Thursday, September 22nd
Twin Studies as a Tool to Understand Adolescent Pain
Chronic pain often begins in childhood/adolescence and is accompanied by anxiety, depression. Clinicians often favour causal interpretations of this comorbidity (e.g., pain causes anxiety/depression). Studies of twin cohorts can test the likelihood of alternative explanations (i.e.: sharing of common genetic/environmental determinants vs. direct causation, e.g.: anxiety causes pain, or vice-versa), and estimate the relative contribution of genetic/environmental influences. This presentation focuses on twin studies of adolescent pain (AP) and its relationship to anxiety, depression and substance use. It will discuss the following main findings: -Although it is composed of multiple symptoms, AP is best represented as a unitary, homogenous dimension -Canadian twin adolescents who are in a trajectory of ‘frequent AP’ are 4 times more likely to be prescribed an opioid at age >19 than those in a trajectory of ‘none-to-minimal’ pain -AP co-occurs with anxiety, depression due to shared genetic/environmental risk factors, and direct causation (e.g.: anxiety causes pain, or vice-versa) appears to be a less likely explanation. - Anxiety-depression together predict higher propensity to adolescent substance use -Physician prescribed opioids for AP can be an entry point for substance diversion-misuse-dependence.