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.

Adults with chronic headache have altered brain hippocampal efficiency networks. Less is known about the mechanisms underlying chronic headache in youth. In total, 29 youth with chronic headache (10–18 years), and 29 healthy, age- and sex-matched controls tracked their headache attacks daily for 1-month period. Following this, they underwent a resting state functional magnetic resonance imaging scan and self-reported on their pubertal status, post-traumatic stress, anxiety, and depression symptoms. Graph-based topological analyses of brain networks, rendering hippocampal efficiency values were performed. T-tests were used to compare hippocampal efficiency metrics between patients and controls. Linear regression was used to examine significant hippocampal efficiency metrics in relation to headache frequency in patients, controlling for age, sex, pubertal status, post-traumatic stress, anxiety, and depression symptoms. Patients had higher right hippocampal global efficiency, shorter right hippocampal path length, and higher right hippocampal clustering coefficient compared to controls (P < 0.05). Higher right hippocampal global efficiency, shorter right hippocampal path length, and higher right hippocampal clustering coefficients were positively associated with greater headache frequency (P < 0.05). The hippocampus is largely involved in memory formation and retrieval, and this data provides additional support for previous findings demonstrating the importance of the hippocampus and pain memories for the chronification of pain.

Background: Approximately 25% of adolescents live with chronic pain, with many reporting symptoms of functional impairment and poor sleep quality. Both chronic pain and poor sleep quality can negatively impact brain functional connectivity and efficiency. Better sleep quality may improve pain outcomes through its relationship with brain functional connectivity. Methods: This pilot prospective cohort study used data from 24 adolescents with chronic pain (aged 10–18 years) participating in an Intensive Interdisciplinary Pain Treatment (IIPT) at the Alberta Children’s Hospital. Data were collected within the first couple of weeks prior to starting IIPT and on the last day of the 3-week IIPT program. Sleep quality was assessed using the modified Adolescent Sleep-Wake Scale. Resting-state functional MRI data were obtained, and graph-theory metrics were applied to assess small-world brain networks. Questionnaires were used to obtain self-reported functional disability data. Paired t-tests were applied to evaluate changes in outcomes from pre- to post-IIPT, and moderation analyses were used to examine the relationships between sleep, small-world brain network connectivity, and functional disability. Results: Total sleep quality (p = 0.005) increased, and functional disability (p = 0.020) decreased, between baseline and discharge from IIPT. Small-world brain networks did not change pre- to post-IIPT (p > 0.05). Unlike adolescents with high small-worldness (p = 0.665), adolescents with low to moderate small-world brain characteristics (1SD below or at the mean) who reported better sleep quality reported less functional disability (all p ≤ 0.001) over time. Conclusions: The IIPT program was associated with improvements in sleep quality and functional disability. Better sleep quality together with greater small-worldness was associated with less pain-related disability. This suggests that it is equally important for IIPTs to target sleep problems in adolescents with chronic pain, as this may have a key role in producing long-term improvements in pain outcomes.