Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.
Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.
Pain. 2017 Oct;158(10):1992-2000. doi: 10.1097/j.pain.0000000000000999.
Theoretical models of pediatric chronic pain propose longitudinal associations between children's pain experiences and parent and family factors. A large body of cross-sectional research supports these models, demonstrating that greater parent distress and maladaptive parenting behaviors are associated with greater child disability. Family-based cognitive-behavioral therapy interventions have been developed for youth with chronic pain which aim to improve child disability and reduce maladaptive parenting behaviors. However, little is known about temporal, longitudinal associations between parent and child functioning in this population. In the present study, we conducted a secondary analysis of data from 138 families of youth with chronic pain aged 11 to 17 years old who received family-based cognitive-behavioral therapy delivered through the Internet as part of a randomized controlled trial. Measures of child disability, parent protective behavior, and parent distress were obtained at pretreatment, immediate posttreatment, 6-month follow-up, and 12-month follow-up. Latent growth modeling indicated that child disability, parent protective behavior, and parent distress improved with treatment over the 12-month study period. Latent growth modeling for parallel processes indicated that higher parent distress at pretreatment predicted less improvement in child disability over 12 months. No other predictive paths between parent and child functioning were significant. These findings indicate that parent distress may increase the risk of poor response to psychological pain treatment among youth with chronic pain. At present, parent distress is not routinely targeted in psychological interventions for pediatric chronic pain. Research is needed to determine optimal strategies for targeting parent and family factors in the treatment of pediatric chronic pain.
儿童慢性疼痛的理论模型提出，儿童的疼痛体验与父母和家庭因素之间存在纵向关联。大量的横断面研究支持这些模型，表明父母的痛苦程度和适应不良的育儿行为与儿童的残疾程度呈正相关。已经为患有慢性疼痛的青少年开发了基于家庭的认知行为疗法干预措施，旨在改善儿童的残疾程度并减少适应不良的育儿行为。然而，对于该人群中父母和儿童功能之间的时间性、纵向关联知之甚少。在本研究中，我们对 138 个患有慢性疼痛的青少年家庭的数据进行了二次分析，这些青少年年龄在 11 至 17 岁之间，他们接受了基于家庭的认知行为疗法治疗，该治疗是通过互联网进行的，作为一项随机对照试验的一部分。在治疗前、即时治疗后、6 个月随访和 12 个月随访时，测量了儿童残疾、父母保护行为和父母痛苦程度。潜在增长模型表明，儿童残疾、父母保护行为和父母痛苦程度在 12 个月的研究期间随治疗而改善。平行过程的潜在增长模型表明，治疗前父母的痛苦程度越高，12 个月内儿童残疾的改善程度越低。父母和儿童功能之间没有其他有意义的预测路径。这些发现表明，父母的痛苦程度可能会增加患有慢性疼痛的青少年对心理疼痛治疗反应不佳的风险。目前，父母的痛苦程度在儿童慢性疼痛的心理干预中并未得到常规针对。需要研究确定针对儿童慢性疼痛治疗中父母和家庭因素的最佳策略。
