Disentangling the complex relations among caregiver and adolescent responses to adolescent chronic pain.

The social context surrounding chronic pain is important, particularly in the case of pain in adolescents, where caregivers can be a key influence on adolescent social and physical activities. In general, greater adolescent difficulties are related to greater caregiver difficulties, and vice versa, although the strength of these relations has not been consistent across studies. Further, existing analyses have not evaluated more complex multivariate models involving both direct and indirect relations among adolescents and caregivers. There is consequently a lack of clarity in this area. The present analyses represent an initial attempt at explicating more precisely how adolescent and caregiver behaviors in response to pain influence adolescent functioning. Initially, a hypothetical model was constructed that included caregiver pain management behaviors, as well as adolescent and caregiver psychosocial responses to pain. The adequacy of this model was first evaluated with Pearson correlations and then with structural equation modelling using data from 120 adolescent-caregiver dyads. After some modification of the model to allow for adequate fit with the data, findings indicated that caregiver variables were only indirectly related to adolescent functioning via adolescent psychosocial responses to pain. This indirect relation may explain previous inconsistency across studies. Perhaps more importantly, the model tested may allow for an improved understanding of the complex relations among adolescents and caregivers factors. Finally, the need to adequately understand caregiver experiences in response to adolescent pain is highlighted and calls for appropriate intervention in young people struggling with chronic pain are reinforced within these analyses.