title: Mental Health Comorbidities in Pediatric Chronic Pain: A Narrative Review of Epidemiology, Models, Neurobiological Mechanisms and Treatment.
abstract: Chronic pain during childhood and adolescence can lead to persistent pain problems and mental health disorders into adulthood. Posttraumatic stress disorders and depressive and anxiety disorders are mental health conditions that co-occur at high rates in both adolescent and adult samples, and are linked to heightened impairment and disability. Comorbid chronic pain and psychopathology has been explained by the presence of shared neurobiology and mutually maintaining cognitive-affective and behavioral factors that lead to the development and/or maintenance of both conditions. Particularly within the pediatric chronic pain population, these factors are embedded within the broader context of the parent-child relationship. In this review, we will explore the epidemiology of, and current working models explaining, these comorbidities. Particular emphasis will be made on shared neurobiological mechanisms, given that the majority of previous research to date has centered on cognitive, affective, and behavioral mechanisms. Parental contributions to co-occurring chronic pain and psychopathology in childhood and adolescence will be discussed. Moreover, we will review current treatment recommendations and future directions for both research and practice. We argue that the integration of biological and behavioral approaches will be critical to sufficiently address why these comorbidities exist and how they can best be targeted in treatment.
authors.affiliation: Department of Anesthesia, University of Calgary, Calgary, AB T3B 6A8, Canada. jillian.vinall@ahs.ca.
authors.forename: Jillian
authors.initials: J
authors.lastname: Vinall
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada. mpavlova@ucalgary.ca.
authors.forename: Maria
authors.initials: M
authors.lastname: Pavlova
authors.affiliation: Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada. Gordon.Asmundson@uregina.ca.
authors.forename: Gordon J G
authors.initials: GJ
authors.lastname: Asmundson
authors.affiliation: Department of Anesthesia, University of Calgary, Calgary, AB T3B 6A8, Canada. nivez.rasic@ahs.ca.
authors.forename: Nivez
authors.initials: N
authors.lastname: Rasic
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada. melanie.noel@ucalgary.ca.|Division of Behaviour and the Developing Brain, Alberta Children's Hospital Research Institute, Calgary, AB T3B 6A8, Canada. melanie.noel@ucalgary.ca.
authors.forename: Melanie
authors.initials: M
authors.lastname: Noel
keywords: anxiety; brain; chronic pain; comorbidity; depression; intervention; neurobiology; parent; posttraumatic stress disorder; stress