Chronic pain and internalizing problems are characterized by concurrent associations but the directionality of this relationship in early childhood remains unclear. This prospective study aimed to investigate the bidirectional effect of chronic pain and internalizing problems and test the persistence of pain over time in a population-based sample of preschoolers. The study was embedded in Generation R, a large population-based cohort. Mothers of 3,996 children assessed their child’s experienced pain and internalizing problems at 3 and 6 years. At 3 years, paternal reports were available too. Reports of family functioning, discipline practices and parental psychopathology were also collected. The prevalence of chronic pain was 2.7% (106) and 8.0% (294) at baseline and follow-up, respectively. The presence of internalizing problems at child age 3 years predicted chronic pain at 6 years, for both maternal (OR 1.05, 95% CI 1.02,1.07, p < 0.001) and paternal (OR 1.03, 95%CI 1.00, 1.06, p < 0.05) internalizing problem reports, when adjusted for potential confounding factors. In contrast, chronic pain did not increase the likelihood of internalizing problems. The temporal relationship between chronic pain and internalizing problems appears to follow a largely unidirectional trend in early childhood, with internalizing problems increasing the likelihood of concurrent physical symptoms. Current understanding of the directionality of this relationship, highlights the importance for comprehensive assessment of psychiatric problems contributing to the manifestation of chronic pain.

慢性疼痛和内化问题的特点是并发关联，但这种关系在儿童早期的方向性仍不清楚。这项前瞻性研究旨在调查慢性疼痛和内化问题的双向影响，并在基于人群的学龄前儿童样本中测试疼痛随时间的持续存在。该研究嵌入了 R 世代，这是一个基于人群的大型队列。3,996 名儿童的母亲评估了他们孩子在 3 岁和 6 岁时经历的疼痛和内化问题。3 岁时，也可以获得父亲的报告。还收集了有关家庭功能、纪律实践和父母精神病理学的报告。慢性疼痛的患病率在基线和随访时分别为 2.7% (106) 和 8.0% (294)。p  < 0.001) 和父亲 (OR 1.03, 95%CI 1.00, 1.06, p  < 0.05) 内化问题报告，当针对潜在的混杂因素进行调整时。相反，慢性疼痛并没有增加内化问题的可能性。慢性疼痛和内化问题之间的时间关系似乎在儿童早期基本上遵循单向趋势，内化问题增加了并发身体症状的可能性。目前对这种关系的方向性的理解，突出了对导致慢性疼痛表现的精神问题进行全面评估的重要性。