A developmental perspective on the impact of chronic pain in late adolescence and early adulthood: implications for assessment and intervention

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The prevalence and severity of chronic pain is well defined in children and adults. Epidemiological studies estimate that 11% to 38% of children25 and 35% to 51% of adults17 have chronic pain; for 5% to 8% of children21 and 10% to 13% of adults,36 the pain is severe and disabling. Although progress has been made in assessment and treatment of chronic pain, there remain significant disparities. We highlight here an age disparity. Most chronic pain research has been conducted on “average” pediatric (ie, older child or adolescent) or adult (ie, middle-age adult) individuals. This has left gaps in knowledge for the subpopulation in the period of late adolescence and early adulthood where important developmental milestones may not be reached leading to lifelong individual and societal consequences. Surprisingly little research attention is directed toward understanding clinically meaningful outcomes, strategies for tailoring pain therapies, and strategies to reduce disparities in access or utilization of care in the older adolescent and young adult population.
While there are limited data on the course of pain during late adolescence and early adulthood, likely a subset experience a continuation of chronic pain from childhood.22,23 Unique vulnerabilities may also increase likelihood of new-onset chronic pain during late adolescence and early adulthood. Although not conclusive, specific point prevalence rates of chronic pain in older adolescents and young adults indicate rates between 7.6% and 14.3% worldwide.15,24,29 Consistent with child and adult literature, females report higher rates of pain than males.4,41,44,50 Reflecting potential age disparities, adolescents and young adults report greater interference from their pain than people with pain older than 35 years4 and may have greater health care needs.29
However, limited data exist on what constitutes clinically meaningful outcomes of chronic pain treatment in early adulthood. Given the differing context related to functioning and productivity, this may include unique domains from childhood or later adulthood. Vulnerabilities that emerge in late adolescence and early adulthood related to health risk behaviors and poor access to health care have significant implications for chronic pain management2,3,5,10,11,47,48 but have not been fully characterized. Furthermore, chronic pain treatments have not been tailored for this subpopulation.
A relevant starting point for progress in chronic pain research in late adolescence and young adulthood is to better understand the impact of chronic pain during this developmental period. Therefore, the objectives of this review are as follows: (1) to highlight chronic pain impact in older adolescents and young adults, specifically within developmentally relevant areas of functioning and productivity, and (2) to present ideas for informing optimal assessment and treatment approaches in adolescents and young adults with chronic pain.
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