August 22, 2008

Study outlines ways children cope with chronic pain

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Lynn Walker, Ph.D.

Study outlines ways children cope with chronic pain

A study by Vanderbilt investigators outlines four general profiles of pain coping strategies used by pediatric patients dealing with chronic abdominal pain.

Lynn Walker, Ph.D., professor of Pediatrics and Adolescent Medicine at the Monroe Carell Jr. Children's Hospital at Vanderbilt, is the lead author of the study, published recently in the journal Pain.

For eight years from 1998 to 2006, Walker and colleagues assessed the pain coping strategies of 686 patients ages 8-18 who were referred to the Pediatric Gastroenterology Clinic at Children's Hospital for an evaluation of chronic abdominal pain lasting one year or longer.

Participants and their parents answered a Pain Response Inventory about the child's thoughts and behaviors during episodes of abdominal pain.

Four major coping profiles emerged — avoidant copers, dependant copers, self-reliant copers and engaged copers.

“These four groups represent distinct patterns of coping with pain,” Walker said. “They are especially interesting to us because they suggest that children's personal mastery efforts, as well as their social interactions, during pain may contribute to pain outcomes.”

• Avoidant copers made little effort to cope with pain by themselves and also withdrew from others during pain. They were depressed, disabled by their pain and had the lowest scores on functioning in social and academic arenas.

• Dependant copers were similar to avoidant copers in that they made little effort to cope with pain by themselves, but they reached out to others, such as their parents, for help.

This group was not as depressed as the avoidant copers but they shared the same level of pain.

• Self reliant copers attempted to master pain on their own by using self-encouragement and minimizing their pain.

They were very stoic, and tried not to let others know that they were in pain. This group had the highest proportion of boys.

• Engaged copers used both personal mastery strategies and social support in dealing with pain.

“They do a lot of problem solving on their own and they also make use of social support, but without becoming overly dependent on others,” Walker said.

“They were the most resilient, had the lowest levels of disability related to their pain, and were doing very well in academic and social functioning.”

Walker said these overall findings indicate that different types of patients with chronic abdominal pain may need different types of intervention.

The avoidant copers will likely benefit by seeing not only a gastrointestinal specialist but also a psychologist or other provider to address depression and their social and academic difficulties.

“For the dependent copers, it would be especially important to involve the family to encourage these patients to develop their own individual strategies, such as distraction techniques, to deal with their pain,” Walker said.

Walker recently received a grant for a follow-up of the study participants who are now five to 10 years older. She is interested in determining if patients with different coping strategies have different outcomes.

The research was supported by a grant from the National Institute on Child Health and Development, a core grant to the Vanderbilt Kennedy Center and by the Vanderbilt Digestive Disease Research Center.

The study was co- authored by Kari Freeman Baber, a Vanderbilt graduate student, Judy Garber, Ph.D., professor of Psychology and Human Development, and Craig Smith, Ph.D., associate professor of Psychology and Human Development.