RUNNING HEAD: PAIN RISK FACTORS IN PEDIATRIC CANCER

Kimberly Klages ¹ Ryan N James ² Zeev N Kain ³ Sean Phipps ² Nicole M Alberts ⁴ Michelle A Fortier ^5*

• ¹ Cincinnati Children's Hospital Medical Center, Cincinnati, United States
• ² St. Jude Children's Research Hospital, Memphis, Tennessee, United States
• ³ School of Medicine, University of California, Irvine, Irvine, California, United States
• ⁴ Department of Psychology, Concordia University, Montreal, Quebec, Canada
• ⁵ Center of Nursing Philosophy, Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, California, United States

Cancer pain remains a significant burden among children with cancer, and many patients experience pain starting around the time of diagnosis and throughout the course of treatment. A biopsychosocial treatment approach has been recommended to improve pain management in this population; however, specific biopsychosocial factors that contribute to pain in the early phases of pediatric cancer treatment have yet to be identified. The purpose of this study was to explore the biopsychosocial factors associated with pain experiences during the early phases of pediatric cancer treatment, with the goal of identifying children who may be at the highest risk for pain to inform future intervention and prevention efforts. Data were collected from 203 children with cancer (M = 12.3 years of age, 53.2% male, 41.4% White, 26.6% Latino) and their primary caregiver within the first several weeks of treatment (M = 10 weeks). Children completed selfreport questionnaires and caregivers completed self-and parent-proxy questionnaires at baseline. Cancer-related data, including diagnosis and date of diagnosis, were abstracted from the child's electronic medical record. Multiple regression analysis was used to examine associations between biopsychosocial risk factors, pain intensity, and pain interference. The analysis revealed that older age, female gender, and elevated depressive symptoms, fatigue, and child self-reported pain catastrophizing were significantly associated with increased pain intensity. Additionally, lower annual income, decreased physical functioning, and greater fatigue, child pain catastrophizing, and parent stress were significantly associated with increased pain interference. These findings underscore the importance of utilizing a comprehensive biopsychosocial approach to pain assessment and management in pediatric oncology. This approach highlights the need for targeted interventions that address not only the physical aspects of pain but also the psychological and social contexts of patients, ensuring a more holistic and effective treatment strategy.