Social Learning Pathways in the Intergenerational Transmission of Risk for Chronic Pain and Functional Impairment from Parents to Offspring

Abstract

Having a parent with chronic pain may confer greater risk for persistence of chronic pain from childhood into young adulthood. Social learning represents one plausible mechanism for the transmission of risk for chronic pain form parents to offspring. The present study aimed to evaluate two aspects of social learning, parental modeling of pain behaviors and parental reinforcement of children’s pain behaviors, in an adolescent sample of pediatric patients with functional abdominal pain. Aim 1 focused on parental modeling of pain behaviors—specifically whether adolescents observe parent pain behaviors and the extent to which these observations prospectively predict adolescents’ own pain severity and functional impairment over a 7-day online diary. Aim 2 focused on parental reinforcement of adolescents’ pain behaviors by examining parents’ self-reported responses to adolescent pain as well as adolescents’ reports of parents’ responses to their pain as prospective predictors of adolescents’ pain severity and functional impairment over the 7-day diary period. Aim 3 tested a comprehensive model of social learning pathways by incorporating not only parental modeling of pain behavior and reinforcement of their adolescents’ pain behavior but also adolescents’ cognitive appraisals of pain threat as potential mechanisms in the relation between parental chronic pain and adolescents’ pain severity and functional impairment. Results indicated a significant indirect pathway from parental chronic pain status to adolescent average daily pain severity and functional impairment over the 7-day diary period through adolescents’ observations of parent pain behaviors and adolescent pain threat appraisal. The indirect pathway through parental responses to adolescents’ pain did not reach significance for either adolescent pain severity or adolescent functional impairment. Based on the present study, parental modeling of pain behaviors represents a potentially promising target for family based interventions to prevent or ameliorate pediatric chronic pain.