Feeling the Pressure to Be Perfect: Effect on Pain-Related Distress and Dysfunction in Youth With Chronic Pain

Randall, Edin T.; Smith, Kelly; Kronman, Corey A.; Conroy, Caitlin; Smith, Allison M.; Simons, Laura E.

doi:10.1016/j.jpain.2017.11.012

Cited by 20 publications

(8 citation statements)

References 47 publications

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“…Beyond the role of emotions, our findings illustrate how other internal characteristics, such as perfectionism, being fed up and low self‐confidence, can act as barriers for adolescents in their road to functional recovery. In support of clinical observations and a recent theoretical framework on perfectionism in paediatric chronic pain (Randall et al., 2018), our findings highlight how perfectionism can exacerbate the impact of chronic pain and be a barrier for adolescents to get better. Underlying mechanisms of how perfectionism contributes to pain‐related disability need further investigations but are theorized to be related to the mismatch between the cognitive rigidity and pride associated with perfectionism on the one hand and the unpredictability of and need to accept help in managing chronic pain on the other hand (Dignon et al., 2006; Gonzalez et al., 2015).…”

Section: Discussionsupporting

confidence: 86%

Which passengers are on your bus? A taxonomy of the barriers adolescents with chronic pain face in achieving functional recovery

Jacobs

Smith

Heathcote

et al. 2020

European Journal of Pain

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BackgroundDespite evidence that intensive interdisciplinary pain treatment (IIPT) is effective in facilitating functional recovery in adolescents with chronic pain, engagement with IIPT is suboptimal among adolescents. A key aspect of IIPT is to support functional recovery via (re)engagement with age‐appropriate daily activities. The aim of this study was to gain a comprehensive insight into adolescents’ perceptions of the barriers they need to overcome to engage with age‐appropriate activities in order to achieve functional recovery.MethodsForty‐one adolescents who were starting an IIPT programme completed the ‘passenger‐on‐the‐bus metaphor’, an exercise in which they identify and describe their perceived barriers (i.e. ‘passengers’ on their bus) that prevent them from engaging with age‐appropriate activities. The responses were analysed using inductive thematic analyses to generate a taxonomy of perceived barriers to functional recovery.ResultsWe generated a taxonomy of seven different barriers that participants described facing on their road to functional recovery: physical constraints, being ‘fed up’, low self‐confidence and self‐esteem, perfectionism, avoidance of engagement with pain, feelings (such as sadness, anger, guilt, anxiety) and social barriers (received from a range of sources such as parents, friends, school and wider society).ConclusionThe findings reveal a variety of barriers that were perceived to hinder functional recovery through reduced engagement with age‐appropriate activities and thereby hamper progress within IIPT. The Passenger on the bus metaphor can be used to identify similar barriers faced by adolescents in an individualized treatment approach, thereby making it possible for clinicians to target their IIPT more precisely.

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Section: Discussionsupporting

confidence: 86%

Which passengers are on your bus? A taxonomy of the barriers adolescents with chronic pain face in achieving functional recovery

Jacobs

Smith

Heathcote

et al. 2020

European Journal of Pain

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“…This shows strong parallels to youth with a history of ACEs or chronic stress and a history of PTSD in that PTSD by nature involves emotionally painful memories and/or altered cognitions/emotions surrounding a traumatic event ( Association, 2013 ). Perfectionism (e.g., socially-prescribed beliefs, non-disclosure of perceived imperfections ( Hewitt et al., 2011 )) as a personality trait has also been commonly seen in youth with chronic pain and found to be significantly related to pain chronicity and increased disability ( Randall et al., 2018 ). Individual characteristics may compound risk for psychopathology in response to stress as well.…”

Section: Resultsmentioning

confidence: 99%

Stressful experiences in youth: “Set-up” for diminished resilience to chronic pain

Nelson

Burns

McEwen

et al. 2020

Brain, Behavior, & Immunity - Health

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Chronic pain in youth is common, with prevalence rates in some reports exceeding 50%. Given the plasticity of brain systems in youth and their general level of activity, the underlying processes relating to the evolution of chronic pain may be different from that observed in adults. One aspect that affects brain development is childhood stress. Preliminary research indicates that maladaptive responses to stressful events that induce biological and psychological inability to adapt may be related to pain chronicity in youth. This relationship is particularly notable given the high rates of exposure to stressful events in pediatric pain populations. A review of the literature was performed in the areas of biological, cognitive, psychological and social processes associated with chronic pain and psychological stress and trauma in youth and adult populations. The current review presents a theoretical framework, adapted from McEwen’s model (1998) on stress and allostatic load, which aims to outline the potential connection between exposure to stressful events and pediatric chronic pain. Avenues for future investigation are also identified.

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“…1,9 In youth with chronic pain, elevated somatic symptoms have been associated with greater pain severity and pain-related functional disability, negative pain cognitions, emotional distress, and the persistence of chronic pain into adulthood. 6,19,23,26,35 Thus, it is possible that elevated somatic symptoms in pediatric patients with chronic pain could be useful information for their health care provider, serving as a red flag for poor adaptation to pain and a poor prognosis.…”

mentioning

confidence: 99%

“…Empirical research on pain includes many studies assessing somatic symptoms in pediatric patients with chronic pain 3,6,19,23,26,35 and in nonclinical populations. 8,11,13,17,18,20,21,27,29 The most commonly used assessment tool is the Children's Somatic Symptoms Inventory (CSSI; formerly known as the Children's Somatization Inventory), a 35-item self-report and parentreport questionnaire developed in 1991, 32 and reduced to 24 items in 2009 based on extensive psychometric evaluation.…”

mentioning

confidence: 99%

Somatic Symptoms in Pediatric Patients With Chronic Pain: Proposed Clinical Reference Points for the Children's Somatic Symptoms Inventory (Formerly the Children's Somatization Inventory)

Stone

Walker

Heathcote

et al. 2019

The Journal of Pain

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Among youth with chronic pain, elevated somatic symptoms across multiple body systems have been associated with greater emotional distress and functional disability and could represent poor adaptation to pain. The Children's Somatic Symptoms Inventory (formerly the Children's Somatization Inventory) is commonly used to assess somatic symptoms in children. However, no studies have evaluated the clinical usefulness of the measure in the assessment of pediatric patients with chronic pain. This study evaluated the factor structure and clinical relevance of the 24-item Children's Somatic Symptoms Inventory (CSSI-24) in youth (n = 1,150) with mixed chronic pain complaints presenting to a tertiary pain clinic. The CSSI-24 total scores were equal or superior to factor scores as indicators of patients' clinical characteristics (functional disability, pain catastrophizing, fear of pain, and anxiety and depressive symptoms) and parental catastrophizing and protective responses. Tertile-derived clinical reference points for the CSSI-24 total score (<18, low; 19−31, moderate; ≥ 32, high) significantly differed on measures of clinical characteristics and parent factors. Controlling for age, sex, pain intensity, and primary pain complaint, the high somatic symptoms group exhibited significantly greater health care use compared with the moderate and low groups. The assessment of somatic symptoms in pediatric patients with chronic pain may provide useful information regarding patients' psychosocial risk and tendency to access health services. Perspective: Clinical reference points based on the CSSI-24 total scores meaningfully differentiated youth with chronic pain on measures of emotional distress, functioning, parent catastrophizing and protective responses, and health care use. Assessing somatic symptoms could provide useful information regarding a pediatric patient's psychosocial risk, tendency to access health services, and need for enhanced care coordination.

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Feeling the Pressure to Be Perfect: Effect on Pain-Related Distress and Dysfunction in Youth With Chronic Pain

Cited by 20 publications

References 47 publications

Which passengers are on your bus? A taxonomy of the barriers adolescents with chronic pain face in achieving functional recovery

Which passengers are on your bus? A taxonomy of the barriers adolescents with chronic pain face in achieving functional recovery

Stressful experiences in youth: “Set-up” for diminished resilience to chronic pain

Somatic Symptoms in Pediatric Patients With Chronic Pain: Proposed Clinical Reference Points for the Children's Somatic Symptoms Inventory (Formerly the Children's Somatization Inventory)

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