December 18, 2009

Pain study looks at parents’ perceptions

Lynn Walker, Ph.D.

Pain study looks at parents’ perceptions

Chronic stomachaches are distressing to both the children who suffer from them and their parents — especially when the medical evaluation reveals no evidence of disease.

A team of Vanderbilt investigators report in the Dec. 5 issue of the journal Pain that parent and provider characteristics influence parents' distress and satisfaction with the evaluation.

Lynn Walker, Ph.D.

Lynn Walker, Ph.D.

Lynn Walker, Ph.D., director of the Division of Adolescent Medicine, was the senior author. The lead author, Sara Williams, Ph.D., completed the study under Walker's mentorship for her Vanderbilt doctoral dissertation and is currently a postdoctoral fellow at Harvard.

The 160 study participants were mothers of children 8-17 who scored either high or low on a “trait anxiety” scale. Mothers were chosen since they are most likely to be the parent who brings their child to the doctor, Walker said.

The participants were asked to read a sketch pretending they were seeking medical evaluation of their 11-year-old daughter who is suffering from recurrent abdominal pain. After reading the sketch, they were asked to complete a questionnaire about how they would think and feel if they were the mother of the child described.

They then were randomly assigned to view one of four videos featuring a physician (Joe Gigante, M.D., associate professor of Pediatrics) delivering results of their daughter's medical evaluation. Each of the four videos was different — varying in diagnosis (functional or organic) and approach (biomedical or biopsychosocial).

After viewing the video, the participants were asked to fill out the original questionnaire again and also evaluate their satisfaction with the physician.
The study showed that participants were generally less distressed after hearing from the physician. But, mothers' dissatisfaction was higher when the physician delivered a functional diagnosis (no evidence of disease) instead of organic (for example, gastritis).

“Functional symptoms are real symptoms, but they have no organic disease,” Walker said. “They are very common. These kids go to the doctor, their stomach hurts or they have headaches, but results of the medical evaluation are normal.”

Mothers identified as “high anxiety” were even more dissatisfied and distressed when the physician delivered a functional diagnosis with a biomedical approach that focused on reassurance that nothing was medically wrong.

The study further showed that the anxious mothers were more satisfied and less distressed when the physician delivered a functional diagnosis with a biopsychosocial approach. Using this approach, the physician explains that the pain is real. Coping skills such as pain and stress management are recommended, and the physician does not imply the problem is psychiatric.

“We would like for physicians within constraints of a busy clinic to take a biopsychosocial approach when explaining functional symptoms,” Walker said. “We know it takes more time but the payoff is that we can help parents understand how to help their children cope with these symptoms.”