Lonelier Than Ever: Examining the Experience of Loneliness amongst Adolescents with Chronic Pain in the Context of COVID-19: A Mixed Methods Study.

Chronic pain effects 1 in 5 teens in Canada. Previous studies found that teens with chronic pain are lonelier than teens without pain and that their loneliness was linked to depressed mood, anxiety, and worse scores on questionnaires about self-esteem, before the COVID-19 pandemic. However, these studies did not describe the type of loneliness teens with chronic pain experienced. For example, one can have a best friend but be lonely for a larger circle of friends, or one can feel that they don't belong to a wider community like their school and therefore suffer loneliness. Interventions to improve loneliness for teens with chronic pain depends on why they are lonely. Understanding more about loneliness, and ways to mitigate it, is important because loneliness has been found to be a risk factor for worse mental and physical health outcomes for children, teens, and adults. In fact, loneliness is as important a risk factor for health as smoking. Moreover, loneliness could have even worse health outcomes for those who already have mental or physical health problems like chronic pain. Also, the longer one is lonely the worse their physical or mental health and our previous research showed that teens with chronic pain remain lonelier than those without pain over a calendar year. During COVID-19, public health restrictions, such as online schooling, social gathering restrictions, and not being able to socialize with people outside of one's home has resulted in higher rates of loneliness in teens without pain but we don't know how COVID-19 has impacted loneliness in teens with chronic pain. Our study will help us understand how the COVID-19 pandemic has impacted loneliness in this specific population, assessing the type of relationships or situations in which they experience loneliness, and how their loneliness has impacted their physical and mental health. Findings from this study will help us understand ways to help teens with chronic pain decrease their loneliness.