1. Young people's social development and emotional management in the presence of persistent pain.

Aim - to understand the effect of pain on social development in young people with chronic pain compared to their own younger selves, and compared to those without.

We hypothesize:

a) That young people will judge themselves to be socially delayed in comparison to their peers, and be less independent

b) That they will be advanced in terms of their emotional management skills.

c) That those high in pain related anxiety will show deficits in all areas of self-rated social development.

2. Young peoples social and physical functioning (including risk taking) in the presence of persistent pain.

Aim - to understand the effect of chronic pain on social behaviour in young people, compared to their own younger selves, and compared to those without.

We hypothesize:

a) that young people with pain will have radically reduced physical activity

b) that young people with pain will be risk averse and show fewer risk behaviours

c) that these effects will be moderated by anxiety.

Dependent variables

1. Pain (location, VAS)

2. Pain related anxiety

Independent variables

1. Social development

2. Social and physical behaviour

3. Age

Background

Pain is a common phenomenon in adolescence (Deere et al 2011)(Clinch et al 2009), with 25% of children and adolescents reporting recurrent or continuous chronic pain and 8% reporting persistent, disabling pain (Perquin et al., 2000). Adolescents who experience chronic pain typically report school absence, elevated levels of disability, emotional distress, social role disruption and complex family issues (Walker et al., 1998, Roth-Isigkeit et al., 2005; Eccleston et al., 2004). It is likely that pain and associated disability will affect adolescents' developmental trajectory. Findings from this research group suggest that adolescents with chronic pain perceive their developmental progression to lag behind that of peers (Eccleston et al.2008), particularly with regard to academic progress. Others have found that adolescents with chronic pain report poor quality relationships with peers and low levels of autonomy (Kashikar-Zuck S 2006).

It has been theorised, but not robustly investigated, that adolescents with persistent pain have altered behaviour that has a direct effect on their physical and psychosocial development. Understanding this relationship will enable therapuetic interventions to be developed, studied and targeted for identified families.

The Bath Centre for Pain Research, in collaboration with Bath Centre for Pain Services, has an international reputation in progressing clinical therapies and academic understanding of disease and non-disease related pain across the lifespan. The teams, under the guidance of Prof Eccleston and Dr Clinch, developed the Bath Adolescent Pain Questionnaire that is now used internationally as a measure of the impact of pain in adolescents and families (Eccleston 2005 , Jordan 2008). 2 domains of this questionnaire, adressing psychosocial aspects of pain, were included in the age 17 ALSPAC pack as part of the ARUK study (Prof Tobias, Dr Clinch et al) evaluating joint hypermobility and pain.

We are now in a position to evaluate the collected data from these 2 domains with respect to current and previous measures of social and physical functioning and development.

We would be grateful if Prof Ecclestone could be allowed access to this psychosocial data (alongside Dr Clinch).

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