Impact of Threat Level, Task Instruction, and Individual Characteristics on Cold Pressor Pain and Fear among Children and Their Parents

Abstract

The cold pressor task (CPT) is increasingly used to induce experimental pain in children, but the specific methodology of the CPT is quite variable across pediatric studies. This study examined how subtle variations in CPT methodology (eg. provision of low‐ or high‐threat information regarding the task; provision or omission of maximum immersion time) may influence children's and parents' perceptions of the pain experience. Forty‐eight children (8 to 14 years) and their parents were randomly assigned to receive information about the CPT that varied on 2 dimensions, prior to completing the task: (i) threat level: high‐threat (task described as very painful, high pain expressions depicted) or low‐threat (standard CPT instructions provided, low pain expressions depicted); (ii) ceiling: informed (provided maximum immersion time) or uninformed (information about maximum immersion time omitted). Parents and children in the high‐threat condition expected greater child pain, and these children reported higher perceived threat of pain and state pain catastrophizing. For children in the low‐threat condition, an informed ceiling was associated with less state pain catastrophizing during the CPT. Pain intensity, tolerance, and fear during the CPT did not differ by experimental group, but were predicted by child characteristics. Findings suggest that provision of threatening information may impact anticipatory outcomes, but experienced pain was better explained by individual child variables.

When “a headache is not just a headache”: A qualitative examination of parent and child experiences of pain after childhood cancer

“…These factors are consistent with theories that highlight the important role of cognitive and affective factors in pain perception . There is strong evidence to support that an individual's experiences of pain can be altered by variables such as their cognitions and affect, past pain experiences, social and family interactions, pain memories, and the threat level of pain . Given the nature of the disease and its treatment, cancer‐related pain may be associated with significant distress, feelings of uncertainty, and threatening thoughts of mortality .…”

Transmission of risk from parents with chronic pain to offspring: an integrative conceptual model

“…145 Observational tasks and measures that assess moment-to-moment interactions between parent—child dyads are needed to establish the behaviors that parents exhibit in response to children’s pain, and behavioral or emotional responses that children may exhibit in response to parents’ pain. A number of studies have examined parent—child dyads in the context of acute pain or laboratory tasks, 10,149 but this research has yet to be conducted in the context of parental chronic pain. In addition, using data collection and analytic techniques (eg, electronic momentary assessment and actigraphy) to capture daily variations in parental pain characteristics and stressors and child responses to parental pain might yield unique perspective on the synchrony of parent—child experiences and may provide insight into the implementation of prevention programs that could target symptoms and behaviors in daily life.…”

Pain Neuroscience Education: State of the Art and Application in Pediatrics

“…In one study [10], non-patient children completing a CPT received either threatening CPT information (CPT described as very painful, high pain expressions depicted) or non-threatening CPT information (standard CPT instructions provided, low pain expressions depicted). Children in the high-threat condition expected more pain, perceived the pain as more threatening, and catastrophized more about the pain.…”