The importance of the family environment in pediatric chronic pain
Open accessAbstract
The impact of chronic pain during childhood and adolescence has been well described (e.g., 1 ).A subset of youth with chronic pain has high levels of anxiety and depressive symptoms, poor quality of life, and impairment in school and activity participation ( 2-4 ).Moreover, pain impacts the entire family.Parents of children with chronic pain report increased parenting stress, anxiety and depressive symptoms, financial strain, and family dysfunction ( 5-6 ).Parents also play a critical role in their child's ability to adapt to living with chronic pain, both in terms of their child's emotional functioning as well as their child's ability to participate in activities of daily life.For example increased parent psychological distress is recognized as a risk factor for poorer outcomes in youth with chronic pain ( 5,7 ).A bidirectional relationship between parent and family factors (e.g., parental responses to pain behavior; family environment) and children's pain experience has been described where parent and family factors may increase risk for pain and disability, and in turn, pain and disability may impact parent and family life ( 8 ).Contemporary research in pediatric pain has focused on the identification of risk factors associated with presence and development of chronic pain as well as longitudinal risk.Such investigations have explored a range of biological, social, and psychological risk factors (e.g., [9][10] ).Findings from the study by Hoftun and colleagues published in this issue of Archives contribute to this body of literature.Using an innovative family linkage study design, their findings revealed that maternal and paternal chronic pain increased the odds of chronic pain in adolescents.Associations were even stronger when both parents reported chronic pain.Several family and psychosocial correlates were examined including the structure of the family living situation.Associations in chronic pain status were strongest among adolescents living exclusively with their mother, or their mother and her new partner.These findings raise important questions about the role of the family environment in pediatric pain.The family environment encompasses a range of variables including individual parent behaviors, dyadic interactions between family members, and the broader family system including socioeconomic conditions, family structure, family functioning, and culture.In their integrative model describing parent and family factors in pediatric pain, Palermo and Chambers 8 highlight the association between different levels of the family system and child pain and disability.For example, at the level of the individual parent, parental emotions, behaviors, and health may play a role in the child's pain experience with overly protective behaviors, increased distress, and history of chronic pain being important
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Parental distress is associated with functional disability in children with chronic pain.
“There is also mounting evidence concerning the association between parental distress, such as anxiety, fear, catastrophizing, and depression, and functional disability in children with chronic pain [12,13,14], even at subclinical levels of parental distress [15].”
Reinterpreting pain sensations shows weak correlations with functional variables such as pain interference and physical disability.
“it shows weak correlations with functional variables such as pain interference and physical disability 281, 284–287.”
From Evaluating psychosocial contributions to chronic pain outcomes (2018) · cites this paper as [285]
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- Authors
- Palermo, T. M., & Holley, A. L.
- Affiliations
- Seattle Children's Hospital (US)
- University of Washington (US)
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2013-01-01
- Volume
- 167
- Issue
- 1
- Pages
- 93
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC4036094
- OpenAlex
- W2036898238
- Cited by
- 76
- References
- 19
- Citations by year
- 2025: 4 · 2024: 1 · 2023: 44 · 2022: 1 · 2021: 4 · 2020: 1 · 2019: 1 · 2018: 7 · 2017: 4 · 2016: 4 · 2015: 1 · 2013: 3 · 2012: 1
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Child Health and Human Development
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD071946, R21HD065180, K24HD060068)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Sociology and Political Science › Family Support in Illness
- Keywords
- pediatric chronic pain, family environment, family structure, adolescents, parental distress, risk factors for chronic pain, family functioning
- MeSH terms
- Female, Humans, Male, Parents, Chronic Pain
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