Advertisement

The (Parental) Whole Is Greater Than the Sum of Its Parts: A Multifactorial Model of Parent Factors in Pediatric Chronic Pain

Published:January 15, 2019DOI:https://doi.org/10.1016/j.jpain.2019.01.004

      Highlights

      • A model in which parent factors contributed to child pain and function was tested.
      • Parent factors included chronic pain, psychological, behavioral, and physical items.
      • The model was supported with the exception of parent behavioral responses to child pain.
      • Parents’ own pain and functioning should be assessed and addressed in treatment.

      Abstract

      Parents play a critical role in children's experience of, and recovery from, chronic pain. Although several parental factors have been linked to child pain and functioning, these factors are typically examined in isolation or as moderators or mediators. Structural equation modeling affords the opportunity to examine the extent to which parental factors are interrelated, and if there are differential associations among parental factors and child outcomes. Based on extant literature, a unified model of parental factors, including chronic pain status, physical functioning, responses to child pain, and psychological factors, and their effect on child pain and functioning, was conceptualized. This model was evaluated using structural equation modeling based on data from 146 dyads recruited from a multidisciplinary pain clinic. Modifications to model iterations were made based on theoretical and statistical justification. The final model revealed associations among all parental factors, with significant loadings on child pain and functioning. Findings indicated the conceptual model was supported, with the exception of parent responses to child pain. Findings support the inclusion of parent chronic pain status and physical and psychological functioning as part of a comprehensive assessment of youth with chronic pain and may inform new parental intervention targets to improve child outcomes.

      Perspective

      A unified structural equation model indicated parents’ own chronic pain characteristics and physical and psychological functioning represent important factors associated with child pain and functioning. Current family-based interventions that often primarily focus on parent responses to child pain may need to be adapted to more comprehensively address parental factors.

      Keywords

      To read this article in full you will need to make a payment
      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Aasland A
        • Flato B
        • Vandvik IH
        Psychosocial factors in children with idiopathic musculoskeletal pain: A prospective, longitudinal study.
        Acta Paediatr. 1997; 86: 740-746
        • Baeyer CLv
        • Lin V
        • Seidman LC
        • Tsao JC
        • Zeltzer LK
        Pain charts (body maps or manikins) in assessment of the location of pediatric pain.
        Pain Manage. 2011; 1: 61-68
        • Brown TA
        Confirmatory Factor Analysis for Applied Research.
        NY. Guilford Publications, New York2014
        • Campo JV
        • Bridge J
        • Lucas A
        • Savorelli S
        • Walker L
        • Di Lorenzo C
        • Iyengar S
        • Brent DA
        Physical and emotional health of mothers of youth with functional abdominal pain.
        Arch Pediatr Adolesc Med. 2007; 161: 131-137
        • Castarlenas E
        • Jensen MP
        • von Baeyer CL
        • Miró J
        Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: A systematic review.
        Clin J Pain. 2017; 33: 376-383
        • Claar RL
        • Guite JW
        • Kaczynski KJ
        • Logan DE
        Factor structure of the Adult Responses to Children's Symptoms: Validation in children and adolescents with diverse chronic pain conditions.
        Clin J Pain. 2010; 26: 410-417
        • Coenders A
        • Chapman C
        • Hannaford P
        • Jaaniste T
        • Qiu W
        • Anderson D
        • Glogauer M
        • Goodison-Farnsworth E
        • McCormick M
        • Champion D
        In search of risk factors for chronic pain in adolescents: A case-control study of childhood and parental associations.
        J Pain Res. 2014; 7: 175-183
        • Cohen LL
        • Vowles KE
        • Eccleston C
        Parenting an adolescent with chronic pain: An investigation of how a taxonomy of adolescent functioning relates to parent distress.
        J Pediatr Psychol. 2010; 35: 748-757
        • Connelly M
        • Anthony KK
        • Sarniak R
        • Bromberg MH
        • Gil KM
        • Schanberg LE
        Parent pain responses as predictors of daily activities and mood in children with juvenile idiopathic arthritis: The utility of electronic diaries.
        J Pain Symptom Manag. 2010; 39: 579-590
        • Connelly M
        • Bromberg MH
        • Anthony KK
        • Gil KM
        • Schanberg LE
        Use of smartphones to prospectively evaluate predictors and outcomes of caregiver responses to pain in youth with chronic disease.
        Pain. 2017; 158: 629-636
        • Cook KF
        • Kallen MA
        • Amtmann D
        Having a fit: Impact of number of items and distribution of data on traditional criteria for assessing IRT's unidimensionality assumption.
        Qual Life Res. 2009; 18: 447-460
        • Crombez G
        • Bijttebier P
        • Eccleston C
        • Mascagni T
        • Mertens G
        • Goubert L
        • Verstraeten K
        The child version of the Pain Catastrophizing Scale (PCS-C): A preliminary validation.
        Pain. 2003; 104: 639-646
        • Cunningham NR
        • Lynch-Jordan A
        • Barnett K
        • Peugh J
        • Sil S
        • Goldschneider K
        • Kashikar-Zuck S
        Child pain catastrophizing mediates the relation between parent responses to pain and disability in youth with functional abdominal pain.
        J Pediatr Gastroenterol Nutr. 2014; 59: 732-738
        • Deyo RA
        • Ramsey K
        • Buckley DI
        • Michaels L
        • Kobus A
        • Eckstrom E
        • Forro V
        • Morris C
        Performance of a Patient Reported Outcomes Measurement Information System (PROMIS) short form in older adults with chronic musculoskeletal pain.
        Pain Med. 2015; 17: 314-324
        • Gatchel RJ
        Comorbidity of chronic pain and mental health disorders: The biopsychosocial perspective.
        Am Psychol. 2004; 59: 795
        • Goubert L
        • Eccleston C
        • Vervoort T
        • Jordan A
        • Crombez G
        Parental catastrophizing about their child's pain. The parent version of the Pain Catastrophizing Scale (PCS-P): A preliminary validation.
        Pain. 2006; 123: 254-263
        • Guo B
        • Perron BE
        • Gillespie DF
        A systematic review of structural equation modelling in social work research.
        Br J Social Work. 2008; 39: 1556-1574
        • Harris PA
        • Taylor R
        • Thielke R
        • Payne J
        • Gonzalez N
        • Conde JG
        Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Informat. 2009; 42: 377-381
        • Hu Lt
        • Bentler PM
        Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives.
        Struct Equ Model. 1999; 6: 1-55
        • International Association for the Study of Pain (IASP)Task Force on Taxonomy
        Classification of Chronic Pain.
        in: Merskey H, Bogduk N Classification of Chronic Pain. 2nd ed. IASP Press, Seattle, WA1994
        • Kaczynski KJ
        • Claar RL
        • LeBel AA
        Relations between pain characteristics, child and parent variables, and school functioning in adolescents with chronic headache: A comparison of tension-type headache and migraine.
        J Pediatr Psychol. 2013; 38: 351-364
        • Karabulut GS
        • Beser OF
        • Erginoz E
        • Kutlu T
        • Cokugras FC
        • Erkan T
        The incidence of irritable bowel syndrome in children using the Rome III criteria and the effect of trimebutine treatment.
        J Neurogastroenterol Motil. 2013; 19: 90-93
        • Kashikar-Zuck S
        • Carle A
        • Barnett K
        • Goldschneider KR
        • Sherry DD
        • Mara CA
        • Cunningham N
        • Farrell J
        • Tress J
        • DeWitt EM
        Longitudinal evaluation of Patient Reported Outcomes Measurement Information Systems (PROMIS) measures in pediatric chronic pain.
        Pain. 2016; 157: 339
        • Kroenke K
        • Yu Z
        • Wu J
        • Kean J
        • Monahan PO
        Operating characteristics of PROMIS four-item depression and anxiety scales in primary care patients with chronic pain.
        Pain Med. 2014; 15: 1892-1901
        • Langer SL
        • Romano JM
        • Levy RL
        • Walker LS
        • Whitehead WE
        Catastrophizing and parental response to child symptom complaints.
        Child Health Care. 2009; 38: 169-184
        • Law EF
        • Fisher E
        • Howard WJ
        • Levy R
        • Ritterband L
        • Palermo TM
        Longitudinal change in parent and child functioning after internet-delivered cognitive-behavioral therapy for chronic pain.
        Pain. 2017; 158: 1992-2000
        • Levy RL
        • Langer SL
        • Walker LS
        • Romano JM
        • Christie DL
        • Youssef N
        • DuPen MM
        • Feld AD
        • Ballard SA
        • Welsh EM
        • Jeffery RW
        • Young M
        • Coffey MJ
        • Whitehead WE
        Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms.
        Am J Gastroenterol. 2010; 105: 946-956
        • Levy RL
        • Whitehead WE
        • Walker LS
        • Von Korff M
        • Feld AD
        • Garner M
        • Christie D
        Increased somatic complaints and health-care utilization in children: Effects of parent IBS status and parent response to gastrointestinal symptoms.
        Am J Gastroenterol. 2004; 99: 2442-2451
        • Little TD
        Longitudinal Structural Equation Modeling.
        Guilford Press, New York, NY2013
        • Logan DE
        • Simons LE
        • Carpino EA
        Too sick for school? Parent influences on school functioning among children with chronic pain.
        Pain. 2012; 153: 437-443
        • McWilliams LA
        • Cox BJ
        • Enns MW
        Mood and anxiety disorders associated with chronic pain: An examination in a nationally representative sample.
        Pain. 2003; 106: 127-133
        • Muthén LK
        • Muthén BO
        Mplus: Statistical analysis with latent variables: User's guide.
        Muthén & Muthén, Los Angeles, CA2010
        • Noel M
        • Palermo TM
        • Essner B
        • Zhou C
        • Levy RL
        • Langer SL
        • Sherman AL
        • Walker LS
        A developmental analysis of the factorial validity of the parent-report version of the Adult Responses to Children's Symptoms in children versus adolescents with chronic pain or pain-related chronic illness.
        J Pain. 2015; 16: 31-41
        • Page MG
        • Campbell F
        • Isaac L
        • Stinson J
        • Katz J
        Parental risk factors for the development of pediatric acute and chronic postsurgical pain: A longitudinal study.
        J Pain Res. 2013; 6: 727-741
        • Palermo TM
        • Law EF
        • Bromberg M
        • Fales J
        • Eccleston C
        • Wilson AC
        Problem solving skills training for parents of children with chronic pain: A pilot randomized controlled trial.
        Pain. 2016; 157: 1213
        • Palermo TM
        • Valenzuela D
        • Stork PP
        A randomized trial of electronic versus paper pain diaries in children: Impact on compliance, accuracy, and acceptability.
        Pain. 2004; 107: 213-219
        • Palermo TM
        • Valrie CR
        • Karlson CW
        Family and parent influences on pediatric chronic pain: A developmental perspective.
        Am Psychol. 2014; 69: 142-152
        • Pincus T
        • Burton AK
        • Vogel S
        • Field AP
        A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain.
        Spine. 2002; 27: E109-E120
        • Reeve BB
        • Hays RD
        • Bjorner JB
        • Cook KF
        • Crane PK
        • Teresi JA
        • Thissen D
        • Revicki DA
        • Weiss DJ
        • Hambleton RK
        • Liu H
        • Gershon R
        • Reise SP
        • J-s Lai
        • Cella D
        • PROMIS Cooperative Group
        Psychometric evaluation and calibration of health-related quality of life item banks: Plans for the Patient-Reported Outcomes Measurement Information System (PROMIS).
        Med Care. 2007; 45: S22-S31
        • Robinson JO
        • Alverez JH
        • Dodge JA
        Life events and family history in children with recurrent abdominal pain.
        J Psychosom Res. 1990; 34: 171-181
        • Ruskin D
        • Lalloo C
        • Amaria K
        • Stinson JN
        • Kewley E
        • Campbell F
        • Brown SC
        • Jeavons M
        • McGrath PA
        Assessing pain intensity in children with chronic pain: Convergent and discriminant validity of the 0 to 10 numerical rating scale in clinical practice.
        Pain Res Manag. 2014; 19: 141-148
        • Savedra MC
        • Tesler MD
        • Holzemer WL
        • Wilkie DJ
        • Ward JA
        Pain location: Validity and reliability of body outline markings by hospitalized children and adolescents.
        Res Nurs Health. 1989; 12: 307-314
        • Schmitt TA
        Current methodological considerations in exploratory and confirmatory factor analysis.
        J Psychoeduc Assess. 2011; 29: 304-321
        • Shelby GD
        • Shirkey KC
        • Sherman AL
        • Beck JE
        • Haman K
        • Shears AR
        • Horst SN
        • Smith CA
        • Garber J
        • Walker LS
        Functional abdominal pain in childhood and long-term vulnerability to anxiety disorders.
        Pediatrics. 2013; 132: 475-482
        • Sieberg CB
        • Williams S
        • Simons LE
        Do parent protective responses mediate the relation between parent distress and child functional disability among children with chronic pain?.
        J Pediatr Psychol. 2011; 36: 1043-1051
        • Simons LE
        • Claar RL
        • Logan DL
        Chronic pain in adolescence: Parental responses, adolescent coping, and their impact on adolescent's pain behaviors.
        J Pediatr Psychol. 2008; 33: 894-904
        • Stinson JN
        • Kavanagh T
        • Yamada J
        • Gill N
        • Stevens B
        Systematic review of the psychometric properties, interpretability and feasibility of self-report pain intensity measures for use in clinical trials in children and adolescents.
        Pain. 2006; 125: 143-157
        • Stone AL
        • Bruehl S
        • Smith CA
        • Garber J
        • Walker LS
        Social learning pathways in the relation between parental chronic pain and daily pain severity and functional impairment in adolescents with functional abdominal pain.
        Pain. 2018; 159: 298-305
        • Stone AL
        • Walker LS
        Adolescents' observations of parent pain behaviors: Preliminary measure validation and test of social learning theory in pediatric chronic pain.
        J Pediatr Psychol. 2017; 42: 65-74
        • Tunks ER
        • Crook J
        • Weir R
        Epidemiology of chronic pain with psychological comorbidity: Prevalence, risk, course, and prognosis.
        Canadian J Psychiatry. 2008; 53: 224-234
        • Van Der Veek SM
        • Derkx H
        • De Haan E
        • Benninga MA
        • Plak RD
        • Boer F
        Do parents maintain or exacerbate pediatric functional abdominal pain? A systematic review and meta-analysis.
        J Health Psychol. 2012; 17: 258-272
        • Van Slyke DA
        • Walker LS
        Mothers' responses to children's pain.
        Clin J Pain. 2006; 22: 387-391
        • Vinall J
        • Pavlova M
        • Asmundson GJ
        • Rasic N
        • Noel M
        Mental health comorbidities in pediatric chronic pain: A narrative review of epidemiology, models, neurobiological mechanisms and treatment.
        Children. 2016; 3: 40
        • von Baeyer CL
        • Spagrud LJ
        • McCormick JC
        • Choo E
        • Neville K
        • Connelly MA
        Three new datasets supporting use of the Numerical Rating Scale (NRS-11) for children's self-reports of pain intensity.
        Pain. 2009; 143: 223-227
        • Vowles KE
        • Cohen LL
        • McCracken LM
        • Eccleston C
        Disentangling the complex relations among caregiver and adolescent responses to adolescent chronic pain.
        Pain. 2010; 151: 680-686
        • Walker LS
        • Garber J
        • Greene JW
        Somatization symptoms in pediatric abdominal pain patients: Relation to chronicity of abdominal pain and parent somatization.
        J Abnorm Child Psychol. 1991; 19: 379-394
        • Walker LS
        • Levy RL
        • Whitehead WE
        Validation of a measure of protective parent responses to children's pain.
        Clin J Pain. 2006; 22: 712-716
        • Wilson AC
        • Fales JL
        Parenting in the context of chronic pain: A controlled study of parents with chronic pain.
        Clin J Pain. 2015; 31: 689-698