Our research, in line with previous literature, has indicated that pain-related stigma plays a role in pain outcomes for children and adolescents with chronic musculoskeletal pain conditions. However, the influence of pain-related stigma on functioning and internalizing symptoms is less clear, as is whether stigma may differently influence youth dependent on gender and chronic pain type. The current study was a secondary analysis of cross-sectional data from 32 youth with Juvenile Idiopathic Arthritis (JIA), 31 youth with Juvenile Primary Fibromyalgia Syndrome (JFM), and 25 youth with non-specific chronic pain (NSCP) from a study examining group differences and biopsychosocial correlates of chronic musculoskeletal pain conditions. Participants self-reported their pain-related stigma, pain, physical, school, emotional and social functioning, and symptoms of anxiety and depression. Multiple regression analyses assessed associations between pain-related stigma and functioning, and pain-related stigma and internalizing symptoms, as well as interactions between stigma and gender as well as stigma and chronic pain type. Results showed that pain-related stigma significantly influenced physical and social functioning across groups. Stigma was associated with worse emotional functioning for girls, who also reported worse overall emotional functioning and greater anxiety and depression symptoms. Youth with JFM and NSCP demonstrated lower functioning compared to children and adolescents with JIA. These findings indicate that stigma substantially influences functioning and wellbeing of children and adolescents with chronic pain, especially for girls. Regardless of stigma experienced, those with chronic pain diagnoses lacking a known pathophysiology reported lower functioning in several domains. PERSPECTIVE: Youth with chronic musculoskeletal pain experience stigma about their pain which contributes not only to pain outcomes, but also physical and social functioning. Girls and youth with chronic pain conditions with unclear pathophysiology are especially at risk for adverse outcomes.

Recent scientific advances point towards an important role for oral and gastrointestinal health in people with chronic pain. Poor oral health (e.g., periodontitis, tooth loss) is observed in subgroups of the chronic pain population, including abdominal pain, low back pain, fibromyalgia, and rheumatoid arthritis. In addition to poor oral health, studies have also revealed altered intestinal microbiota compositions in various types of chronic pain, including people with chronic low back pain, knee osteoarthritis, visceral pain, fibromyalgia, tinnitus, and migraine. While overweight/obesity contributes to the likelihood of gut dysbiosis, normal-weight individuals with chronic pain also more often present with poor gut health. Both gastrointestinal and oral health problems (e.g., periodontitis, tooth loss) are increasingly recognized across multiple chronic pain conditions, including abdominal pain, low back pain, fibromyalgia, and rheumatoid arthritis. This perspective paper provides an overview of the requirements for integrating oral and gastrointestinal health in chronic pain management. First and foremost, oral and gastrointestinal health issues need to be recognized as common chronic pain comorbidities that require tailored treatment. Next to recognition of the issue, individuals seeking care for chronic pain need to be screened routinely for these oral and gastrointestinal comorbidities. In terms of management, the following options are suggested: (1) providing oral and gastrointestinal health science education; (2) considering the possible interplay between the gut microbiome and drug treatment (including polypharmacy); (3) expanding the importance of dietary interventions; and (4) considering the potential interplay with other lifestyle factors (e.g., chronic insomnia, overweight/obesity, depression and anxiety). To inform the implementation of these suggestions, longitudinal cohort studies investigating the role of oral and gastrointestinal health in people with chronic pain, as well as studies exploring possible (modifiable) factors that affect the oral and/or gut microbiome, are needed. This includes the bidirectional interplay between the gut microbiome and drugs commonly prescribed to patients with chronic pain. Likewise, adequately powered and controlled clinical trials evaluating the effectiveness of possible treatments for oral and/or gastrointestinal comorbidities in people with chronic pain represent another research priority. Such randomized clinical trials can not only examine the possible causal link between poor oral/gut health and treatment outcomes, but also inform the development of new, innovative ways to improve care for people with chronic pain.

Children with painful disorders of gut–brain interactions (DGBIs) endorse pain-related stigmatization. However, little is known about how stigma may be associated with pain intensity. Consequently, we conducted a cross-sectional study to identify a potential pathway between felt stigma and abdominal pain in youth with DGBIs. 120 youth completed measures of health-related stigma, depressive symptoms, sleep disturbances, and pain severity. As expected, greater felt stigma was significantly correlated with greater depressive symptoms, sleep-related impairments, and abdominal pain. Furthermore, a sequential mediation analysis revealed a significant indirect effect of stigma on abdominal pain via higher depressive symptoms and greater sleep-related impairments. Results suggest potential considerations for modifying current treatments for DGBIs targeting abdominal pain. More specifically, providers should incorporate screening for and addressing felt stigma, sleep-related impairment, and depressive symptoms into their treatment planning. Involving pediatric behavioral health providers may help facilitate this aspect of DGBI intervention.

Introduction: Recent research suggests that early‐life adversities, or adverse childhood events (ACEs), may play a role in the development and exacerbation of various chronic pain conditions. While this association is discussed in the adult literature, this study aimed to examine the relations among ACEs, abdominal pain, and health‐related quality of life in children diagnosed with pain‐predominant disorders of gut‐brain interaction (DGBIs). Methods: Participants consisted of 120 youth with a DGBI diagnosis involving chronic abdominal pain and their caregivers who responded to the Pediatric ACEs and Related Life Events Screener (PEARLS) tool. The PEARLS was organized by the following domains: Maltreatment (e.g., sexual, verbal, physical, and emotional abuse, and physical neglect), Household Challenges (e.g., caregiver mental or physical illness), and Social Context (e.g., housing and food insecurity). Child participants provided a retrospective 7 day rating of average abdominal pain intensity and completed the Pediatric Quality of Life Inventory. Results: Seventy‐two (60%) caregivers reported that their child had experienced maltreatment. In adjusted models, results revealed that maltreatment was significantly associated with a greater 7‐day average report of abdominal pain intensity ( p < 0.05). Household challenges and social context were not significantly associated with abdominal pain intensity (both p 's > 0.05). Additionally, the experience of maltreatment was significantly associated with worse overall health‐related quality of life ( p < 0.001). Conclusion: These findings highlight the profound impact that experiences of childhood maltreatment are likely to have on abdominal pain intensity and quality of life in pediatric patients with pain‐predominant DGBI.