Abstract
The current study examined the Fear Avoidance (FA) model of chronic pain in pediatric
chronic pain patients. Multiple structural equation models were tested in the current
study with pairwise parameter comparisons made between younger children (8–12 years)
and adolescents (13–17 years). Within a sample of 350 children and adolescents, we
examined functional disability and depressive symptoms in separate models with the
following predictor variables—pain, pain catastrophizing, fear of pain, and avoidance
of activities—after controlling for duration of pain. For a subset of patients (n
= 151), we also tested a brief prospective outcome model with baseline predictor variables
and functional disability at 1-month follow-up. The FA models predicting functional
disability concurrently and prospectively were an excellent fit to the data. The theorized
FA model for depression was a poor fit. When the model was modified to include direct
pathways from the cognitive processes of pain catastrophizing and fear of pain to
depressive symptoms, the model fit was significantly improved. In the examination
of developmental differences between younger children and adolescent patients, duration
of pain contributed to the model for younger children, whereas pain-related fears
were more influential for adolescent patients.
Perspective
The FA model of chronic pain appears to be applicable for pediatric patients with
some modification to account for developmental differences across childhood. We discuss
the developmental, theoretical, and clinical implications of these results.
Key words
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Article info
Publication history
Published online: July 26, 2012
Accepted:
May 10,
2012
Received in revised form:
April 13,
2012
Received:
March 19,
2012
Footnotes
Supported by NIH grant K23HD067202 (LS) and the Sara Page Mayo Endowment for Pediatric Pain Research and Treatment, and the Department of Anesthesiology, Perioperative and Pain Medicine at Children’s Hospital Boston.
There are no conflicts of interest to report.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
