Title: Elevated Reports of Anxiety Symptoms among Pediatric Chronic Pain Patients: A Need for Routine
Screening?
Authors: Susan T. Heinze, BA, University of Wisconsin-Milwaukee
Kim Anderson Khan, PsyD, Medical College of Wisconsin, Children’s Hospital of Wisconsin
Keri R. Hainsworth, PhD, Medical College of Wisconsin
Steven J. Weisman, MD, Medical College of Wisconsin, Children’s Hospital of Wisconsin
Corresponding Author: Susan T. Heinze, Department of Psychology, University of Wisconsin-Milwaukee
2441 E. Hartford Ave, Milwaukee, WI 53211
stheinze@uwm.edu
Purpose/Background: Children with chronic pain report more symptoms of anxiety than those in nonclinical populations (Tsao et al., 2009); a point specifically true for those with recurrent abdominal pain
(Campo et al., 2004). Although recommended for adults with chronic pain, little attention has been paid
to routine screening for anxiety disorders in pediatric chronic pain populations. The primary goal of this
study is to quantify the prevalence of anxiety and sub-clinical levels of anxiety in a pediatric chronic pain
population. A secondary goal is to examine differences in anxiety symptoms in children with headache
and abdominal pain.
Methods: Children and adolescents (N = 92; 73.9% female; 79.6% Caucasian) ages 8-18 (M = 14.1, SD =
2.56) completed measures before beginning treatment at a multidisciplinary pain clinic. Included were
self-reports of pain location, intensity and duration. Youth also completed the Screen for Child Anxiety
Related Disorders (SCARED). The SCARED is a validated child report that yields a total anxiety score and
several subscales: panic or somatic symptoms, generalized anxiety, separation anxiety, social anxiety,
and school avoidance.
Results: Based on clinical cutoff scores (greater than or equal to 25), 34.9% (N = 30) of children and
adolescents had total scores indicating a possible anxiety disorder. Within this group, 22 children and
adolescents (21.7% of the total sample) scored above a more stringent cutoff (greater than or equal to
30). If we include children and adolescents falling just below the clinical cutoff score (greater than or
equal to 20), 43.4% (N = 42) of our sample warrant further assessment of anxiety symptoms. Subscale
scores: 21.7% of participants reported elevated panic or somatic symptoms, 24.1% reported elevated
generalized anxiety, 19.5% reported elevated separation anxiety, 9.6% reported social anxiety, and
47.6% reported elevated school avoidance. Worst pain level was correlated with child report of total
anxiety (r = .26, p < .05) and generalized anxiety symptoms (r = .24, p < .05). Best pain level was
correlated with child report of total anxiety, separation anxiety and social anxiety (r range = .24 - .29, p <
.05).
The two most common primary pain locations reported were head (40.0%) and abdomen (18.9%). These
two groups did not differ in age or gender. In comparing these two groups, children with abdominal pain
reported higher overall anxiety (t (45) = 2.51, p < .05), panic and somatic complaints (t (45) = 3.21, p <
.01), and school avoidance (t (45) = 2.22, p < .05) than children reporting headaches. The two groups did
not differ in their reports of pain intensity, however, those with abdominal pain reported experiencing
pain for a longer duration than those with headache (t (47) = 2.12, p < .05).
Conclusions: Given these findings, anxiety symptoms should be assessed when treating children with
chronic pain. Pediatric patients with chronic pain have elevated symptoms in several anxiety-related
domains. Children reporting abdominal pain experienced more overall anxiety, panic and somatic
complaints, and school avoidance than those who reported headache pain, suggesting possible
differences in patterns of comorbidity or etiology.