Biopsychosocial Intergenerational Risk and Resilience Factors in Pediatric Amplified Musculoskeletal Pain

About This Grant

PROJECT SUMMARY/ABSTRACT Pediatric Amplified Musculoskeletal Pain Syndrome (AMPS) is becoming increasingly common, affecting between 11 – 38% of youth. AMPS is associated with significant stress, psychological impairment, and functional disability, resulting in tremendous healthcare costs. Moreover, AMPS conditions often persist into adulthood, increasing lifetime risk for psychiatric and medical comorbidities and earlier mortality. There is a critical lack of understanding of the processes involved in the onset, maintenance, and exacerbation of chronic pain conditions in youth, hampering efforts to develop interventions, which are currently limited and ineffective for a significant subset of patients. Comprehensive understanding of the biopsychosocial factors underlying chronic pain disorders like AMPS are needed to inform the development of novel, effective prevention and treatment approaches. Data suggest that altered stress physiology (e.g., allostatic load) may play a role in chronic pain conditions, with possible intergenerational implications. Parallel lines of research indicate that adversity exposure (e.g., abuse, violence), neurobiological functioning, and psychological impairment across youth-parent dyads contribute to the onset and maintenance of pain. The overall goal of the proposed project is to test an intergenerational model of chronic amplified musculoskeletal pain syndrome (AMPS) in youth and their biological mother/birthing parent that incorporates these constructs to elucidate mechanisms responsible for AMPS, thereby identifying potential prevention and intervention targets. The project aims will be accomplished by following a cohort of pediatric AMPS patient-parent dyads (N = 170) and healthy control – parent dyads (N = 85) over a 2-year period, repeatedly assessing pain characteristics (e.g., intensity, frequency), stress exposures, neurobiological functioning (conceptualized as allostatic load), psychological impairment, and psychosocial- biobehavioral resilience. Analyses will (a) identify the combination of neurobiological stress measures in isolation and cumulatively (as allostatic load) most predictive of AMPS symptoms in youth; (b) define correspondence of these measures in parent-child dyads; (c) identify parental characteristics (e.g., adversity history, parent mental health, parent stress neurobiology, parent-child relationship quality) most predictive of AMPS symptoms in youth; (d) identify psychosocial and biobehavioral resilience characteristics (e.g., coping style, social support, physical activity) that buffer the effects of intergenerational adversity exposure on pain characteristics; and (e) compare neurobiological stress processes in chronic pain patients and sociodemographically-matched healthy controls. The findings may be translated into the development of mechanistically informed prevention and treatment methods that target the most influential modifiable biopsychosocial pathways involved in AMPS and stress physiology and that may be personalized based on individual and familial risk profiles for maximum benefit. Studying these phenomena in youth-parent dyads is critical given that the majority of research in this area has focused on adult populations or with individually focused (i.e., pediatric pain patients) cross-sectional designs.