Chronic pain and parent-child relations in later life: An important, but understudied issue

Facilitating open family communication when a parent has chronic pain: A scoping review

BACKGROUND

When a parent has chronic pain, family communication can become strained. Clinicians are encouraged to identify and support families struggling with open communication. Occupational therapists are commonly involved in the provision of pain management services but their role in facilitating open communication in families affected by this condition has not been clearly articulated.

OBJECTIVE

To develop a comprehensive understanding of what is being done and/or thought to be helpful for facilitating open communication in families affected by chronic pain, in order to articulate the role of occupational therapy in this area of care.

METHODS

A scoping review was conducted and 24 items analyzed using qualitative content analysis.

RESULTS

The facilitation of open communication in families affected by parental chronic pain is dependent on a variety of factors, including the skills that members possess and occupations which they perform individually and together. It can also be prompted by relationship tension or a family accessing professional support. Occupational therapy literature on the matter is currently limited and focused on assertiveness training.

CONCLUSION AND SIGNIFICANCE

There is scope for occupational therapist to extend their role beyond assertiveness training and use occupation-centered interventions to facilitate communication within families affected by parental chronic pain.

Problem Adaptation Therapy for Pain (PATH-Pain): A Psychosocial Intervention for Older Adults with Chronic Pain and Negative Emotions in Primary Care

Chronic pain is highly prevalent in older adults, contributes to activity restriction and social isolation, disrupts family and interpersonal relationships, and poses a significant economic burden to society. Negative emotions such as sadness, anxiety, helplessness, and hopelessness are associated with chronic pain and contribute to poor quality of life, impaired interpersonal and social functioning, and increased disability. Psychosocial interventions for older adults with chronic pain have been historically developed for, and are almost exclusively delivered to, cognitively intact patients. Therefore, many older adults with chronic pain and comorbid cognitive deficits have limited treatment options. Our multidisciplinary team developed Problem Adaptation Therapy for Pain in Primary Care (PATH-Pain), a psychosocial intervention for older adults with chronic pain, negative emotions, and a wide range of cognitive functioning, including mild-to-moderate cognitive impairment. In the current article, we describe the principles underlying PATH-Pain, review the steps taken to adapt the original PATH protocol, outline the treatment process, and present a case illustrating its potential value.

Impact of Pain on Family Members and Caregivers of Geriatric Patients

This article provides an overview of the literature describing the effects of geriatric patients' pain on family members' relationships, psychological well-being, and physical health. The theoretic mechanisms that underlie the association between patients' pain and family members' outcomes are outlined, and studies describing these mechanisms are summarized. Limitations to the current literature are discussed, and key recommendations for future research and practice are presented.

Operationalizing Pain Treatment in the Biopsychosocial Model: Take a Daily "SWEM"--Socialize, Work, Exercise, Meditate

In the United States, chronic pain is often poorly treated at an exceedingly high cost. The use of the biomedical model to manage pain is frequently ineffective, and evidence suggests that the biopsychosocial (BPS) model is a better choice. A problem with the BPS model is that it has not been operationalized in terms of patient behavior. This commentary addresses that issue by suggesting that people with chronic pain and illness participate daily in four self-management health behaviors: socialize, work, exercise, and meditation, and discusses evidence that supports these recommendations. These self-management behaviors may decrease pain and thus reduce the need for pain medications and other medical interventions. Additional topics include patient adherence and health coaching.

Chronic Pain in Older Adults

This review summarizes existing evidence relevant to the epidemiology of chronic pain in older adults, age-related differences relevant to pain, pain assessment, and important considerations regarding pain management in later life. Features unique to pain assessment in older adults include the likelihood of multiple diagnoses contributing to chronic pain, the ability of older adults to self-report, including those with mild to moderate cognitive impairment, and recognition that some older adults with cognitive impairment may demonstrate various behaviors to communicate pain. Management is best accomplished through a multimodal approach, including pharmacologic and nonpharmacologic treatments, physical rehabilitation, and psychological therapies. Interventional pain therapies may be appropriate in select older adults, which may reduce the need for pharmacologic treatments.

Moderators of Mother's Problems on Middle-Aged Offspring Depressive Symptoms

OBJECTIVES

Conservation of Resources (COR) theory postulates that individuals utilize various resources to manage stressful circumstances. Children employ many resources to cope with the problems of parents who suffer from disabilities, cognitive impairment, and functional limitations. This phenomenon is rarely explored among middle-aged offspring and their aging parents.

METHOD

Drawing from the Family Exchanges Study, we focus on a sample (N = 308) of middle-aged adults (mean age = 51) whose only living parent was their mother. We use multiple regression to examine maternal support and self-reported health as moderators of maternal problems on offspring depressive symptoms.

RESULTS

Participants whose mothers had few problems generally reported low levels of depressive symptoms. When mothers had high problems, results indicate a negative association between depressive symptoms and physical health. When maternal problems were high, the amount of support offspring receive from their mother had a negative association with offspring depressive symptoms. When mothers had low problems, receiving more maternal support was associated with lower depressive symptoms and receiving low support was associated with increased depressive symptoms.

DISCUSSION

Middle-aged offspring use both personal and family-based resources to buffer the psychological ramifications of their mother's problems. Our results provide a unique extension of COR theory.