Background Pain is a primary symptom in juvenile idiopathic arthritis (JIA), and we have previously shown that children with JIA have a decreased pain threshold when compared with healthy age-related children. The reason for this, however, remains uncertain. Biological as well as psychological factors may be influential. The association between pain and coping strategies is well known and well documented. It is important to clarify the effect of coping strategies on pain threshold among children with JIA in order to better target pain treatment of these children.
Objectives To assess the pressure pain threshold and pain coping strategies of children with JIA compared with a healthy control group. We also aim to assess any association between pressure pain threshold and pain coping strategies among children with JIA.
Methods We included 58 children with JIA born 1995 to 2000 admitted to the pediatric rheumatology clinic. Ninety-one age-related healthy school children served as a control group. All children were asked to complete a subscale of the Pain Coping Questionnaire. Afterwards, pain threshold was measured using a digital pressure algometer on 17 symmetric, anatomically predefined joint or bone-related points.
Results Children with JIA were less likely to use positive self-statements (t: -2.85, p=0.005, Cohen’s d = -0.48) as well as cognitive and behavioral distraction (t: -3.81, p<0.001, Cohen’s d = -0.63, and t: -2.71, p=0.008, Cohen’s d = -0.46, respectively). They used significantly more internalizing/catastrophizing coping strategies when compared with children in the healthy control group (t: 2.22, p=0.028, Cohen’s d =0.38).
However, we found no correlation between pain threshold and any of the pain coping strategies among the children with JIA (p=0.138-0.608, r =0.07-0.20).
The pain threshold was significantly lower among children with JIA (total mean PT =1.33±0.69 kg/cm2) when compared with the healthy control group (total mean PT =1.77±0.67 kg/cm2). The same pattern was found in all areas measured (p<0.001-0.005).
Conclusions Although children with JIA seem to differ from healthy children with regard to their pressure pain threshold as well as to their pain coping strategies, the lack of association between the two outcomes suggests that the enhanced use of mal-adaptive pain coping strategies cannot explain the decreased pressure pain threshold of children with JIA in our study. Other factors such as sensitization may be influential, but further studies in this area are needed.
Disclosure of Interest None Declared
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