Family pain history predicts child health status in children with chronic rheumatic disease

Objectives. To examine the relationships of parental and family pain histor y on the pain experience of children with chronic rheumatic disease. The ai ms of the study were as follows: 1) to describe the pain history of parents and families of children with rheumatic disease, 2) to examine relationshi ps between parental and family pain history and the pain report and physici an-rated health status of children with chronic rheumatic disease, and 3) t o determine whether child coping mediates the relationship between family p ain history and the child's pain and physician-rated health status. Method. Parents of 100 children were recruited from a pediatric rheumatolog y clinic during routine visits. Parents completed questionnaires assessing parental pain history and family characteristics. Children in the study com pleted a series of questionnaires to assess pain and pain coping strategies , including the Coping Strategies Questionnaire and parts of the Pediatric Pain Questionnaire. A pediatric rheumatologist provided a global assessment of disease severity on a 100-mm visual analog scale as an index of child h ealth status. Results. A high number of parents of children seen in a pediatric rheumatol ogy clinic described a personal pain history. More than 90% of parents repo rted having at least 1 chronic pain condition, with an equal proportion rep orting an episode of pain in the past month. The most commonly reported pai n conditions were lower back pain, shoulder/neck pain, and migraine headach e pain. On average, this group of parents reported a history of 3.5 chronic pain conditions (standard deviation: 2.3) and reported having sought treat ment for 1.7 (standard deviation: 2.3) of these conditions. Additionally, 9 3% of all parents reported extended family members experiencing at least 1 chronic pain condition. Correlational analyses indicated that parents repor ting higher levels of current pain and higher mean levels of pain during th e past month were more likely to have children reporting higher levels of c urrent pain (r = 0.23 and r = 0.27). In addition, parents who sought more t reatment for their own pain were more likely to have children reporting hig her levels of pain (r = 0.22) and presenting with poorer health status (r = 0.22). Similarly, parents reporting higher levels of pain-related interfer ence with activity were more likely to have children reporting higher level s of current pain (r = 0.23). Correlational analyses also indicated that ch ildren whose extended families reported a history of multiple pain conditio ns were more likely to report higher levels of current pain (r = 0.24) and more pain locations (r = 0.23). Finally, a series of mediational statistica l models confirmed that child use of the pain coping strategy, catastrophiz ing, partially accounted for the relationship between several parent and fa mily pain history variables and the child's own current pain ratings and ph ysician global assessment. Specifically, child catastrophizing mediated the relationships between the total number of treated pain conditions and chil dren's current pain ratings and physician global assessment. In addition, c hild catastrophizing was shown to mediate the relationship between parental mean level of pain in the past month and children's current pain rating an d the relationship between total number of family pain conditions and child ren's current pain rating. Taken together, our results suggest that parenta l and familial pain experiences predict children's use of catastrophizing t o cope with pain, which in turn predicts physician global assessment and ch ildren's current pain. Conclusions. The results from the present study indicate that many of the p arents of children seen in a pediatric rheumatology clinic have a personal pain history and highlight the potential impact of parental pain history on children's pain experiences. Specifically, parents who were more likely to seek treatment for their own pain or more likely to report interference wi th recreational activities because of pain had children with higher pain ra tings and poorer health status as measured by the physician global assessme nt. Additionally, a series of mediational models showed that child catastro phizing serves as a specific mechanism through which parental and familial pain history variables influence child ratings of current pain and physicia n ratings of health status. Future studies are needed to determine exactly how children living in families with painful conditions become more reliant on catastrophizing to cope with their pain. In addition, more research is needed to identify other potential mediators, such as positive ways parents may influence children's pain coping. There are several important clinical implications of our findings. First, our results suggest that by gathering information from parents about their own pain histories, health care provi ders may be able to identify children at risk for developing maladaptive pa in coping strategies and higher levels of disease-related pain and disabili ty. Second, our results indicate that intervention programs should focus sp ecifically on reducing children's use of catastrophizing to cope with their pain. Perhaps most importantly, our results highlight the need to include parents in interventions aimed at reducing children's pain and improving ch ildren's abilities to cope with pain.