Original Report| Volume 17, ISSUE 6, P729-738, June 2016

The Longitudinal Impact of Parent Distress and Behavior on Functional Outcomes Among Youth With Chronic Pain

  • Erika T. Chow
    Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts

    Boston University School of Medicine, Boston, Massachusetts
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  • John D. Otis
    Research Division, VA Boston Healthcare System, Boston, Massachusetts

    Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts

    Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
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  • Laura E. Simons
    Address reprint requests to Laura E. Simons, PhD, Boston Children's Hospital, 21 Autumn St., Boston, MA 02215.
    Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts

    Department of Psychiatry, Harvard Medical School, Boston, Massachusetts

    P.A.I.N. Group, Boston Children's Hospital and Center for Pain and the Brain, Boston, Massachusetts
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      • Parents' distress and behavior can longitudinally affect a child's chronic pain.
      • Parent avoidance and protective behavior are predictors of child functioning.
      • Pediatric chronic pain treatment should also address parent distress and behavior.


      Accumulating evidence supports the concurrent association between parent distress and behavior and child functioning in the context of chronic pain, with existing longitudinal studies limited to a pediatric surgical context that identify parent catastrophizing as influential. In this study, we examined how parent factors assessed at a multidisciplinary pediatric pain clinic evaluation affect child psychological and functional outcomes over time. A cohort of 195 patients with chronic pain (ages 8–17 years) and their parents who presented for a multidisciplinary evaluation completed measures at baseline and at 4-month follow-up. Patients completed measures of pain catastrophizing, pain-related fear and avoidance, generalized anxiety, depressive symptoms, and functional disability. Parents completed measures of pain catastrophizing, pain-related fear and avoidance, and protective responses to child pain. Parent-reported child school functioning was also collected. Parent distress and behavior was concurrently associated with child distress and functioning at evaluation. After controlling for baseline child functioning, baseline parent avoidance and protective behavior emerged as significant predictors of child functioning at 4-month follow-up. Parent distress and behavior influence child distress and functioning over time and these findings identify key parent domains to target in the context of a child's pain treatment.


      Parent behavior, specifically avoidance and protective responses, influence child distress and functioning over time. Child pain treatment interventions should include influential parent factors to ensure successful outcomes.

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