Sinclair Cate M, Meredith Pamela, Strong Jenny, Feeney Rachel
*School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; †Anaesthetic and Pain Management, Royal Children's Hospital, Melbourne, Australia.
J Dev Behav Pediatr. 2016 May;37(4):327-42. doi: 10.1097/DBP.0000000000000300.
Chronic pain can significantly impair functioning of children and adolescents; however, evidence suggests that current psychological approaches have limited effect on functioning post treatment. The objective of this review is to present the current evidence for the personal and contextual factors that affect functioning and disability of children and adolescents with chronic pain, to support the evolution of new treatments.
Key word searches were conducted in PsycINFO, MEDLINE via Ovid, CINAHL, and PubMed from 1995 to October 2014. Studies were included if they (1) were written in English, (2) included children or adolescents with chronic pain (>3 mo), (3) had at least 1 personal attribute or 1 contextual factor, (4) had 1 measure of functional ability, and (5) had reported correlations between personal or contextual factors and functional measure.
Thirty-three studies were identified which met all inclusion criteria. Several personal factors (depression, anxiety, pain intensity, and catastrophizing) and contextual/environmental factors (parenting characteristics) were consistently associated with higher levels of disability, whereas evidence for other factors was less consistent. Complex interactions between personal and contextual factors were reported. Child physical/cognitive capacities, teacher/peer behaviors, and broader cultural and environmental social systems, received little attention.
Several parent and child factors were consistently linked with functional disability, whereas better family functioning was associated with functional ability. Applying an ecological framework, assisted identification of areas for further research, and provides direction for treatments that may be more effective in optimizing long-term functional outcomes, extending current psychological approaches.
慢性疼痛会严重损害儿童和青少年的机能；然而，有证据表明当前的心理治疗方法对治疗后的机能改善效果有限。本综述的目的是呈现当前关于影响慢性疼痛儿童和青少年机能及残疾状况的个人因素和环境因素的证据，以支持新治疗方法的发展。
于1995年至2014年10月期间在PsycINFO、通过Ovid检索的MEDLINE、CINAHL和PubMed中进行关键词搜索。纳入的研究需满足以下条件：（1）英文撰写；（2）纳入患有慢性疼痛（超过3个月）的儿童或青少年；（3）至少有1个个人属性或1个环境因素；（4）有1项机能能力测量指标；（5）报告了个人或环境因素与机能测量指标之间的相关性。
共识别出33项符合所有纳入标准的研究。若干个人因素（抑郁、焦虑、疼痛强度和灾难化思维）以及环境/背景因素（养育特征）始终与较高水平的残疾相关，而其他因素的证据则不太一致。研究报告了个人因素与环境因素之间的复杂相互作用。儿童的身体/认知能力、教师/同伴行为以及更广泛的文化和环境社会系统很少受到关注。
若干父母和儿童因素始终与机能残疾相关，而更好的家庭功能则与机能能力相关。应用生态框架有助于确定进一步研究的领域，并为可能更有效地优化长期机能结果的治疗方法提供方向，扩展当前的心理治疗方法。
