Research Article| Volume 19, ISSUE 2, P196-206, February 2018

Unravelling the Relationship Between Parent and Child PTSD and Pediatric Chronic Pain: the Mediating Role of Pain Catastrophizing

  • Alexandra Neville
    Address reprint requests to Alexandra Neville, BA, Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
    Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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  • Sabine Soltani
    Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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  • Maria Pavlova
    Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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  • Melanie Noel
    Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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Published:October 25, 2017DOI:


      • Parent and child post-traumatic stress disorder (PTSD) symptoms influence children’s pain.
      • Child pain catastrophizing mediated the relationship between child PTSD symptoms and child pain.
      • Child pain catastrophizing mediated the relationship between parent PTSD symptoms and child pain.
      • Child chronic pain treatment should address parent/child mental health symptoms.


      Clinically elevated rates of post-traumatic stress disorder (PTSD) symptoms are found among many youth with chronic pain and their parents and are linked to worse child pain outcomes. Conceptual models of mutual maintenance in pediatric PTSD and chronic pain posit that child and parent pain catastrophizing are key mechanisms underlying this co-occurrence. To our knowledge, the current study is the first to examine child and parent pain catastrophizing as potential mediators in the child PTSD-child pain and parent PTSD-child pain relationships among a cohort of youth with chronic pain. One hundred two children (72.5% female, mean age=13.5 years), recruited from a tertiary level chronic pain program, and 1 of their parents participated. At intake, parents completed psychometrically sound self-report measures of PTSD symptoms and catastrophizing about child pain. Children completed self-report measures of PTSD symptoms, pain catastrophizing, pain interference, and pain intensity. Findings revealed that relationships between child PTSD and child pain as well as parent PTSD and child pain were mediated by child (but not parent) pain catastrophizing. This suggests that children's catastrophic thinking about pain may explain how child and parent PTSD symptoms influence children's experience of chronic pain and is a potential target in family-based interventions to improve pain and mental health outcomes.


      Consistent with conceptual models of co-occurring PTSD and chronic pain, children's catastrophic thinking about child pain mediated relationships between parent and child PTSD symptoms and child chronic pain outcomes. Child pain catastrophizing may be a fruitful target in interventions to improve children's chronic pain and mental health outcomes.

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