Article summary with Parent and family factors in pediatric chronic pain and disability: An integrative approach by Palermo & Chambers - 2005

Why should family factors be studied when looking at children with chronic pain?

Children who suffer from chronic pain have increased risk of having chronic pain syndrome in adulthood. The family is an important context for understanding, assessing, and managing pediatric chronic pain. There are associations between family and parent factors and the outcomes of chronic pain in their child, such as later disability. To understand the effect of the family and parents on the future of a child with chronic pain, specific parental behaviors and broader family factors should be examined.

Which models allow for studying parent and family factors?

It is often unclear what kinds of family factors are being investigated. There are two dominant theoretical models in which parent and family factors may be considered:

• Operant behavioral theories are centered on the role of social reinforcement in maintaining maladaptive pain behaviors. Treatments based on these theories attempt to shift social contingencies through operant conditioning to reinforce well behaviors.

• Family systems theories emphasize individuals’ behavior within the context of their family situations, such as the child’s response to pain under the conditions of the family’s overall functioning. Treatments based on these theories try to change dysfunctional patterns of relating and communicating using more traditional family therapy approaches to achieve change.

Why is there a need for an integrative approach when studying family factors and child chronic pain?

The specific relationship between parental responses and child pain outcomes are far more complex than has been considered yet. An integrative approach will improve understanding of the influence of parent and family factors through examining testable paths by which individual levels and family level variables may influence children’s pain and disability. This will emphasize the multiple levels of family assessment and integrate operant and behavioral theories of parent behavior within the broader family systems theories.

What would such an integrative model look like?

Parenting variables, like parenting style, are situated within a broader context of dyadic variables, like the quality of parent-child interaction. This is further embedded in a more global familial environment (e.g. the environment of family functioning). There is a reciprocal influence of the child’s pain itself and its accompanying levels of disability, as well as child and parental factors, and it interacts with all levels of individual, dyadic, and family variables. All these relationships need to be placed in the developmental context where family variables need to be viewed in correspondence with the age and developmental stage of the child.