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Treatment Expectations Among Adolescents With Chronic Musculoskeletal Pain and Their Parents Before an Initial Pain Clinic Evaluation

Guite, Jessica W. PhD*,†; Kim, Sohee BS*; Chen, Chia-Pei MS; Sherker, Jennifer L. PsyD§; Sherry, David D. MD†,§; Rose, John B. MD*,†; Hwang, Wei-Ting PhD†,∥

Clinical Journal of Pain:
doi: 10.1097/AJP.0b013e3182851735
Original Articles
Abstract

Objectives: To understand expectations regarding treatment recommendations among treatment-seeking adolescents with chronic musculoskeletal pain and their parents.

Methods: A total of 102 adolescent-parent dyads were recruited at the time of initial contact with a multidisciplinary pain management clinic. Each participant completed reports of adolescent pain intensity and disability, biopsychosocial perspective of pain, and treatment expectations related to recommendations and feedback for a vignette description of an adolescent presenting at an initial multidisciplinary pain clinic evaluation.

Results: Descriptive findings for individual treatment expectations and adolescent-parent dyad agreement statistics were examined. Slight to fair levels of agreement occurred for 50% of the expectations assessed. The strongest shared expectations were for recommendations to return to school, pursue psychological counseling, and pursue PT/OT treatment. Stronger agreement occurred for items reflecting alternative, emotional, behavioral, and activity recommendations with weaker agreement for medical interventions (eg, medication and surgery). Correlations emerged between individual expectations and adolescent pain intensity, disability, with the greatest number of significant relationships found for adolescent and parent expectations and biopsychosocial perspectives of pain.

Discussion: Our results document that adolescents and parents show modest levels of agreement on expectations for treatment at the time of an initial pain clinic evaluation. This may relate to expectations being internal perspectives not clearly expressed within families; thus, the initial treatment consultation may provide an important opportunity to create and align appropriate expectations. Implications of our findings are considered with respect to education, treatment, and future research to understand factors that contribute to treatment adherence and outcomes.

Author Information

Departments of *Anesthesiology and Critical Care Medicine

§Pediatrics, Division of Rheumatology, The Children’s Hospital of Philadelphia

Departments of Biostatistics and Epidemiology

Biotechnology, School of Engineering and Applied Science

Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA

The authors declare no conflict of interest. Supported by Award Number R03HD054596 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development, Bethesda, MD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health, Bethesda, MD.

Reprints: Jessica W. Guite, PhD, Division of Pain and Palliative Medicine, Connecticut Children’s Medical Center, Hartford Hospital/The Institute of Living, University of Connecticut School of Medicine, 282 Washington Street, Hartford, CT 06106 (e-mail: jguite@connecticutchildrens.org).

Received January 24, 2012

Accepted December 27, 2012

© 2014 by Lippincott Williams & Wilkins