Associations between biased threat interpretations, fear and avoidance of pain and pain‐linked disability in adolescent chronic pain patients

Abstract

Background: Biased interpretations of ambiguous bodily threat situations characterize youth with chronic pain, and have been associated with functional disability for this population. Despite predictions by the fear-avoidance model of chronic pain, that fear and avoidance of pain explain the association between threat perceptions and disability, this has not yet been explored in youth with chronic pain. This study aimed to address this gap by investigating these proposed relationships, in addition to the association between bodily threat interpretations and daily aspects of disability (as well as social, and emotional impairments). Method: Sixty-eight adolescents aged 11-18 years old with a clinical diagnosis of chronic pain completed an extended version of the Adolescent Interpretations of Bodily Threat task to assess interpretations of bodily and social threat situations, alongside measures of disability and fear and avoidance of pain. Results: Using mediation analysis, fear and avoidance of pain statistically accounted for the relationship between negative bodily threat interpretations and functional disability. Significant associations were also demonstrated between negative bodily threat interpretations and adolescent-reported impairments in daily, emotional and social impairments. Data revealed a significant relationship between negative social interpretations and daily functional disability. Conclusions: Findings indicate the clinical relevance of bodily and social threat interpretations, and fear and avoidance of pain, for this population and raise further questions regarding the content-specificity of threat interpretations. Significance: Psychological theories of pain-associated impact and disability point to fear and avoidance of pain, as well as information-processing biases. Here, we present novel data showing the clinical relevance of bodily and social threat interpretations in explaining pain-related disability amongst youth with chronic pain, potentially by shaping fear and avoidance of pain. Longitudinal designs will be required to assess these temporally sensitive mediation pathways.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

A systematic review of the biopsychosocial dimensions affected by chronic pain in children and adolescents: identifying reliable and valid pediatric multidimensional chronic pain assessment tools

“…The specific objectives of this review were to (1) identify multidimensional biopsychosocial assessment tools used in the pediatric (ie, ages 2-18 years) population with chronic pain; (2) describe the relationships between chronic pain and the biopsychosocial domains (precipitant variables, intervening variables, and functional status variables) measured in each tool, as defined by the Multidimensional Biobehavioral Model of Pain; and (3) review the reliability and validity evidence of such tools and their biopsychosocial domains in the pediatric population with chronic pain.…”

“…Multidimensional biopsychosocial assessment tools included in this review were those that (1) included variables reflecting at least 2 of the Multidimensional Biobehavioral Model of Pain domains of pain, precipitant variables, intervening variables, and functional status variables; (2) were developed specifically to measure the impact of pain rather than general functional interference not specific to pain; and (3) intended for use in patients with primary chronic pain diagnoses (as defined by the International Classification for Disease (ICD-11) classification). 72 We excluded disease-specific tools, such as those for children with sickle cell disease or cancer and parent proxy measures.…”

“…Our inclusion criteria for studies describing these tools included the following: (1) The population exclusively involved pediatric patients (ages 2-18) with primary idiopathic chronic pain diagnoses/locations. (2) The outcomes of the study focused on the relationship between pain intensity and the multidimensional biopsychosocial items captured by the tool under investigation.…”

“…Atkinson-Jones et al 2 Benore et al 4 Benore et al 5 Caes et al 8 Cohen et al 10 Cohen et al 11 Connolly et al 12 Eccleston et al 16 Eccleston et al 17 Eccleston et al 18 Fales et al 21 Fisher et al 24 Gagnon et al 26 Gauntlett-Gilbert et al 30 Gauntlett-Gilbert et al 29 Harrison et al 33 Jordan et al 39 Kermani et al 40 Kersch et al 41 Liam et al 44 McCracken et al 48 McGarrigle et al 49 Murray et al 52 Murray et al 52 Palermo et al 55 Palermo et al 55 Revivo et al 57 Robinson et al 58 Sinclair et al 62 Vowles et al 77 Waldron et al 79…”

The Relationship Between Fear Avoidance Belief and Threat Learning in Postoperative Patients After Lung Surgery: An Observational Study

“…When individuals have negative beliefs about pain and its consequences, including catastrophic thoughts, they may experience feelings of FOP, avoid daily activities, and become hypervigilant. 18 As a result of this misinterpretation, individuals repeatedly avoid activities that cause pain and are likely to overestimate any future pain from such activities and finally lead to disability. 19 This disability is associated with several deleterious consequences including physical deconditioning, diminished muscle mass, increased pulmonary complications (atelectasis and pneumonia), and increased risk of venous thrombosis embolism.…”