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Clin J Pain. 2015 Oct;31(10):867-75. doi: 10.1097/AJP.0000000000000181.

Predicting Multiple Facets of School Functioning in Pediatric Chronic Pain: Examining the Direct Impact of Anxiety.

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*Department of Anesthesiology, Medical College of Wisconsin, Children's Hospital of Wisconsin §Department of Pediatrics and Quantitative Health Sciences ∥Department of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI †Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology ‡Department of Psychology, University of Cincinnati, Cincinnati, OH.



The relationships among chronic pain, anxiety, and school functioning are complex, and school functioning is often negatively impacted in youth with chronic pain. The objective of this study was to empirically test a model of associations between constructs predicting school functioning in youth with chronic pain to examine the direct effect of anxiety on school attendance and other indicators of school-related disability.


Participants included 349 youth and their parents (311 mothers and 162 fathers) who attended a multidisciplinary pain clinic. Youth, mothers, fathers, and clinicians completed assessments of clinical outcomes important to family and clinician perceptions of school functioning; youth, mothers, and fathers completed an assessment of youth anxiety. Structural equation modeling was used to examine interrelations among predictors.


Measurement and structural models for predicting youth school functioning provided a very good fit of the data to the conceptual model. Anxiety was directly related to problems with school attendance and avoidance, concentration, and keeping up with schoolwork.


Anxiety was a robust predictor of school functioning across a range of domains. Evaluating anxiety symptoms in pediatric chronic pain will likely facilitate case conceptualization and treatment planning. This study supports a shift in focus from pain to anxiety as the driving force of school impairment in youth with chronic pain.

[Indexed for MEDLINE]

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