Evaluating Differential Effects of Specific Pain Dismissal Interactions With Physicians.

OBJECTIVES: Over 40% of adolescents with chronic pain report experiencing pain dismissal, which is a response from another individual that is perceived as diminishing, denying, or disbelieving an individual's report of pain. Pain dismissal by physicians often leaves patients feeling discredited, which may discourage them from seeking and receiving proper treatment for their pain. The purpose of this study was to investigate how the 4 most commonly reported types of physician pain dismissal differentially affect individuals' reactions. MATERIALS AND METHODS: Emerging adults, age 18- to 25-years old (N=352, 60% female), were randomly assigned to read 1 of 4 vignettes describing patient-provider interactions that included the most commonly reported types of pain dismissal identified by previous research: denial/disbelief, minimizing, faking for secondary gain, and psychogenic. Participants answered questions regarding their reactions to the pain dismissal vignettes. RESULTS: All 4 vignettes were perceived as dismissive and problematic by the majority of participants, but participants who read the psychogenic pain dismissal vignette were less dissatisfied overall with the hypothetical medical appointment than participants who read the other 3 vignettes. DISCUSSION: All 4 types of physician pain dismissal were broadly perceived negatively, suggesting that the experience of pain dismissal is likely not due to patient hypersensitivity but to physician behavior. Discussion of the psychological factors associated with pain was less likely to be perceived as dismissive. Psychologists and physicians should collaborate to develop recommended language that validates patients' experiences of pain, communicates appropriate levels of empathy, and reduces the frequency of perceived physician pain dismissal.

The Experience of Pain Dismissal in Adolescence.

CONTEXT: Pain in adolescence has psychosocial effects lasting into adulthood, including increased likelihood of pain in adulthood and higher rates of depression and anxiety. Many adolescents with chronic pain describe skepticism of pain reports, but this has not yet been evaluated in a sample of typically developing adolescents. OBJECTIVE: The current study sought to describe the experience of perceived pain dismissal during adolescence in a community sample. METHOD: Nearly 2000 (1931) emerging adults were recruited from the community and answered open-ended questions regarding whether they had experienced dismissal of their pain in adolescence, who dismissed their pain, characteristics of the dismisser, and what that experience was like. Qualitative responses were coded using a Delphi method. RESULTS: One in 10 young adults reported an experience of pain dismissal during adolescence. Young adults reported that dismissals by parents and physicians were the most distressing. Often, this experience was associated with a lasting sense of hostility toward the person who dismissed their pain, as well as anger, self-directed negativity, damage to the relationship, and feelings of isolation. CONCLUSIONS: One in 10 young adults reported at least one instance of dismissed pain and half of these instances involved a parent or medical provider. Results suggest a lasting negative impact of perceived dismissal. Pain in adolescence is a complicated experience and the current study indicates that parents and physicians need further guidance on how best to respond to reports of pain.

Gender differences in the experience of pain dismissal in adolescence.

This study examined physician-generated pain dismissal experiences in adolescence between males and females. Young adults (ages 18-24, N = 178) with chronic or recurrent pain reported at least one pain dismissal experience in adolescence and answered a series of questions regarding the experience during this time period. Females were significantly more likely to report pain dismissal and a physician as the dismisser. Males were more likely to report that the dismisser expressed hostility toward them, feeling ambivalent regarding the dismissal experience, and a desire to avoid the dismisser. Females were more likely to report a desire to plead for understanding with the dismisser. Results suggest that female adolescents are more likely to report a pain dismissal experience with physicians, raising concerns that adolescent females may receive, or at least perceive, differential treatment for their chronic pain.

Predicting parent health-related quality of life: evaluating conceptual models.

PURPOSE: Parents of children with chronic illnesses are at risk for poor health-related quality of life (HRQoL), with numerous identified risk factors, but the most informative statistical model considering their combined impact is unclear. The authors conceptualized risk for poor HRQoL using a summed model, comprehensive multivariate model, and latent profile analysis (LPA). METHODS: Community parents completed an online survey, providing information about demographics, child's chronic illness, family functioning, and parent and child HRQoL. Parents reported that their children had a variety of chronic conditions (e.g., asthma, headaches, attention deficit/hyperactivity disorder, neurofibromatosis). RESULTS: The summed model did not account for a significant proportion of variance in parent HRQoL. The comprehensive multivariate model (R 2 = 0.614) and LPA (R 2 = 0.305) both significantly predicted parent HRQoL. The LPA identified two risk profiles for lower HRQoL: parents who reported milder illnesses, but poorer family functioning; and parents who reported greater disease severity, but better family functioning. CONCLUSIONS: Comprehensive multivariate models or LPAs best conceptualize patterns of risk for poor parental HRQoL in the community; though the findings in the current community sample may not extend to parents recruited from specialty clinics whose children may have more severe chronic illnesses. Parents of children with mild chronic conditions are still at risk for poor HRQoL, warranting attention from health care providers.

"What Does Weight Have to Do with It?" Parent Perceptions of Weight and Pain in a Pediatric Chronic Pain Population.

Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child's initial appointment; questions addressed parents' perceptions of their child's weight, and their perceptions of multiple aspects of the relationship between their child's weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child's weight; this group of parents was also more concerned (p < 0.05) about their child's weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child's weight contributed to his/her pain, or that weight was relevant to their child's pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child's pain. Results support the need for addressing parents' perceptions of their child's weight status, and educating parents about the relationship between excessive weight and chronic pain.

The Choking Game on YouTube: An Update.

The choking game (TCG) is an adolescent activity in which asphyxiation is used to obtain a "high," occasionally resulting in seizures or death. A plethora of TCG information is available through YouTube, though this content has not been evaluated recently. The current study described TCG as portrayed in YouTube videos and compared views and ratings of TCG videos to unrelated videos. The TCG videos demonstrated diverse methods of asphyxiation, with a minority showing injury to the participants. TCG videos were less likely to be commented on or rated positively than non-choking game videos. TCG prevention videos differed significantly from actual TCG videos in the way they depicted the social context of TCG. Thus, TCG videos are accessible through YouTube, but the prevention materials available on YouTube are not accurate or representative. Accurate and educational online prevention materials should be created to decrease the occurrence of TCG.