Use of smartphones to prospectively evaluate predictors and outcomes of caregiver responses to pain in youth with chronic disease

Abstract

This study examined outcomes and predictors of different types of responses to child pain used by caregivers of youth with chronic disease. Sixty-six children and adolescents (ages 7–18) with juvenile idiopathic arthritis answered questions about pain, pain interference in activities, and mood on a smartphone three times per day for one month, while a caregiver contemporaneously answered questions about their own mood and use of protecting, monitoring, minimizing, or distracting responses to their child's pain. Multilevel models were used to evaluate (a) how a child's pain and pain interference changes after a caregiver uses different types of pain responses; (b) the extent to which caregiver responses to pain vary across days; and (c) whether variability in caregiver responses to pain is predicted by changes in child pain characteristics, child mood, and/or caregiver mood. Results showed that children’s pain intensity and pain interference increased following moments when caregivers used more protective responses, whereas children’s pain interference decreased following times when caregivers responded with minimizing responses. Caregiver pain responses varied considerably across days, with caregivers responding with more protecting and monitoring responses and fewer minimizing responses at moments when their child reported high levels of pain unpleasantness and pain interference. Caregivers also were found to respond with fewer protective responses at moments when they themselves were in a more positive mood. Implications for clinical recommendations and future studies are discussed.

Disentangling the Sleep-Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms

“…Longitudinal studies assessing mood, anxiety, sleep, and pain on a daily basis are needed to examine fluctuations and dynamic relationships between these factors in more ecologically valid settings over time. Existing microlongitudinal studies have captured daily relationships between mood and pain [ 52 ] or pain levels and sleep [ 14 ]; however, our results suggest that investigations integrating all three factors/processes are needed.…”

From the Child’s Word to Clinical Intervention: Novel, New, and Innovative Approaches to Symptoms in Pediatric Palliative Care

“…Another smartphone app allows tracking of child pain and interference caused by pain while simultaneously tracking parent response to their pain. Such a strategy allows analysis of the inter-relationships between the child’s pain experience and caregiver responses, such as how a child’s pain and pain interference changes after a given type of caregiver responses (protective versus minimizing responses) and whether caregiver responses to pain is predicted by child factors, pain, or caregiver mood [ 89 ]. The validated measures utilized within these apps are varied, making it difficult to compare one to another.…”

The (Parental) Whole Is Greater Than the Sum of Its Parts: A Multifactorial Model of Parent Factors in Pediatric Chronic Pain

“…Parents are important influencers of symptoms and functioning in youth with chronic pain. 37 A number of parental factors are associated with child pain and functioning, including responses to child pain (eg, protectiveness), 10,33 psychological functioning (eg, anxiety), 4,34 and chronic pain history. 4,7,22,40 However, these parental factors typically have been evaluated as separate domains with few studies examining their interrelations.…”