Prevalence of Chronic Pain among School-aged Children in the United States During the First Year of the COVID-19 Pandemic: A Nationally Representative Study

The COVID-19 pandemic and its associated disruptions have been shown to increase rates of childhood depression, anxiety, obesity, and insomnia. Thus far, the epidemiological impact of the pandemic on the national prevalence of pediatric chronic in the United States has not been systematically addressed. We aimed to compare the national prevalence of pediatric chronic pain between 2019 (pre-pandemic) and 2020 (first year of the pandemic) and determine whether changes varied across sociodemographic groups. Cross-sectional analysis of children (6-17 years) participating in the National Survey of Children's Health (NSCH) 2019 and 2020 (n=48,319). Chronic pain was defined as the caregiver reporting their children had “frequent or chronic difficulty with repeated or chronic physical pain during the past 12 months”. We computed adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) comparing the prevalence of chronic pain between survey years using survey-weighted Poisson regression adjusted for age, sex, race/ethnicity, parental education, and Census region. In separate Poisson models with interactions between sociodemographic variables and survey year, we tested for multiplicative effect measure modification using joint Wald tests for all interaction terms. The estimated national prevalence (95% CI) of chronic pain in children 6-17 years was 10.6% (9.7, 11.6%) in 2019, decreasing to 7.3% (6.7, 8.0%) in 2020. The adjusted prevalence of chronic pain was estimated to be 31% lower in 2020 than in 2019 (aPR=0.69, 95% CI: 0.61, 0.79; p<0.001). We found no differences in the change in chronic pain prevalence by age (p=0.68), sex (p=0.65), race/ethnicity (p=0.55), parental education (p=0.76), and Census region (p=0.28). Contrary to our expectations, the national prevalence of pediatric chronic pain decreased during the first year of the COVID-19 pandemic relative to the same period one year earlier. Additional studies are needed to investigate longitudinal patterns and mechanisms explaining reduced pain burden.