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Hogendoorn E, Münker L, Rimvall MK, Frostholm L, Carlsen AH, Jeppesen P, Rosmalen JGM, Rask CU. Family healthcare patterns as a proxy for transgenerational transmission of functional somatic symptoms in early childhood - A longitudinal cohort study. J Psychosom Res 2024:111805. [PMID: 38944597 DOI: 10.1016/j.jpsychores.2024.111805] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/17/2024] [Accepted: 05/19/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVE Functional somatic symptoms (FSS) accumulate within families. Exposure to family patterns of high healthcare use may induce maladaptive symptom coping and thereby potentially contribute to the transgenerational transmission of FSS. This study aimed to uncover associations between parental and child healthcare use during the child's first years of life (age 0-4) and childhood FSS at age 5-7. METHODS We utilized data from the Copenhagen Child Cohort (CCC2000), a population-based birth cohort. Parent-reported FSS of their 5-7-year-old children were linked to Danish national registry data on parental and child healthcare use (including general practitioner [GP] consultations and hospital contacts) during child age 0-4 years. Logistic regression analyses were performed to investigate longitudinal associations between family healthcare use and child FSS. RESULTS We found an association between prior parental healthcare use and child FSS at age 5-7 (OR = 1.02, 95% CI [1.01-1.04]). Key sensitivity analyses specifically focusing on GP consultations, revealed modest but statistically significant associations between parental (OR = 1.03, 95% CI [1.02-1.05]) and child (OR = 1.18, 95% CI [1.04-1.34]) GP consultations and impairing FSS at age 5-7. CONCLUSION Family healthcare use, especially within the general practice, may play a role in the transgenerational transmission of FSS. Early-stage FSS identification and care might be improved through training aimed at GPs. Future research may identify vulnerable families at whom parent-focused interventions for symptom-coping could be targeted. This could potentially contribute to the prevention of transgenerational transmission of FSS.
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Affiliation(s)
- Elske Hogendoorn
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Lina Münker
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lisbeth Frostholm
- Department of Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Anders Helles Carlsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Pia Jeppesen
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark; Child and Adolescent Mental Health Centre, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, the Netherlands
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Stone AL, Epstein I, Bruehl S, Garber J, Smith CA, Walker LS. Twenty-year Outcomes of a Pediatric Chronic Abdominal Pain Cohort: Early Adulthood Health Status and Offspring Physical and Behavioral Health. THE JOURNAL OF PAIN 2023; 24:145-156. [PMID: 36126817 PMCID: PMC9789180 DOI: 10.1016/j.jpain.2022.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 02/08/2023]
Abstract
Chronic abdominal pain (CAP) represents a common pediatric primary pain disorder that can have long-term effects on physical and mental health into adulthood. Pediatric CAP and Control cohorts recruited in childhood (∼11 years old, T1) and then assessed in emerging adulthood (∼20 years old, T2) were evaluated again for health outcomes in early adulthood (∼30 years old, T3) for the current study. Further, the study evaluated the mental and physical health of offspring of participants who had become parents. Participants who agreed to enroll at T3 (CAP: n = 90, Control: n = 55) completed measures regarding current health, health-related quality of life (HRQoL), and their child's health when applicable. Results indicated close to 20% of the CAP cohort reported recurrent CAP across all 3 timepoints. Participants with current CAP reported poorer HRQoL compared to participants with remitted CAP who reported poorer HRQoL compared to Control participants. The CAP cohort reported higher health-related anxiety compared to the Control cohort regardless of current pain status. CAP compared to Control participants reported greater emotional problems and fewer conduct problems in their children. Longitudinal studies are needed to assess the developmental course of pediatric chronic pain and intergenerational pathways of risk and resilience. Perspective: This article evaluates patterns of chronic abdominal pain from childhood into early adulthood. Patients with pediatric chronic abdominal pain continue to present with health-related anxiety in adulthood and report greater emotional problems in offspring.
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Affiliation(s)
- Amanda L Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Isabel Epstein
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Craig A Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Abstract
OBJECTIVE Parent chronic illness may increase somatic symptomology risk in children. The current study examines this association in relation to a variety of chronic illnesses and also considers possible related parental and adolescent background factors. METHODS Secondary analyses used longitudinal data from the University of North Carolina National Longitudinal Study of Adolescent to Adult Health. Interviews were used to assess demographics, adolescent somatic symptoms, living situation, and parental illness and general physical health. Somatic symptoms in adolescents with no ill parents (n = 2302 adolescents; Mage = 15.3) were compared with adolescents with ill mothers (n = 2336; Mage = 15.3), ill fathers (n = 1304; Mage = 15.3), or two ill parents (n = 3768; Mage = 15.3) using Poisson regression models. We also examined the role of living status, adolescent sex, and parent general physical health on somatic symptom outcomes. RESULTS Elevated somatic symptoms were observed in adolescents with ill mothers (mean ratio [MR] = 1.15, p = .015) and with both parents ill (MR = 1.10, p < .001). Among adolescents with ill parents, females had more symptoms than males (ill mother: MR = 1.12, p < .001; ill father: MR = 1.23, p < .001; and both parents ill: MR = 1.23, p < .001). Poorer maternal physical health also increased somatic symptom risk (MR = 1.12, p = .02). Longitudinally, adolescents with ill mothers (MR = 1.14, p < .001), ill fathers (MR = 1.13, p < .001), or both parents ill (MR = 1.16, p < .001) had increased somatic symptom risk. Wave I somatic symptoms also increased future risk: ill mother (MR = 1.19, p < .001), ill father (MR = 1.22, p < .001), or both parents ill (MR = 1.20, p < .001). CONCLUSIONS The results highlight that having an ill parent is a risk factor for adolescent somatic symptoms. In addition, other factors such as adolescent sex play an additional role in adolescent somatic symptoms.
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Affiliation(s)
- Lindsey C. Elliott
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
- Department of Psychiatry, University of Texas at Austin
| | - Lindsay M. Stager
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Dustin Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Aaron D. Fobian
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL
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Brown D, Schenk S, Genent D, Zernikow B, Wager J. A scoping review of chronic pain in emerging adults. Pain Rep 2021; 6:e920. [PMID: 34712883 PMCID: PMC8546842 DOI: 10.1097/pr9.0000000000000920] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/06/2021] [Accepted: 02/22/2021] [Indexed: 12/26/2022] Open
Abstract
Much of the adult chronic pain literature addresses pain in typical pain cohorts of middle-aged to older individuals. To date, little research has focused on chronic pain in younger adults, who likely have a completely different pain experience. This scoping review aimed to address this gap by describing the emerging adult (18-29 years) chronic pain experience regarding prevalence, associated factors, outcomes, and pain management. Searches of primary electronic databases including PubMed, Embase, PsycINFO, and CINAHL were performed on February 26, 2020, restricting the publication date from database inception to December 31, 2019. The search strategy, conducted in English, covered search term combinations of "chronic pain" and "young adults." A total of 6,612 records were considered-3,141 after removing duplicates. These records were screened by title and abstract; 871 through full-text screening. Of these, 78 articles covered the topic of emerging adults with chronic pain. Collectively, results indicated that between 5% and 30% of emerging adults experience chronic pain, depending on the sample and exact chronic pain definition. The most consistent associated factors were female sex, familial chronic pain, and previous experiences of chronic pain in childhood. Anxiety, depression, and sleep issues appeared associated both before and after the onset of chronic pain. Outcomes of pain included interruptions to study and work, poorer physical functioning, and pain-related interference to socializing. We observed that few pain treatments have been tested specifically in this cohort. A greater ongoing focus on chronic pain in emerging adults is required to improve long-lasting outcomes.
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Affiliation(s)
- Donnamay Brown
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Sabrina Schenk
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Dunja Genent
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Witten/Herdecke University, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, School of Medicine, Faculty of Health, Witten/Herdecke University, Germany
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Abstract
Paediatric functional abdominal pain disorders, currently referred to as disorders of gut-brain interaction, comprise irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain not otherwise specified, as defined by the Rome IV diagnostic criteria. Functional abdominal pain disorders are common disorders with a prevalence of 3-16% depending on country, age and sex. A greater understanding of aetiopathogenesis and pathophysiology is emerging and includes intestinal components (inflammation, motility and the microbiota), central factors (psychological aspects, sensitization and/or differences in connectivity or activity of certain brain regions) as well as extrinsic factors (infections). In particular, the timing of disruption of the microbiota-gut-brain axis seems to be important. Diagnosis is challenging but is primarily based on clinical symptoms and exclusion of other organic causes, with an emphasis on avoiding unnecessary invasive diagnostic procedures. The available pharmacological interventions are limited in children and, therefore, management has focused on combined approaches, including mind-targeted interventions (hypnotherapy and cognitive behavioural therapy), diet (probiotics) and percutaneous electrical nerve field stimulation. The evidence for their clinical efficacy, although limited, is favourable, with positive impacts on symptoms and overall quality of life. The coming decades hold promise for improved understanding and management of these enigmatic disorders.
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Subgroups of Pediatric Patients With Functional Abdominal Pain: Replication, Parental Characteristics, and Health Service Use. Clin J Pain 2020; 36:897-906. [PMID: 32969866 DOI: 10.1097/ajp.0000000000000882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Prior work in a cohort of youth with functional abdominal pain (FAP) identified patient subgroups (High Pain Dysfunctional, High Pain Adaptive, Low Pain Adaptive) that predicted differences in the course of FAP from childhood into young adulthood. We aimed to replicate these subgroups in a new sample of adolescents with FAP using the original classification algorithm and to extend subgroup characteristics to include parental characteristics and health service use. METHODS Adolescents (n=278; ages 11 to 17 y, 66% females) presenting to a gastroenterology clinic for abdominal pain, and their parents (92% mothers) completed self-report measures; adolescents also completed a 7-day pain diary. RESULTS The replicated patient subgroups exhibited distress and impairment similar to subgroups in the original sample. Moreover, in novel findings, the High Pain Dysfunctional subgroup differed from other subgroups by the predominance of mother-daughter dyads jointly characterized by high levels of anxiety, depressive symptoms, pain behavior, and pain catastrophizing. The High Pain Dysfunctional subgroup used more health care services than Low Pain Adaptive but did not differ from High Pain Adaptive. DISCUSSION Findings replicate and extend the original FAP classification and suggest that the subgroups have unique patient and parent features that may reflect distinct illness mechanisms requiring different treatments.
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8
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Newton E, Schosheim A, Patel S, Chitkara DK, van Tilburg MAL. The role of psychological factors in pediatric functional abdominal pain disorders. Neurogastroenterol Motil 2019; 31:e13538. [PMID: 30729663 DOI: 10.1111/nmo.13538] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pediatric functional abdominal pain disorders (FAPDs) are disorders of brain-gut dysregulation. Psychological factors are known to be related to etiology, maintenance, and exacerbation of pediatric FAPDs. With the evolving literature in the past two decades, a better understanding has emerged of precisely which psychological factors are associated with childhood FAPDs. PURPOSE This narrative literature review summarizes the literature of both child and parent psychological factors in pediatric FAPD. Where anxiety and depression were major targets in the older literature, present-day focus is increasingly on pain-specific cognitions and coping strategies including disease threat and catastrophizing. In addition, parental reaction to a child's pain is increasingly recognized as an important moderator of a child's outcomes and has become an area for clinical intervention. Screening for these factors and integrative treatment approaches are recommended in childhood FAPD.
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Affiliation(s)
- Emily Newton
- Department of Clinical Research, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, North Carolina
| | - Alex Schosheim
- Department of Pediatric Gastroenterology, Stony Brook University Hospital, Stony Brook, New York
| | - Samit Patel
- Department of Pediatric Gastroenterology, Arnold Palmer Hospital, Orlando, Florida
| | - Denesh K Chitkara
- Department of Pediatric Gastroenterology, Saint Peters University Hospital, New Brunswick, New Jersey
| | - Miranda A L van Tilburg
- Department of Clinical Research, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, North Carolina
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- School of Social work, University of Washington, Seattle, Washington
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Social learning pathways in the relation between parental chronic pain and daily pain severity and functional impairment in adolescents with functional abdominal pain. Pain 2019; 159:298-305. [PMID: 29016461 DOI: 10.1097/j.pain.0000000000001085] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Having a parent with chronic pain (CP) may confer greater risk of persistence of CP from childhood into young adulthood. Social learning, such as parental modeling and reinforcement, represents one plausible mechanism for the transmission of risk of CP from parents to offspring. Based on a 7-day pain diary in 154 pediatric patients with functional abdominal CP, we tested a model in which parental CP predicted adolescents' daily average CP severity and functional impairment (distal outcomes) via parental modeling of pain behaviors and parental reinforcement of adolescent's pain behaviors (mediators) and adolescents' cognitive appraisals of pain threat (proximal outcome representing adolescents' encoding of parents' behaviors). Results indicated significant indirect pathways from parental CP status to adolescent average daily pain severity (b = 0.18, SE = 0.08, 95% confidence interval: 0.04-0.31, P = 0.03) and functional impairment (b = 0.08, SE = 0.04, 95% confidence interval: 0.02-0.15, P = 0.03) over the 7-day diary period via adolescents' observations of parent pain behaviors and adolescent pain threat appraisal. The indirect pathway through parental reinforcing responses to adolescents' pain did not reach significance for either adolescent pain severity or functional impairment. Identifying mechanisms of increased risk of pain and functional impairment in children of parents with CP ultimately could lead to targeted interventions aimed at improving functioning and quality of life in families with CP. Parental modeling of pain behaviors represents a potentially promising target for family-based interventions to ameliorate pediatric CP.
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10
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Stone AL, Walker LS. Adolescents' Observations of Parent Pain Behaviors: Preliminary Measure Validation and Test of Social Learning Theory in Pediatric Chronic Pain. J Pediatr Psychol 2018; 42:65-74. [PMID: 28175325 DOI: 10.1093/jpepsy/jsw038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/08/2016] [Accepted: 04/12/2016] [Indexed: 12/19/2022] Open
Abstract
Objective Evaluate psychometric properties of a measure of adolescents’ observations of parental pain behaviors and use this measure to test hypotheses regarding pain-specific social learning. Methods We created a proxy-report of the Patient Reported Outcomes Measurement Information System (PROMIS) Pain Behavior–Short Form (PPB) for adolescents to report on parental pain behaviors, which we labeled the PPB-Proxy. Adolescents (n = 138, mean age = 14.20) with functional abdominal pain completed the PPB-Proxy and a parent completed the PPB. Adolescents and their parents completed measures of pain and disability during the adolescent’s clinic visit for abdominal pain. Adolescents subsequently completed a 7-day pain diary period. Results The PPB-Proxy moderately correlated with the PPB, evidencing that adolescents observe and can report on parental pain behaviors. Both the PPB-Proxy and PPB significantly correlated with adolescents’ pain-related disability. Conclusions Parental modeling of pain behaviors could represent an important target for assessment and treatment in pediatric chronic pain patients.
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Affiliation(s)
- Amanda L Stone
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Lynn S Walker
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt University, TN, USA
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11
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Transmission of risk from parents with chronic pain to offspring: an integrative conceptual model. Pain 2017; 157:2628-2639. [PMID: 27380502 DOI: 10.1097/j.pain.0000000000000637] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Offspring of parents with chronic pain are at increased risk for pain and adverse mental and physical health outcomes (Higgins et al, 2015). Although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs. Identifying mechanisms for the transmission of risk that leads to the development of chronic pain in offspring is important for developing preventive interventions targeted to decrease risk for chronic pain and related outcomes (eg, disability and internalizing symptoms). This review presents a conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions. Our proposed model highlights 5 potential mechanisms for the relation between parental chronic pain and pediatric chronic pain and related adverse outcomes: (1) genetics, (2) alterations in early neurobiological development, (3) pain-specific social learning, (4), general parenting and family health, and (5) exposure to stressful environment. In addition, the model presents 3 potential moderators for the relation between parent and child chronic pain: (1) the presence of chronic pain in a second parent, (2) timing, course, and location of parental chronic pain, and (3) offspring's characteristics (ie, sex, developmental stage, race or ethnicity, and temperament). Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family centered and include at-risk children.
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12
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Huguet A, Olthuis J, McGrath PJ, Tougas ME, Hayden JA, Stinson JN, Chambers CT. Systematic review of childhood and adolescent risk and prognostic factors for persistent abdominal pain. Acta Paediatr 2017; 106:545-553. [PMID: 28036098 DOI: 10.1111/apa.13736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 12/02/2016] [Accepted: 12/28/2016] [Indexed: 12/26/2022]
Abstract
This review aimed to identify childhood and adolescence risk and prognostic factors associated with onset and persistence of persistent abdominal pain and related disability and assess quality of the evidence. While findings suggest a possible role for negative emotional symptoms and parental mental health as risk and prognostic factors for onset and persistence of persistent abdominal pain, the evidence is of poor quality overall and nonexistent when it comes to prognostic factors associated with disability. CONCLUSION Further research is needed to increase confidence in existing evidence and to explore new factors. This research will inform prevention.
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Affiliation(s)
- A Huguet
- IWK Health Centre; Halifax NS Canada
- Department of Community Health and Epidemiology; Dalhousie University; Halifax NS Canada
| | - J Olthuis
- Department of Psychology; University of New Brunswick; Federicton NB Canada
| | - PJ McGrath
- IWK Health Centre; Halifax NS Canada
- Department of Community Health and Epidemiology; Dalhousie University; Halifax NS Canada
- Departments of Pediatrics and Psychiatry; Dalhousie University; Halifax NS Canada
| | - ME Tougas
- Department of Psychology & Neuroscience; Dalhousie University; Halifax NS Canada
| | - JA Hayden
- Department of Community Health and Epidemiology; Dalhousie University; Halifax NS Canada
| | - JN Stinson
- Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto ON Canada
| | - CT Chambers
- IWK Health Centre; Halifax NS Canada
- Departments of Pediatrics and Psychiatry; Dalhousie University; Halifax NS Canada
- Department of Psychology & Neuroscience; Dalhousie University; Halifax NS Canada
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13
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Fryer BA, Cleary G, Wickham SL, Barr BR, Taylor-Robinson DC. Effect of socioeconomic conditions on frequent complaints of pain in children: findings from the UK Millennium Cohort Study. BMJ Paediatr Open 2017; 1:e000093. [PMID: 29637128 PMCID: PMC5862210 DOI: 10.1136/bmjpo-2017-000093] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Frequent complaints of pain (FCP) are common in high-income countries, affecting about 25% of children, and may have significant adverse consequences including prolonged school absence and disability. Most FCP are unexplained, and the aetiology is poorly understood. This study aimed to identify risk factors for FCP and explore how risk factors explain variation in pain reporting by childhood socioeconomic conditions (SECs). METHODS Analysis of the UK Millennium Cohort Study, including 8463 singleton children whose parents provided data throughout the study. At 11 years, mothers were asked whether their child frequently complains of pain. Risk ratios (RR) and 95% CIs for FCP were estimated using Poisson regression, according to maternal education. Other risk factors were explored to assess if they attenuated any association between FCP and SECs. RESULTS 32.3% of children frequently complained of pain. Children of mothers with no educational qualifications were more likely to have FCP than children of mothers with higher degrees (RR 2.06, 95% CI 1.64 to 2.59) and there was a clear gradient across the socioeconomic spectrum. Female sex, fruit consumption, childhood mental health and maternal health measures were associated with childhood FCP in univariable and multivariable analyses. Inclusion of these factors within the model attenuated the RR by 17% to 1.70 (95% CI 1.36 to 2.13). CONCLUSION In this representative UK cohort, there was a significant excess of FCP reported in less advantaged children that was partially attenuated when accounting for indicators of parental and childhood mental health. Addressing these factors may partially reduce inequalities in childhood FCP.
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Affiliation(s)
- Benjamin Adam Fryer
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Gavin Cleary
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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14
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Paul SP, Basude D. Non-pharmacological management of abdominal pain-related functional gastrointestinal disorders in children. World J Pediatr 2016; 12:389-398. [PMID: 27363985 DOI: 10.1007/s12519-016-0044-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/02/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Abdominal pain-related functional gastrointestinal disorder (AP-FGID) comprises of 4 main conditions: functional dyspepsia, irritable bowel syndrome, abdominal migraine and functional abdominal pain. AP-FGIDs are diagnosed clinically based on the Rome IV criteria for FGIDs of childhood. There is limited evidence for pharmacological therapies. DATA SOURCES This review article discusses nonpharmacological management of AP-FGID based on the current literature including systematic reviews, randomized controlled trials, cohort and case control studies. We aim to provide a comprehensive overview on the available evidence for the pediatricians and pediatric gastroenterologists involved in managing children with AP-FGID. RESULTS Managing AP-FGIDs can be challenging. This should follow a stepwise approach with focused history, identification of "red flag" signs and symptoms, physical examination and investigations done following initial consultation. Family needs explaining that there is nothing seriously wrong with the child's abdomen. This explanation and reassurance can achieve symptom control in large number of cases. Non-pharmacological interventions are delivered through lifestyle and dietary changes and bio-psychosocial therapies. Dietary interventions vary depending on the type of AP-FGID. Bio-psychosocial therapies such as hypnotherapy, cognitive behavioral therapy and yoga aim at stress reduction. CONCLUSION There is increasing evidence for use of non-pharmacological interventions in children with APFGID.
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Affiliation(s)
- Siba Prosad Paul
- Torbay Hospital, Vowden Hall, Lowes Bridge, Torquay, TQ2 7AA, UK.
| | - Dharamveer Basude
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, UK
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15
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Kaasbøll J, Ranøyen I, Nilsen W, Lydersen S, Indredavik MS. Associations between parental chronic pain and self-esteem, social competence, and family cohesion in adolescent girls and boys--family linkage data from the HUNT study. BMC Public Health 2015; 15:817. [PMID: 26296339 PMCID: PMC4546097 DOI: 10.1186/s12889-015-2164-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 08/17/2015] [Indexed: 01/22/2023] Open
Abstract
Background Parental chronic pain has been associated with adverse outcomes in offspring. However, knowledge on individual and family resilience factors in adolescent offspring of chronic pain sufferers is scarce. This study thus aimed to investigate the associations between parental chronic pain and self-esteem, social competence, and family cohesion levels reported by adolescent girls and boys. Methods Based on cross-sectional surveys from the Nord Trøndelag Health Study (the HUNT 3 study), the study used independent self-reports from adolescents aged 13 to 18 years (n = 3227) and their parents and conducted separate linear regression analyses for girls and boys. Results Concurrent maternal and paternal chronic pain was associated with reduced self-esteem, social competence, and family cohesion in girls. Moreover, maternal chronic pain was associated with higher social competence in boys and reduced self-esteem in girls. The majority of the observed associations were significantly different between girls and boys. Paternal chronic pain was not found to be associated with child outcomes. Conclusions The findings indicate that the presence of both maternal and paternal chronic pain could be a potential risk factor for lower levels of individual and family resilience factors reported by girls. Further research on the relationship between parental pain and sex-specific offspring characteristics, including positive resilience factors, is warranted. The study demonstrates the importance of targeting the entire family in chronic pain care.
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Affiliation(s)
- Jannike Kaasbøll
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) of Central Norway, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, Medisinsk teknisk forskningssenter (MTFS), N-7491, Trondheim, Norway.
| | - Ingunn Ranøyen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) of Central Norway, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, Medisinsk teknisk forskningssenter (MTFS), N-7491, Trondheim, Norway.
| | - Wendy Nilsen
- Department of Child Development and Mental Health, Division of Mental Health, Norwegian Institute of Public Health, PO Box 4404, Nydalen, 0403, Oslo, Norway.
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) of Central Norway, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, Medisinsk teknisk forskningssenter (MTFS), N-7491, Trondheim, Norway.
| | - Marit S Indredavik
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU) of Central Norway, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Postbox 8905, Medisinsk teknisk forskningssenter (MTFS), N-7491, Trondheim, Norway. .,Department of Child and Adolescent Psychiatry, St. Olav's Hospital, Trondheim University Hospital, Postbox 6810, Elgeseter, N-7433, Trondheim, Norway.
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16
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Cservenka A, Stein H, Wilson AC, Nagel BJ. Neurobiological Phenotypes of Familial Chronic Pain in Adolescence: A Pilot fMRI Study. THE JOURNAL OF PAIN 2015; 16:913-25. [PMID: 26117812 DOI: 10.1016/j.jpain.2015.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 04/24/2015] [Accepted: 05/18/2015] [Indexed: 11/26/2022]
Abstract
Parental history of chronic pain has been associated with self-reported pain in adolescent offspring. This suggests that there may be neurobiological mechanisms associated with pain heritability. Because emotional circuitry is an important component of pain processing and may also influence cognition, we used functional magnetic resonance imaging to examine affective processing and cognitive control using an Emotional Go/NoGo task in youth with (FH + Pain, n = 8) and without (FH - Pain, n = 8) a parental history of chronic pain (mean age = 14.17 ± .34 years). FH + Pain youth had widespread reductions in brain activity within limbic and visual processing regions during processing of positively valenced emotional stimuli, as well as reduced frontoparietal response while processing negatively valenced emotional stimuli compared with their peers. In addition, during inhibition within a positive emotional context, FH + Pain youth had reduced cognitive control and salience-related brain activity. On the other hand, default mode-related brain response was increased during inhibitory control within a negative emotional context in these adolescents compared with their peers (P/α < .05). The current findings indicate differences in both emotional processing and cognitive control brain response in FH + Pain compared with FH - Pain youth, suggesting that both affective and executive functioning pathways may be important markers related to the intergenerational transmission of pain. Perspective: This is the first study to examine neurobiological markers of pain risk in adolescents with a family history of chronic pain. These findings may aid in the identification of neural phenotypes related to vulnerability for the onset of pain in at-risk youth.
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Affiliation(s)
- Anita Cservenka
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Hannah Stein
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon
| | - Anna C Wilson
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon; Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon
| | - Bonnie J Nagel
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon; Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon.
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17
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Wei HJ, Xie S. Progress in Chinese medical diagnosis and treatment of functional abdominal pain in children. Shijie Huaren Xiaohua Zazhi 2015; 23:1266-1271. [DOI: 10.11569/wcjd.v23.i8.1266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Functional abdominal pain is a common clinical condition in children, which significantly affects children's health. In this paper, we summarize the progress in understanding the traditional Chinese medicine (TCM) etiology and pathogenesis, therapeutic principle and treatment of this disease. We point out that more studies should be performed to clarify the TCM etiology and pathogenesis of the disease, and the epidemiology and evidence-based medicine should be established. Depending on the characteristics of children, drugs should be made in good taste, so that medication compliance could be increased. In addition, clinicians' clinical ability and parents' health knowledge should be improved.
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18
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Laird KT, Preacher KJ, Walker LS. Attachment and adjustment in adolescents and young adults with a history of pediatric functional abdominal pain. Clin J Pain 2015; 31:152-8. [PMID: 24751542 PMCID: PMC4201885 DOI: 10.1097/ajp.0000000000000090] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This study tested predictions of the Attachment-Diathesis Model (ADM) of Chronic Pain in a cross-sectional sample of adolescents and young adults with a history of childhood functional abdominal pain (FAP). ADM posits that attachment anxiety is a diathesis for poor adjustment (physical health, mental health, and functioning) in the context of chronic pain and that pain self-efficacy, pain threat appraisal, and passive coping mediate this effect. METHODS Participants (N=261) were recruited from a database of consecutive new patients evaluated for abdominal pain at a pediatric gastroenterology clinic. Participants' mean age at the follow-up assessment was 21 years. Structural equation modeling was used to test the fit of our conceptual model to the data. RESULTS Model fit was good (comparative fit index=0.971, the Tucker-Lewis index=0.940, root mean square error of approximation=0.067). Attachment anxiety significantly predicted poorer health in both the mental and physical domains. Model fit was consistent with our hypothesis that pain self-efficacy mediates the effect of attachment anxiety on passive coping and that passive coping, in turn, mediates the effect of pain self-efficacy and pain threat appraisal on mental and physical health. DISCUSSION Among individuals with a childhood history of FAP, those with anxious attachment may be at higher risk for poor physical and mental health. Pain beliefs and coping may mediate the relation between anxious attachment and health outcomes and may serve as effective targets for intervention in chronic pain.
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Laird KT, Sherman AL, Smith CA, Walker LS. Validation of the Abdominal Pain Index using a revised scoring method. J Pediatr Psychol 2015; 40:517-25. [PMID: 25617048 DOI: 10.1093/jpepsy/jsu118] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 12/09/2014] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Evaluate the psychometric properties of child- and parent-report versions of the four-item Abdominal Pain Index (API) in children with functional abdominal pain (FAP) and healthy controls, using a revised scoring method that facilitates comparisons of scores across samples and time. METHODS Pediatric patients aged 8-18 years with FAP and controls completed the API at baseline (N = 1,967); a subset of their parents (N = 290) completed the API regarding the child's pain. Subsets of patients completed follow-up assessments at 2 weeks (N = 231), 3 months (N = 330), and 6 months (N = 107). Subsets of both patients (N = 389) and healthy controls (N = 172) completed a long-term follow-up assessment (mean age at follow-up = 20.21 years, SD = 3.75). RESULTS The API demonstrated good concurrent, discriminant, and construct validity, as well as good internal consistency. CONCLUSION We conclude that the API, using the revised scoring method, is a useful, reliable, and valid measure of abdominal pain severity.
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Affiliation(s)
- Kelsey T Laird
- Department of Psychology and Human Development, Vanderbilt University and Department of Pediatrics, Vanderbilt University
| | - Amanda L Sherman
- Department of Psychology and Human Development, Vanderbilt University and Department of Pediatrics, Vanderbilt University
| | - Craig A Smith
- Department of Psychology and Human Development, Vanderbilt University and Department of Pediatrics, Vanderbilt University
| | - Lynn S Walker
- Department of Psychology and Human Development, Vanderbilt University and Department of Pediatrics, Vanderbilt University
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20
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Kaasbøll J, Lydersen S, Indredavik MS. Substance use in children of parents with chronic pain - the HUNT study. J Pain Res 2014; 7:483-94. [PMID: 25187735 PMCID: PMC4149451 DOI: 10.2147/jpr.s67819] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose The aim of the present study was to investigate possible associations between parental chronic pain and smoking, alcohol, and drug use in adolescent offspring. Methods Cross-sectional data from Nord-Trøndelag Health Study (HUNT 3), a Norwegian population-based health survey conducted in the period 2006–2008 was utilized. The present sample consisted of adolescents aged 13–18 years (n=3,227) for whom information was available on maternal and paternal health statuses. Results Results from multivariable ordinal and binary logistic regression analyses, adjusting for potential confounding factors (child age, parental age, education, and organ specific illness) indicated that the estimated odds ratios (OR) for smoking (OR =1.72, 95% confidence interval [CI] [1.00, 3.05], P=0.049) and alcohol intoxication (drunkenness) (OR =1.56, 95% CI [1.05, 2.33], P=0.029) were higher for boys whose mother and father had chronic pain, compared with boys for whom neither parent had chronic pain. These associations were slightly attenuated by additional adjustment for pain-related factors, such as parental smoking and symptoms of anxiety and depression. Parental chronic pain was not significantly associated with girls’ levels of substance use. There were significant interaction effects between parental chronic pain and child sex on offspring’s alcohol intoxication and smoking. Conclusion The present study expands on existing knowledge and provides groundwork for preventive and specific measures targeting substance use in families burdened with parental chronic pain.
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Affiliation(s)
- Jannike Kaasbøll
- Regional Centre for Child and Youth Mental Health and Child Welfare of Central Norway, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare of Central Norway, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit S Indredavik
- Regional Centre for Child and Youth Mental Health and Child Welfare of Central Norway, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway ; Department of Child and Adolescent Psychiatry, St Olav's Hospital, Trondheim University Hospital Trondheim, Norway
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21
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Sandhu BK, Paul SP. Irritable bowel syndrome in children: pathogenesis, diagnosis and evidence-based treatment. World J Gastroenterol 2014; 20:6013-23. [PMID: 24876724 PMCID: PMC4033441 DOI: 10.3748/wjg.v20.i20.6013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 01/20/2014] [Accepted: 03/19/2014] [Indexed: 02/07/2023] Open
Abstract
Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.
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