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Living Life With My Child’s Pain

The Parent Pain Acceptance Questionnaire (PPAQ)

Smith, Allison M. PhD*,†; Sieberg, Christine B. PhD*,†; Odell, Shannon PsyD*,†; Randall, Edin PhD*,†; Simons, Laura E. PhD*,†,‡

The Clinical Journal of Pain: July 2015 - Volume 31 - Issue 7 - p 633–641
doi: 10.1097/AJP.0000000000000140
Original Articles

Objective: Parents’ emotional, cognitive, and behavioral responses are highly influential on children’s pain and functional outcomes. One important response to pediatric pain is acceptance: the degree to which an individual participates in routine daily activities in the presence of pain and is willing to let pain be a part of their life without efforts to control or avoid it. However, no tool currently exists to assess parents’ own acceptance of their child’s pain. The aim of this study was to validate the Parent Pain Acceptance Questionnaire (PPAQ).

Materials and Methods: The PPAQ was administered to 310 parents of youth with chronic pain in an outpatient pediatric headache program and a day hospital pain rehabilitation program. An exploratory factor analysis revealed 2 factors for the PPAQ: an 11-item Activity Engagement scale and a 4-item Acceptance of Pain-related Thoughts and Feelings scale.

Results: The PPAQ total score and subscales demonstrated strong internal consistency. Greater parent pain acceptance was positively associated with child pain acceptance, and was negatively correlated with parent protective behaviors, parent minimizing behaviors, parent and child pain catastrophizing, and child fear of pain. Parent protective behaviors and child pain acceptance both served as mediators of the relationship between parent pain acceptance and child functional disability.

Conclusions: The PPAQ is a valid measure of parent pain acceptance and may provide valuable insights into parent responses to child pain and the ways in which parent acceptance influences child outcomes. Clinical implications and suggestions for future research are discussed.

*Pain Treatment Service, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Boston Children’s Hospital

Department of Psychiatry, Harvard Medical School

P.A.I.N. (Pain & Analgesia Imaging Neuroscience) Group, Boston Children’s Hospital, Center for Pain in the Brain, Harvard Medical School, Boston, MA

Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health, Bethesda, MD, (K23HD067202) to L.E.S., the Boston Children’s Hospital Career Development Fellowship Award, Boston, MA, to C.B.S., the Sara Page Mayo Endowment for Pediatric Pain Research and Treatment, Boston, MA, and the Department of Anesthesiology, Perioperative and Pain Medicine at Boston Children’s Hospital, Boston, MA. The authors declare no conflict of interest.

Reprints: Allison M. Smith, PhD, Pain Treatment Service, Department of Anesthesiology, Perioperative and Pain Medicine, Division of Pain Medicine, Boston Children’s Hospital, 333 Longwood Avenue, 5th floor, Boston, MA 02115 (e-mail:

Received March 6, 2014

Received in revised form July 12, 2014

Accepted July 12, 2014

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