At the recently concluded American College of Rheumatology annual meeting in Washington, DC, one of the sessions dealt with pain in childhood. Is it all in the head—or, I should say, all in the parent’s head?

One study described involved electronic diaries to examine how parent responses to their child’s pain predict that child’s adjustment when dealing with juvenile arthritis: Children provided information on pain level, mood and participation in social, academic and physical activities. Their parents independently rated their mood and behavioral responses to their child’s pain.

The researchers found that when parents reported using protective pain responses, there was a decrease in child activity and positive mood. In contrast, the use of distracting responses by parents resulted in less child activity restrictions (in children with higher disease activity). However, an unexpected trend was noted, in which parents’ use of more distracting pain responses is associated with lower child positive mood.

Another study discussed examined chronic pain in adolescents with conditions such as migraine, abdominal pain, and neuropathic pain. In this age group, protective parental responses had no added impact on adolescent pain behaviors for adolescents engaging in high levels of passive and active coping. Adolescents employing lower levels of passive coping strategies and exposed to higher levels of parental protective behavior experienced greater functional disability and more somatic complaints. And adolescents engaging in fewer active coping strategies experienced more somatic complaints when exposed to high levels of parental protective behavior.

It would appear that there are situations where parental protective responses to pain may inadvertently promote greater disability and symptom complaints in adolescents with chronic pain.

Teaching parents to depart from being overly protective or solicitous as well as discounting or criticizing the adolescent's pain as excessive to a middle ground of validating the individual's pain experience and encouraging functioning even in the presence of pain may lead to better outcomes for the adolescent. In addition, parents of adolescents with chronic pain may need additional support to cope, as they struggle to accept some degree of uncertainty with an often vague diagnosis. Equipping parents with tools to help their adolescents, while simultaneously teaching adolescents the means of coping with their pain, will ultimately result in better outcomes for the adolescent and parent.

It is not that easy to exorcise the ghost of the family, particularly when dealing with chronic pain in the family. There is unhealthy enmeshment, and illness behavior encouragement. It is a family, and it brings its full psychosocial influence to bear on the pain sufferer, adolescent or child.

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