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Pediatric Fear-Avoidance Model of Chronic Pain

Pain: Foundation, Application and Future Directions

Here is one of her most cited papers (and it’s open access!!) exploring the fear/avoidance model relating to pain. (link below)
Not only does this paper explore the link between fear and anxiety for the child’s experience of pain. But also touches upon the role of the parent and the impact upon the parent.
“Parent catastrophizing about child pain has been linked to more childhood illness-related parenting stress, anxiety and depression, as well as greater disability and poorer school attendance among children and adolescents, over and above child pain intensity”
It reminds me of something the head of the paediatric ward used to say waaaaay back when I was working the wards: Support the parent, support the child.’ Remembering that the parent is the most influential analgesic, soother and skilled distracter, one role for clinicians may be in helping parents to develop informed and helpful reactions to their child’s’ pain experiences. But how we navigate may require developing our communication skills.

The Paper

The fear-avoidance model of chronic musculoskeletal pain has become an increasingly popular conceptualization of the processes and mechanisms through which acute pain can become chronic. Despite rapidly growing interest and research regarding the influence of fear-avoidance constructs on pain-related disability in children and adolescents, there have been no amendments to the model to account for unique aspects of pediatric chronic pain. A comprehensive understanding of the role of fear-avoidance in pediatric chronic pain necessitates understanding of both child/adolescent and parent factors implicated in its development and maintenance. The primary purpose of the present article is to propose an empirically-based pediatric fear-avoidance model of chronic pain that accounts for both child/adolescent and parent factors as well as their potential interactive effects. To accomplish this goal, the present article will define important fear-avoidance constructs, provide a summary of the general fear-avoidance model and review the growing empirical literature regarding the role of fear-avoidance constructs in pediatric chronic pain. Assessment and treatment options for children with chronic pain will also be described in the context of the proposed pediatric fear-avoidance model of chronic pain. Finally, avenues for future investigation will be proposed.

Click here to access the paper

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