The Role of Catastrophizing in Pediatric Migraine

The following article is part of live conference coverage from the 2017 American Headache Society (AHS) Annual Meeting in Boston, Massachusetts. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AHS 2017.

BOSTON — Concordance or discordance in pain catastrophizing between parents and children may impact pain coping in children with migraine, according to a study presented by Grace Tunning, a graduate research assistant at Tufts University, as part of the “Future of Headache Medicine” series at the 59^th annual scientific meeting of the American Headache Society.

The role of pain catastrophizing is well supported by research and is an important construct in understanding children’s experiences with chronic headache and informing possible responses to treatments. The goal of the study led by Ms Tunning was to examine the concordance and discordance between parent and child levels of catastrophizing in a sample of children and adolescents with migraine. Pain catastrophizing is a significant psychological construct in pediatric chronic pain and headache. However, little research has focused on the parent-child dyad as a unit, noted Ms Tunning.

Migraines severely impact a child’s daily activities, and pain catastrophizing refers to a “negative mental status characterized into 3 domains: helplessness, rumination, and magnification.” Greater levels of pain catastrophizing are linked to greater pain intensity and poor functioning in children and adolescents with chronic pain, as well as poor quality of life and increased depressive symptoms in adolescents. Greater parent pain catastrophizing has been associated with greater child pain intensity, functional disability, and increased school absences.

The current study Included 201 children and adolescents ages 7 to 17 years (mean age, 13 years; 66% girls; 92% white) with a diagnosis of migraine and who joined a multidisciplinary headache clinic. Patients and their parents were asked to complete a battery of questionnaires prior to being seen in the clinic, and both had to have completed the measures of pain catastrophizing and have a primary diagnosis of migraine (for children) in order to participate in the study.

Youth completed the Pain Catastrophizing Scale (PCS) questionnaire, a 13-question item; the Functional Disability Inventory, which assesses children’s self-reported difficulty in physical and psychosocial functioning; and the Core Bereavement Inventory which evaluates children’s self-reported depressive symptoms. Parents completed a parent version of the PCS to assess the degree to which they were catastrophizing their child’s pain.

Parents and children were classified into concordant or discordant dyads based on their distance from the mean difference scores on questionnaires. Parents were classified as concordant if their difference was within 1 standard deviation of the mean. The majority of dyads showed concordance (n=134; 66.7%); 35 dyads (17.4%) had the parent reporting higher recordings of pain catastrophizing, and 32 dyads (15.9%) had the child reporting greater catastrophizing levels.

To determine the impact of dyad catastrophizing classification on the child’s reported outcomes of anxiety, functional disability, and depression, the researchers ran 3 1-way between-group multivariant ANOVAs. Overall, it was found that the discordant greater child catastrophizing group had significantly higher levels of anxiety and functional disability than both the concordant and discordant greater parent catastrophizing groups, and greater depression than the discordant group.

Much of the research being conducted focuses on the experience from a child or parent perspective, but little work has focused on the parent-child dyad as a unit. “To our knowledge, this study represents the first to explore the parent-child dyad with respect to pain catastrophizing in a pediatric population with migraine,” said Ms Tunning. “Based on our results, we found that the majority of parent-child dyads are concordant, suggesting an inclination for dyads to share similar coping styles. Also, when dyads are discordant, especially when the child experienced greater pain catastrophizing, children showed worse behavioral and emotional functioning. Another important finding was that when there were better outcomes in the concordant group, regardless of whether it was high or low catastrophizing, the child showed better functioning,” she added.

“This research utilizing the parent-child dyad offers further exploration into the parent implications on the pain experienced by children and adolescents with migraine,” she concluded.

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Reference

Tunning G. Concordance and discordance between parent-child levels of catastrophizing in children and adolescents with migraine. Presented at: The American Headache Society 59th Annual Meeting. June 8-11, 2017; Boston, Massachusetts.