Learning about pain through observation: the role of pain-related fear

Observational learning may contribute to development and maintenance of pain-related beliefs and behaviors. The current study examined whether observation of video primes could impact appraisals of potential back stressing activities, and whether this relationship was moderated by individual differences in pain-related fear. Participants viewed a video prime in which back-stressing activity was associated with pain and injury. Both before and after viewing the prime, participants provided pain and harm ratings of standardized movements drawn from the Photograph of Daily Activities Scale (PHODA). Results indicated that observational learning occurred for participants with high levels of pain-related fear but not for low fear participants. Specifically, following prime exposure, high fear participants showed elevated pain appraisals of activity images whereas low fear participants did not. High fear participants appraised the PHODA-M images as significantly more harmful regardless of prime exposure. The findings highlight individual moderators of observational learning in the context of pain

Impact of parental catastrophizing and contextual threat on parents' emotional and behavioral responses to their child's pain

Limited research has addressed processes underlying parents' empathic responses to their child's pain. The present study investigated the effects of parental catastrophizing, threatening information about the child's pain, and child pain expression upon parental emotional and behavioral responses to their child's pain. A total of 56 school children participated in a heat pain task consisting of 48 trials while being observed by 1 of their parents. Trials were preceded by a blue or yellow circle, signaling possible pain stimulation (i.e., pain signal) or no pain stimulation (i.e., safety signal). Parents received either neutral or threatening information regarding the heat stimulus. Parents' negative emotional responses when anticipating their child's pain were assessed using psychophysiological measures - i.e., fear-potentiated startle and corrugator EMG activity. Parental behavioral response to their child's pain (i.e., pain attending talk) was assessed during a 3-minute parent-child interaction that followed the pain task. The Child Facial Coding System (CFCS) was used to assess children's facial pain expression during the pain task. Results indicated that receiving threatening information was associated with a stronger parental corrugator EMG activity during pain signals in comparison with safety signals. The same pattern was found for parental fear-potentiated startle reflex, particularly when the child's facial pain expression was high. In addition, parents who reported high levels of catastrophizing thought about their child's pain engaged, in comparison with low-catastrophizing parents, in more pain-attending talk when they received threatening information. The findings are discussed in the context of affective-motivational theories of pain. © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved

Injustice perceptions about pain: parent–child discordance is associated with worse functional outcomes

Pain is experienced within and influenced by social environments. For children with chronic pain, the child–parent relationship and parental beliefs about pain are particularly important and may influence pain outcomes. Pain-related injustice perceptions have recently been identified as an important cognitive–emotional factor for children with pain. The current study aimed to better understand the pain-related injustice perceptions of children with chronic pain and their parents. The sample consisted of 253 pediatric chronic pain patients (mean age = 14.1 years, 74% female) presenting to a tertiary pain clinic. Patients completed measures of pain intensity, pain-related injustice perceptions, stress, functional disability, and quality of life. Parents completed a measure of pain-related injustice perceptions about their child's pain. Child–parent dyads were categorized into 1 of 4 categories based on the degree of concordance or discordance between their scores on the injustice measures. One-way analysis of variances examined differences in pain intensity, stress, functional disability, and quality of life across the 4 dyad categories. Our findings indicated that both the degree (concordant vs discordant) and direction (discordant low child–high parent vs discordant high child–low parent) of similarity between child and parent injustice perceptions were associated with child-reported pain intensity, stress, functional disability, and quality of life. The poorest outcomes were reported when children considered their pain as highly unjust, but their parents did not. These findings highlight the important role of parents in the context of pain-related injustice perceptions in pediatric chronic pain

Pain intensity and attribution mediate the impact of patient weight and gender on activity recommendations for chronic pain

Background and purpose: Despite the notable benefits of physical activity for chronic pain, a large proportion of patients with chronic pain report that they do not receive activity-related recommendations from their providers. Research suggests that patient factors such as weight and gender influence activity-related recommendations for chronic pain. Research also suggests that appraisals of the intensity and cause of pain may explain these weight and gender effects. We investigated the influence of patient weight and gender on observers' likelihood of recommending activity-related treatments for pain. We also explored the mediating effects of observers' ratings of pain severity and the extent to which pain was due to medical and lifestyle factors (pain attribution). Patients and methods: Healthy young adults (N=616; 76% female) viewed videos (Ghent Pain Videos of Daily Activities) and vignettes of 4 patients with chronic back pain performing a standardized functional task. Patients varied by gender (female, male) and weight (normal, obese), but were otherwise equivalent on demographic characteristics and pain behaviors. Participants rated how much pain they perceived the patients to be experiencing, the extent to which they attributed the pain to medical and lifestyle factors, and their likelihood of recommending exercise, physical therapy (PT), and rest. Results: Patient weight and gender significantly interacted to influence exercise, PT, and rest recommendations. Both pain intensity and pain attribution mediated the relationships between patient weight and activity recommendations; however, these mediation effects differed across gender and recommendation type. Conclusion: Patient weight and gender influenced laypeople's activity recommendations for chronic pain. Moreover, the results suggest that observers' perceptions of pain intensity and pain attributions are mechanisms underlying these effects. If these findings are replicated in providers, interventions may need to be developed to reduce provider biases and increase their recognition of the benefits of physical activity for chronic pain

Emotion regulatory function of parent attention to child pain and associated implications for parental pain control behaviour

We investigated the function of parental attention to child pain in regulating parental distress and pain control behaviour when observing their child performing a painful (cold pressor) task (CPT); we also studied the moderating role of parental state anxiety. Participants were 62 schoolchildren and one of their parents. Parental attention towards or away from child pain (ie, attend to pain vs avoid pain) was experimentally manipulated during a viewing task pairing unfamiliar children's neutral and pain faces. Before and after the viewing task, parental distress regulation was assessed by heart rate (HR) and heart rate variability (HRV). In a subsequent phase, parents observed their own child perform a CPT task, allowing assessment of parental pain control behaviour (indexed by latency to stop their child's CPT performance) and parental distress, which was assessed via self-report before and after observation of child CPT performance. Eye tracking during the viewing task and self-reported attention to own child's pain confirmed successful attention manipulation. Further, findings indicated that the effect of attentional strategy on parental emotion regulation (indexed by HR, self-report) and pain control behaviour depended on parents' state anxiety. Specifically, whereas low anxious parents reported more distress and demonstrated more pain control behaviour in the Attend to Pain condition, high anxious parents reported more distress and showed more pain control behaviour in the Avoid Pain condition. This inverse pattern was likewise apparent in physiological distress indices (HR) in response to the initial viewing task. Theoretical/clinical implications and further research directions are discussed

Perceived Injustice Is Associated With Pain and Functional Outcomes in Children and Adolescents With Chronic Pain: A Preliminary Examination

Chronic pain is prevalent in children/adolescents and contributes to high rates of healthcare utilization. Research suggests injustice perceptions about pain are important in adult patients and a possible treatment focus. We conducted a preliminary evaluation of the psychometric properties of the Injustice Experiences Questionnaire (IEQ) and the relationship between injustice perceptions, pain, and functioning in chronic pain patients (N = 139, mean age = 15 years, 72% female) presenting to a pediatric pain clinic. Patients completed measures assessing pain intensity, injustice perceptions about pain, catastrophizing, overall functional disability, emotional functioning, social functioning, and school functioning. The IEQ showed good reliability and validity. Higher levels of perceived injustice were associated with higher levels of pain intensity, catastrophizing, and functional disability, and with poorer emotional, social, and school functioning. Additionally, perceived injustice remained significantly associated with pain intensity, functional disability, emotional functioning, social functioning, and school functioning after accounting for relevant demographic and clinical factors. This is the first study to suggest that injustice perceptions are important in the experience of pediatric chronic pain patients. Future studies should more thoroughly examine the psychometric properties of the IEQ in children/adolescents and elucidate the causal nature of these relationships, which will inform treatment efforts to improve pediatric pain care. Perspective This initial investigation suggests that injustice perceptions about pain can be reliably and validly measured and are tied to important clinical outcomes in children/adolescents. Future studies that replicate and extend these preliminary results are necessary to determine the extent to which injustice perceptions are an important target for intervention

Examining Gender Differences in Pain Treatment Recommendations

poster abstractUnderstanding how pain treatment decisions are made has important clinical implications for healthcare. Research suggests that men and women receive disparate pain care, however, little is known about the specific treatment recommendations that are differentially made for men and women. The purpose of this study was to examine differences between the types of pain treatments recommended for men and women. Undergraduate psychology students from Indiana University-Purdue University Indianapolis (IUPUI) and the University of North Texas (UNT) (n=621) made treatment recommendations for 8 chronic pain patients after reading a vignette describing the patient’s pain and watching a video of each patient completing a pain-inducing task (i.e., transition between sitting and standing). Participants made pain treatment recommendations for each patient using separate 0-100 visual analogue scales (VASs). Dependent samples t-tests indicated that participants were more likely to recommend workplace accommodations (t(620)= -3.05, p= .002, d= 0.17), disability compensation (t(620)= -7.77, p< .001, d= 0.44), and opioid medications (t(620)= -5.16, p< .001, d= 0.29) for men compared to women. Moreover, participants were more likely to recommend psychological therapy (t(620)= 4.59, p< .001, d= 0.26), rest (t(620)= 7.80, p< .001, d= 0.44), and diet/exercise (t(620)= 2.97, p= .003, d= 0.17) for women compared to men. These results are consistent with social psychological theories of gender-based stereotyping and suggest that men’s pain was perceived to be more legitimate, severe, and disabling than was women’s pain. Future studies are needed to examine how these differences affect pain outcomes and whether knowledge of these factors can improve training for future health care providers