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The Role of Acceptance and Mindfulness in Pediatric Chronic Pain Outcomes

13 December 2013


Pediatric chronic pain prevalence rates are now reported between 20-40% (Abu-Afareh et al., 2010; Goodman & McGrath, 1991; Huguet & Miro, 2008; Perquin et al., 2000; Stanford, Chambers, Biesanz, & Chen, 2008). Researchers have found that children with chronic pain report significant functional disability, including significant disruptions at school and work, and psychological difficulties including depression (Kashikar-Zuck, Goldschneider, Powers, Vaught, & Hershey, 2001; Palermo, 2009). The primary objectives of the current dissertation were to describe acceptance of pain along with psychological and pain correlates in a clinical sample of youth with chronic pain and to examine acceptance of pain a moderator of pain-related disability. Fifty-five participants between the ages of 8-17 years (M = 14.36, SD = 2.47) and their parents were recruited from pediatric pain management, neurology, and gastrointestinal clinics at a children’s hospital housed within a university medical center in the Pacific Northwest. The total child sample consisted of 41 females (74.5%) and 14 males (25.5%), who reported mean pain duration as 2.28 years (SD = 2.44). The most commonly reported ethnic groups were Caucasian (n = 36, 65.5%) and Mixed Ethnicity (n = 8, 14.5%). Participants completed online surveys, which included demographic information, pain characteristic information (i.e., pain intensity and frequency), the Pain Catastrophizing Scale – Child Version (PCS-C-C), the Child and Adolescent Mindfulness Measure (CAMM), the Chronic Pain Acceptance Questionnaire – Adolescent Version (CPAQ-A), the Child Activity Limitations Interview (CALI-21), and the Children’s Depression Inventory (CDI). Results indicated that participants reported moderate to high levels of pain and 69% of participants reported daily pain. Correlational findings indicated a significant positive correlation between pain intensity and functional disability. Chronic pain acceptance ratings were positively correlated with general mindfulness ratings, but negatively correlated with depressive symptoms and pain catastrophizing. General mindfulness ratings were also negatively correlated with depressive symptoms and pain catastrophizing. Participants’ depressive symptoms and pain catastrophizing were also positively correlated. Results of hierarchical regression models indicated that participants’ typical pain intensity ratings were the strongest predictor of functional disability scores. It was hypothesized that chronic pain acceptance would uniquely and significantly predict functional disability. However, results indicated that while an overall model including pain intensity, child age, gender, and pain-specific acceptance was highly associated with functional disability scores, neither pain-specific acceptance nor general mindfulness scores uniquely predicted functional disability scores. Pain-specific acceptance did not moderate the relationship between depression and functional disability or between pain catastrophizing and functional disability. Although these results suggest that pain-specific acceptance and general mindfulness are not associated with functional disability within a pediatric chronic pain population, methodological issues within the current study suggest results should be interpreted with caution. Moreover, extant literature suggests that acceptance-based approaches are indeed effective in decreasing functional disability related to pediatric chronic pain.


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