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

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.

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

“…Parents' chronic pain, emotional distress and responses to their child's pain play a pivotal role for this familial transmission (Stone & Wilson, 2016). In line with previous studies (Hechler et al, 2011;Law et al, 2017;Wilson, Moss, Palermo, & Fales, 2014), Cordts, Stone, Beveridge, Wilson, and Noel (2019) found that parental pain-related catastrophizing -the tendency to highly focus on child pain, to magnify the threatening value of pain (Stone & Wilson, 2016) -was impactful on child pain and functioning. Behavioural responses such as solicitousness (positive reinforcement of child pain behaviours; Noel et al, 2015) are also associated with worsened child pain outcomes (Connelly, Bromberg, Anthony, Gil, & Schanberg, 2017;Hechler et al, 2011;Law et al, 2017).…”

“…Parents differ in pain-related catastrophizing and solicitousness (Frerker, Hirschfeld, Thielsch, & Hechler, 2018). However, the vast majority of studies have focused on the impact of parental responses on child outcomes (Connelly et al, 2017;Cordts et al, 2019;Hechler et al, 2011;Higgins et al, 2015;Hoftun et al, 2013;Law et al, 2017;Stone, Bruehl, Smith, Garber, & Walker, 2018;Stone & Wilson, 2016;Wilson et al, 2014), rather than investigating modulating factors. Modulating factors may be subdivided into top-down and bottom-up processes (Goubert et al, 2005).…”

“…Noteworthy, there is evidence for high co-occurrence of anxiety symptoms and chronic pain in adults (Gureje, 2008). Parents with chronic pain and/or anxiety have been consistently found to report higher parental pain-related catastrophizing and solicitousness (Cordts et al, 2019;Wilson & Fales, 2015). Bottom-up processes refer to the impact of child variables, such as child chronic pain and anxiety, on parental responses.…”

“…Bottom-up processes refer to the impact of child variables, such as child chronic pain and anxiety, on parental responses. Child's pain, functional disability and anxiety are associated to higher parental pain-related catastrophizing (Cordts et al, 2019).…”

Adverse childhood experiences in parents of youth with chronic pain: prevalence and comparison with a community-based sample

“…The impact of parenting behaviors on the functioning of youth with chronic pain is well-established, 16 and research suggests parents' mental health and physical health are also related to children's chronic pain outcomes. 10 , 12 , 19 , 26 , 32 , 42 , 47 However, adverse childhood experiences (ACEs) among parents of youth with chronic pain have not been examined.…”