Investigating How Parental Instructions and Protective Responses Mediate the Relationship Between Parental Psychological Flexibility and Pain-Related Behavior in Adolescents With Chronic Pain: A Daily Diary Study

Parent Anxiety, Depression, Protective Responses, and Parenting Stress in the Context of Parent and Child Chronic Pain: A Daily Diary Study of Parent Variability

Parents with (vs without) chronic pain report poorer psychosocial functioning (eg, worse mental health, parenting difficulties), which has been linked to poorer child outcomes (eg, child pain). However, emerging research suggests that individuals vary in their functioning from day-to-day, particularly those with chronic pain. This study used daily diaries to compare parents with (versus without) chronic pain on variability in their anxiety, mood, protective responses, and parenting stress. We also examined parent chronic pain status as a moderator of the associations between parent variability and youth daily pain and interference. Participants were 76 youth with chronic pain (Mage = 14.26; 71.1% female) and one of their parents (89.5% mothers; n = 38 or 50.0% endorsing chronic pain). Parents and youth completed self-report questionnaires and 7 days of diaries. Parent variability was calculated to reflect the frequency and size of day-to-day changes. Multilevel models revealed that parents with (vs without) chronic pain were significantly more variable in their parenting stress, but not in their anxiety, mood, or protective responses. Contrary to hypotheses, parent variability was not significantly related to youth daily pain intensity or interference and parent chronic pain did not moderate any associations. Instead, mean levels of parent anxiety, protective responses, and parenting stress across the week significantly predicted youth daily pain interference. Findings suggest that while variability was observed among parents (with and without chronic pain) of youth with chronic pain, it did not significantly predict youth's daily pain-related functioning. Further research is needed to confirm these initial findings. PERSPECTIVE: Parents with chronic pain have expressed concerns that the variable nature of their pain negatively impacts their children. Our results found that parents (with and without chronic pain) were variable in their anxiety, mood, protective responses, and parenting stress, but this variability did not significantly predict youth's chronic pain-related functioning.

Parents' Experiences of Communicating With Children About Their Diagnosis of Nonterminal Cancer and Its Related Issues: A Systematic Review of Qualitative Studies

BACKGROUND

Many children experience serious symptoms when they are diagnosed with and treated for cancer. Through appropriate parent-child communication, parents were able to identify children's physical and psychological problems, adjust their behavior, and help them cope with the disease.

OBJECTIVE

This study aimed to systematically search for and integrate evidence from qualitative studies on communication between parents and children with nonterminal cancer from parents' perspectives.

METHODS

A thorough systematic review and metasynthesis of qualitative studies were conducted. Articles were searched from PubMed/MEDLINE, EMBASE, Web of Science, CINAHL, PsycINFO, and PsycArticles from the database inception to November 6, 2022. After screening and quality appraisal, 14 articles were finally included in the metasynthesis.

RESULTS

Three themes and 11 subthemes were identified: (1) communication content, including diagnosis, treatment, health management, health risk, and emotion; (2) factors influencing communication, including ages of children, parents' experience of communication, parents' awareness of protection, and culture; and (3) children's responses, including acceptance and resistance.

CONCLUSIONS

This systematic review found that parents were influenced by various factors during the decision-making process of parent-child communication about childhood cancer and its related issues. Parents tended to adjust their communication content and style to protect their children.

IMPLICATIONS FOR PRACTICE

Future research should be conducted to explore children's experiences of communicating with their parents and analyze the similarities and differences between the communication needs of parents and children. Healthcare professionals should provide professional communication guidance to facilitate the parent-child relationship and improve the mental health of both children and their parents.

Broadening the Scope of Resilience in Chronic Pain: Methods, Social Context, and Development

PURPOSE OF REVIEW

A wellspring of new research has offered varying models of resilience in chronic pain populations; however, resilience is a multifaceted and occasionally nebulous construct. The current review explores definitional and methodological issues in existing observational and clinical studies and offers new directions for future studies of pain resilience.

RECENT FINDINGS

Definitions of pain resilience have historically relied heavily upon self-report and from relatively narrow scientific domains (e.g., positive psychology) and in narrow demographic groups (i.e., Caucasian, affluent, or highly educated adults). Meta-analytic and systematic reviews have noted moderate overall quality of resilience-focused assessment and treatment in chronic pain, which may be attributable to these narrow definitions. Integration of research from affiliated fields (developmental models, neuroimaging, research on historically underrepresented groups, trauma psychology) has the potential to enrich current models of pain resilience and ultimately improve the empirical and clinical utility of resilience models in chronic pain.

Diagnostics of psychological flexibility and the ability to cope with the inevitable changes among psychology students

The study concerns the question of how much the emotional competence and the ability to cope with problems in one's own personality increase in the process of professional psychological education, for which students of different years of study were tested. The aim of this study is to deeply diagnose various components of psychological flexibility and the ability to cope with unexpected events among psychology students. The study involved 30 students from 1 to 4 years of university grade level participated into study, divided into 4 equal groups from. Based on testing various aspects of psychological flexibility, emotional intelligence test (EQ test), Emotion Regulation Questionnaire (ERQ) and D.V. Lyusin emotional intelligence instrument (Emin) were used; it was tested using Student's t-test and Kruskal-Wallis H-test to evaluate differences between three or more samples simultaneously. As a result of the study, the significant differences between all groups of participants and between the assessment of individual factors of psychological flexibility in different groups was accepted. Each of the groups demonstrated its specific characteristics of the relationship between emotional competence and coping with stress. Comparison of the results of students from different years of study showed that psychological education does not have a significant effect on emotional intelligence as an indicator of emotional flexibility, but positively affects the development of coping with stress, although in predominantly passive forms. The practical application of the research lies in improving psychology students' learning; the research results can be used as methods for determining psychological flexibility factors that require development in study groups.

Glass half full: A diary and interview qualitative investigation of flourishing among adolescents living with chronic pain

BACKGROUND

Counter to paediatric pain literature that typically highlights the deleterious impacts associated with adolescent chronic pain, evidence suggests that some adolescents flourish in their experience of pain. This study sought to explore how adolescents experience, understand and perceive flourishing while living with chronic pain.

METHODS

Twenty-four adolescents aged 11-24 years were recruited via clinical and online settings. All adolescents were asked to complete daily diary entries, with a subset of 10 participants asked to complete follow-up interviews.

RESULTS

Inductive reflexive thematic analysis generated two themes: 'Appreciating the moment' and 'Becoming a better version of myself'. Themes addressed how self and other comparisons facilitated a renewed appreciation for achievements and pleasures in life due to living with chronic pain. Adolescents further demonstrated a perception of continued personal and social growth in their experience of chronic pain, including increased emotional maturity, resilience, positivity, kindness and improved communication skills.

CONCLUSIONS

We conclude that adolescents can experience positive changes in functioning and flourish in some domains of life despite, or resulting from, chronic pain. Further research with an exclusive focus on flourishing is needed to build on this work and address this important gap in knowledge.

SIGNIFICANCE

We present evidence that adolescents can flourish when living with chronic pain. Such knowledge may inform the development of positive psychological treatment strategies that are focused on reinforcing adolescents' existing strengths, to expand on current treatment options for adolescents living with chronic pain.

Development of a text message-based headache diary in adolescents and children

BACKGROUND

International guidelines recommend diaries in migraine trials for prospective collection of headache symptoms. Studies in other patient populations suggest higher adherence with electronic diaries instead of pen-and-paper. This study examines the feasibility of a text message-based (texting) diary for children and adolescents with headache.

METHODS

This is a secondary analysis of data from a study validating a pediatric scale of treatment expectancy. We developed a Health Insurance Portability and Accountability Act-compliant texting diary collecting headache characteristics, medication use, and disability with 3-5 core daily questions for 4 or 12 weeks depending on headache treatment. Adherence was incentivized.

RESULTS

93 participants consented to the expectancy study. Five participants opted for a paper diary for follow-up. 88 participants chose the texting diary with 28 4-week and 60 12-week participants. Five participants did not complete the enrollment visit. Of those remaining 83, 89% of 4-week and 93% of 12-week participants responded on at least 80% of days. On average, participants fully completed 88% (4-week cohort) and 90% (12-week) of diary entries.

CONCLUSIONS

Text messages are a promising method for collecting patient-reported data. Adherence was similar to that reported for paper diaries in other pediatric migraine trials, but time-stamped entries ensure real-time data collection.

Association of parental and adolescent emotion-related factors with adolescent chronic pain behaviors

ABSTRACT

Chronic pain is a prevalent condition in youth, and the pain experience is strongly influenced by emotional processes. Studying emotion variability and regulation (ER) may help better understand pain behavior. As the development of emotion-related abilities predominantly takes place in the family context, examining ER within parent-adolescent dyads is important. We set out to test the association of parent and adolescent ER and adolescent emotional variability with adolescent pain behavior (ie, pain interference, activity avoidance, and activity engagement). A sample of 56 adolescents (Mage = 14.5, 85.7% women) with chronic pain and one of their parents (92.9% mothers) participated in this study. Adolescents completed baseline measures of average pain intensity, ER, and mean positive and negative affect. Furthermore, adolescents completed an electronic diary for 14 consecutive days, reporting on emotional state, activity avoidance, activity engagement, and pain interference. Parents completed measures of ER and their own history of pain. We performed a variable selection procedure, the least absolute shrinkage and selection operator method, to determine important predictors of adolescent pain behavior. Adolescent high positive affect was associated with more activity engagement, less pain interference, and less activity avoidance, indicating that positive affect might enhance the willingness to engage in activities in the presence of pain. Adolescent ER strategy emotional reappraisal and parents' own history of pain were predictors of less activity engagement. Parent ER was not related to adolescent ER. In conclusion, our results highlight the potential of enhancing positive affect as an intervention target for chronic pain.

Parental Pain Catastrophizing, Communication Ability, and Post-surgical Pain Outcomes Following Intrathecal Baclofen Implant Surgery for Patients With Cerebral Palsy

There is strong evidence that psychosocial variables, including pain catastrophizing, influence parental and child ratings of pain, pain expression, and long-term outcomes among children with chronic pain. The role of these factors among children who have communication deficits due to cerebral palsy (CP) and other intellectual and developmental disabilities is currently unclear. In this study, parental pain catastrophizing was assessed before intrathecal baclofen (ITB) pump implantation for spasticity management in 40 children and adolescents with CP, aged 4 to 24 years. Pain was assessed before and after surgery with two methods: a parent-reported pain interference scale, and behavioral pain signs during a standardized range of motion exam. Linear mixed models with clinical/demographic factors and scores from the Pain Catastrophizing Scale for Parents (PCS-P), and child spoken language ability as predictors and the pain variables as the outcomes were implemented. On average, both pain outcomes improved after surgery. Only child spoken language ability predicted change in behavioral reactivity scores, with children with phrase speech showing an increase in reactivity at follow-up compared to pre-surgery levels, on average. A significant interaction between PCS-P scores and spoken language ability on change in pain interference scores over time showed that dyads with children with phrase speech whose parents reported high PCS-P scores reported the least improvement in pain interference at follow-up. Due to the preliminary nature of the study, future work is needed to investigate the parental behaviors that mediate the relationships between parental catastrophizing and pain outcomes in this population.

Narrative Diaries in Pediatrics: A Scoping Review

PROBLEM

Health diaries with both clinical and narrative elements have been widely used in pediatrics to study children's and families' experiences of illness and coping strategies. The objective of this study is to obtain a synthesis of the literature about narrative health diaries using the PRISMA extension for scoping reviews.

ELIGIBILITY CRITERIA

Sources were limited to: English language; narrative diaries; children/adolescents and/or parents/caregivers.

SAMPLE

The following databases were searched: PubMed, Embase and CINAHL with no time limits.

RESULTS

Among 36 articles included the most common context where a diary was implemented was the home (61%), the hospital (17%) and the school (14%). The most common diarist is the child or adolescent (50%). Paper diary was the most common type (53%), followed by the video diary (19%), the e-diary (8%) or the audio diary (8%). None of the studies explored the impact of the use of diaries on patient outcomes.

CONCLUSIONS

The narrative health diary is used to report patient experiences of illness or common life from the point of view of the child, adolescent or other family members. The diversity of the diaries found shows how the narrative diary may be 'adapted' to different settings and pediatric populations.

IMPLICATIONS

The narrative diary is a relevant tool for the exploration of children's and adolescents' experiences of illness and common life. Studies are still needed to describe the impact of narrative diaries keeping on children's health outcomes.

Topical Review: Examining Multidomain Pain Resilience in Late Adolescents and Young Adults

OBJECTIVE

Upwards of 14% of late adolescents and young adults (AYAs) experience chronic pain; however, limited research has focused on factors specifically influencing late AYAs as they transition to adulthood. In this topical review, we propose a conceptual model of multidomain pain resilience (MDPR) in late AYAs with chronic pain that extends existing pain resilience literature, including the Ecological Resilience-Risk Model for Pediatric Chronic Pain.

METHOD

A conceptual framework for MDPR in late AYAs was developed from the existing literature on resilience in young people with chronic pain. Gaps in knowledge specific to late AYAs are identified, and relevant research examining MDPR in adults with pain are summarized to inform applications of this concept to youth as they transition to adulthood.

RESULTS

Few studies have explored resilience factors in pediatric pain. Of note, these endeavors have largely neglected late adolescence and young adulthood, despite unique considerations germane to this crucial developmental period. Existing research has also focused exclusively on assessing resilience as a unitary, rather than a multidimensional construct. Although limited, MDPR has been examined in midlife and older adults with chronic pain, highlighting the need to expand prior models of pain resilience and extend these principles to emerging adulthood.

CONCLUSIONS

Understanding MDPR in late AYAs with chronic pain may provide insights regarding measurable and modifiable resilience factors (e.g., adaptive and personal resources) that promote healthy pain-related outcomes (e.g., reduced pain and enhanced physical functioning) and optimize prevention and/or treatment strategies for this group.

Video-based Pain Education in Schools: A Study With Adolescents

OBJECTIVE

School-based educational programs have shown positive changes in health-related behaviors among adolescents. The aim of this study was to analyze the changes in pain-related knowledge among adolescents and in the use of positive responses to their peers' pain behaviors after watching a brief educational video.

METHODS

One hundred and thirty-five adolescents (mean age=13.27; SD=1.17) participated and provided demographic and pain-related information. They also responded to a pain-related knowledge questionnaire before (T1), after (T2), and 1 month after (T3) watching a brief pain educational video, and to a modified version of the Inventory of Parent/Caregiver Responses to the Children's Pain Experience at T1 and at T3.

RESULTS

There was a significant increase in pain knowledge for all participants between T1 and T2 (η2p=0.73) and between T1 and T3 (η2p=0.62). An increase in responses considered to be positive to peers' pain behaviors (ie, the promotion of well-behaviors and coping responses) 1 month after watching the educational video was also found. Interestingly, these results were not associated with the chronic pain status of the participant.

DISCUSSION

The findings showed that a brief and inexpensive educational video-based intervention in schools helps to increase pain-related knowledge and change responses to students with chronic pain. This has the potential to prevent chronic pain and related disability among students, and decrease bullying-like behaviors toward students with chronic pain.

Baseline Characteristics of a Dyadic Cohort of Mothers With Chronic Pain and Their Children

OBJECTIVES

A growing body of research has demonstrated a robust link between parental chronic pain and child pain and psychological function. Although the association between parent and child pain is strong, there are limited data to understand environmental and behavioral processes that account for the association and how this develops over time. This longitudinal cohort study was designed to understand the potential mechanisms that confer risk or resilience for chronic pain among child offspring of mothers with chronic pain.

METHODS

The current paper presents baseline data on the cohort to describe the pain and psychosocial characteristics of mothers with chronic pain and their 8- to 12-year-old children. A total of 400 mothers with chronic pain and their children were enrolled into the longitudinal study and completed measures of pain, physical, and psychosocial functioning.

RESULTS

Mothers reported a range of pain and pain-related disability and were grouped into 4 pain grades (PGs) representing different pain and disability levels. Mothers in these groups differed on rates of widespread pain and opioid use. Maternal PGs also differed by physical function, fatigue, sleep disturbance, and psychological function. Most children in this sample reported pain and psychosocial symptoms in the nonclinical range, and child variables did not differ by maternal PG. Maternal disability and function were concurrently associated with child psychosocial function.

DISCUSSION

While maternal PGs map broadly onto several dimensions of maternal functioning, they were not significantly related to child pain or function. Results may help identify potential protective factors in the intergenerational transmission of risk for chronic pain.