Living with paediatric chronic pain: a study of treatment outcomes and processes

This thesis investigated treatment outcomes and processes in young people with chronic pain. The first chapter describes a systematic review, which examined the effectiveness of acceptance and mindfulness-based interventions in improving pain-related outcomes in young people. Secondary aims were to review changes in proposed treatment processes following the interventions, and to compare the effectiveness of these interventions to control conditions. Although there was evidence to suggest that these treatments may improve outcomes, particularly levels of daily functioning, further research is needed to adequately assess the utility of acceptance and mindfulness-based approaches with paediatric chronic pain populations. The second chapter details a cross-sectional study of contextual and cognitive processes in adolescents with chronic pain. Specifically, the study tested the mediating effects of acceptance, catastrophising and kinesiophobia in the relationship between pain intensity and indicators of adjustment. Both acceptance and kinesiophobia mediated the effects of pain intensity on disability and quality of life, while catastrophising mediated the effect of pain intensity on levels of anxiety and depression. The results demonstrated that both contextual and cognitive factors are important determinants of young people’s well-being. Future research would benefit from gaining a greater understanding of how these processes interact with each other to affect pain-related outcomes

Further validation of the chronic pain acceptance questionnaire for adolescents in a broader paediatric context

Background: The Chronic Pain Acceptance Questionnaire for Adolescents (CPAQ-A) is a measure of acceptance, which is associated with quality of life and functional disability in adolescents with chronic pain. The CPAQ-A could identify adolescents who may benefit from an acceptance based intervention to manage their chronic pain. However, the measure has yet to be validated in paediatric clinics other than pain services. Methods: Adolescents (N=128; mean age 14.46) with chronic pain attending gastroenterology, neurology, rheumatology and pain services across Scotland completed self-report measures assessing pain, pain acceptance, functional disability, health-related quality of life, pain catastrophizing, anxiety and depression. Results: Factor analysis supported a two-factor structure explaining 46.84% of the variance. The total scale and subscales had excellent reliability (α ≥ 0.83). Correlation analyses suggested good convergent and concurrent validity with the other measures. Hierarchical multiple regression analyses identified that the CPAQ-A significantly contributed to the prediction of functional disability and health-related quality of life, suggesting predictive validity. Conclusion: The CPAQ-A is a valid and reliable measure for use in a range of paediatric clinics. The measure is likely to be useful to assess chronic pain acceptance, identify adolescents who may benefit from an acceptance-based intervention and to evaluate these interventions

Psychological mediators in the relationship between paediatric chronic pain and adjustment: an investigation of acceptance, catastrophising and kinesiophobia

Background and Aim: Acceptance, catastrophising and kinesiophobia have been identified within the adult literature as important processes in the relationship between pain intensity and functioning. While these constructs have received some attention within paediatric chronic pain, research is still in its infancy in understanding how these processes relate to one another and pain-related outcomes. The current study aimed to explore the mediating roles of acceptance, catastrophising, and kinesiophobia in the relationship between pain severity and adjustment. Methods: A sample of 129 adolescents (aged 12–18 years) with heterogeneous pain conditions completed self-report measures of: pain intensity, acceptance, catastrophising, kinesiophobia, disability, anxiety, depression and quality of life once. Multiple mediation analysis was used to compare the specific mediating effects of the three processes in the relationship between pain and functioning. Results: The current study demonstrated that acceptance and kinesiophobia partially mediated the effects of pain across measures of disability and quality of life, while catastrophising mediated the relationship between pain and emotional distress. Conclusions: The results demonstrated that all three processes play an important role in the well-being of adolescents with chronic pain, and support emerging models, which adopt a more encompassing perspective of paediatric chronic pain