Bottom‐up or top‐down?: The role of child and parent chronic pain and anxiety in the context of parental catastrophizing and solicitousness

Abstract

Purpose Children of parents with chronic pain are a high‐risk group to develop own chronic pain. There is evidence that parental responses such as catastrophizing and solicitousness play an important role in the familial transmission of chronic pain. However, little is known about factors that modulate these responses. Based on the literature, we assumed that top‐down processes, such as parent chronic pain and anxiety, would be associated with increased catastrophizing and solicitousness. Bottom‐up processes, such as child chronic pain and anxiety, were assumed to moderate this association. Methods N = 118 parents (mean age: 43 years, 80.5% females) with chronic pain and/or anxiety symptoms with N = 190 children (mean age: 11 years, 49% females) were recruited in specialized hospitals and via online panels. Parents reported chronic pain, anxiety, catastrophizing and solicitousness by use of validated questionnaires. Child pain and anxiety were assessed via parent report. Results Multilevel model results showed that top‐down processes, rather than bottom‐up processes, predicted parental responses to child’s pain. Specifically, parents with more severe chronic pain reported less catastrophizing. Parent anxiety was positively associated with parental catastrophizing and solicitousness. While child chronic pain and anxiety did not exert an impact on parental responses, the parents’ and child’s age emerged as additional modulating factors for parental solicitousness. Conclusion Findings support the assumption that top‐down processes, particularly parent anxiety, rather than bottom‐up processes, exert an impact on parental responses. Specific interventions to decrease parent anxiety in the context of chronic pain and effects of adult treatment on parental responses to child’s pain warrant further investigation. Significance This study increases our knowledge on modulating factors on maladaptive parental reactions such as parental pain‐related catastrophizing towards their children in pain. According to our findings, it is not the child variables, that is (parental perception of) child chronic pain or anxiety that modulate parental reactions but parent factors, particularly parent anxiety. Thus, parent anxiety should be regularly assessed and addressed during pain treatment of adult populations, and in interventional studies in children with chronic pain and their parents with chronic pain and anxiety symptoms.

A Review of the Evidence and Recommendations on Communication Skills and the Patient–Provider Relationship: A Rome Foundation Working Team Report

“…[91][92][93][94] In particular, parental anxiety is related to diagnostic uncertainty 95 and the desire to provide effective strategies for pain management. 96 Parental anxiety is also associated with pain-related catastrophizing 97 and solicitous behavior. 98,99 Children and adolescents exposed to this behavior demonstrate increased dysfunction, catastrophizing, and a higher frequency of pain-related symptoms.…”

Elterliche Reaktionen auf kindliche Schmerzen

“…Betroffene Eltern katastrophisieren stärker bezüglich des kindlichen Schmerzes und zeigen mehr zuwendendes Verhalten [ 31 ]. Auch Eltern mit Angstsymptomen zeigen verstärktes schmerzbezogenes Katastrophisieren und vermehrte zuwendende Reaktionen [ 30 ]. Maladaptive elterliche kognitiv-affektive und/oder verhaltensbezogene Reaktionen [ 3 ] scheinen demnach bei der Chronifizierung der kindlichen Schmerzen eine bedeutende Rolle zu spielen [ 5 , 13 ].…”

“…Als schmerzbezogene Beeinträchtigung gelten Auswirkungen des chronischen Schmerzes auf die Schulfehltage, verringerte Sozialkontakte und Freizeitaktivitäten sowie die Vernachlässigung von Pflichten [ 15 ]. In einer der ersten Studien, die beide Prozesse – „top-down“ und „bottom-up“ – einbezogen haben, konnte in einer Stichprobe aus N = 118 Eltern mit chronischen Schmerzen und Angstsymptomen gezeigt werden, dass es vorwiegend Top-down-Prozesse wie die elterliche Angst waren, die das Ausmaß des elterlichen Katastrophisierens modulierten [ 30 ]. Neben dem Mangel an Studien, die Top-down- und Bottom-up-Prozesse untersucht haben, fokussieren die meisten Studien nach wie vor vorwiegend auf Mütter.…”

“…Neben dem Mangel an Studien, die Top-down- und Bottom-up-Prozesse untersucht haben, fokussieren die meisten Studien nach wie vor vorwiegend auf Mütter. Zwar gibt es in den wenigen existierenden Studien mit beiden Elternteilen widersprüchliche Ergebnisse hinsichtlich der Unterschiede von Müttern und Vätern im schmerzbezogenen Elternverhalten [ 8 , 30 ], jedoch zeigt sich in der Geschlechterforschung [ 32 ] sowie in vergleichbaren Samples [ 13 ] verstärktes Katastrophisieren bei Frauen.…”

The Brain Stress Systems II: The Mind Level of Brain Operations

“…An ample literature suggests that maladaptive patterns of stress appraisal by children or their parents are associated with less healthy coping strategies, the development of functional somatic symptoms, and greater functional disability (Williams et al 2011;Walker et al 2007;Wallrath et al 2019). Likewise, the importance of maladaptive appraisal processes and rumination has also been documented in adult patients with NES (see summary in Testa et al [2012]), in patients with chronic fatigue (see summary in Meeus et al [2010]), and chronic pain conditions more generally (see Jackson et al [2014] and Kim et al [2015]).…”