Parent cognitive, behavioural, and affective factors and their relation to child pain and functioning in pediatric chronic pain: a systematic review and meta-analysis

Abstract

Previous studies have demonstrated that parental cognitive, behavioral, and emotional factors are related to child functioning in children and adolescents with chronic pain. This is particularly important to understand how to potentially enhance the efficacy of psychological interventions for children by incorporating interventions targeting parents. We conducted a systematic review and meta-analysis to identify the specific parent factors that have been examined in the literature and to quantify the associations observed between parent factors and child pain and disability. A search of the electronic databases EMBASE, PsychINFO, Medline, and PubMed was conducted, using search terms related to chronic pain, pediatric population, and parents. Fifty-four studies met criteria and were included in the review. Parent pain catastrophizing and protective behavior were the most commonly assessed parental constructs in the literature. Meta-analyses were conducted for associations between parent pain catastrophizing, parent protective behaviors, parent anxiety and depression, and parent stress associated with parenting a child with chronic pain with child pain, disability, school functioning, and emotional functioning. Correlation coefficients were pooled using the random-effects model. A medium relationship was observed between higher protective behavior and poorer school functioning (r = −0.39), and small relationships were found between higher parent pain catastrophizing and increased child disability (r = 0.29); higher protective behaviors and increased child disability (r = 0.25); and increased parent depression and anxiety with increased child disability (r = 0.23 and r = 0.24, respectively). Future research is needed to investigate broader parent variables and overcome methodological weaknesses in this field.

<p>A Conceptual Model of Biopsychosocial Mechanisms of Transition from Acute to Chronic Postsurgical Pain in Children and Adolescents</p>

“… 10 , 16 , 38 In contrast, parent factors have been consistently related to outcomes associated with other types of pediatric chronic pain. 60 In general, more research is needed to explore the relationships between a range of parent and family factors and pediatric CPSP. In particular, future research should examine parent behaviors and emotional functioning, the parent–child dyadic relationship, and global family functioning at baseline and over time to better understand possible influences on CPSP.…”

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

“…Parents play an important role in children's chronic pain experience. 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.…”

“… 33 , 34 , 36 , 46 , 50 , 55 , 58 Thus, parent ACEs may contribute to chronic pain in youth, especially given their association with parent factors (eg, mental and physical health) that are implicated in pediatric chronic pain. 4 , 14 , 16 , 26 , 42 , 46 …”

Something Else Going On? Diagnostic Uncertainty in Children with Chronic Pain and Their Parents

“…In addition, while parent diagnostic uncertainty may influence the child’s response to their pain, it is also important to consider how parent diagnostic uncertainty influences the parents’ own response to and cognitions about their child’s pain. A large body of research has shown that parent cognitions, particularly catastrophizing about the child’s pain and resultant protective behaviors, are associated with poor child functioning [ 13 , 14 ]. Of particular relevance to diagnostic uncertainty is a study that found that parents who told a distress (versus resilience) narrative, characterized by more negative affect and an unresolved orientation toward the child’s diagnosis of chronic pain, reported higher levels of catastrophizing about their child’s pain (helplessness subscale) [ 15 ].…”