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Maternal Protective Parenting Accounts for the Relationship Between Pain Behaviors and Functional Disability in Adolescents

Lynch-Jordan, Anne M., PhD*,†; Peugh, James, PhD*,†; Cunningham, Natoshia R., PhD*,†; Trygier, Jessica R., BS; Kashikar-Zuck, Susmita, PhD*,†

doi: 10.1097/AJP.0000000000000638
Original Articles

Introduction: A variety of factors influence parent responses to pain behaviors they observe in their adolescents with chronic pain. Certain parental responses to pain, such as attention or overprotection, can adversely impact adolescent adaptive functioning and correspond to poor clinical outcomes.

Objectives: It was hypothesized that the relationship between adolescent pain behaviors and functional disability was mediated by maladaptive parenting (protective, monitoring, solicitousness) responses.

Materials and Methods: Participants were 303 adolescents and their mothers presenting to a pain clinic. Adolescents completed measures of functional disability and pain intensity; mothers completed measures assessing adolescent pain behaviors, their own catastrophizing about their adolescent’s pain, and responses to pain. A path model tested the direct and indirect associations between pain behaviors and disability via 3 parenting responses, controlling for average pain intensity and parent pain catastrophizing.

Results: Greater pain behavior was associated with increased protective responses (α path, P<0.001); greater protective behavior was associated with increased disability (β path, P=0.002). Including parenting responses in the model, the path between pain behaviors and disability remained significant (c′ path, P<0.001). The indirect path between pain behaviors and disability via parenting responses was significant for protective responses (P<0.02), controlling for pain intensity and parent pain catastrophizing. The indirect effect of protective responses explained 18% of the variance between pain behaviors and disability.

Discussion: Observing adolescent pain behaviors may prompt parents to engage in increased protective behavior that negatively impacts adolescents’ functioning, even after controlling for the effects of parental pain catastrophizing.

*Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center

College of Medicine, University of Cincinnati, Cincinnati, OH

S.K.-Z. is supported by a National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)/NIH Grant K24AR056687, Cincinnati, Ohio, USA. The remaining authors declare no conflict of interest.

Reprints: Anne M. Lynch-Jordan, PhD, Pediatrics & Anesthesiology, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 3015, Cincinnati, OH 45229 (e-mail: anne.lynch-jordan@cchmc.org).

Received September 15, 2017

Received in revised form June 4, 2018

Accepted July 5, 2018

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