Electronic Momentary Assessment of Child Pain, Parent Responses, and Emotion in Children with Arthritis

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Presentation Number:1383

Presentation Time:11/9/2007 5:00:00 PM

Title:Electronic Momentary Assessment of Child Pain, Parent Responses, and

Emotion in Children with Arthritis

Category:Pediatrics

Author(s):Mark Connelly1, K. 2, M. Gil3,

Sarniak3, Maggie A. Hood2, Janet Wootton2, E. Schanberg2. 1Children's

Mercy Hospital, Kansas City, MO; 2Duke University Medical Center, Durham,

NC; 3University of North Carolina, Chapel Hill, NC

PURPOSE: The pain experience and functional outcomes of children with

arthritis are only partly understood through characteristics of the disease

itself. Rather, psychological and social variables appear to be highly

influential in these children's pain reports. Parent responses to a child's

pain have been shown in some populations to be a key determinant of

functional impairment from pain, but this has yet to be studied in children

with arthritis. The intent of the current preliminary study was to use

rigorous prospective methodology to examine in real-time the effect of

parent responses to their child's pain on child function.

METHODS: A sample of 9 children aged 8-16 (M=12 y, 89% female) along with

one of their primary caregivers (7 mothers, 2 fathers) was recruited during

clinic visits. All children had been diagnosed with polyarticular arthritis

(7 JIA; 2 spondyloarthropathy). Two children were characterized as in

remission, 3 with mild disease activity, and 5 with moderate to severe

disease activity.

After demographic and disease severity data were obtained, primary

caregivers were given Palm pilots on which they answered items regarding

their own emotional state and responses to their child's pain three times

per day for 14 days. During this same time period, children separately

responded to items on pain, reduction in school, social, and physical

activities, and emotional state on their own Palm device. Data were analyzed

using multilevel modeling techniques.

RESULTS: Regardless of the child's baseline disease severity or level of

pain intensity, parent " solicitous " responses (emphasizing passive coping or

a focus on pain) predicted the level of total activity reductions, as well

as reductions in social, physical, and school activities. Such parent

responses also significantly predicted lower positive emotion and higher

negative emotion in the child. Parents who themselves reported higher levels

of positive emotion at a given time were significantly less likely to

respond to their child in a solicitous way.

CONCLUSIONS: These data highlight the impact of family context on the pain

report of children with arthritis, reinforcing the need for interventions

targeting parents as part of the comprehensive care of children with

arthritis pain.

Disclosures: M. Connelly, None; K.K. , None; K.M. Gil, None; R.

Sarniak, None; M.A. Hood, None; J. Wootton, None; L.E. Schanberg, Pfizer, 2.