Adolescents and young adults’ experiences of living with everyday pain: a systematic review protocol of qualitative evidence

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Review question/objectiveWhat are the experiences of adolescents and young adults (AYA) living with everyday pain?The objective of this systematic review is to identify and synthesize the best available evidence from qualitative primary studies on how adolescents and young adults’ experience living with everyday pain.BackgroundDuring the last 10 years pain has been recognized as a growing health problem in children and adolescents worldwide, and there is increasing evidence that daily life, function and well-being are affected by pain.1 The literature shows that as much as 15%-30 % of adolescents are suffering from persistent or chronic pain conditions, and this is regarded as a significant public health problem.2-6According to the International Association for the Study of Pain (IASP), pain is always subjective.8 Pain is a common concept in the nursing literature, and McCaffery's well-known definition of pain is often cited: “Pain is whatever the experiencing person says it is, existing whenever he says it does”.7(p.15) The International Association for the Study of Pain also recognizes the central role of emotions in pain defining pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.8(p.94) According to Eccleston two core aspects of pain are however missing from these definitions. In addition to the private felt character of pain it is also a social and communicative event. Pain expression may function to communicate to others the possibility of danger and presence of personal suffering.9 Further pain may function to override other concerns and to motivate escape or avoidance. Everyday pain is described by Eccleston as: “pain that is clinically unimportant that arises from normal everyday activity. Pain functions to interrupt current concerns and promote problem solving typically in the form of escape, pain management, or request for assistance”.10(p.47)The literature shows that self-reported pain increases with age, and older children report more pain than younger children.3,5 The expression of pain as having an emotional basis also increases with age, and is expressed more frequently by adolescents.11 The most commonly reported pains in adolescents are headache, abdominal pain, backache, and limb pain, and many adolescents report multiple pain sites.5 Qualitative studies on adolescents’ experiences reveal how living with chronic everyday pain strongly influences adolescents’ daily life in different ways. It may result in absence from school, poor school performance, problems with social activities, isolation, stigma and sleeping problems.3,12-14The adolescents’ pain experience is influenced by a complex interaction between biological, sociocultural, and psychological factors.15 Children from families with low socioeconomic status report more pain than children from families with higher socioeconomic status.6,16 Moreover social factors such as parents’ income, education, and also psychosocial variables, such as divorce, anxiety, and depression, have been shown to be related to pain in children and adults.16 Pain may be symptoms of underlying causes, and have been associated with psychosomatic problems, such as stress, problems in relations with schoolmates, and with lack of sleep or exercise.17 The association between stress and headaches is stronger among teens with frequent headaches,18 and living with a high stress level over time may give adolescents feelings of helplessness.It has been suggested that changes in modern society and in the lifestyles of adolescents such as their frequent use of computers, more sedentary behaviour, greater stress, less sleep and greater psychological burdens may contribute to the increase in self-reported pain.19,20 Managing stability through stressful challenges called allostasis (stability through change) is a challenge to adolescents and young adults.21 Continuous stress may induce allostatic overload, which might partly explain why some adolescents frequently experience pain and become high frequency users of over-the-counter (OTC) analgesics.22 Holmström's study of Swedish teenagers’ OTC drug use revealed how vulnerable teenagers may be as new consumers of OCT drugs.23 A knowledge gaps among the teenagers concerning OTC drugs was identified, and also that their OCT drug use was significantly influenced by parents and peers.The high prevalence of pain is a cause of concern, especially because pain negatively affects adolescents’ daily life and activities in different ways. Adolescence is a period in life in which great changes occur, and children are faced with physical, psychological and social changes that may be challenging. Pain problems may also have serious long term consequences, as pain problems can persist into adulthood and develop into chronic or persistent pain.24 Studies show that children with recurrent headaches, abdominal pain and other symptoms are at increased risk of developing chronic musculoskeletal pain in adulthood.25Different coping strategies are described in the literature, and a passive coping strategy has been associated with higher levels of pain.26 Peer influence is apparent in the socialization of pain experience,27 and qualitative studies have shown that girls are more likely to talk to friends about pain problems than boys.28 Studies have also showed that more girls than boys use pain medication as coping strategy.28 Moreover, qualitative studies illuminated that children describe a stressful life and too little sleep as common causes of pain.Adolescents’ and young adults’ search for pain relief may lead to an increase in the use of pain relievers as OTC analgesics, illicit drugs and alcohol.29 Recent Nordic studies show that adolescents have a high frequency use of analgesics.22 The frequence of adolescent users of OTC analgesics in Norway and Denmark has also increased remarkably from 5% among boys and 14% among girls, to 26% for both genders during the last years.22,23,30Even if we have knowledge of the prevalence and impact of pain, and this topic has been well investigated during the last years, much remains unknown about the causes of pain, adolescents own experience of living with pain, and also their coping strategies. To be able to support adolescents to relate to their pain in such way that it does not lead to chronic or persistent pain, we need more knowledge about their own thoughts and experience according to pain experience. There are few such studies in a non-clinical population.9An initial search on the keywords “adolescent*” OR “young adults” AND “pain” in the databases Medline, CINAHL, PsychINFO, EMBASE, JBIConnect+, PROSPERO or Cochrane Library indicated that no systematic review of qualitative evidence on this topic exists, or is currently underway. Thus a qualitative systematic review with metasynthesis by meta-aggregation may provide important and relevant evidence about this topic.

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