The authors would like to acknowledge the families at the Children’s Hospital of Wisconsin Jane P. Pettit Pain and Palliative Care Center.

For more information, please contact Katherine Simon at simon@uwm.edu.

Pain Catastrophizing and Social Support: Pain Catastrophizing and Social Support: The Role of Social Consequences for Youth with Chronic PainThe Role of Social Consequences for Youth with Chronic Pain

Katherine Simon, MSKatherine Simon, MS11, Amy Sato, MS, Amy Sato, MS11, Ayala Y. Gorodzinsky, BS, Ayala Y. Gorodzinsky, BS11, Keri Hainsworth, PhD, Keri Hainsworth, PhD22, , W. Hobart Davies, PhDW. Hobart Davies, PhD1,2,31,2,3, Renee J. Ladwig, RN, Renee J. Ladwig, RN33, Kimberly Anderson Khan, PsyD, Kimberly Anderson Khan, PsyD2,32,3, and Steven J. Weisman, MD, and Steven J. Weisman, MD2,32,3

University of Wisconsin-MilwaukeeUniversity of Wisconsin-Milwaukee11, Medical College of Wisconsin, Medical College of Wisconsin22, & Children’s Hospital of Wisconsin, & Children’s Hospital of Wisconsin33

IntroductionIntroductionLimited research focused on social consequences of pain has indicated that children and adolescents may receive solicitous support and social attention from others as a consequence of pain or illness (Walker, Claar, & Garber, 2002). Typically, it is thought that these social consequences perpetuate the pain behavior through behavioral responses in the environment. However, it is plausible that social consequences may be a form of social support and thus, adaptive. Recent research among adults with chronic pain has suggested that pain catastrophizing may be associated with perceptions of increased social support, congruent with the communal coping model (CCM; Buenaver, et al., 2007). From this perspective, pain catastrophizing among children and adolescents with chronic pain could be associated with bolstering social support.

MethodsMethods This study is from patients presenting to a multidisciplinary pain clinic at a large Midwestern children’s hospital. At intake, mothers, fathers, and youth complete a packet of questionnaires that assess clinical, behavioral, and psychosocial variables related to pain.The current study includes youth 7 - 18 years old with chronic pain (e.g., headache, gastrointestinal pain, musculoskeletal pain).

Table II: CorrelationsTable II: Correlations

HypothesesHypotheses The current study examined the association between pain catastrophizing and social consequences among children and adolescents with chronic pain. Hypothesis: Social consequences of pain will mediate the relationship between pain catastrophizing and child reported pain.

MeasuresMeasures Demographic and Medical Information, including age, gender, ethnicity, diagnosis, and pain intensity (worst, usual, best) and frequency, are collected upon arrival at the comprehensive pain center. Average pain was calculated by taking the mean of worst, usual, and best pain intensity. The primary caregiver completes this information.

Social Consequences of Pain Questionnaire (SCP; Walker et al., 2002) is a 32-item questionnaire, with scores ranging from 32 to 128, designed to assess the social consequences of pain behavior. The SCP measures four types of consequences on four subscales Positive Attention, Activity Restrictions, Negative Attention, and Privileges. All family members (child, mom dad) completed the SCP.

Pain Catastrophizing Scale (PCS; Sullivan, Bishop, & Pivik, 1995) is a 13-item questionnaire, with scores ranging from 0 – 26, designed to assess the level of pain catastrophizing by the reporter. A total score was calculated for the PCS. All family members (child, mom dad) completed the PCS.

Participant DemographicsParticipant Demographics

ResultsResults

ConclusionsConclusions

Holmbeck’s (1997) recommendations for exploring mediation were used to investigate the models. Preliminary results indicated four potential mediation models:

• Mother-reported PCS – SCP Positive Attention – Best Pain• Mother-reported PCS – SCP Activity Restrictions – Best Pain• Mother-reported PCS – SCP Privileges – Best Pain• Father-reported PCS – SCP Activity Restrictions –Usual Pain

See Table I for descriptive statistics, Table II for correlations, and Figure I for mediation analyses.

The results of this preliminary study indicate that social consequences of pain, particularly restriction in daily activities, may mediate the relationship between pain catastrophizing and pain intensity, especially for mothers.

One explanation for the study findings is that pain catastrophizing may be potentially useful in eliciting social support, as hypothesized in the communal coping model (CCM).

Future research is needed to explore discrepancies based upon informants (e.g., father- versus mother-report) as well as the hypothesis that pain catastrophizing may elicit social support.

Table I: Descriptive StatisticsTable I: Descriptive Statistics

*p < . 10. **p < .05. ***p < .01.

Figure I: Mediation AnalysesFigure I: Mediation Analyses

*p < . 10. **p < .05. ***p < .01.

SCP Positive

Attention

M (SD)

SCP Activity

Restriction

M (SD)

SCP Negative Attention

M (SD)

SCP Privileges

M (SD)

PCS Total Score

M (SD)

Youth-Report 1.71 (0.88) 2.03 (0.92) 1.06 (0.76) 0.79 (0.70) 28.7 (11.48)

Mother-Report 1.57 (1.13) 1.86 (0.93) 0.98 (0.60) 0.85 (0.73) 18.9 (14.32)

Father-Report 1.64 (0.73) 1.91 (0.96) 0.97 (0.67) 0.96 (0.65) 19.6 (11.68)

Youth

N = 93

Gender 65.6% female

Age 13.07 yrs (2.90)

Ethnicity 84.9% Caucasian

Best Pain Intensity 2.32 (2.73)

Worst Pain Intensity 8.36 (1.51)

Usual Pain Intensity 5.99 (1.93)

Average Pain Intensity 5.79 (1.64)

Best Pain

r (p)

Usual Pain

r (p)

Worst Pain

r (p)

Average Pain

r (p)

PCS Score

r (p)

SCP Positive Atten

Mom

.22 (.057)*

.11

(NS)

.25 (.025)**

.32 (.004)***

.62 (.000)***

SCP Activity Restrict

Mom

.41

(.000)***

.29

(.009)***

.41 (.000)***

.55 (.000)***

.50 (.000)***

SCP Privilege

Mom

.35

(.002)***

.13

(NS)

.02

(NS)

.34 (.002)***

.48 (.000)***

SCP Activity Restrict

Dad

.36

(.002)***

.24 (.034)**

.28 (.013)**

.40 (.000)***

.39 (.000)***

SCP Activity Restrict

Youth

.24 (.045)**

.35 (.002)**

.35 (.002)***

.44 (.000)***

.18

(NS)

Variable β t p

Model 1:

Best Pain

F(2,67) =1.99, R2 = .06,

p = (NS)

Mother-reported PCS Total .11 .74 NS

SCP Positive Attention .15 1.00 NS

Model 2:

Best Pain

F(2,67) =5.93, R2 = .16,

p = (.004)***

Mother-reported PCS Total .03 .22 NS

SCP Activity Restrictions .38 2.92 .005***

Model 3:

Best Pain

F(2,67) =4.96, R2 = .13,

p = (.010)***

Mother-reported PCS Total .04 .27 NS

SCP Privileges .35 2.59 .012**

Model 4:

Usual Pain

F(2,72) =3.66, R2 = .10,

p = (.031)**

Father-reported PCS Total .15 1.17 NS

SCP Activity Restrictions .22 1.78 .080*