Intergenerational examination of pain and posttraumatic stress disorder symptoms among youth with chronic pain and their parents

Abstract

Introduction:Posttraumatic stress disorder (PTSD) symptoms are prevalent among youth with chronic pain, and associated with poorer pain outcomes and health-related quality of life (HRQoL). Conceptual models suggest that parent factors, including parents' own chronic pain, may be linked to higher co-occurring pain and PTSD symptoms and lower HRQoL in children. However, this has not been empirically examined.Objectives:The aim of this study was to examine the relationship between parental chronic pain and (1) parent PTSD symptoms, (2) child PTSD symptoms, (3) child pain outcomes, and (4) child HRQoL in a sample of treatment-seeking youth with chronic pain and their parents.Methods:Youth (n = 173) aged 8 to 18 years and parents (n = 204) recruited from a tertiary-level pediatric chronic pain program completed psychometrically-sound measures of pain and PTSD symptoms. Youth also completed measures of pain interference and HRQoL.Results:Half of the parents in this sample reported chronic pain. A series of analyses of covariances revealed that parents with vs without chronic pain reported significantly higher PTSD symptoms, and children of parents with vs without chronic pain reported significantly higher PTSD symptoms and pain interference and lower HRQoL.Conclusion:Findings from this study suggest that having a parent with chronic pain may confer additional risk for children with chronic pain experiencing higher PTSD symptoms, poorer pain outcomes, and lower HRQoL than having a parent without chronic pain. This could be due to genetics or social learning. Future longitudinal research is needed to understand how parental pain influences co-occurring pain and PTSD symptoms, and HRQoL, in children.

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

“…This finding is consistent with previous ACE research showing unique associations between physical neglect and chronic pain 52 , 57 and may reflect the high rates of chronic pain observed in parents of youth with chronic pain. 10 , 53 The community-based sample comprised adults attending primary care clinics for various issues and was thus treatment-seeking. Given associations between ACEs and poor health, treatment-seeking adults may be more likely to report ACEs than adults not attending medical appointments.…”

“…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.…”

Talking to Children and Families about Chronic Pain: The Importance of Pain Education—An Introduction for Pediatricians and Other Health Care Providers

“…In addition, it is important to keep in mind that many patients who present with chronic pain also report symptoms of anxiety or depression, and have a history of psychological trauma or adverse childhood experiences [ 86 , 87 , 88 , 89 ]. Symptoms that are associated with posttraumatic stress disorder have a high prevalence in youth with chronic pain – and in their parents [ 90 ]. Hence, having an interdisciplinary team of professionals who share a common understanding of pediatric chronic pain and is familiar with psychiatric disorders and diagnostics is crucial to provide the best care possible for this patient group that often presents with a range of symptoms and comorbidities.…”

Parenting in the Context of Children’s Chronic Pain: Balancing Care and Burden

“…Among treatment seeking families of youth with chronic pain, recent literature has identified that 50% of parents of youth with chronic pain also report having chronic pain themselves [56]. In addition to potential increased risk for chronic pain conferred via genetic factors, a parent’s personal experience of coping with their own chronic pain can have powerful implications for the support that they are able to provide their child to effectively self-manage their own pain.…”