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PEDIATRICS Vol. 108 No. 3 September 2001, p. e47
Received Oct 6, 2000; accepted Apr 23, 2001.
,,
From the * Department of Pediatrics, Division of Rhematology,
Duke University Medical Center Durham, North Carolina; Objectives. To examine the
relationships of parental and family pain history on the pain
experience of children with chronic rheumatic disease. The aims of the
study were as follows: 1) to describe the pain history of parents and
families of children with rheumatic disease, 2) to examine
relationships between parental and family pain history and the pain
report and physician-rated health status of children with chronic
rheumatic disease, and 3) to determine whether child coping mediates
the relationship between family pain history and the child's pain and
physician-rated health status.
Method. Parents of 100 children were recruited from a
pediatric rheumatology clinic during routine visits. Parents completed
questionnaires assessing parental pain history and family
characteristics. Children in the study completed a series of
questionnaires to assess pain and pain coping strategies, including the
Coping Strategies Questionnaire and parts of the Pediatric Pain
Questionnaire. A pediatric rheumatologist provided a global assessment
of disease severity on a 100-mm visual analog scale as an index of
child health status.
Results. A high number of parents of children seen in a
pediatric rheumatology clinic described a personal pain history. More
than 90% of parents reported having at least 1 chronic pain condition, with an equal proportion reporting an episode of pain in the past month. The most commonly reported pain conditions were lower back pain,
shoulder/neck pain, and migraine headache pain. On average, this group
of parents reported a history of 3.5 chronic pain conditions (standard
deviation: 2.3) and reported having sought treatment for 1.7 (standard
deviation: 2.3) of these conditions. Additionally, 93% of all parents
reported extended family members experiencing at least 1 chronic pain
condition. Correlational analyses indicated that parents reporting
higher levels of current pain and higher mean levels of pain during the
past month were more likely to have children reporting higher levels of
current pain (r = 0.23 and r = 0.27). In addition, parents who sought more treatment for their own
pain were more likely to have children reporting higher levels of pain
(r = 0.22) and presenting with poorer health status
(r = 0.22). Similarly, parents reporting higher
levels of pain-related interference with activity were more likely to have children reporting higher levels of current pain
(r = 0.23). Correlational analyses also indicated
that children whose extended families reported a history of multiple
pain conditions were more likely to report higher levels of current
pain (r = 0.24) and more pain locations
(r = 0.23). Finally, a series of mediational statistical models confirmed that child use of the pain coping strategy, catastrophizing, partially accounted for the relationship between several parent and family pain history variables and the child's own current pain ratings and physician global assessment. Specifically, child catastrophizing mediated the relationships between
the total number of treated pain conditions and children's current
pain ratings and physician global assessment. In addition, child
catastrophizing was shown to mediate the relationship between parental
mean level of pain in the past month and children's current pain
rating and the relationship between total number of family pain
conditions and children's current pain rating. Taken together, our
results suggest that parental and familial pain experiences predict
children's use of catastrophizing to cope with pain, which in turn
predicts physician global assessment and children's current pain.
Conclusions. The results from the present study indicate
that many of the parents of children seen in a pediatric rheumatology
clinic have a personal pain history and highlight the potential impact
of parental pain history on children's pain experiences. Specifically, parents who were more likely to seek treatment for their own pain or
more likely to report interference with recreational activities because
of pain had children with higher pain ratings and poorer health status
as measured by the physician global assessment. Additionally, a series
of mediational models showed that child catastrophizing serves as a
specific mechanism through which parental and familial pain history
variables influence child ratings of current pain and physician ratings
of health status. Future studies are needed to determine exactly how
children living in families with painful conditions become more reliant
on catastrophizing to cope with their pain. In addition, more research
is needed to identify other potential mediators, such as positive ways
parents may influence children's pain coping. There are several
important clinical implications of our findings. First, our results
suggest that by gathering information from parents about their own pain histories, health care providers may be able to identify children at
risk for developing maladaptive pain coping strategies and higher
levels of disease-related pain and disability. Second, our results
indicate that intervention programs should focus specifically on
reducing children's use of catastrophizing to cope with their pain.
Perhaps most importantly, our results highlight the need to include
parents in interventions aimed at reducing children's pain and
improving children's abilities to cope with pain.
Department of
Psychology, University of North Carolina at Chapel Hill, Chapel Hill,
North Carolina; and § Department of Psychology, Wofford College,
Spartanburg, South Carolina.
This article has been cited by other articles:
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  Y. S. Wasfi, C. S. Rose, J. R. Murphy, L. J. Silveira, J. C. Grutters, Y. Inoue, M. A. Judson, and L. A. Maier A New Tool To Assess Sarcoidosis Severity Chest, May 1, 2006; 129(5): 1234 - 1245. [Abstract] [Full Text] [PDF]
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