T. Palermo, Ph.D.
Chronic pain affects 25-40% of children and adolescents, and results in a measurable decline in children's overall quality of life. Parents not only play a significant role in how their children cope with chronic pain but they also can experience their own widespread social, relational, emotional and financial impact. In particular, parents of youth with chronic pain report increased role stress, increased depressive symptoms, and reduced social functioning. Regardless of the reason for increased distress, multiple studies have found that parental psychological distress is associated with poorer child adjustment. Therefore, there is a critical need to consider methods of reducing parental distress in order to more effectively manage children's chronic pain and disability. To date, no intervention has been developed specifically to treat parents in the context of their child's chronic pain, despite need, and success in other evidence-based pain treatments in youth. The proposed project is designed to evaluate problem-solving skills training (PSST), an intervention proven effective for reducing parental distress in other caregiver populations of individuals with medical conditions. Our aims are to evaluate the feasibility and acceptability of PSST as an intervention in parent caregivers of youth with chronic pain, and to conduct a preliminary efficacy trial of PSST in parents of youth with chronic pain. In this application, we propose first testing the intervention with 5 parent-child dyads in a pilot phase and then carrying out a randomized controlled trial of PSST in 60 parent caregivers of youth (10-17 years) with chronic pain recruited from two pain clinics. All children will be receiving specialty care for chronic pain. Parents randomized to the PSST intervention will, in addition, receive 8 individual sessions of problem-solving skills training over an 8-week treatment period while parents in the Standard Care control group will continue with prescribed treatments and recommendations for chronic pain management from the pain clinics. The primary study outcomes are parental depression and anxiety, parenting stress, and problem-solving skills and child physical and emotional functioning measured at pre-treatment, immediately post-treatment, and at 3-month follow-up. Secondary outcomes include parental impact of chronic pain and treatment satisfaction and acceptability. We propose the first ever intervention designed for, and delivered directly to, parental caregivers of youth with chronic pain. Findings will increase understanding of the interrelationships among parental and child functioning, and specifically will provide knowledge of how to augment effectively child and parent focused interventions. This innovation in treatment development will significantly advance psychological therapies for pediatric pain management, and ultimately may enhance quality of life in the substantial population of youth and their families affected by chronic pain.
Reducing parental distress and negative affectivity may be critical to influencing children's abilities to manage chronic pain. Testing of interventions developed specifically for parents will increase understanding of how effectively to reduce parental distress, and how to complement child treatment with parental intervention strategies. The long-term goal of the research is to develop effective treatments to manage chronic pain and disability in youth through reducing parental distress and increasing their coping abilities.