Leader(s): Melanie Noel
Institution(s): Alberta Children’s Hospital (site lead), University of Calgary/Foothills Medical Centre, Hospital for Sick ChildrenIWK Health Centre
Other Member(s): Syed, N.; Rasic, N.; Vinall, J.; Bray, S.; Harris, A.; Palermo, T.; Kazak, A.; Vervoort, T.; Sears, C.; Stinson, J.; Finley, A.; Latimer, M.; Chorney, J. 


Why was the study done?
Chronic pain in children and adolescents is a rising epidemic, affecting approximately 1 in 5 Canadian youth, and costing society $19 billion USD/year. Many youth with chronic pain also have mental health issues, such as anxiety, depression, and PTSD. What is more, we’ve shown that 50% of their parents have chronic pain and many have mental health issues themselves, which affect their children’s pain and functioning. This study aimed to answer the following questions: Why do chronic pain and mental health issues co-occur and how do they ‘get under the skin’ to influence the next generation? How can we better treat children and parents who have these co-occurring issues and prevent these problems from developing?

How was the study done?
This study was conducted at the Alberta Children’s Hospital, SickKids, and the IWK Health Centre, where we assess mental health and chronic pain, as well as a variety of mechanisms that may account for this co-occurrence. These include cognitive (attention, memory biases), behavioral (parent responses to pain), physiological (sleep disturbances), and neurobiological (gene expression) factors. Over 200 youth (aged 10-18 years old) with idiopathic chronic pain have participated in this study. Parents and youth reported on their pain, mood, sleep and other factors at baseline and 3-months later. Specifically, they filled out a battery of questionnaires, then reported on their daily pain, mood and sleep for 7 consecutive days at each timepoint.

What were the study results?
Findings from this study show that many underlying mechanisms contribute to chronic pain in youth. We found evidence of an attentional bias in youth with chronic pain and showed that parent protectiveness and poorer parent mood predicted worse youth pain on a day-to-day basis. Higher PTSD symptoms, sleep disturbances, intolerance of uncertainty, and adverse childhood experiences in youth are related to worse pain. Diagnostic uncertainty is experienced by nearly a third of youth with chronic pain and their parents, and is linked to worse youth pain and health-related quality of life.

Was there a patient-partner involved?
Janice Sumpton has provide invaluable insight throughout the project.

Recent Updates:
We have recruited 190 dyads from the main study site (ACH) into the study. All families have completed their baseline and follow-up assessments. We have recruited 30 dyads from additional sites (IWK and SickKids); of these, 25 have completed baseline and follow-up assessments.


Last updated: May 2021

Selected Publications:
  • Noel, M., Pavlova, M., Lund, T., Jordan, A., Chorney, J., Rasic, N., Brookes, J., Hoy, M., Yunker, W., & Graham, S. A. (2019). The role of narrative in the development of children’s pain memories: influences of father- and mother-child reminiscing on children’s recall of pain. PAIN. 160(8), 1866-1875.
  • Noel, M., Rosenbloom, B., Pavlova, M., Campbell, F., Isaac, L., Pagé, M.G., Stinson, J., Katz, J. (2019). Remembering the pain of surgery one year later: A longitudinal examination of anxiety in children’s pain memory development. PAIN. 160(8), 1729-1739.