The Reported Pain Coping Strategies of Pediatric Burn Survivors—Does a Correlation Exist Between Coping Style and Development of Anxiety Disorder?

Abstract

Unresolved pediatric pain, both acute and chronic, has been associated with negative short- and long-term physical and mental health outcomes. This study sought to determine whether an association existed between self-reported pain coping skills and anxiety levels in a cohort of pediatric burn patients, and whether gender would influence their responses. The sample comprised burn-injured children in attendance at one of three mature burn camp sites. The self-report measures utilized included the 41-item Screen for Child Anxiety Related Disorders Child Version and the 39-item Pain Coping Questionnaire. Parental consent was obtained. A psychologist administered the measures. Participants included 187 youth, mean age 12.4 ± 2.4 years, girls (n = 89) boys (n = 98) with 67% reporting visible burn scars. Among boys, the use of Internalizing Coping Strategies was moderately correlated with elevated scores on Panic Disorder symptoms (r = .42, P < .001). Among girls, the use of Internalizing Coping Strategies was associated with elevated Generalized Anxiety (r = .51, P < .001), Panic Disorder (r = .46, P < .001), and Total Anxiety Symptom Scores (r = .49, P < .001). Those children who reported using Behavioral Distraction Strategies did not have any elevated anxiety scores. These findings suggest that burn-injured children, who employ Internalization as their pain coping strategy, may be more vulnerable to the development of long-term anxiety disorder, which, if left untreated may result in a negative psycho/social outcome. Applicability to Practice: Assessment of in-patient pediatric patients with the Pain Coping Questionnaire may help to identify children who are more likely to experience long-term anxiety. Future studies should seek to confirm these findings and determine whether improved pain management and early treatment of anxiety can help to diminish the long-term implications of unhelpful pain strategies and increased anxiety in burn-injured children.

Nonpharmacologic Management of Procedural Pain in Pediatric Burn Patients: A Systematic Review of Randomized Controlled Trials

“…A study by Rimmer et al found children engaging in internalization coping behaviors such as catastrophizing to be more likely to develop long-term anxiety disorders, indicating that adverse psychological outcomes in children may be directly mediated by patients' pain coping strategies. 16 While children with maladaptive pain coping strategies had an increased risk of developing anxiety disorders, patients using behavioral distraction did not. 16 This suggests distraction-based nonpharmacologic pain treatments may improve the risk of long-term psychological sequelae of burns in children.…”

“…16 While children with maladaptive pain coping strategies had an increased risk of developing anxiety disorders, patients using behavioral distraction did not. 16 This suggests distraction-based nonpharmacologic pain treatments may improve the risk of long-term psychological sequelae of burns in children.…”

“…Acute pain has longterm health consequences and is associated with delayed wound healing as well as increased risk of chronic pain, post-traumatic stress disorder, anxiety, and depressive disorders. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Traditional pharmacologic methods of procedural pain management in pediatric patients do not always provide complete control and carry risks; opioids, the mainstay of pharmacologic procedural pain management, can lead to user dependence, hyperalgesia, and respiratory depression. 1,[20][21][22] To address these limitations, nonpharmacologic modes of procedural pain management are being developed for pediatric patients.…”

The Pain Coping Questionnaire short-form: preliminary reliability and validity

“…7 A child or adolescent's choice of coping strategies can have beneficial or detrimental effects on their overall well-being. Adaptive coping strategies, such as information seeking, 4 , 39 may lessen negative physical and mental consequences of chronic pain in childhood 8 ; whereas avoidant coping, passive coping, or catastrophizing about the pain is associated with elevated psychological distress, 11 , 27 , 28 , 38 a more intense pain experience, 20 , 43 , 47 and increased functional disability. 10 , 21 , 31 …”

Coping in Pediatric Burn Survivors and Its Relation to Social Functioning and Self-Concept

“…In contrast, active coping strategies (i.e., seeking social support, problem solving, and openly talking about stressors) are most effective for promoting the psychosocial adjustment of chronically ill pediatric patients ( Meijer et al, 2002 ) and a key to family functioning and support in pediatric oncology patients ( Trask et al, 2003 ; Martin et al, 2012 ). In the context of pediatric burns, adaptive coping strategies are negatively associated with post-traumatic stress symptoms ( Enlow et al, 2019 ), whereas internalizing (e.g., rumination, fixating on anxieties) and externalizing coping behaviors (e.g., screaming, breaking things) have been related to greater panic and general anxiety disorder symptoms ( Rimmer et al, 2015 ).…”