Influence of Social Modeling and Learning on Somatic, Emotional and Functional Disability in Children with Headache

摘要

Background. Several studies evidenced an influence of parental pain variables on the child’s processing of pain.Method. In two successive annual waves, children and parents (n = 1803 at first assessment) were questioned about headaches and various pain-related variables. Parent-child associations concerning pain catastrophizing and pain avoidance behavior were examined in a cross-sectional design. Using hierarchical regression analyses, pain catastrophizing of parent and child, their interaction and parental pain avoidance behavior were examined as predictors of headache-related somatic, emotional and functional disability in the child one year later.Results. Results demonstrated significant but moderate parent-child concordance in pain catastrophizing and pain avoidance behavior. Regression analyses revealed pain catastrophizing in the child as a significant predictor for all disability variables in both boys and girls. In contrast, parental pain catastrophizing had low predictive power, only for some of the dependent disability variables and depending on the sex of the subsample. In boys and girls, parental pain avoidance behavior was a significant but weak predictor only for functional disability.Conclusions. Data suggest a low influence of pain-related social learning mechanisms in this population-based sample. This result may be ascribed to the generally rather low level of headaches and related disability. INTRODUCTION Headache, compared to abdominal and back pain, is the most common pain complaint from children and adolescents [1]. In an epidemiologic study by Kr?ner-Herwig, Heinrich and Morris [2] a 6-month prevalence of 53.2% in 7 to 14 year old children and adolescents was found according to parent reports. As childhood headaches can be associated with severe disability and risk of developing a chronic state [2], the identification of etiological and sustaining factors is of high clinical relevance for effective prevention and treatment plans.Based on the background of biopsychosocial models [3, 4] parental pain experience and behavior are discussed as influential social factors for the development and persistence of childhood headaches [5,6]. In reference to the social learning theory by Bandura [7], pain-associated modeling was repeatedly considered as one mechanism of parental influence on the child’s pain. It was hypothesized that children acquire – through observation and interaction with their parents – attitudes and behaviors concerning health and pain-associated symptoms. This parental influence was assumed to also affect the child’s appraisal of pain and cognitive, emotional and behavioral coping with pain [5, 8, 9]. Based on the assumption that most health problems are first dealt with in the family context, it was presumed that a parental pain model with pronounced pain symptoms and dysfunctional coping contributes to focusing on pain and negative coping behavior from the child [10-12].An association between the pain experience of parent and child was confirmed in several cross-sectional correlative and experimental studies [10, 11, 13, 14]. In a correlation study, Turkat [15] investigated pain avoidance behavior as a directly observable behavioral coping response. Results revealed that individuals with a parental model of passive avoidance showed the same kind and frequency of passive avoidance as their parent and reported a lower quality of life. Moreover, an experimental study by Goodman and McGreath [16] found that children’s pain thresholds changed in a cold-pressor test depending on maternal reaction to pain. Children whose mothers were instructed to exaggerate their expression of pain reported lower pain thresholds than children whose mothers were asked to minimize their expression of pain or did not receive specific instructions. In addition, Craig reported that the familial behavioral reaction to pain influenced the child’s cognitive-emotional evaluation of pain and pain intensity [17].In addition