Background: Fear of pain is fundamentally defined as a fear of movement that develops as a result of negative experiences associated with physical activity [1]. Factors such as pain during movement, the risk of injury, and fear of falling can contribute to its onset. This movement-related fear is significant within the biopsychosocial framework of patient assessment and is observed across various populations [2]. In pediatric populations with childhood-onset rheumatic diseases, such as Juvenile Idiopathic Arthritis (JIA) or Familial Mediterranean Fever (FMF), symptoms like joint pain, muscle weakness, and fatigue can lead to pain-related fear, which often develops into movement-related fear [3]. This fear fosters a negative association between pain and movement, prompting children to avoid physical activity. Over time, such avoidance behaviors may intensify kinesiophobia and lead to a decline in functional abilities among affected children.

Objectives: The aim of this study was to investigate the relationship between fear of pain and functional capacity, pain at rest, and pain during activity in children with childhood-onset rheumatic diseases. By examining how pain-related fear influences both pain experiences and functional abilities, the study seeks to illuminate the interplay between these factors and propose therapeutic approaches to improve patient outcomes.

Methods: The study included 62 patients with JIA (n=48) and with FMF (n=14), comprising 39 girls and 23 boys. The Fear of Pain Questionnaire for Children-Short Form (FOPQC-SF) was used to assess fear related to movement and pain. The FOPQC-SF contains 10 items, each rated on a 5-point Likert scale ranging from 0 (“not at all”) to 4 (“extremely”), with higher scores indicating greater fear of pain. Pain levels at rest and during activity were evaluated using a 10-point Likert scale, where 0 represented no pain and 10 represented severe pain. The Physical Activity-Specific Rumination Scale for Children (PARSC) was employed to assess rumination specific to physical activity. PARSC consists of 10 items rated on a 3-point Likert scale (1 to 3), with higher scores reflecting increased rumination. Functional capacity and physical performance were measured using the 6-Minute Walk Test (6MWT) and the 30-Second Sit-to-Stand Test (30SSTS).

Results: The mean age of the children was 15.23±1.87 years, with a mean height of 162.40±10.03 cm and a mean weight of 56.81±13.44 kg. The mean of the FOPQC-SF score was 14±8.65. The mean of the 6MWT, 30SSTS, rest and during activity pain level and PARCS were shown in Table 1. No significant correlation was found between the FOPQC-SF scores and the physical performance measures, including the 6MWT and the 30SSTS (p>0.005). However, a significant correlation was observed between the FOPQC-SF scores and pain levels reported during activity and at rest (p<0.005).

Conclusion: The findings indicate no significant correlation was found between fear of pain and the physical performance outcomes. This suggests that fear of pain may not directly affect physical performance or that the relationship between these outcomes could be influenced by more complex factors in our patients. The lack of a significant relationship may be attributed to the influence of various personal factors and the relatively small sample size of the study. However, a significant correlation between the fear of pain and pain levels reported during both activity and rest indicates that fear of pain may impact children’s pain experiences. Fear and pain are often intertwined and difficult to separate, particularly in pediatric populations with chronic conditions. This suggests that fear of pain may not only influence subjective pain perception but also impact children’s participation in daily activities. These results underscore the importance of considering psychosocial factors in interventions aimed at improving pain management and participation in physical activity in patients with pediatric rheumatic disease. Future studies should explore these relationships in more depth, utilizing larger sample sizes and examining outcomes across diverse age groups.

REFERENCES: [1] Leona McGarrigle, et al. (2020) Psychological mediators in the relationship between paediatric chronic pain and adjustment: An investigation of acceptance, catastrophising and kinesiophobia, Journal of Contextual Behavioral Science, 18(1):294-305.

[2] Tran ST, et al. Preliminary Outcomes of a Cross-Site Cognitive-Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia. Arthritis Care Res, 2017, 69(3):413-420.

[3] Woolnough, L.U., et al. (2022) The relationships of kinesiophobia and physical function and physical activity level in juvenile idiopathic arthritis. Pediatr Rheumatol 20,73.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.