A Systematic Review of the Psychosocial Factors Associated with Pain in Children with Juvenile Idiopathic Arthritis

Abstract Background: Pain is one of the most frequently reported experiences amongst children with Juvenile Idiopathic Arthritis (JIA); however, the management of JIA pain continues to be a challenge. As pain is a multidimensional experience that is influenced by biological, psychological, and social factors, the key to effective pain management lies in understanding these complex relationships. The objective of this study is to systematically review the literature on psychosocial factors 1) associated with and 2) predictive of later JIA pain intensity, frequency, and sensitivity in children 0-17 years of age. Methods: The Joanna Briggs Institute methodology for etiology and risk and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. Terms related to pain and JIA were searched in English without date restrictions across various databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Central Register of Controlled Trials) in September 2021. Two independent reviewers identified, extracted data from, and critically appraised the included studies. Conflicts were resolved via consensus. Results: Of the 9,929 unique studies identified, 61 were included in this review and reported on 516 associations. Results were heterogeneous, likely due to methodological differences and moderate study quality. Results identified significant associations between pain and child and parent internalizing symptoms, child and parent cognitions (e.g., more pain beliefs, lower self-efficacy), worse social functioning, and lower well-being and health-related quality of life. Prognostically, studies had 1-to-60-month follow-up periods. Internalizing symptoms and lower well-being were predictive of later pain reports, however bidirectional relationships were also identified. Cognitions (i.e., fewer beliefs of harm, disability, and lack of control) were associated with reduced pain over time. Conclusions: Despite the heterogeneous results, this review highlights important associations between psychosocial factors and JIA pain. Clinically, this information supports an interdisciplinary approach to pain management. More specifically, it informs the role of psychosocial supports and provides information to better optimize JIA pain assessments and interventions. It also identifies a need for high quality studies with larger sample sizes and more complex and longitudinal analyses to understand factors that impact the pain experience in children with JIA. Registration: PROSPERO CRD42021266716