Risk, Resilience, and Recovery: A Longitudinal Mixed-Method Study Examining the Role of Peer Relationships in Pediatric Pain - Project Summary/Abstract Pediatric chronic pain is a critical public health problem, affecting up to a third of adolescents and contributing to significant emotional distress, poor sleep, and difficulties in social functioning. These difficulties include social isolation, friendship instability, and high rates of peer victimization both on and offline. Whether peer relationship problems are a cause, correlate, or consequence of chronic pain is largely unknown. Although research has long demonstrated links between social pain (e.g., social exclusion, loneliness) and physical pain—little research has examined the prospective, daily, or chronic impact of peer relationship problems on pain persistence and pain-related disability in childhood. Further, no research has examined how positive peer relationship factors (e.g., social connectedness, social support) may promote recovery or protect against the development of disabling pediatric chronic pain. The objective of the proposed research is to identify specific peer relationship processes that influence pain persistence, exacerbation, and recovery in a cohort of 450 early adolescents (ages 11-14) at risk for developing chronic pain (i.e., youth seeking treatment for an acute pain problem). Longitudinal studies that model the trajectories of peer relationship processes are needed to establish temporal relationships and disentangle social risk and protective factors from outcomes. If peer relationship factors contribute to pain persistence and pain-related disability, improving these relationships should become an immediate goal of both prevention and intervention efforts. Here we combine 1) a large- scale longitudinal cohort design, 2) comprehensive assessment of peer relationship processes and pain, and 3) a model-based approach to determine whether and how specific peer relationship processes (e.g., social exclusion, cyber-victimization, social connectedness) contribute to pain outcomes in at-risk youth during the critical transition from early to middle adolescence (Aims 1 and 2). Electronic daily diary monitoring of peer victimization experiences and pain, incorporating objective assessment of social media use and sleep, will be combined with qualitative interview data to characterize the temporal dynamics between peer victimization, social media use, shared comorbidities, (i.e., poor sleep, low mood) and pain outcomes (Aim 3). Our broad hypothesis is that peer relationship problems will contribute to pain persistence and disability, directly and indirectly (through mood and sleep mechanisms)—and that these effects will be mitigated by the presence of strong social support and social connectedness. The proposed methodologically rigorous mixed-methods investigation of peer relationship trajectories from early to middle adolescence will advance our understanding of the specific peer relationship processes that contribute to pain risk and resilience in childhood. Mechanistic insights regarding the role of modifiable social contextual factors will influence clinical practice guidelines and the development of preventative interventions designed to reduce risk of high impact chronic pain in childhood and beyond.
