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Social learning pathways in the relation between parental chronic pain and daily pain severity and functional impairment in adolescents with functional abdominal pain

Stone, Amanda L.a,b,*; Bruehl, Stephenc; Smith, Craig A.b; Garber, Judyb; Walker, Lynn S.d

doi: 10.1097/j.pain.0000000000001085
Research Paper

Having a parent with chronic pain (CP) may confer greater risk of persistence of CP from childhood into young adulthood. Social learning, such as parental modeling and reinforcement, represents one plausible mechanism for the transmission of risk of CP from parents to offspring. Based on a 7-day pain diary in 154 pediatric patients with functional abdominal CP, we tested a model in which parental CP predicted adolescents' daily average CP severity and functional impairment (distal outcomes) via parental modeling of pain behaviors and parental reinforcement of adolescent's pain behaviors (mediators) and adolescents' cognitive appraisals of pain threat (proximal outcome representing adolescents' encoding of parents' behaviors). Results indicated significant indirect pathways from parental CP status to adolescent average daily pain severity (b = 0.18, SE = 0.08, 95% confidence interval: 0.04-0.31, P = 0.03) and functional impairment (b = 0.08, SE = 0.04, 95% confidence interval: 0.02-0.15, P = 0.03) over the 7-day diary period via adolescents' observations of parent pain behaviors and adolescent pain threat appraisal. The indirect pathway through parental reinforcing responses to adolescents' pain did not reach significance for either adolescent pain severity or functional impairment. Identifying mechanisms of increased risk of pain and functional impairment in children of parents with CP ultimately could lead to targeted interventions aimed at improving functioning and quality of life in families with CP. Parental modeling of pain behaviors represents a potentially promising target for family-based interventions to ameliorate pediatric CP.

Parental chronic pain predicted adolescents' pain severity and functional impairment over a daily diary via parental modeling of pain behaviors and adolescents' pain threat appraisals.

aDepartment of Pediatrics, Oregon Health & Science University, Portland, OR, USA

bDepartment of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA

Departments of cAnesthesiology and

dPediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA

*Corresponding author. Address: Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines St, Portland, OR 97239, USA. Tel.: (503)494-4195. E-mail address:; (A.L. Stone).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

© 2017 International Association for the Study of Pain
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