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Accurate assessment of adolescent chronic pain is critical to guiding treatment decisions. Given the multifaceted role of the parents in their children's lives, parents, and patients often each provide reports of adolescents' pain-related functioning. In order to make sense of these data, clinicians should be aware of patterns of discordance in perspectives. In this study, we aimed to examine concordance and discordance in adolescents' self-report and mothers' proxy-report of adolescents' chronic pain-related functioning. Results suggested that although there were high correlations between the raters, there were also significant discordance with mothers rating their adolescents as having greater disability in social functioning, depression, and pain-specific anxiety. Analyses suggested that high pain and being older predicted greater concordance in ratings. Findings suggest that mothers and adolescents tended to have greater concordance for more observable and shared disability (e.g., physical disability, family functioning) and greater discordance for internal experiences (e.g., pain-specific anxiety, depression). Awareness of these patterns of concordance and discordance should help clinicians in interpreting mothers' proxy-reports and adolescents' self-reports of chronic pain-related functioning.

Emerging evidence has indicated that adolescent chronic pain is a significant healthcare issue, the impact of which is determined by a complex interplay of biological, emotional, social, and familial factors. Recently, progress has been made in assessment of pain and functioning in adolescents with chronic pain. A next step is to evaluate whether discrete subgroups of patients exist and whether assessment measures can be used to determine subgroup membership for individual pain sufferers. The present study sought to address these two issues. A battery of questionnaires, including the bath adolescent pain questionnaire, was completed by 209 adolescents with chronic pain presenting for an assessment appointment. Results from cluster analyses indicated the presence of four distinct subgroups. Three clusters differed from one another along a single continuum of severity and the fourth was characterized by good family cohesion, moderate emotional difficulties, and significant difficulties with physical functioning. Follow-up analyses indicated significant differences among the clusters across eight of nine measures of functioning including pain intensity, healthcare utilization, school attendance, amount of weekly exercise, depression, disability, social functioning, and catastrophic thinking. A discriminant analysis was able to correctly classify over 95% of participants into the correct cluster. These results provide strong support for the derived four cluster solution, which may be useful in both clinical and research settings, as it allows for individual adolescent pain sufferers to be classified into groupings according to the severity and type of difficulties being experienced.

Recurrent pain is a common childhood problem which for some becomes chronic and is associated with severely impaired functioning. Relationships of psychological variables with impaired functioning have rarely been investigated in samples of children reporting pain in non-clinical settings. The aim of this study was to examine the role of cognitive appraisal in the relationship between chronic pain and level of functioning in a normal school-attending population of children who report pain as a common experience. Five hundred and sixty one schoolchildren aged between 8 and 16 years and their parents participated in a cross-sectional interview and questionnaire study. Child functioning was measured in two ways: self-reported quality of life, and self-reported functional disability associated with pain. Results showed a consistent pattern across both specific measures of functioning used. Catastrophic appraisals of pain can explain partially the functional impairment found in a sample of normal schoolchildren with chronic pain. Positive expectations about ability, the responsibility to exert control over the pain, and the belief that medication and doctors will help to control the pain, were found to be protective of normal functioning in chronic pain. Cognitive factors were found to mediate but not moderate the relationship between pain and disability, and quality of life.

Pain-related anxiety and depression are important correlates of disability amongst chronic pain patients. Furthermore, women may differ in their experience of pain, anxiety and depression when compared to men. The aim of the current study was to determine the relative contribution of anxiety and depression on disability in male and female chronic pain patients. The sample consisted of 260 patients (101 males, 159 females) referred to the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases in Bath, UK. As part of an initial assessment, all patients completed measures of depression, pain-related anxiety and disability. As predicted, both anxiety and depression were found to be significant positive predictors of pain, number of medications used and disability. Although gender did not significantly predict disability, it did moderate the relationship between depression and disability, in that when depression was high, women report greater disability than men. Gender was also found to moderate the relationship between depression and number of medications used, in that a positive association was found for men, but not women. However, gender did not significantly moderate the relationship between anxiety and disability. Together these results not only suggest that gender is an important moderator of the relationship between emotional responses and disability, but that such associations may be related more to depression than anxiety.

Previous research suggests that to define the problem of chronic pain as a problem of coping may not be as useful as framing it as a problem of acceptance for some patients. The coping approach may encourage, or at least permit, a somewhat inflexible agenda of pain reduction or control while the acceptance approach may allow a more flexible agenda of willingness to have pain in some circumstances where that serves the goal of better life functioning. The purpose of this study was to continue to examine the relative utility of concepts of coping and acceptance of pain. Two hundred and thirty consecutive patients seeking assessment from a pain management service were the participants in the study. Patients completed the Coping Strategies Questionnaire (CSQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). A revised scoring method was used for the CSQ (to correct for technical limitations noted in the past) and recently developed subscales of the CPAQ were examined. Correlation results showed that the acceptance variables were reliably stronger predictors of distress and disability compared with coping variables. Regression analyses confirmed that, compared with coping variables, acceptance accounted larger unique increments in variance in measures of patient functioning regardless of whether the coping variables were given priority in the regression equations. Increasing data support the view that the pain management field may benefit from evolving toward incorporating a less control-oriented and more accommodating view of aversive private experiences in some circumstances.

Patients and clinicians sometimes take coping with chronic pain primarily as a process of gaining more control over pain. An alternate approach might include helping the pain sufferer to discriminate parts of their situation that can be effectively controlled from those that cannot. When faced with situations that do not yield to attempts at direct control patients may gain better results from leaving those situations as they are and investing their efforts elsewhere. This study was designed to examine this type of expanded view of coping with pain, a view that includes both attempts at control and acceptance. 200 adults seeking treatment for chronic pain were the subjects of this investigation. They completed a number of self-report inventories including a measure called the Brief Pain Coping Inventory, an inventory assessing accepting responses to pain as well as pain management responses standardly targeted by cognitive-behavioral treatment methods. Preliminary results showed that the BPCI yields scores with adequate temporal consistency and validity. Further results showed that a number of the responses assessed by the BPCI were reliable predictors of patient functioning. In general less frequent struggling to control pain, fewer palliative and avoidant coping responses, and more explicit persistence with activity despite acknowledged pain were associated with less depression and anxiety and greater life functioning. These results demonstrate that, in some instances, attempts at avoidance and control of chronic pain may be less helpful compared with a willingness to experience pain and focus on functioning.

Patients with chronic pain often report negative and aversive rumination about pain and its consequences. Little is known about how and why patients with chronic pain worry. This study provides a description of worrying by chronic pain patients. Eighteen female and 16 male chronic pain patients reported, over a 7-day period, their experience of pain-related and non-pain-related worry. Results indicated that, in comparison with non-pain related worry, worry about chronic pain is experienced as more difficult to dismiss, more distracting, more attention grabbing, more intrusive, more distressing and less pleasant. Further analyses suggest that these characteristics of worry about chronic pain do not arise from a general disposition to worry or from a general disposition to anxiety. Worry is, however, related to awareness of somatic sensations. These results are discussed within an attentional model in which worry functions to maintain vigilance to threat.