Poster #102 - Associations Between Internalizing, Pain Appraisals, and Chronic Pain Symptoms During Middle Childhood

• In Event: 1-061 - Poster Session 02
  In Poster Session: PS 02 Section - Health, Growth, Injury

Integrative Statement

Background
Benign chronic or recurrent pain among children and adolescents is common, with up to two-thirds reporting at least monthly pain (Peterson, Brulin, & Bergstorm, 2006). Because prevalence rates have been increasing over the last 20 years for unknown reasons (King et al., 2011), identifying factors related to the etiology of pediatric chronic pain is critical for informing prevention and treatment efforts. Among adults, anxiety predicts negative appraisals of pain, which in turn, predict more intense acute and chronic pain experiences (Granot & Ferber, 2005; Luana & Benedetti, 2007). Existing literature indicates that children’s internalizing symptoms are often comorbid with recurrent pain (Noel et al., 2016), but little research has examined the extent to which cognitive appraisals during an experience of pain in children mediate the internalizing—recurrent pain link.

Purpose
This study examined associations between internalizing symptoms, appraisals of pain threat, and chronic pain symptoms in a nonclinical sample of 9-year-old twin children.

Methods
Participants were mothers and their 9-year-old twin children (N=328 children; 50.9% male; 59.8% Caucasian, 24.7% Latino, 15.5% multi-race and other) who were recruited from birth records and enrolled in a community-based study of child socioemotional development. During study home visits, children were asked about the level of agreement (1-disagree a lot, 2-disagree a little, 3-agree a little, 4-agree a lot) with two appraisal statements adapted from the Pain Appraisal Inventory (PAI; Unruh & Ritchie, 1998) threat scale following a cold pressor pain-induction task: #1: “I worried that I wouldn’t be able to do the task”, and #2: “I worried that something bad might happen from the pain.” Child-reported internalizing symptoms were measured via a modified version of the Berkeley Puppet Interview (BPI; Measelle, Ablow, Cowan, & Cowan, 1998), and child-reported chronic pain symptoms by number of body sites (head, back, stomach) with weekly or more frequent pain over the last three months (Perquin et al., 2000). Correlations and multilevel modeling were used to evaluate whether pain appraisals mediate the internalizing—recurrent pain relation.

Results
Internalizing symptoms were positively associated with pain appraisal #1 (r=.29, p<.01) and appraisal #2 (r=.36, p<.01), and with number of body locations with weekly or more pain (r=.18, p<.01). Chronic pain symptoms were positively associated with level of agreement with pain appraisal #2 (r=.17, p<.01) but not pain appraisal #1 (r=.08, ns). Agreement with the pain appraisal #2 partially mediated the internalizing—recurrent pain symptom relation (indirect effect: ab = .086, SE = .033, p < .01).

Conclusion
Chronic pain in childhood is increasingly common, not well-understood, and elevates risk of chronic pain in adulthood. The current findings indicate that internalizing and chronic pain symptoms co-occur in middle childhood (Noel et al., 2016). Moreover, they suggest that appraisal of pain as a threat may mediate the internalizing—chronic pain relation in children in a manner similar to that observed in adults. Future research should examine longitudinal relations between internalizing, pain appraisals, and recurrent pain in children to aid interdisciplinary efforts to understand the etiology and prevent the growth of pediatric chronic pain.

Authors

• Shannon V. Moore, Arizona State University
  Presenting Author

• Mary C. Davis, Arizona State University
  Non-Presenting Author

• Kathryn Lemery-Chalfant, Arizona State University
  Non-Presenting Author