Risk and Resilience in Pediatric Pain: The Roles of Parent and Adolescent Catastrophizing and Acceptance.

OBJECTIVES: Both pediatric and parent pain catastrophizing and pain acceptance are key factors associated with pediatric pain outcomes; however, the interactive effects of these factors within the parent-child dyad have yet to be tested. The aims of this study were to examine: (1) the mediating role of child catastrophizing between parent catastrophizing and child outcomes (pain interference and mobility), (2) the mediating role of child acceptance between parent acceptance and child outcomes, and (3) whether child acceptance buffers the relation between parent catastrophizing and child catastrophizing, which in turn impacts child outcomes. MATERIALS AND METHODS: Cross-sectional data from 324 youth with chronic pain ages 10 to 17 years (mean age=14.72, [SD=2.12]; 73.1% female; 59% Caucasian) and their parents were collected. Participants completed measures assessing pediatric Patient-Reported Outcome Measurement Information System (PROMIS) domains (mobility and pain interference), pain catastrophizing, pain acceptance, and child pain intensity. Mediation was conducted via 1000-draw bootstrap-adjusted analyses in Mplus. RESULTS: Parent pain catastrophizing was indirectly associated with child pain interference via child catastrophizing but was not associated with mobility difficulties in the mediation model. Parent pain acceptance was indirectly associated with both child pain interference and mobility via child acceptance. We did not find evidence of child acceptance-buffering parent and child pain catastrophizing. DISCUSSION: The findings of this study highlight the need for caregiver involvement in multidisciplinary treatments to mitigate risk and enhance resilience in youth with chronic pain.

Yoga Intervention for an Adolescent With Juvenile Idiopathic Arthritis: A Case Study.

Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease associated with pain, stiffness, and psychosocial difficulties. The purpose of this case study was to investigate the impact of a yoga intervention on pain and morning stiffness in an adolescent female with JIA. A secondary aim was to assess the impact of this intervention on self-efficacy, mindfulness, health-related quality of life, and disease activity. A 17-y-old female with JIA participated in 3 yoga groups and home yoga practice with a digital video disc. She engaged in daily self-monitoring of pain and stiffness and completed questionnaires assessing psychosocial functioning and disease activity at pre- and postintervention, and psychosocial functioning at 3-mo follow-up. Primary outcomes were evaluated using quasi-experimental single-case design structure (ie, ABAB), with emphasis on the report of means. Results suggested that yoga reduced pain intensity, stiffness intensity, and duration of morning stiffness. Outcomes for disease activity also suggested improvements. Modest changes were revealed on psychosocial outcome measures, however not consistently in the direction of hypotheses. Anecdotal reports from the participant indicated acceptability of the intervention and improvements in pain and stiffness attributed to engaging in the yoga intervention. More research is warranted to further explore the impact of yoga for youth with JIA as an adjunctive component of multidisciplinary treatment targeting pain, stiffness, disease activity, and psychosocial factors.

Pediatric chronic pain and health-related quality of life.

The aim of this study was to investigate the health-related quality of life (HRQOL) of children and adolescents with chronic pain. Sixty-nine participants (53 girls and 16 boys, 8-18 years old) were recruited, along with their caregivers, from an outpatient pain management clinic. Participants completed questionnaires regarding the child's pain intensity and HRQOL (physical, emotional, social, and school functioning). Findings indicated that children with chronic pain report significantly lower HRQOL scores compared to population-based normative data and data of children with other chronic illnesses. Lower levels of pain were associated with higher HRQOL scores. In addition to targeting pain management, interventions focused on emotional health are necessary to enhance health outcomes for children with chronic pain.