Hesitancy to adopt a self-management approach to chronic pain coping: Fear, perfectionism, and parent-child disagreement

• In Event: Poster Session 10
  In Poster Session: PS 10 Topic - Health, Growth, Injury

Abstract

Youth with chronic pain and their parents often present with wide variability in willingness to engage in self-management of their pain, or “readiness to change.” This variability is important to understand given that greater willingness to self-manage pain has been associated with key aspects of youth pain management, including decreased fear of pain (FOP) and decreased functional disability, as well as better response to treatment overall. Other significant predictors of functional disability among youth with chronic pain include FOP and perfectionism; while several studies have linked FOP with youth readiness to self-manage pain, little work has examined links with perfectionism. Further, despite ample evidence that parent-child discrepancies frequently predict outcomes in a way that individual informants do not (e.g., poorer therapy outcomes, higher treatment drop-out), no work to date has examined parent-child discrepancies in readiness to change or the relation of discrepancies to youth FOP or perfectionism. Thus, the current study sought to examine connections between youth and parents’ stage of change, associations between stage of change and youths’ FOP and perfectionism, and the relation of parent-adolescent discrepancies in their stage of change to youth FOP and perfectionism. Participants were 246 youth with chronic pain (75% female; 69% White), aged 10-20 (M=14.32, SD=2.22), presenting for initial multidisciplinary pain clinic evaluation. As part of the intake, youth and parents completed a measure of readiness for change (Pain Stages of Change Questionnaire, with subscales of precontemplation, contemplation, action, and maintenance), and youth additionally completed measures of fear of pain (FOP) and avoidance of activities (AOA; Fear of Pain Questionnaire) as well as self-oriented perfectionism (SOP) and socially-prescribed perfectionism (SPP; Children and Adolescent Perfectionism Scale). Compared to parent report, youths were notably more likely to report a lower stage of change than parents (60% of parents fell in the action or maintenance stage, while only 25% of adolescents were in the action or maintenance stage). Youth FOP, AOA, SOP, and SPP were positively associated with lower readiness for change. Parents endorsing highest readiness for self-management strategies (i.e., higher maintenance stage) had children with lower FOP and AOA. Regarding parent-child discrepancies, greater discrepancies in the precontemplation stage of change predicted youth FOP, such that when parents and children simultaneously endorsed aversion to self-management strategies, the association compounded and these youth reported the highest FOP. Further, parent readiness emerged as particularly important and protective, such that when parents had a higher readiness for change, youth endorsed lower FOP even when youth themselves denied readiness to self-manage pain. Taken together, results indicate that when both parents and children endorse hesitance to engage in pain coping self-management strategies, children simultaneously report greater fear of pain, avoidance of activities, and perfectionism. These findings point to the importance of considering parent and child report individually and in connection when evaluating and making recommendations in this pediatric population.

Authors

• Allison Gornik, Kennedy Krieger Institute
  Presenting Author

• Angela Fletcher, Nurses' Memorial Chapel
  Non-Presenting Author

• Kelsey Borner, Children's National Medical Center
  Non-Presenting Author