The Association Between Depressive Symptoms and Pain-Related Functioning Among Adolescents With Recurrent Musculoskeletal Pain: A Longitudinal Study

Clin J Pain. 2026 Jun 1;42(6):e1378. doi: 10.1097/AJP.0000000000001378.

ABSTRACT

BACKGROUND: Chronic musculoskeletal pain is reported by 1 of 4 adolescents worldwide. Pain-related functioning is negatively affected by pain itself but also related to depressive symptoms. Although the association between pain-related functioning and depressive symptoms is established, there is a lack of longitudinal studies that establish the direction of the association.

OBJECTIVES: The aim was to analyse the temporal association between depressive symptoms and pain-related functioning among adolescents with recurrent musculoskeletal pain.

METHODS: This longitudinal sample comprised 604 adolescents in seventh and eighth grade (M = 13.7 y) who reported recurrent musculoskeletal pain at baseline, defined as occurring at least every week over the previous 6 months. The adolescents were followed yearly for 2 consecutive years (T1, T2, and T3). Temporal associations of self-reported pain-related functioning and depressive symptoms were analysed. Using cross-lagged panel modelling, 4 models were estimated: autoregressive; depressive symptoms predicting pain-related functioning; pain-related functioning predicting depressive symptoms; and a bidirectional model. Pain intensity was entered as a covariate.

RESULTS: The results indicate high stability of depressive symptoms and pain-related functioning over time. Although the strength of the prediction was strongest in the autoregressive paths, cross-lagged paths revealed that depressive symptoms at T1 and T2 significantly predicted pain-related functioning at T2 and T3, respectively. Conversely, pain-related functioning at T1 and T2 did not predict depressive symptoms at T2 and T3, respectively.

CONCLUSIONS: The model where depressive symptoms predict pain-related functioning provided the best model fit and thus, in this general population sample, depressive symptoms drive pain-related functioning more than vice versa. Screening for and targeting depressive symptoms might be essential in affecting the functional consequences of pain.

PMID:41811236 | DOI:10.1097/AJP.0000000000001378