The Association Between Alexithymia, Interoception, and Pain in Pediatric Chronic Pain: A Systematic Review
Bibliographic record
Abstract
Objectives: Pediatric chronic pain negatively affects emotional, psychological, and social function. This may be due to differences in interoception, the ability to notice and contextualize sensations arising inside the body, and alexithymia, the inability to identify and communicate emotions, as has been shown in adults. In children with chronic pain, interoceptive impairment include difficulties perceiving, interpreting, or responding to physical symptoms such as hunger or pain. Alexithymia symptoms include limited emotional vocabulary or reliance on complaining about physical symptoms to communicate emotional distress. Both alexithymia and interoceptive impairment could contribute to the development or maintenance of chronic pain and lead to issues with pain management. However, whether these are altered in pediatric chronic pain has not been investigated. Methods: The protocol was written prospectively and indexed online in the International Prospective Register of Systematic Reviews (PROSPERO; #42023439236). The literature search included the Cumulative Index to Nursing and Allied Health (CINAHL), PsycINFO, PubMed/MEDLINE, Scopus, and Google Scholar databases. Eligible studies included participants aged ≤18 years old with chronic pain conditions, assessed for symptoms of alexithymia or interoception. Study screening and data extraction were completed independently in duplicate. PRISMA guidelines were followed; the Newcastle-Ottawa Scale assessed risk of bias. Results: Fourteen studies assessing alexithymia in children/adolescents with/without chronic pain were identified. Of eight studies that reported mean alexithymia symptoms between groups, six reported significantly higher symptoms in the pain group. Alexithymia symptoms were associated with "pain bother" and "interference" but not "intensity." Two studies also assessed interoception; one compared pain/non-pain groups, finding a significant association between decreased self-reported interoception and higher chronic pain. Conclusions: Alexithymia symptoms may be increased in children/adolescents with chronic pain. Our review was limited by incomplete reporting and inconsistent measures across studies, decreasing certainty in the overall strength of the evidence. There is a need to understand the role of interoception and alexithymia in pediatric pain to better mitigate and treat pediatric pain. More research is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.006 | 0.006 |
| Bibliometrics | 0.008 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".