in females and rural adolescents, and less in Asian youth compared to other ethnic groups. Increased severity of pain was associated more with poorer daily functioning and socialising than with frequency of pain. Severe pain occurring weekly or more often was more common among students who had a disability (2.3% vs. 9.8%) or a history of sexual abuse (2.4% vs. 8.5%). Alongside lower wellbeing and more significant depressive symptoms, those reporting chronic pain had lower self-reported school engagement and lower access to health care, particularly for those reporting higher levels of intensity and frequency of pain.

 

As measures of school engagement, those with severe and recurrent pain were more likely to rate achievement below average than young people with no pain (aOR 2.5). There were trends towards those with more frequent pain to report they felt less like a part of their school or education institution and that attending school was less important, but this did not reach significance. 

 

Young people with chronic pain report significantly higher rates of inability to access health care when needed than the population without pain. 48% percent of young people with severe and frequent pain report that they have been unable to access health care when required during the previous 12 months, compared with 17% without persistent pain (aOR 3.4). Those with less frequent low to moderate pain (26.8%), more frequent low to moderate pain (35.1%) and less frequent severe pain (43.1%) also reported significant and increasing rates of inability to access health care when needed.

Chronic pain is common in adolescent populations and has a significant association with decreased academic achievement and challenges accessing health care. Adolescents with chronic pain report significant unmet health-care needs, as well as a trend towards seeing education as less important and being less engaged with school. Differences in chronic pain prevalence and characteristics must be addressed in both clinical and public health practice, to ensure effective adolescent chronic pain prevention and management and mitigate the associated negative developmental outcomes.

 

In school environments, this emphasises the importance of considering the implications of persistent pain in adolescents more widely than just academic achievement, into all aspects of school engagement.    

 

In terms of access to health care - these findings likely reflect that health services are underserving the needs of adolescents with chronic and recurrent pain. This may also signal a lack of available local expertise and services in primary and secondary care to address pain from an adolescent developmental approach. 

 

There may also be a mis-match between adolescents and their families understanding of the treatment options for chronic pain versus an evidence-based biopsychosocial-cultural- spiritual framework focused on improving function and pain management.  This may be due to widely held biomedically-focussed, mechanistic pain beliefs (such as persistent pain being due to  ongoing bodily damage, and that it can be ‘cured’ with  pharmacological or surgical approaches). 

 

This may result in disappointment when young people and their families’ expectations for health care (including surgery or medication, which may have limited efficacy in chronic pain) are not met, or when care offered (such as physical therapy or psychological approaches) are not seen as relevant or taking their pain seriously. 

 

Services that are responsive, engaging and work towards solutions that reduce the physical and psychosocial impacts of pain on young people are required.