Maternal Chronic Pain: Risk for Pain and Poor Outcomes in Children

 描述（由申请人提供）：与健康母亲的孩子相比，患有疼痛的母亲的孩子有更大的疼痛风险，但很少有工作确定了这种风险被赋予的机制。虽然慢性疼痛的存在无疑会给养育带来挑战，但我们对特定父母行为如何影响儿童的理解有限。确定暴露于产妇慢性疼痛的机制，使疼痛的风险和不良的健康结果的儿童将能够早期筛查和预防干预措施的发展，以改变风险。这项研究计划的长期目标是确定 父母的慢性疼痛对儿童和青少年产生负面影响的机制。这些机制的识别将为慢性疼痛风险增加的青年预防干预措施的制定提供信息。儿童期慢性疼痛的发病率在青春期早期增加，这使得从儿童期到青春期早期的过渡成为研究慢性疼痛和相关问题风险的关键时期。拟议的研究将利用母体慢性疼痛影响的发育模型。在从童年到青春期早期的三年过渡期内，将对风险传递的直接机制和交易机制进行测试。核心假设是，产妇慢性疼痛通过几个直接和交互的途径影响儿童疼痛和负面健康结果的风险。母亲对儿童疼痛和痛苦的反应，以及身体活动养育和整体家庭压力将作为潜在的机制进行检查。将在患有慢性疼痛的母亲及其8-12岁子女（n= 400对母子）的样本中测试风险传递的纵向模型。这些母子二人组将在三年内每年进行评估，并将报告母亲的疼痛和残疾、认知情感因素、身体活动养育和家庭压力。这些因素将作为儿童疼痛，躯体症状，内化问题，医疗保健利用，缺课和功能限制的预测因子进行检查。还将检查母亲功能限制与儿童慢性疼痛风险之间的日常联系。在这一发展转型过程中确定风险的机制和调节因素将为设计旨在减少风险青年疼痛和其他负面健康结果的干预措施提供关键信息。

 DESCRIPTION (provided by applicant): Children of mothers with pain have a greater risk for pain compared to children of healthy mothers, but little work has identified mechanisms through which this risk is conferred. While the presence of chronic pain certainly presents parenting challenges, our understanding of how exposure to specific parent behaviors impacts children is limited. Identifying mechanisms through which exposure to maternal chronic pain confers risk for pain and poor health outcomes to children would enable early screening and development of preventive interventions to modify risk. The long-term goal of this research program is to identify mechanisms through which chronic pain in parents negatively impacts children and adolescents. Identification of these mechanisms will inform the development of preventative interventions for youth at increased risk for chronic pain. The incidence of childhood chronic pain increases in early puberty, which makes the transition from childhood to early adolescence a critical period for studying risk for chronic pain and related problems. The proposed study will utilize a developmental model of the impact of maternal chronic pain. Both direct and transactional mechanisms of risk transmission will be tested over the course of a three year period during the transition from childhood to early adolescence. The central hypothesis is that maternal chronic pain influences risk for child pain and negative health outcomes through several direct and transactional pathways. Maternal responses to child pain and distress, as well as physical activity parenting and overall family stress will be examined as potential mechanisms. Longitudinal models of risk transmission will be tested in a sample of mothers with chronic pain and their 8-12 year old children (n= 400 mother-child dyads). These mother-child dyads will be assessed annually over a three year period, and will report on mother pain and disability, cognitive-affective factors, physical activity parenting, and family stress. These factrs will be examined as predictors of child pain, somatic symptoms, internalizing problems, healthcare utilization, school absences, and functional limitations. Daily associations between maternal functional limitations and child risks for chronic pain will also be examined. Determining mechanisms and moderators of risk during this developmental transition will provide critical information for the design of interventions aimed at reducing pain and other negative health outcomes in at-risk youth.