Introduction

1. The Relationship between Pediatric Chronic Pain and Global Impairment: Moderating Effects of Social Consequences of Pain Amy F. Sato1, W. Hobart Davies1,2, Kristoffer S. Berlin3, Jessica M. Joseph1, Kimberly Anderson Khan2,4 & Steven J. Weisman2,4 University of Wisconsin – Milwaukee1, Children’s Hospital of Wisconsin2, Brown Medical School & Bradley Hasbro Children’s Research Center3, & Medical College of Wisconsin4 Figure 3 • Introduction • The relationship between pediatric chronic pain and impairment is complex (Palermo & Chambers, 2005). Social consequences of pain are likely to influence this relationship. Examples of pain-contingent consequences include special attention, activity restriction, and negative attention. These consequences may be influenced by child age and gender. • The purpose of this study was to examine the relationship between pain intensity and impairment in functioning (called “global impairment”), and to determine whether this relationship is moderated by social consequences of pain, either alone or in interaction with child age and gender. • This study hypothesized that higher levels of favorable consequences, negative attention, and activity restriction would strengthen (i.e., moderate) the positive relationship between pain and impairment. • Methods • 291 youth 8 - 17 years old (M = 13.3, SD = 2.7) presenting to a tertiary chronic pain clinic. • Youth were primarily female (72.2% female) and Caucasian (80.4%) • African American (9.8%), Latino (3.8%), Biracial (3.8%), Asian (0.4%), Native American (0.4%) • On a 0-to-10 pain rating scale, participants’ best, worst, and usual pain ratings were 1.7 (SD = 2.4), 8.7 (SD = 1.7), and 5.9 (SD = 2.1). • As part of a multidisciplinary intake evaluation, participants completed demographics and psychosocial questionnaires. • Measures • The Social Consequences of Pain scale (SCP; Walker et al., 2002) measured perceptions of favorable and unfavorable social consequences of pain in interaction with parents, teachers, and peers. • Functional disability and HRQoL were measured as indicators of Global Impairment. Youth completed the Functional Disability Inventory (FDI; Claar & Walker, 2006; Walker & Greene, 1991) and Pediatric Quality of Life InventoryTM Version 4.0 (PedsQL) Generic Core Scales (Varni et al., 2001). • Cronbach’s Alphas ranged from adequate to excellent: • FDI Total Score (.91) • PedsQL: Total Score (.90), Physical Health Summary Score (.89), Psychosocial Health Summary Score (.86) • SCP: Favorable Consequences (.85), Activity Restriction (.88), Negative Attention (.70) • The Pain Intensity and Global Impairment variables were latent variables formulated in a separate measurement model. • Results • Regression-based moderation analyses examined the relationship between Pain Intensity and Global Impairment. Complex moderations (i.e., 3-way interactions) were examined in a step-down approach with elimination of nonsignificant higher order interaction terms. • The Pain Intensity x Activity Restriction x Gender 3-way interaction emerged as significant (t = -2.37, p < .05). • Activity Restriction moderated the relationship between Pain Intensity and Global Impairment among girls (t = 2.60, p < .05, Fig. 1), but not boys (t = -1.25, p = .22, Fig. 2). • Favorable Consequences moderated the relationship between Pain Intensity and Global Impairment (t = 3.31, p < .01, Fig. 3). • Pain Intensity x Age interaction emerged as significant (t = -2.35, p < .05, Fig. 4). *p <.01. Calculated via step-down analysis of Pain Intensity x Favorable Consequences x Age. Parallel finding via step-down analysis of Pain Intensity x Favorable Consequences x Gender. Figure 4 Figure 1 *p <.01. Calculated via step-down analysis of Pain Intensity x Age x Gender. Parallel finding via step-down analysis of Pain Intensity x Negative Attention x Age. • Discussion • Higher levels of Favorable Consequences strengthened the relationship between Pain Intensity and Global Impairment. • Among girls only, higher levels of Activity Restriction strengthened the relationship between Pain Intensity and Global Impairment. • Younger child age strengthened the relationship between Pain Intensity and Global Impairment at high level of Pain Intensity, but buffered the relationship at low levels of Pain Intensity. • Among clinical samples of youth with chronic pain, favorable consequences and activity restriction may put children at increased risk for reinforcement of pain and associated impairment. *p <.01. Significant Pain Intensity x Activity Restriction interaction among females. Figure 2 Presented to the 2009 Midwest Conference on Pediatric Psychology Contact Information: Amy F. Sato (asato@lifespan.org) *p <.01. Pain Intensity x Activity Restriction interaction failed to reach significance among males.