- Email: [email protected]
Structural equation modeling of the relationships among parent and child anxiety sensitivity and child laboratory pain
S62
F08 - Pain in Children: Psychosocial (815) Structural equation modeling of the relationships among parent and child anxiety sensitivity and child laboratory pain J. Tsao, Q. Lu, N. Turk, S. Kim, C. Myers, L. Zeltzer; UCLA Pediatric Pain Program, Dept. of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA Anxiety sensitivity (AS) refers to the tendency to interpret anxiety-related bodily sensations as dangerous. Recent work has linked AS to childhood learning history for somatic symptoms generally, suggesting that parental AS may impact children’s responses to a range of somatic experiences including pain. This study tested a theoretical model hypothesizing that parent AS is associated with child AS, which in turn, is predictive of child laboratory pain intensity ratings. To examine sex differences in these relationships, the model was compared across boys and girls. Participants were 223 healthy children (111girls, mean age ⫽ 12.73⫹ 3 years, range ⫽ 8 –18 years) and their parents (188 mothers). Standardized tasks for cold, pressure and heat pain were presented to children in counterbalanced order. Parent and child AS were assessed using established measures. Multiple-group confirmatory factor analyses (CFAs) and predictive path models were used to test the model. Results indicated good model fit with a single latent factor for laboratory pain intensity and invariance of factor structures in boys and girls. Parent AS significantly predicted child AS in girls (r ⫽ 0.256) which in turn predicted pain intensity (r ⫽ 0.338). In boys, parent AS did not significantly predict child AS, although child AS did significantly predict pain intensity (r ⫽ 0.264). Lagrange Multiplier Test indicated that the path between parent AS and child AS differed significantly by sex (c2 ⫽ 6.461, p ⫽ 0.011), but the path between child AS and pain intensity did not differ by sex (c2 ⫽ 2.309, p ⫽ 1.29). The results indicate that child AS mediates the relationship between parent AS and laboratory pain in girls only. Our findings suggest that parents’ AS has an indirect effect on children’s laboratory pain responses by directly influencing AS in girls but not in boys.
Abstracts (817) How is chronic pain perceived and managed in school? D. Logan; Children’s Hospital Boston, Boston, MA This study investigates teachers’ understanding of and responses to adolescents’ chronic pain behaviors in the school setting. We sought to assess the impact of (1) presence/absence of documented medical evidence supporting the pain complaint, (2) parents’ cooperative vs. confrontational approach to the school, and (3) communication from the medical team on teachers’ attributions for and responses to chronic pain. Teachers are presented with a vignette describing a hypothetical student who develops chronic pain with subsequent decline in school attendance and performance. Follow-up questions assess perceptions of pain severity, attributions for the causes of pain (psychological vs. medical), and predicted responses to the student. Health locus of control beliefs are examined to determine whether beliefs influence individuals’ responses to pain behaviors. The final sample will include 250 middle- and high-school teachers. Preliminary results (n ⫽ 130) indicate that overall, more teachers (49.6%) attributed chronic pain to psychological causes rather than medical causes (32.1%, with 18.3% believing the causes of pain were equally psychological and medical). Teachers presented with medical evidence supporting the pain complaint were more likely to attribute pain to medical causes (t (128) ⫽ ⫺2.0, p⬍.05) and to predict that the child would eventually succeed in school (t (128) ⫽ ⫺2.3, p⬍.05). Among teachers given a vignette in which the parents approached the school confrontationally, there was a trend toward more teachers attributing pain to psychological causes (t (128) ⫽ 1.9, p⬍.06). Higher scores on internalized health locus of control correlated with less sympathy for the parents (r ⫽ ⫺.23, p⬍.01) and a trend toward less sympathy for the student (r ⫽⫺.17, p ⫽ .06). Preliminary results highlight that adolescents with pain syndromes without clear medical etiology may face (and pose) particular challenges in school, and that individual teacher characteristics influence responses to pain behaviors in school.
(816) Maternal Negative Life Events (NLE) and somatization: Relationship to children’s laboratory pain responses
(818) Factors associated with functional disability in adolescents with chronic pain
S. Kim, N. Turk, J. Tsao, C. Myers, Q. Lu, B. Bursch, L. Zeltzer; David Geffen School of Medicine at UCLA, Los Angeles, CA Prior research has demonstrated that a number of psychosocial factors have been associated with the experience of pain in children. Such factors include the family system as a context within which NLE experienced by a family member may impact other family members through the transmission of stress as well as by modeling of responses to stressors. Additionally, characteristics and behaviors of a family member, such as somatization, may be transmitted to other members through similar processes. This study examined mother-experienced NLE, mother somatization, child age and child sex in relation to children’s responses to heat and pressure laboratory pain tasks in 165 healthy mother-child dyads [84 male; 8-17 years old (M⫽12.1, SD⫽2.6)]. We also examined child-experienced NLE on child laboratory pain responses. Mothers completed standardized measures of NLE and somatization; children completed a standardized measure of NLE before undergoing laboratory pain tasks. In general linear models, maternal somatization positively predicted child ratings of heat (p⫽.044) and pressure (p⫽.021) pain intensity. A significant interaction between maternal NLE and child sex was found, with higher heat (p⫽.002) and pressure (p⫽.003) pain intensity ratings and lower heat pain tolerance (p⫽.015) associated with increased mother NLE for girls but not for boys. In contrast to maternal NLE, child NLE did not predict experimental pain responses (p⬎.05); child age was the only significant child predictor in these models, with older children reporting lower intensity ratings and showing greater tolerance for both heat and pressure laboratory pain (p⬍.001 for all models). These results suggest that maternal factors, such as NLE and somatization, which take place outside the pain laboratory, may influence children’s experimental pain responses. These factors warrant further exploration for their potential role in child clinical pain as well as interventions aimed at impacting child pain through addressing maternal somatization and responses to NLE.
E. Cassidy, C. Eccleston, G. Crombez, H. Connell, J. Clinch; Royal National Hospital for Rheumatic Diseases, Bath, UK Traditionally paediatric chronic pain research has focused on pain characteristics to the neglect of functioning. The primary objective of this study was to investigate patterns and associates of reported functional disability in 121 adolescents (83 female, mean age 14.67) with chronic pain. The adolescents and their parents completed questionnaire measures assessing adolescent functional disability, anxiety, depression and family coping. The adolescents also reported on pain intensity and coping strategies, and the adults completed a parental stress inventory. The adolescents and the parents reported high levels of disability, though hierarchical regression analyses revealed different predictors for the two forms of disability report. Adolescents’ reported pain intensity emerged as the only unique predictor of adolescent disability report in all steps of a hierarchical regression involving the above variables (final step, beta ⫽ .35, t(55) ⫽ 2.83, P ⬍ 0.01). Family reframing [beta ⫽ .23, R2 change ⫽ .04, Fchange (1, 72) ⫽ 4.33, P ⬍ 0.05] and behavioural distraction [beta ⫽ ⫺.23, R2 change ⫽ .05, Fchange (1, 71) ⫽ 4.59, P ⬍ 0.05] were found to independently predict adult reports of adolescent disability, in a regression including demographics, family coping, parental distress and adolescent coping variables. This preliminary study highlights the salience of the pain intensity concept and expression in adolescents with chronic pain, and the value of assessing parental influence and needs, in relation to the adolescents’ functional disability. Further research ideas highlight the need to investigate underlying psychological processes, examine alternative measures of disability and conduct analyses at various time-points.
F08 - Pain in Children: Psychosocial (815) Structural equation modeling of the relationships among parent and child anxiety sensitivity and child laboratory pain J. Tsao, Q. Lu, N. Turk, S. Kim, C. Myers, L. Zeltzer; UCLA Pediatric Pain Program, Dept. of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA Anxiety sensitivity (AS) refers to the tendency to interpret anxiety-related bodily sensations as dangerous. Recent work has linked AS to childhood learning history for somatic symptoms generally, suggesting that parental AS may impact children’s responses to a range of somatic experiences including pain. This study tested a theoretical model hypothesizing that parent AS is associated with child AS, which in turn, is predictive of child laboratory pain intensity ratings. To examine sex differences in these relationships, the model was compared across boys and girls. Participants were 223 healthy children (111girls, mean age ⫽ 12.73⫹ 3 years, range ⫽ 8 –18 years) and their parents (188 mothers). Standardized tasks for cold, pressure and heat pain were presented to children in counterbalanced order. Parent and child AS were assessed using established measures. Multiple-group confirmatory factor analyses (CFAs) and predictive path models were used to test the model. Results indicated good model fit with a single latent factor for laboratory pain intensity and invariance of factor structures in boys and girls. Parent AS significantly predicted child AS in girls (r ⫽ 0.256) which in turn predicted pain intensity (r ⫽ 0.338). In boys, parent AS did not significantly predict child AS, although child AS did significantly predict pain intensity (r ⫽ 0.264). Lagrange Multiplier Test indicated that the path between parent AS and child AS differed significantly by sex (c2 ⫽ 6.461, p ⫽ 0.011), but the path between child AS and pain intensity did not differ by sex (c2 ⫽ 2.309, p ⫽ 1.29). The results indicate that child AS mediates the relationship between parent AS and laboratory pain in girls only. Our findings suggest that parents’ AS has an indirect effect on children’s laboratory pain responses by directly influencing AS in girls but not in boys.
Abstracts (817) How is chronic pain perceived and managed in school? D. Logan; Children’s Hospital Boston, Boston, MA This study investigates teachers’ understanding of and responses to adolescents’ chronic pain behaviors in the school setting. We sought to assess the impact of (1) presence/absence of documented medical evidence supporting the pain complaint, (2) parents’ cooperative vs. confrontational approach to the school, and (3) communication from the medical team on teachers’ attributions for and responses to chronic pain. Teachers are presented with a vignette describing a hypothetical student who develops chronic pain with subsequent decline in school attendance and performance. Follow-up questions assess perceptions of pain severity, attributions for the causes of pain (psychological vs. medical), and predicted responses to the student. Health locus of control beliefs are examined to determine whether beliefs influence individuals’ responses to pain behaviors. The final sample will include 250 middle- and high-school teachers. Preliminary results (n ⫽ 130) indicate that overall, more teachers (49.6%) attributed chronic pain to psychological causes rather than medical causes (32.1%, with 18.3% believing the causes of pain were equally psychological and medical). Teachers presented with medical evidence supporting the pain complaint were more likely to attribute pain to medical causes (t (128) ⫽ ⫺2.0, p⬍.05) and to predict that the child would eventually succeed in school (t (128) ⫽ ⫺2.3, p⬍.05). Among teachers given a vignette in which the parents approached the school confrontationally, there was a trend toward more teachers attributing pain to psychological causes (t (128) ⫽ 1.9, p⬍.06). Higher scores on internalized health locus of control correlated with less sympathy for the parents (r ⫽ ⫺.23, p⬍.01) and a trend toward less sympathy for the student (r ⫽⫺.17, p ⫽ .06). Preliminary results highlight that adolescents with pain syndromes without clear medical etiology may face (and pose) particular challenges in school, and that individual teacher characteristics influence responses to pain behaviors in school.
(816) Maternal Negative Life Events (NLE) and somatization: Relationship to children’s laboratory pain responses
(818) Factors associated with functional disability in adolescents with chronic pain
S. Kim, N. Turk, J. Tsao, C. Myers, Q. Lu, B. Bursch, L. Zeltzer; David Geffen School of Medicine at UCLA, Los Angeles, CA Prior research has demonstrated that a number of psychosocial factors have been associated with the experience of pain in children. Such factors include the family system as a context within which NLE experienced by a family member may impact other family members through the transmission of stress as well as by modeling of responses to stressors. Additionally, characteristics and behaviors of a family member, such as somatization, may be transmitted to other members through similar processes. This study examined mother-experienced NLE, mother somatization, child age and child sex in relation to children’s responses to heat and pressure laboratory pain tasks in 165 healthy mother-child dyads [84 male; 8-17 years old (M⫽12.1, SD⫽2.6)]. We also examined child-experienced NLE on child laboratory pain responses. Mothers completed standardized measures of NLE and somatization; children completed a standardized measure of NLE before undergoing laboratory pain tasks. In general linear models, maternal somatization positively predicted child ratings of heat (p⫽.044) and pressure (p⫽.021) pain intensity. A significant interaction between maternal NLE and child sex was found, with higher heat (p⫽.002) and pressure (p⫽.003) pain intensity ratings and lower heat pain tolerance (p⫽.015) associated with increased mother NLE for girls but not for boys. In contrast to maternal NLE, child NLE did not predict experimental pain responses (p⬎.05); child age was the only significant child predictor in these models, with older children reporting lower intensity ratings and showing greater tolerance for both heat and pressure laboratory pain (p⬍.001 for all models). These results suggest that maternal factors, such as NLE and somatization, which take place outside the pain laboratory, may influence children’s experimental pain responses. These factors warrant further exploration for their potential role in child clinical pain as well as interventions aimed at impacting child pain through addressing maternal somatization and responses to NLE.
E. Cassidy, C. Eccleston, G. Crombez, H. Connell, J. Clinch; Royal National Hospital for Rheumatic Diseases, Bath, UK Traditionally paediatric chronic pain research has focused on pain characteristics to the neglect of functioning. The primary objective of this study was to investigate patterns and associates of reported functional disability in 121 adolescents (83 female, mean age 14.67) with chronic pain. The adolescents and their parents completed questionnaire measures assessing adolescent functional disability, anxiety, depression and family coping. The adolescents also reported on pain intensity and coping strategies, and the adults completed a parental stress inventory. The adolescents and the parents reported high levels of disability, though hierarchical regression analyses revealed different predictors for the two forms of disability report. Adolescents’ reported pain intensity emerged as the only unique predictor of adolescent disability report in all steps of a hierarchical regression involving the above variables (final step, beta ⫽ .35, t(55) ⫽ 2.83, P ⬍ 0.01). Family reframing [beta ⫽ .23, R2 change ⫽ .04, Fchange (1, 72) ⫽ 4.33, P ⬍ 0.05] and behavioural distraction [beta ⫽ ⫺.23, R2 change ⫽ .05, Fchange (1, 71) ⫽ 4.59, P ⬍ 0.05] were found to independently predict adult reports of adolescent disability, in a regression including demographics, family coping, parental distress and adolescent coping variables. This preliminary study highlights the salience of the pain intensity concept and expression in adolescents with chronic pain, and the value of assessing parental influence and needs, in relation to the adolescents’ functional disability. Further research ideas highlight the need to investigate underlying psychological processes, examine alternative measures of disability and conduct analyses at various time-points.