Parent Responses to Their Child's Pain: Systematic Review and Meta-Analysis of Measures

Abstract

Objective Parent responses can have a major impact on their child’s pain. The purpose of this systematic review is to (a) identify and describe measures assessing pain-related cognitive, affective, and behavioral responses in parents of children with chronic pain and (b) meta-analyze reported correlations between parent constructs and child outcomes (i.e., pain intensity, functional disability, and school functioning). Prospero protocol registration ID: CRD42019125496. Methods We conducted a systematic search of studies including a measure of parent/caregiver responses to their child’s chronic pain. Study characteristics and correlations between parent measures and child outcomes were extracted. Data were summarized and meta-analyzed. Results Seventy-nine met inclusion criteria using 18 different measures of cognitive/affective (n = 3), behavioral (n = 5), and multidimensional responses (n = 10). Measures were used a median of three times (range 1–48), predominantly completed by mothers (88%), and primarily in mixed pain samples. Psychometrics of measures were generally adequate. Meta-analyses were based on 42 papers across five measures. Results showed that each of the cognitive, affective, and behavioral parent constructs we examined was significantly associated with pain-related functional disability. A small number of measures assessing parent cognitions and affective functioning were associated with higher child pain intensity; however, the majority were not. Conclusion Findings demonstrate that there is a wealth of measures available, with adequate reliability overall but a lack of psychometrics on temporal stability. Synthesizing data across studies revealed small effects between parent responses and child functioning, and even smaller and/or absent effects on child pain intensity.

Something Else Going On? Diagnostic Uncertainty in Children with Chronic Pain and Their Parents

“…In addition, while parent diagnostic uncertainty may influence the child’s response to their pain, it is also important to consider how parent diagnostic uncertainty influences the parents’ own response to and cognitions about their child’s pain. A large body of research has shown that parent cognitions, particularly catastrophizing about the child’s pain and resultant protective behaviors, are associated with poor child functioning [ 13 , 14 ]. Of particular relevance to diagnostic uncertainty is a study that found that parents who told a distress (versus resilience) narrative, characterized by more negative affect and an unresolved orientation toward the child’s diagnosis of chronic pain, reported higher levels of catastrophizing about their child’s pain (helplessness subscale) [ 15 ].…”

Parenting an adolescent with complex regional pain syndrome: A dyadic qualitative investigation of resilience

“…This is an area worthy of further research. It is important to acknowledge the critical role that parents play in their child's adaptation to chronic pain (Palermo, Valrie, & Karlson, 2014) and the association between parental psychological distress and functional impairment in young people with chronic pain (Harrison et al, 2020). Furthermore, parental resilience may buffer the association between parental symptoms of depression and child pain intensity which highlights the important interaction between resilience and risk factors (Khu, Soltani, Neville, Schulte, & Noel, 2018).…”

“…Additionally, parents report feelings of helplessness regarding their inability to relieve their child's pain (Jordan et al, 2007), fear, lack of control, and believe their parenting skills are impaired (Baert et al, 2020). Parental behaviours play a critical role in their child's adaptation to chronic pain and associated functioning (Harrison et al, 2020). Parental responses may be a risk factor for child pain and associated disability, and in turn, child pain and disability may impact parental responses (Palermo & Chambers, 2005).…”

Parental Pain Catastrophizing, Communication Ability, and Post-surgical Pain Outcomes Following Intrathecal Baclofen Implant Surgery for Patients With Cerebral Palsy

“…Among parents of children with chronic pain without IDD, parental behaviors, including modeling of pain behaviors and responses to child pain behaviors, have been shown to affect their child's pain expression, ratings of pain severity, and mental health and functional outcomes (10)(11)(12)(13). In these studies, however, the children experiencing pain had no developmental or physical disabilities that affected their ability to communicate about their pain.…”