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Parents Play Role in Child's Postop Pain

March 31, 2015
Research on pain catastrophizing is growing, and a new study looks at a range of modifiable risk factors facing children's postoperative outcomes. Interestingly, a child's parents could have a major influence on how the child experiences pain during their recovery.

Approximately 5 million children in the US undergo surgery every year.1,2 For 40% to 60% of those children, enduring moderate to severe pain after an operation can be a significant issue, leading to poor outcomes.3

According to a new study, poor sleep and anxiety before a surgery may not be the only reasons a child experiences increased postoperative pain—whether a parent catastrophizes about their child's pain could play a major role, as well.4

Researchers at the Seattle Children’s Research Institute in Seattle, Washington, studied 60 adolescents (10 to 16 years old) who underwent spinal fusion and pectal repair surgeries. The children, predominantly white (83.34%) and female (66.7%), were assessed before and 2 weeks after their surgeries.

The children wore sleep actigraphy bracelets and used electronic diaries to report their pain and sleep, while questionnaires assessed pain location, child anxiety, Health Related Quality of Life (HRQOL), child and parent-related pain catastrophizing, and sociodemographic information. None of the children had comorbid conditions or took prescriptions prior to their procedures.

What Was Found

The researchers found that children who reported less presurgery sleep and more parental pain catastrophizing had greater pain intensities 2 weeks after their procedures.

"These findings highlight the significant impact parents can have on their child’s postsurgical recovery, particularly when they go home from the hospital," the authors said. Past studies have looked at parent catastrophizing before.5-7 The scant literature does vary, although they may have used imperfect methodologies, the authors noted.

By contrast, this new study measured "parental factors before the child’s surgery," which likely limited the "impact that the early perioperative experience may have on parents’ responses." The researchers also looked at the parent's catastrophizing in regards to their child's pain, not their own, which was more relevant to the context.

Parent's Perception of Pain Influences Children

According to Beth Darnall, PhD, a clinical associate professor at Stanford University School of Medicine in Palo Alto, California, research into the effects of parent pain catastrophizing, while nascent, has indeed shown that in the context of chronic pain, parental responses to their child's pain are  a "strong predictor" of their child's pain outcomes.

"Children model parental responses. If parents become anxious and hypervigilant about their children's pain, children are more likely to respond similarly," Dr. Darnall said.

Interestingly, the study's authors also noted how parental pain catastrophizing predicted the level of the child's physical functioning in the acute recovery phase after surgery. To Dr. Darnall, this is a concrete example of how parents can be an intrinsic factor in the child's recovery process.

"Parental responses shape the child’s behavior—for better or for worse," Dr. Darnall said. "For instance, helping their children get to school versus allowing them to miss more and more days from school—something that can quickly evolve into a cycle of disability."

The study's authors mentioned the importance of involving parents in interventions that could reduce children's postsurgical pain and improve HRQOL.

"There is a very big opportunity to conduct high-impact work in this space," Dr. Darnall said.

Intervention Therapy

Back in 2013, Dr. Darnall developed a successful single-session intervention for catastrophizing.8 Stanford is currently studying a pain psychology treatment Dr. Darnall developed for adults preparing for surgery, which can be tailored to children, as well, she said.

"Practitioners can help connect parents to the right information that empowers them to help themselves—and especially help their children," Dr. Darnall said.

"I tell my patients that some discomfort after surgery is normal. And, there’s a lot you can do to control the discomfort by using mind-body skills and techniques. Parents can steer their children towards active coping skills that will help them learn to control their own experience of pain, instead of staying in bed and waiting it out – that's a strategy that doesn’t work in the long run."

The study published in The Journal of Pain is ongoing. It will collect follow-up data a year after the children's surgeries. Hopefully, this further data will reveal more inferences on how presurgery psychosocial and behavioral factors can influence children's pain after surgery, as well as their HRQOL.

The study received support from the Clinical Research Scholars Program at the Seattle Children’s Research Institute. The authors reported no conflicts of interest.

Last updated on: May 1, 2015
Continue Reading:
Targeting a Saboteur of Surgical Outcomes: Pain Catastrophizing