Stressful experiences in youth: "Set-up" for diminished resilience to chronic pain

Sarah Nelson; Maureen Burns; Bruce McEwen; David Borsook

doi:10.1016/j.bbih.2020.100095

Stressful experiences in youth: "Set-up" for diminished resilience to chronic pain

Brain Behav Immun Health. 2020 Jun 11:5:100095. doi: 10.1016/j.bbih.2020.100095. eCollection 2020 May.

Authors

Sarah Nelson^{1

2}, Maureen Burns¹, Bruce McEwen³, David Borsook^{1

4}

Affiliations

¹ Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children's Hospital, USA.
² Department of Psychiatry, Harvard Medical School, USA.
³ The Rockefeller University, USA.
⁴ Department of Anesthesia, Harvard Medical School, USA.

Abstract

Chronic pain in youth is common, with prevalence rates in some reports exceeding 50%. Given the plasticity of brain systems in youth and their general level of activity, the underlying processes relating to the evolution of chronic pain may be different from that observed in adults. One aspect that affects brain development is childhood stress. Preliminary research indicates that maladaptive responses to stressful events that induce biological and psychological inability to adapt may be related to pain chronicity in youth. This relationship is particularly notable given the high rates of exposure to stressful events in pediatric pain populations. A review of the literature was performed in the areas of biological, cognitive, psychological and social processes associated with chronic pain and psychological stress and trauma in youth and adult populations. The current review presents a theoretical framework, adapted from McEwen's model (1998) on stress and allostatic load, which aims to outline the potential connection between exposure to stressful events and pediatric chronic pain. Avenues for future investigation are also identified.

Keywords: Brain; Cortisol; Immunological; Pain chronification; Pediatric pain; Stress.

Publication types

Review