Protective parenting and parent catastrophizing increases risk of functional disability in youth with chronic sickle cell pain

Chronic pain in sickle cell disease (SCD) often begins during adolescence, affecting approximately 23% of youth and up to 37% of adults. Youth with chronic SCD pain report moderate-severe levels of functional disability and reduced quality of life. Protective parenting and parent pain catastrophizing are known to contribute to poor functional outcomes among youth with chronic pain; however, little is known about parent influences that contribute to the persistence of chronic pain and disability in SCD. This study examined the interplay between protective parenting and parent catastrophizing and its impact on functional disability among youth with chronic SCD pain. Adolescents with SCD (n=40, Mage = 14.4, SD = 2.6) characterized as having chronic pain (i.e., pain ≥ 3 days/week/month, persisting for ≥ 3 months) completed measures of pain characteristics and disability (Functional Disability Inventory). Parents completed measures of catastrophizing (Pain Catastrophizing Scale) and parenting behaviors in response to pain (Adult Responses to Children’s Symptoms). As predicted, controlling for pain intensity, a significant two-way interaction emerged between protective parenting and parent catastrophizing in predicting adolescent disability (t=2.88, p<.01). For parents who reported high levels of pain catastrophizing, high engagement in protective parenting behaviors was associated with severe levels of child disability. In contrast, for parents reporting low levels of catastrophizing, protective parenting was not predictive of disability. Youth with chronic SCD pain are most adversely affected in their disability by both high parent catastrophizing and high engagement in protective parenting. Parents’ increased anxiety about pain combined with solicitous parenting responses likely results in adolescents’ restricted engagement in daily activities and fewer opportunities to gain independence; these patterns may limit adolescents’ ability to improve function despite chronic pain. More targeted parent training during behavioral pain treatment may promote more robust functional improvements in pediatric SCD. Abstract source