Social modulation of facial pain display in high-catastrophizing children: An observational study in schoolchildren and their parents

Abstract

The present study examined existing communal and operant accounts of children's pain behavior by looking at the impact of parental presence and parental attention upon children's pain expression as a function of child pain catastrophizing. Participants were 38 school children and 1 of their parents. Children completed a cold pressor pain task (CPT) twice, first when told that no one was observing (alone condition) and subsequently when told that they were being observed by their parent (parent-present condition). A 3-minute parent-child interaction occurred between the 2 CPT immersions, allowing measurement of parental attention to their child's pain (ie, parental pain-attending talk vs non-pain-attending talk). Findings showed that child pain catastrophizing moderated the impact of parental presence upon facial displays of pain. Specifically, low-catastrophizing children expressed more pain in the presence of their parent, whereas high-catastrophizing children showed equally pronounced pain expression when alone or in the presence of a parent. Furthermore, children's catastrophizing moderated the impact of parental attention upon facial displays and self-reports of pain; higher levels of parental nonpain talk were associated with increased facial expression and self-reports of pain among high-catastrophizing children; for low-catastrophizing children, facial and self-report of pain was independent of parental attention to pain. The findings are discussed in terms of possible mechanisms that may drive and maintain pain expression in high-catastrophizing children, as well as potential limitations of traditional theories in explaining pediatric pain expression. The impact of parental presence and parental attention to the child's pain upon the child's pain expression is moderated by the child's catastrophizing about pain. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved

Examining Affective-Motivational Dynamics and Behavioral Implications Within The Interpersonal Context of Pain

“…For instance, a parent soothing a screaming infant (an ostensible approach behaviour) may be underpinned by approach motivation (reflecting an other-oriented goal of providing comfort, and accompanied by sympathetic emotion); alternatively, the same soothing behaviour may be underpinned by avoidance motivation (reflecting self-oriented goals of peace and quiet and reflecting efforts to regulate self-oriented emotional distress). Given this potentially paradoxical association between motivation and behavioural output, it stands to reason that, within the Further, in the context of pain, we propose that these differential motivational substrates (i.e., approach vs. avoidance) may underlie either traditionally-defined category of caregiving response -broadly, behaviours designed to control pain (such as offering medication) versus those not focused on pain control (such encouraging activity participation or distraction) [13,87]. As in the example above, a parent providing analgesic medication to a child in pain (a pain control behaviour) may be underpinned by avoidance motives and associated self-oriented goals and emotions; in-turn, these self-oriented goals may be related to pain (the parent may be uncomfortable in the presence of the child's suffering) or be non-pain related (the parent may wish to return to a personal work assignment).…”

“…), and potential mechanisms of action. unfairness of the pain experience, and prejudicial/discriminatory beliefs or attitudes [3,18,19,20,40,87]. Type of relationship between pain observer and sufferer is likely important here.…”

Emotion regulatory function of parent attention to child pain and associated implications for parental pain control behaviour

“…These pictures were selected from videotapes drawn from an existing pool of school children who had taken part in previous studies using the CPT [see e.g., 76,78] and who had provided consent for using/showing the videos for research purposes. All pictures were reliably coded for occurrence and intensity of facial pain display by means of the Child Facial Coding System (CFCS) [21] and were used in previous studies assessing parental and child attention to child pain [75,80].…”

“…As above, parental state anxiety was entered in each analysis to examine its potential moderating impact. Further, as child behaviour during CPT performance may influence parental responses [see e.g., 76,77], additional exploratory analyses were performed to examine the role of child facial pain expression in parents' selfreported distress and pain control behaviour; accordingly, these analyses were re-run whilst also controlling for the child's facial pain expression. Table 1 Pearson correlation analyses indicated that HR reactivity was negatively associated with both 2 Restricting analyses to the sample for whom complete data were available (i.e., 38 parent/child dyads; N = 19 in each group) revealed comparable findings but represented a decrease in statistical power (i.e., power analyses indicated this restricted sample size was insufficient to detect a medium effect [d = .50] with power .80 using α = .05 two-tailed).…”

“…Given that the nature and consequences of attentional processing may be modulated by individual differences, particularly level of anxiety [10,26,28], we examined the moderating role of parental anxiety on attentional control (eye-tracking/self-report), emotion regulation indices (HRV, HR, distress), and pain control behaviour. As child behaviour during CPT performance may influence parental responses [see e.g., 76,77], we explored the role of child facial pain expression in parents' self-reported distress and pain control behaviour.…”