Systematic review of family functioning in families of children and adolescents with chronic pain
Open accessAbstract
Unlabelled Disturbances in family functioning have been identified in youth with chronic pain and are associated with worse child physical and psychological functioning. Assessment measures of family functioning used in research and clinical settings vary. This systematic review summarizes studies investigating relationships among family functioning, pain, and pain-related disability in youth with chronic pain. Sixteen articles were reviewed. All studies were cross-sectional; 7 utilized between-group comparisons (chronic pain versus healthy/control) and 12 examined within-group associations among family functioning, pain, and/or pain-related disability. Studies represented youth with various pain conditions (eg, headache, abdominal pain, fibromyalgia) ages 6 to 20 years. Findings revealed group differences in family functioning between children with chronic pain and healthy control subjects in 5 of 7 studies. Significant associations emerged among family variables and pain-related disability in 6 of 9 studies with worse family functioning associated with greater child disability; relationships between family functioning and children's pain were less consistent. Different patterns of results emerged depending on family functioning measure used. Overall, findings showed that families of children with chronic pain generally have poorer family functioning than healthy populations and that pain-related disability is more consistently related to family functioning than pain intensity.Perspective This review highlights the importance of family factors in pain-related disability in youth with chronic pain. Results suggest that family-level variables may be an important target for intervention. Family functioning measures showed significant variation, and researchers should take this into account when selecting instruments for use in research and clinical settings.
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Family functioning impacts disability more than pain intensity.
“Family functioning is so vital that it impacts disability more than pain intensity [3].”
From Multi-family pediatric pain group therapy: Capturing acceptance and cultivating change (2017) · cites this paper as [3]
The Abstract and Results (Outcomes of Studies; page unavailable) report that family functioning was more consistently associated with pain-related disability than with children’s pain. They do not establish that family functioning has a greater impact on disability than pain intensity does. The reviewed studies were cross-sectional, so “impacts” also overstates the causal evidence. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPeers, parents, and families can cultivate adaptive outcomes or foster progressive dysfunction in youth with chronic pain.
“Peers [2], parents, and families can cultivate adaptive outcomes or foster progressive dysfunction [3].”
From Multi-family pediatric pain group therapy: Capturing acceptance and cultivating change (2017) · cites this paper as [3]
The Discussion reports that better family functioning was associated with less disability in youth with chronic pain, supporting the parent-and-family portion of the claim. It also states that none of the reviewed studies was longitudinal, so the source does not establish that families cause progressive dysfunction. The peer portion is cited to a different source [2] and is not judged here. (LLM, conf=0.86)
Experimental — accuracy not yet measuredScores ≥2 on the reliable and valid FAD-GF reflect greater concern regarding family dynamics.
“Scores ≥2 on the reliable and valid FAD-GF reflect greater concern regarding family dynamics [3].”
From Multi-family pediatric pain group therapy: Capturing acceptance and cultivating change (2017) · cites this paper as [3]
The Results section (‘Family Functioning Measures Included’; page unavailable) says the FAD includes a General Functioning subscale, has documented reliability and validity, and has cutoffs distinguishing healthy from unhealthy family functioning. It also says lower scores indicate better functioning. It does not specify that the cutoff is ≥2, so the numerical threshold is unsupported by this copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe occurrence of functional changes in the absence of any significant changes in pain level in an intervention with a family component was congruent with previous literature highlighting the impact of family dynamics on functional changes over and above pain amelioration.
“The occurrence of functional changes in the absence of any significant changes in pain level in an intervention with a family component was also congruent with previous literature highlighting the impact of family dynamics on functional changes over and above pain amelioration”
From Multi-family pediatric pain group therapy: Capturing acceptance and cultivating change (2017) · cites this paper as [3]
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredPediatric chronic pain is related to poorer family functioning and may lead to an economic burden for parents and society.
“Pediatric chronic pain is related to poorer family functioning and may lead to an economic burden for parents and society [3,4].”
From A clinical pilot study of individual and group treatment for adolescents with chronic pain and their parents: Effects of acceptance and commitment therapy on functioning (2016) · cites this paper as [3]
The Discussion (page not provided) reports poorer family functioning in four of seven comparisons involving youth with chronic pain, supporting the first part of the claim. The passages found do not address an economic burden for parents or society, so that part is not supported by this source. (LLM, conf=0.88)
Experimental — accuracy not yet measured
The most studied family factors include family history of chronic pain, parental emotional distress, parental thoughts/behaviours related to pain, parent-child interactions, and overall family environment/functioning.
“The most studied factors include family history of chronic pain, parental emotional distress, parental thoughts/behaviours related to pain (eg, parent pain catastrophizing, protective responses to pain), parent-child interactions and overall family environment and family functioning (eg, the extent of conflict, cohesion and expressiveness within the family).”
From Ecological system influences in the treatment of pediatric chronic pain (2012) · cites this paper as [3]
The Introduction describes parenting, parent-child interactions, and overall family functioning, including conflict and cohesion; the Results also discuss family expressiveness. But this review does not establish the full list as the 'most studied' factors, and the passages found for family history, parental emotional distress, catastrophizing, and protective responses do not substantiate those items. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFamily, school and the peer network each shape the pain experience of the individual child or adolescent, and each also represents a domain of functioning that is often impaired by chronic pain.
“Family, school and the peer network each shape the pain experience of the individual child or adolescent, and each also represents a domain of functioning that is often impaired by chronic pain.”
From Ecological system influences in the treatment of pediatric chronic pain (2012) · cites this paper as [3]
The Introduction links family functioning with pain-related experiences, and the Abstract reports poorer family functioning in families of youth with chronic pain. The paper does not establish the corresponding claims about school or peer networks; its review focuses on family functioning. The reported family–pain relationships are associations, not proof that family factors shape an individual child’s pain. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA systematic review yielded 16 studies on associations between parent/family functioning and child pain outcomes.
“A recent systematic review of the literature regarding family factors in pediatric chronic pain (3) yielded 16 studies that focused on associations between parent and family functioning and child pain outcomes.”
From Ecological system influences in the treatment of pediatric chronic pain (2012) · cites this paper as [3]
The Results report that 16 studies met the review’s inclusion criteria. But the Results > Outcomes of Studies section says the primary aim of seven studies was to compare family functioning between groups, so the source does not support saying that all 16 focused on associations between family functioning and child pain outcomes. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMany of these family factors have been examined both as predictors of chronic pain and as outcomes altered by the child's pain.
“Many of these factors have been examined both as predictors of chronic pain and as outcomes altered by the existence of a child's pain within the family.”
From Ecological system influences in the treatment of pediatric chronic pain (2012) · cites this paper as [3]
The Results (Outcomes of Studies; page unavailable) describe studies examining associations between family functioning and children’s pain, and the Discussion reports differences in family functioning between families with and without a child in chronic pain. But the Discussion also says none of the reviewed studies was longitudinal, so temporal relationships could not be assessed. The review therefore supports that these factors were examined together, not that they were established as predictors of chronic pain or outcomes altered by it. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMuch of the research on family factors in pediatric chronic pain has been cross-sectional.
“Much of the research to date has been cross-sectional, leaving open questions about whether premorbid family functioning influences painrelated disability or vice versa.”
From Ecological system influences in the treatment of pediatric chronic pain (2012) · cites this paper as [3]
The Lewandowski et al review concluded that the best evidence supports an association between better family functioning and lower child disability in the face of chronic pain.
“A review by Lewandowski et al (3) published in 2008 concluded that the best evidence exists in support of an association between family functioning and pain-related disability, with better family functioning associated with lower levels of child disability in the face of chronic pain.”
From Ecological system influences in the treatment of pediatric chronic pain (2012) · cites this paper as [3]
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- Authors
- Lewandowski, A. S., Palermo, T. M., Stinson, J., Handley, S., & Chambers, C. T.
- Affiliations
- Oregon Health & Science University (US)
- University of Toronto (CA)
- Dalhousie University (CA)
- Corresponding author
- Lewandowski, Amy S.
- Venue
- The Journal of Pain
- Publisher
- Elsevier BV
- Published
- 2010-11
- Volume
- 11
- Issue
- 11
- Pages
- 1027-1038
- ISSN
- 1526-5900 (ISSN-L)
- PMC
- PMC2993004
- OpenAlex
- W2170191452
- Cited by
- 374
- References
- 34
- Citations by year
- 2026: 20 · 2025: 31 · 2024: 39 · 2023: 37 · 2022: 38 · 2021: 37 · 2020: 28 · 2019: 19 · 2018: 21 · 2017: 16 · 2016: 25 · 2015: 12 · 2014: 17 · 2013: 18 · 2012: 12
- FWCI
- 1.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Canadian Institutes of Health Research
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (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
- family functioning, chronic pain, children and adolescents, pain-related disability, headache, abdominal pain, fibromyalgia
- MeSH terms
- Adolescent, Child, Chronic Disease, Family Health, Female, Humans, Male, Pain, Children with Disabilities, Disabled Children, Young Adult
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