Association of parental and adolescent emotion-related factors with adolescent chronic pain behaviors

Abstract

Chronic pain is a prevalent condition in youth, and the pain experience is strongly influenced by emotional processes. Studying emotion variability and regulation (ER) may help better understand pain behavior. As the development of emotion-related abilities predominantly takes place in the family context, examining ER within parent-adolescent dyads is important. We set out to test the association of parent and adolescent ER and adolescent emotional variability with adolescent pain behavior (ie, pain interference, activity avoidance, and activity engagement). A sample of 56 adolescents (Mage = 14.5, 85.7% women) with chronic pain and one of their parents (92.9% mothers) participated in this study. Adolescents completed baseline measures of average pain intensity, ER, and mean positive and negative affect. Furthermore, adolescents completed an electronic diary for 14 consecutive days, reporting on emotional state, activity avoidance, activity engagement, and pain interference. Parents completed measures of ER and their own history of pain. We performed a variable selection procedure, the least absolute shrinkage and selection operator method, to determine important predictors of adolescent pain behavior. Adolescent high positive affect was associated with more activity engagement, less pain interference, and less activity avoidance, indicating that positive affect might enhance the willingness to engage in activities in the presence of pain. Adolescent ER strategy emotional reappraisal and parents' own history of pain were predictors of less activity engagement. Parent ER was not related to adolescent ER. In conclusion, our results highlight the potential of enhancing positive affect as an intervention target for chronic pain.

Figure 1.

Mediation models were examined for each of the adolescent outcomes (total = 6 models). (A) Mediation model with adolescent expressive suppression as a mediator between parent expressive suppression and adolescent outcomes (ie, pain interference, activity avoidance, and activity engagement). (B) Mediation model with adolescent cognitive reappraisal as a mediator between parental cognitive reappraisal and adolescent outcomes. These relations were tested using a bootstrapping method. This is a modern approach to test statistical mediation which evolved as a response to several critiques towards the frequently used “normal theory” or “causal steps” methods based on a method by Baron and Kenny. One of the most common critiques is that this type of approach lacks power and has the risk for inflation of type I errors. A bootstrap approach focuses only on the indirect effect (a × b), which is assumed to be the most relevant to conclude if mediation has occurred. There is no need of a direct effect (c’) to indicate mediation. If there is a mediated effect (a × b) in the absence of a direct effect, this is classified as an ‘indirect-only’ mediation (typology offered by Zhao et al.).