Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation

Sarah Nelson; David Borsook; Michelle Bosquet Enlow

doi:10.1097/PR9.0000000000000953

Targeting the stress response in pediatric pain: current evidence for psychosocial intervention and avenues for future investigation

Pain Rep. 2021 Sep 3;6(3):e953. doi: 10.1097/PR9.0000000000000953. eCollection 2021 Sep-Oct.

Authors

Sarah Nelson^{1

2}, David Borsook³, Michelle Bosquet Enlow^{2

4}

Affiliations

¹ Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA.
² Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
³ Department of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.

Abstract

Nonpharmacological treatments for chronic pain in youth have been identified as first-line treatments over and above medication. Therapies such as cognitive-behavioral therapy and mindfulness-based stress reduction have shown good efficacy in reducing the psychological correlates (eg, anxiety, depression, and stress) and social or behavioral sequelae (eg, limited physical activity and lack of school engagement) associated with pediatric chronic pain. However, minimal research has examined the physiological mechanism(s) of action for these interventions. A recent review (Cunningham, et al., 2019) emphasized the need for objective (ie, physiological) assessment of treatment response in pediatric pain populations. The current review adds to this literature by identifying the physiological stress response as a particular target of interest in interventions for pediatric pain. Research indicates that youth with chronic pain report high rates of psychological stress, posttraumatic stress symptoms, and exposure to adverse childhood experiences (abuse/neglect, etc). In addition, a host of research has shown strong parallels between the neurobiology of pain processing and the neurobiology of stress exposure in both youth and adults. Interventions such as narrative or exposure therapy (eg, trauma-focused cognitive-behavioral therapy) and mindfulness-based or meditation-based therapies have shown particular promise in alleviating the neurobiological impact that stress and pain can have on the body, including reduction in allostatic load and altered connectivity in multiple brain regions. However, no study to date has specifically looked at these factors in the context of pediatric pain treatment. Future research should further explore these constructs to optimize prevention in and treatment of these vulnerable populations.

Keywords: Pediatric pain; Psychosocial intervention; Stress response; Treatment outcomes.

Publication types

Review

Grants and funding

K23 AT010643/AT/NCCIH NIH HHS/United States