Factors that Alleviate and Exacerbate Chronic Pain in Children and Adolescents: A Systematic Review

Background: Pediatric chronic pain is a complex, multidimensional phenomenon with profound implications for children’s and adolescents’ biopsychosocial development. Despite its high prevalence and clinical significance, the underlying mechanisms remain insufficiently characterized. Accumulating evidence suggests that chronic pain in youth results from the dynamic interplay between biological vulnerabilities, psychological distress, and adverse social conditions. However, prior research has often isolated these domains rather than investigating their integrated effects.  Objectives: This systematic review aimed to synthesize current empirical findings regarding the biological, psychological, and social determinants of chronic pain in individuals aged ۵–۱۸ years. A particular focus was placed on identifying exacerbating and alleviating factors, such as maladaptive emotional responses or resilience mechanisms, to inform the development of holistic and developmentally attuned interventions. Methods: We performed a systematic review adhering to preferred reporting items for systematic reviews and meta-analyses (PRISMA) ۲۰۲۰ guidelines. Multiple databases (Google Scholar, PubMed, Scopus, Web of Science, EMBASE, and PsycINFO) were searched for studies from ۲۰۱۰ to ۲۰۲۴ involving children and adolescents (aged ۵–۱۸ years) with chronic pain. Eligible studies were evaluated using the STROBE checklist. Results: Thirty-eight studies met the inclusion criteria. The findings indicated that among the biological factors, female gender, dysfunction in pain inhibitory systems, obesity and systemic inflammation, functional alterations in the mesolimbic dopaminergic pathway, neuroplasticity changes, and increased age and maturation of neural systems play a role in pediatric chronic pain. Among psychological factors, psychological distress, pain catastrophizing, difficulties in emotion regulation, low resilience, and receiving physical and psychological treatments were identified as contributing factors. Furthermore, among social factors, adverse family conditions, educational environment and peer relationships, and low socioeconomic status were found to influence chronic pain in children and adolescents. Conclusions: A multifactorial approach is essential to understanding chronic pain in children and adolescents. Integrating biological vulnerabilities, social contexts, and individual psychological coping mechanisms, particularly pain acceptance and adaptive strategies, can inform holistic and personalized treatment planning.

کلیدواژه ها:

Chronic pain ، Child ، adolescent ، Risk factors ، Pain management