Social functioning and peer relationships in children and adolescents with chronic pain: a systematic review

Authors:
FORGERON Paula A., et al
Journal article citation:
Pain Research and Management, 15(1), January 2010, pp.27-41.
Publisher:
Hindawi Publishing Corporation

The studies included in this narrative review varied in their primary focus, study design, the pain types studied and their use of outcome measures; only nine of the 42 studies included examined peer relationships as a primary focus. The evidence indicates that young people with chronic pain have difficulties with peer relationships but further research is required.

Extended abstract:
Author

FORGERON Paula A; et al.;

Social functioning and peer relationships in children and adolescents with chronic pain: a systematic review.

Journal citation/publication details

Pain Research and Management, 15(1), January 2010, pp.27-41.

Summary

The studies included in this narrative review varied in their primary focus, study design, the pain types studied and their use of outcome measures; only nine of the 42 studies included examined peer relationships as a primary focus. The evidence indicates that young people with chronic pain have difficulties with peer relationships but further research is required.

Context

There is some evidence that, as in adults, chronic pain can have a negative impact on peer relationships in children and adolescents. The aim of the current review was to investigate social functioning and peer relationships in young people with chronic pain.

Methods

What sources were searched?
Four electronic databases were searched: EMBASE, Medline, CINAHL, and PsycINFO. Reference lists of relevant articles were hand searched for additional studies.

What search terms/strategies were used?
Details of specific search strategies are not included but the following search terms were used: ‘child’, ‘adolescent’, ‘chronic pain’, ‘pain’, ‘disability’, ‘peer relationships’, ‘friendships’, ‘school functioning’, ‘social functioning’, ‘social inclusion’, ‘teachers’, ‘abdominal pain’, ‘headache’, ‘migraine’, ‘sickle cell disease’, ‘arthritis’, ‘juvenile fibromyalgia’, ‘musculoskeletal pain’, ‘neuropathic pain’. Searches were conducted by an information specialist.

What criteria were used to decide on which studies to include?
Studies of children and/or adolescents with any type of chronic pain, whether recurrent or continuous, reporting outcome measures of peer relationships, friendships, social functioning, pain, or disability were eligible for inclusion. In addition, studies had to be primary research published in peer reviewed journals in English or French between 1988 and 2008. Dissertations were excluded.

Who decided on their relevance and quality?
Initial screening based on titles and abstracts was carried out independently by two named authors. Disagreements were resolved by consensus. The same two reviewers also examined the full text of relevant articles. Study quality was not formally assessed.

How many studies were included and where were they from?
Of the 1,740 articles initially retrieved, 135 were examined in full and 42 were included in the review. Twenty two studies were set in the USA, and four in each of Norway, Canada and the Netherlands. The remaining studies were mostly from other European countries.

How were the study findings combined?
Study data was extracted onto standardised forms and were categorised according to their primary focus. These were ‘peer relationships’, ‘quality of life’, ‘mental health factors’ or ‘other’. A meta-analysis was not carried out due to the variability of the studies. The findings are presented as a narrative synthesis under the four primary focus categories and the study details are summarised in Tables 1 to 4.

Findings of the review

There were nine studies in each of the primary focus categories apart from the ‘quality of life’ category which had 15 studies. The number of participants ranged from 36 to 9,264; the age range varied between studies.

Seven of the nine studies which examined peer relationships as a primary focus found that chronic pain had a negative impact on peer relationships. Studies looked at general peer relationships or reciprocal friendships but none of them evaluated friendship quality.

The 15 studies focusing on quality of life used a variety of measures, making comparison of results difficult. Overall, having chronic pain had a negative impact on quality of life due to missing out on activities and thereby having less opportunity to interact with peers.

In general mental health factors, such as internalising or externalising problems, and chronic pain were related to higher rates of peer difficulties. But mental health factors alone did not account for the differences, suggesting that the presence of chronic pain may have an unique impact. There is also evidence that peers may play a protective mental health role for young people with chronic pain.

The primary focus of the studies in the ‘other’ category ranged from population studies of the physical and behavioural correlates associated with headaches to mothers’ attributed causes and remedies of abdominal pain. All but one study reported some form of negative impact of chronic pain on social functioning and/or peer relationships in young people.

Authors' conclusions

‘Little research exists that specifically and empirically examines the impact of chronic pain on peer relationships. Studies included in this descriptive systematic review suggest that children and adolescents with chronic pain may have fewer friends, are more isolated and may be subjected to increased rates of victimisation by peer compared with children and adolescents without pain.’

Implications for policy or practice

None are discussed.

Subject terms:
interpersonal relationships, pain, peer groups, young people, children;
Content type:
systematic review
Link:
Journal home page
ISSN online:
1918-1523
ISSN print:
1203-6765

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