Parental emotion and pain control behaviour when faced with child's pain: the emotion regulatory role of parental pain-related attention-set shifting and heart rate variability

The Influence of Children's Pain-Related Attention Shifting Ability and Pain Catastrophizing Upon Negatively Biased Pain Memories in Healthy School Children

The current study investigated the influence of children's ability to flexibly shift attention toward and away from pain information on the development of negatively biased pain memories, thereby employing a direct measure of attention control reliant on behavioral responses in the context of pain (ie, an attention switching task). The direct influence of children's attention-shifting ability and pain catastrophizing as well as the moderating role of this shifting ability in the relationship between pain catastrophizing and the development of negatively biased pain memories was examined. Healthy school children (N = 41; 9-15 years old) received painful heat stimuli and completed measures of state and trait pain catastrophizing. They then performed an attention-switching task wherein they had to shift attention between personally relevant pain-related and neutral cues. Two weeks after the painful task, children's pain-related memories were elicited via telephone. Findings indicated that children's reduced ability to disengage attention away from pain information predicted more fear memory bias 2 weeks later. Children's pain-related attention-shifting ability did not moderate the relationship between children's pain catastrophizing and negatively biased pain memories. Findings highlight the contribution of children's attention control skills in the development of negatively biased pain memories. PERSPECTIVE: Results of the current study indicate that children with a reduced ability to shift attention away from pain information are at risk for developing negatively biased pain memories. Findings can inform interventions to minimize the development of these maladaptive negatively biased pain memories by targeting pain-relevant attention control skills in children.

Multicentre, randomised controlled trial to investigate the effects of parental touch on relieving acute procedural pain in neonates (Petal)

INTRODUCTION

Newborn infants routinely undergo minor painful procedures as part of postnatal care, with infants born sick or premature requiring a greater number of procedures. As pain in early life can have long-term neurodevelopmental consequences and lead to parental anxiety and future avoidance of interventions, effective pain management is essential. Non-pharmacological comfort measures such as breastfeeding, swaddling and sweet solutions are inconsistently implemented and are not always practical or effective in reducing the transmission of noxious input to the brain. Stroking of the skin can activate C-tactile fibres and reduce pain, and therefore could provide a simple and safe parent-led intervention for the management of pain. The trial aim is to determine whether parental touch prior to a painful clinical procedure provides effective pain relief in neonates.

METHODS AND ANALYSIS

This is a multicentre randomised controlled trial. A total of 112 neonates born at 35 weeks' gestation or more requiring a blood test in the first week of life will be recruited and randomised to receive parental stroking either preprocedure or postprocedure. We will record brain activity (EEG), cardiac and respiratory dynamics, oxygen saturation and facial expression to provide proxy pain outcome measures. The primary outcome will be the reduction of noxious-evoked brain activity in response to a heel lance. Secondary outcomes will be a reduction in clinical pain scores (Premature Infant Pain Profile-Revised), postprocedural tachycardia and parental anxiety.

ETHICS AND DISSEMINATION

The study has been approved by the London-South East Research Ethics Committee (ref: 21/LO/0523). The results will be widely disseminated through peer-reviewed publications, international conferences and via our partner neonatal charities Bliss and Supporting the Sick Newborn And their Parents (SSNAP). If the parental tactile intervention is effective, recommendations will be submitted via the National Health Service clinical guideline adoption process.

STUDY STATUS

Commenced September 2021.

TRIAL REGISTRATION NUMBER

NCT04901611; 14 135 962.

Biopsychosocial Contributors to Parent Behaviors during Child Venipuncture

Children’s needle-related distress is strongly related to parental verbal behaviors. Yet, empirical data supporting theorized contributors to parent behaviors in this context remain limited. This is the first study to collectively measure biological (heart rate variability; HRV), psychological (catastrophizing, anxiety), and social (child behaviors) contributors to parent verbal behaviors throughout pediatric venipuncture. HRV was used as a measure of emotion regulation capacity and examined as a moderator in the associations between parent psychological factors and their behaviors, and between child and parent behaviors. Sixty-one children aged 7 to 12 years who presented at an outpatient blood lab for venipuncture and a parent participated. Parent baseline HRV, state catastrophizing, and anxiety were measured prior to venipuncture. The procedure was video-recorded for later coding of pairs’ verbal behaviors. Strong associations emerged between child behaviors and parent behaviors. Baseline HRV moderated the association between parent catastrophizing and behavior. Social factors remain a strong influence related to parent behaviors. Psychologically, parent negative cognitions differentially related to parent behaviors based on their emotion regulation capacity. Biologically, low baseline HRV may increase the risk that certain parents engage in a constellation of behaviors that simultaneously direct their child’s attention toward the procedure and inadvertently communicate parental worry, fear, or concern.

A framework for incorporating physical activity in treatment: Competencies, guidelines, and implications for family therapists

Physical activity can have a profound impact on the cognitive, emotional, and social aspects of our clients' lives, and can even boost and sustain therapy outcomes. And yet, family therapists may not be trained or educated in the importance of physical activity nor how to assess, educate, and collaborate with health professionals to incorporate physical activity in treatment. As the evidence grows on the connection between physical activity and biopsychosocial functioning and more family therapists enter medical and healthcare settings, a framework for physical activity competencies is needed. As such, the purpose of this conceptual and empirical review paper is to (a) review the important brain-boosting benefits of physical activity for mental, cognitive, and social health, (b) provide a framework for the domains for family therapists for incorporating exercise in assessment and treatment, and finally, (c) outline recommendations for practice, education and supervision, and research for family therapists.

The Moderating Role of Attention Control in the Relationship Between Pain Catastrophizing and Negatively-Biased Pain Memories in Youth With Chronic Pain

The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing and negatively-biased pain memories. Youth with chronic pain (N = 105) performed a cold pressor task (CPT) and completed self-report measures of state/trait pain catastrophizing and attention control, with the latter comprising both attention focusing and attention shifting. Two weeks after the CPT, youth's pain-related memories were elicited via telephone allowing to compute pain and anxiety memory bias indices (ie, recalling pain intensity or pain-related anxiety, respectively, as higher than initially reported). Results indicated no main effects of attention control and pain catastrophizing on pain memories. However, both components of attention control (ie, attention focusing and attention shifting) moderated the impact of pain catastrophizing on youth's memory bias, with opposite interaction effects. Specifically, whereas high levels of attention shifting buffered the influence of high pain catastrophizing on the development of pain memory bias, high levels of attention focusing strengthened the influence of high pain catastrophizing on the development of anxiety memory bias. Interaction effects were confined to trait catastrophizing (ie, not state catastrophizing). Theoretical and clinical implications are discussed. PERSPECTIVE: This article investigates the role of attention control in the development of negatively-biased pain memories in children with chronic pain. Findings underscore the importance of targeting differential components of attention control and can inform intervention efforts to minimize the development of negatively biased pain memories in youth with chronic pain.

The Impact of Parental Pain-attending and Non-pain-attending Responses on Child Pain Behavior in the Context of Cancer-related Painful Procedures: The Moderating Role of Parental Self-oriented Distress

OBJECTIVES

Literature has demonstrated inconsistent findings regarding the impact of parental responses on child pain-related outcomes. Yet, research into factors that may underlie inconsistent findings regarding the variable impact of parental responses is lacking. The current study investigated the moderating role of parental distress in understanding the impact of parental pain-attending (eg, reassuring the child) and non-pain-attending (eg, distracting the child with humor) responses on child pain behavior (eg, crying).

METHODS

Children (18 y and younger) with leukemia, undergoing a lumbar puncture (LP) and/or bone marrow aspiration procedure, and one of their parents, were recruited from the Pediatric Ghent University Hospital. Parent-child interactions were videotaped after the procedure allowing coding of parental responses and child pain behavior. Parents self-reported on experienced personal distress.

RESULTS

Participants consisted of 42 children (24 boys, 18 girls) with leukemia and one of their parents. Children were 0.6 to 15 (7.08±4.39) years old. Findings indicated a positive association between parental pain-attending and child pain behavior, but only when parents reported high levels of distress (β=0.56, P=0.001). No association was observed for parents reporting low levels of distress (β=-0.09, ns). Parental non-pain-attending responses contributed to lower child pain behavior (β=-0.24, P=0.045), independently of parental distress (β=-0.07, ns).

DISCUSSION

The current findings point to the moderating role of parental distress in understanding the impact of parental responses on child pain behavior and highlight the importance of interventions targeting parental emotion regulation to promote optimal child pain outcomes.

A Multi-Method Approach to Understand Parent Behaviors During Child Acute Pain

Abstract. Parent behaviors strongly predict child responses to acute pain; less studied are the factors shaping parent behaviors. Heart rate variability (HRV) is considered a physiological correlate of emotional responding. Resting or “trait” HRV is indicative of the capacity for emotion regulation, while momentary changes or “state” HRV is reflective of current emotion regulatory efforts. This study aimed to examine: (1) parent state HRV as a contributor to parent verbal behaviors before and during child pain and (2) parent trait HRV as a moderator between parent emotional states (anxiety, catastrophizing) and parent behaviors. Children 7–12 years of age completed the cold pressor task (CPT) in the presence of a primary caregiver. Parents rated their state anxiety and catastrophizing about child pain. Parent HRV was examined at 30-second epochs at rest (“trait HRV”), before (“state HRV-warm”), and during their child’s CPT (“state HRV-cold”). Parent behaviors were video recorded and coded as coping-promoting or distress-promoting. Thirty-one parents had complete cardiac, observational, and self-report data. A small to moderate negative correlation emerged between state HRV-cold and CP behaviors during CPT. Trait HRV moderated the association between parent state catastrophizing and distress-promoting behaviors. Parents experiencing state catastrophizing were more likely to engage in distress-promoting behavior if they had low trait HRV. This novel work suggests parents who generally have a low (vs. high) HRV, reflective of low capacity for emotion regulation, may be at risk of engaging in behaviors that increase child distress when catastrophizing about their child’s pain.

Testing the intergenerational model of transmission of risk for chronic pain from parents to their children: an empirical investigation of social transmission pathways

Children of parents with chronic pain have higher rates of pain and internalizing (eg, anxiety and depressive) symptoms than children of parents without chronic pain. Parental modeling of pain behaviour and reinforcement of child pain have been hypothesized to underlie these relationships. These mechanisms were tested in a sample of 72 parents with chronic pain and their children (aged 8-15 years). Standardized measures were completed by parents (pain characteristics, pain interference, and child internalizing) and children (pain catastrophizing, pain over previous 3 months, and internalizing). In a laboratory session, children completed the cold pressor task in the presence of their parent, and parent-child verbalizations were coded. Significant indirect effects of parental pain interference on child self-reported (B = 0.12, 95% confidence interval [CI]: 0.01-0.29) and parent-reported (B = 0.16, 95% CI: 0.03-0.40) internalizing symptoms through child pain catastrophizing were found (parental modeling mechanism), and were not moderated by child chronic pain status. Significant indirect effects were found between parent pain-attending verbalizations and child self-reported (B = 2.58, 95% CI: 1.03-5.31) and parent-reported (B = 2.18, 95% CI: 0.93-4.27) cold pressor task pain intensity and tolerance (B = -1.02, 95% CI: -1.92 to -0.42) through child pain-attending verbalizations (parental reinforcement mechanism). Although further understanding of the temporal relationships between these variables is needed, the current study identifies constructs (eg, parent pain interference, child pain catastrophizing, and parent reinforcement of child pain) that should be further examined as potential targets for prevention and intervention of pain and internalizing symptoms in children of parents with chronic pain.