The influence of maternal vulnerability and parenting stress on chronic pain in adolescents in a general population sample: the TRAILS study

Chronic pain (i.e. suffering from pain in the last 3 months) in children and adolescents is widespread, with prevalences of up to 25% (Perquin et al., 2000; Huguet and Miro, 2008; Stanford et al., 2008). A majority of them report pain in the absence of an underlying physical condition. Investigating possible pychosocial predictors of unexplained chronic pain in adolescents is crucial in understanding its development and prevention. A general population sample of adolescents (n=2230) from the TRAILS cohort study was investigated longitudinally to assess the influence of maternal vulnerability, in terms of anxiety, depression, stress, and parenting stress at age 10-12 years, on the presence of chronic pain at age 12-15 years. Of these adolescents, 269 (12.9%) reported experiencing chronic pain, of which 77% reported severe chronic pain (> 50 mm on a Visual Analogue Scale). Logistic regression analyses showed that mothers with high levels of anxiety, stress or parenting stress were more likely to have a child with chronic pain than those with low levels. Mediation analyses indicated that parenting stress mediates the effect between maternal anxiety, stress, and chronic pain.
One of the limitations of the study is that even if the data represent a longitudinal investigation we cannot be completely sure of cause and effect relationships, since chronic pain was not measured at both time points in the same way. Further, the role of the father has not been examined in this study, as a potential source of influence on chronic pain.
The strength of the study lies in the large number of adolescents questioned, the longitudinal nature and the elaborate questions posed to them regarding pain. Future studies should thoroughly explore additional factors relating to maternal vulnerability, such as the specific parenting behavior.
Concerning its potential for clinical practice, the findings suggest that interventions to diminish anxiety complaints and parenting stress in the mother may prevent chronic pain in later phases of adulthood.