An analysis of the pain experience and spontaneous coping abilities of children and adolescents with arthritis

Very few good empirical investigations of pain and coping in children and adolescents currently appear in the published literature. In contrast to the adult literature, for ethical reasons, a foundation of basic research using experimentally-induced pain does not exist in the pediatric literature (McGrath, in press). This remaining deficiency in knowledge about children's spontaneous abilities to cope with pain is particularly harmful because it means that clinicians must base their assessment and treatment of pain in children on their knowledge of adults (Jeans, 1983). The need to consider cognitive-developmental issues has been emphasized in several recent papers (Lavigne, Schulein, & Hahn, 1986; Maddux, Roberts, Sledden, & Wright, 1986; Thompson & Varni, 1986). The present investigation evaluated the pain experienced and spontaneous coping strategies used by 39 children and adolescents with various forms of arthritis, during a painful joint-measuring task which is typically part of physiotherapy treatments for this illness. The two purposes of the study were: 1) to assess age/cognitive-developmental differences and 2) to compare "effective copers" versus children who were having some difficulties coping with pain (i.e. pain was interfering with their activities of daily living). Three age groups (5-7 years, 8-10 years, and 11-18 years), corresponding to the Piagetian stages of preoperational, concrete operational and formal operational thought, were compared. Subjects were videotaped while the range of motion in their joints was measured by the physiotherapist. Videotapes were subsequently coded for behavioral coping strategy use. Immediately following the joint measurement task, subjects were interviewed regarding thoughts they recalled experiencing. Transcribed interviews were subsequently coded for cognitive coping strategies reportedly used and catastrophizing cognitions reportedly experienced. In addition, parents completed two questionnaires rating the degree to which pain interferes with their child's activities of daily living, and the physiotherapist made a global rating of each child's functional capacity. The overall MANOVA using age group as a between groups factor, with self-reported pain variables entered as dependent measures was nonsignificant. A significant multivariate effect did emerge, however, when the coping variables were entered as dependent measures in a second overall MANOVA. Follow up univariate analyses revealed an age/cognitive-developmental trend in behavioral and cognitive coping strategy use. Children in the youngest group (preoperational) used primarily behavioral strategies to cope with pain elicited by the physiotherapy joint-measuring task, whereas slightly older children (concrete operational) began to supplement their repertoire of behavioral coping strategies with some cognitive coping strategies. A significant rise in reported cognitive coping strategy use was observed in the oldest group (formal operational). In addition, a discriminant function revealed that the two most important discriminators between "effective copers" versus children having some difficulties coping with pain were the amount of pain expression (vocal or nonvocal) coded and the amount of catastrophizing thoughts reportedly experienced during the physiotherapy task. Implications of these results for the treatment of children having difficulties coping with arthritic pain are discussed.Arts, Faculty ofPsychology, Department ofGraduat