Inflamm Bowel Dis. 2020 May 27;izaa115. doi: 10.1093/ibd/izaa115. Online ahead of print.

Lexa K Murphy ¹, Rocio de la Vega ¹, Sara Ahola Kohut ^2 3, Joy S Kawamura ^4 5, Rona L Levy ⁶, Tonya M Palermo ^1 7

Author information

¹Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.

²Department of Psychology and Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada.

³‡Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

⁴Department of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, Washington, USA.

⁵Department of Psychiatry, University of Washington, Seattle, Washington, USA.

⁶Department of Social Work, University of Washington, SeaAttle, Washington, USA.

⁷Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.

Abstract

Background: Pain is a common symptom in pediatric inflammatory bowel disease (IBD) and is associated with poor health outcomes, yet additional knowledge about the psychosocial correlates of pain is needed to optimize clinical care. The purpose of this study is to systematically review the psychosocial factors associated with pain and pain impact in youth diagnosed with IBD within a developmentally informed framework.

Methods: Manual and electronic searches yielded 2641 references. Two authors conducted screening (98% agreement), and data extraction was performed in duplicate. Average study quality was rated using the National Institutes of Health Quality Assessment Tool.

Results: Ten studies (N = 763 patients; N = 563 Crohn disease, N = 200 ulcerative/ indeterminate colitis) met the inclusion criteria. Findings showed consistent evidence that higher levels of child depression symptoms and child pain catastrophizing were associated with significantly greater pain and pain impact (magnitude of association ranged from small to large across studies). Greater pain and pain impact were also associated with higher levels of child anxiety symptoms, child pain threat, child pain worry, and parent pain catastrophizing. Within the included studies, female sex and disease severity were both significantly associated with pain and pain impact. Study quality was moderate on average.

Conclusions: There is evidence that child psychosocial factors are associated with pain and pain impact in pediatric IBD; more studies are needed to examine parent- and family-level psychosocial factors. Youth with IBD should be routinely screened for pain severity, pain impact, and psychosocial risk factors such as anxiety/depression.