1. Elevated Reports of Anxiety Symptoms among Pediatric Chronic Pain Patients: A Need for Routine Screening? Susan T. Heinze¹, B.A., Kim Anderson Khan², ³, Psy.D., Keri R. Hainsworth², Ph.D., Steven J. Weisman², ³, M.D., & W. Hobart Davies¹ ¹University of Wisconsin-Milwaukee, ²Medical College of Wisconsin, & ³Children’s Hospital of Wisconsin Children with chronic pain report more symptoms of anxiety than non-clinical controls (Tsao et al., 2009). This is especially 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. Children and adolescents (See Table 1) completed demographic measures before beginning treatment at a multidisciplinary pain clinic. Youth also completed the Screen for Child Anxiety Related Disorders (SCARED). Includes 5 factors with clinical cutoffs and a total score (Birmaher et al., 1999). Cutoff score of 25 may indicate the presence of an anxiety disorder, with a cutoff of 30 being more stringent. A significant number of youth (35%) with complex chronic pain have elevated anxiety symptoms. Additionally, youth reported anxiety across several domains, with notable endorsement of school avoidance (48%). 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. Given these findings, anxiety symptoms should be assessed when treating children with chronic pain. PURPOSE/BACKGROUND MEASURES TABLE 3: Reports of Anxiety Compared by Pain Location CONCLUSION For more information, please contact: Susan T. Heinze, stheinze@uwm.edu STUDY GOALS To quantify the prevalence of clinical and sub-clinical levels of anxiety in a pediatric chronic pain population. To examine differences in anxiety symptoms in children with headache and abdominal pain. RESULTS General Findings Based on clinical cutoff scores, 35% of children and adolescents had total scores indicating a possible anxiety disorder; 22% of the total sample scored above the more stringent cutoff. See Table 2 for prevalence of elevated total and subscale scores. Nearly half of our sample endorsed significant school avoidance symptoms (See Figure 1 for items). TotalN = 92Worst painM = 8.6 SD = 1.37 Gender73.9% female Best painM = 2.82 SD = 2.70 Ethnicity79.6% Caucasian Pain duration < 1 year 55.6% > 1 year 44.4% AgeM = 14.1 SD = 2.56 Pain location40% Head 18.9% Abdomen TABLE 1: Participant Characteristics Percentage of youth elevated ≥ 25 Overall Anxiety ≥ 30 Overall Anxiety 35% (n = 30) 22% (n = 18) ≥ 7 Panic and Somatic22% (n = 18) ≥ 9 GAD24% (n = 20) ≥ 5 Separation20% (n = 16) ≥ 8 Social10% (n = 8) ≥ 3 School Avoidance48% (n = 39) TABLE 2: Youth with Elevated Scores across Subscales Exploratory Analyses Many youth endorsed symptoms of anxiety, but fell just below the clinical cutoff score. Including all youth who scored greater than or equal to 20, 43.4% (n = 42) of our sample warrant further assessment of anxiety symptoms. Pain Intensity Worst pain level was positively correlated with child report of total anxiety (r =.26, p <.05) and generalized anxiety symptoms (r =.24, p <.05). Best pain level was positively correlated with child report of total anxiety, separation anxiety and social anxiety (r range =.24 -.29, p <.05). Group with Head Pain Group with Abdominal Pain t (df)p Overall AnxietyM = 17.31 SD = 9.22 M = 25.53 SD = 12.86 -2.51 (45).016* Panic and Somatic M = 2.63 SD = 2.34 M = 6.53 SD = 6.05 -3.21 (45).002** GADM = 5.06 SD = 3.60 M = 6.13 SD = 3.56 -0.95 (45).345 SeparationM = 2.66 SD = 2.21 M = 3.60 SD = 3.16 -1.19 (45).242 SocialM = 3.94 SD = 3.02 M = 5.00 SD = 4.14 -1.00 (45).324 School Avoidance M = 3.03 SD = 1.62 M = 4.27 SD = 2.09 -2.22 (45).031* * p <.05, ** p <.01 RESULTS (CONTINUED) Pain Location The two most common primary pain locations reported were head and abdomen. These two groups did not differ in age or gender. Children with abdominal pain reported higher overall anxiety, panic and somatic complaints, and school avoidance than children reporting headaches (See Table 3). Youth grouped by location 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). RESULTS (CONTINUED) I get headaches when I am at school. I worry about going to school I get stomachaches at school. I am scared to go to school. FIGURE 1: SCARED School Avoidance Items