PM2095: Sex, Puberty and Pain in the Adolescent Brain Cognitive Development Cohort

Background: Females appear to be disproportionally affected by widespread pain and associated mental health symptoms. However, evidence for sex differences in pediatric pain is conflicting, with some data suggesting that differences may emerge following puberty. To deepen our understanding of the relationships between sex, puberty, and widespread pain in healthy young adolescents, this study examined self-reported pain in the Adolescent Brain Cognitive Development (ABCD) Study cohort.

Methods: We analyzed second year follow-up data collected between 2018-2021, when a self-reported pain survey was introduced. Participants reported past-month pain presence, its location (electronic body map), and degree to which pain interfered with daily functioning (0-10 Rating Scale). We coded pain location as singular region (head/neck, abdomen/pelvic, musculoskeletal) or overlapping (≥ 2 major or non-contiguous regions). Pubertal stage was calculated from 1 (pre-pubertal) to 4 (late/post-pubertal) based on a child-reported puberty survey. Child’s sex at birth, race, and ethnicity were derived from parent baseline surveys.

Results: 10,320 participants (aged 12.0 ± 0.7; 48% female; 40% pre-early puberty; 39% mid-puberty; 21% late puberty) completed the pain survey. One third of boys (34%) and girls (36%) reported past month pain, which was singular region in 14% and 14% and overlapping in 20% and 21%, respectively (p>.05). Girls were more likely than boys to report headache (8.9% vs. 7.4%; OR 1.2 [95% CI 1.1, 1.4]) or abdominal pain (12.1% vs. 5.4%; OR 2.43 [2.1, 2.8]) but had similar rates of musculoskeletal pain (27.3% vs. 28.9%; OR 0.92 [0.85, 1.01]; see Figure 1). Ordinal logistic regression demonstrated that sex interacted with puberty stage such that advancing pubertal stage in boys and girls increased the odds of singular or overlapping pain compared to pre-pubertal stage (see Table). The effect was strongest for girls at late-stage puberty (OR 2.4 vs 1.5 for boys at late puberty). Although Black and Hispanic participants had lower odds of reporting singular or overlapping pain, among children reporting pain, Black and Hispanic children reported greater pain interference compared to white children (adj.OR 1.13 [95% CI 1.08, 1.17] and adj.OR 1.05 [95% CI 1.02,1.09), respectively). Overlapping pain was also associated with higher pain interference (adj.OR 1.04 [95% CI 1.01, 1.07), while sex and puberty were not associated.

Conclusion: Our cross-sectional analysis of self-reported pain in a nationally representative, early adolescent cohort suggests that pain may increase with advancing pubertal stage, and that sex differences may arise as puberty progresses. Our findings also suggest potential differences in self-report of pain and pain interference across racial/ethnic groups. Further analyses are needed to validate and explore these findings in the context of psychologic and sociocultural factors as longitudinal ABCD data become available.