Neurobiology of pain experiences in youth in the ABCD study Project Summary Chronic pain is a massive public health problem, with wide impact and profound detrimental effects on mental and physical health of those afflicted, resulting in large societal cost. Of chronic pain syndromes, many are more prevalent in females, and incidence increases dramatically during adolescence. Pediatric chronic pain is costly in its own right, and unfortunately individuals with chronic pain in adolescence are likely to have pain persist into adulthood, and experience high rates of comorbid depression and substance abuse. There are known risk factors for chronic pain, including female sex, low levels of physical activity, depressed mood, and sleep disturbance, but mechanisms underlying pain persistence are not well understood, particularly from a neurobiological perspective. Additionally, in pediatric populations there is minimal research on neurobiological correlates of pain in sufficiently large samples, and limited prospective research on pain trajectories incorporating neurobiological data. In this study, we will prospectively examine neurobiological and biopsychosocial features associated with pain during adolescence, a critical period for development of emotional and regulatory functioning, to predict pain maintenance and associated impacts over time. To do this, we will utilize data from an estimated n=3773 11-12 year olds (49% female) participating in the ABCD Study who report experiencing pain in the past month, as well as an equal-sized comparison sample, matched on age and demographic variables, who report experiencing no pain in the past month. We will utilize resting state, functional, and structural neuroimaging, and comprehensive phenotypic assessment of risk factors at baseline to characterize the neurobiological correlates of pain experiences in this large sample. We will then examine pain trajectories over time (maintenance, increases, or decreases in reports of pain intensity, pain locations, and pain-related activity limitations), and utilize hypothesis-driven longitudinal modeling approaches to identify brain-based and biopsychosocial risk factors predicting sustained and escalating pain. Results will inform our fundamental understanding of neurobiological and related biopsychosocial risk for the development of chronic pain during a key developmental period, and will inform development of screening protocols and targeted preventive interventions.

Project Narrative PUBLIC HEALTH RELEVANCE: Identifying risk factors for persistent pain during the adolescent developmental period is key to preventing the development of pain, as well as comorbid conditions such as depression and substance abuse. Understanding neurobiological features and circuits that are underlying the risk for persistent pain is particularly important in this developmental period, when brains are still developing and may be more amenable to intervention. The long term goal of this research program is to identify neurobiological and biopsychosocial risk and protective factors that contribute to chronic pain, which will directly inform the development of preventative interventions for youth at increased risk.