Browsing by Author "Neville, Alexandra"

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    The Interpersonal Context of Co-occurring Posttraumatic Stress Disorder Symptoms and Pediatric Chronic Pain: The Role of Parent Responses
    (2018-09-18) Neville, Alexandra; Noel, Melanie; Giesbrecht, Gerald; Yeates, Keith Owen; Schulte, Fiona S. M.
    Introduction: Posttraumatic stress disorder (PTSD) symptoms occur at elevated rates among youth with chronic pain and their parents and are associated with worse youth pain outcomes. Interpersonal factors, such as parent distress and protective behaviours, have been posited as key mechanisms likely to influence the persistence of pain and PTSD symptoms in youth. Parent responses to youth pain have been shown to be dynamic over time, pointing to the importance of examining the interpersonal context of pediatric chronic pain using an ecological momentary assessment (EMA) approach. Method: The current study adopted a multi-method approach to examine the role of parent protective responses in the relationship between parent and youth PTSD symptoms and youth chronic pain outcomes, among a sample of youth with chronic pain and their parents. Eighty-four youth with chronic pain (70% female, Mage = 14.2 years), recruited from a tertiary level pediatric chronic pain program, and one of their parents, participated. At baseline, youth and one of their parents participated in a diagnostic clinical interview of internalizing mental health symptoms. Youth also completed self-report measures assessing pain intensity, pain interference, pain unpleasantness, and PTSD symptoms. Parents completed self-report measures of their own PTSD symptoms and protective responses to youth pain. Following baseline assessment, youth and parents completed daily electronic assessments of pain and parent protective responses for 7 days. Finally, youth and parents participated in a lab-visit, where parents and youth engaged in a discussion task following youth completion of the cold pressor task. Results: Findings revealed that higher parent PTSD symptoms predicted a stronger daily association between parent protective behaviours and youth pain unpleasantness, but not youth pain intensity or interference. However, parent protective responses measured with a static questionnaire, parents’ stop tendency following an experimental pain task, and pain attending talk during a discussion task following the experimental pain task, were not associated with youth or parent PTSD symptoms or youth pain outcomes. Conclusion: These findings suggest that parent protective responses to youth pain may be an interpersonal mechanism through which parent PTSD impacts children’s chronic pain symptoms. Additionally, EMA methodology may be a more ecologically valid approach to studying pediatric chronic pain.
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    Uncertainty Among Youth with Chronic Pain, their Parents, and Clinicians
    (2022-08) Neville, Alexandra; Noel, Melanie; Yeates, Keith; Schulte, Fiona
    Objective: Uncertainty is inherent to the experience of chronic primary pain (CPP). Diagnostic uncertainty (DU) has been alluded to in the pediatric chronic pain literature; however, the prevalence, facets, impacts, and drivers of this phenomenon have yet to be explored. The objectives of this dissertation were to explore DU among youth with CPP, their parents, and clinicians, and how it is influenced by the clinical encounter. As well, youth and parent intolerance of uncertainty were investigated as potential risk factors in the Interpersonal Fear Avoidance Model of Pain. Methods: Data included samples of youth with CPP seeking treatment in tertiary level care settings, their parents, and clinicians who treat youth with CPP. These samples spanned three geographical locations, including Canada, the United Kingdom, and the United States. Uncertainty was investigated using a multi-method approach. DU was explored qualitatively from the perspectives of youth, parents, and clinicians, as well as quantitatively among youth and parents. Intolerance of uncertainty was investigated quantitatively using self-report measures. Finally, interpretative phenomenological analysis was used to explore components of the clinical encounter that influence youth’s and parents’ experiences of DU. Results: DU is characterized by fear that something more serious is causing youth’s pain, which fuels a search for alternative diagnoses. Approximately one-third of youth with CPP and their parents experience DU, which is linked to poorer youth pain, pain-related constructs, and health-related quality of life. Clinicians also experience DU treating youth with CPP. Components of the clinical encounter, including pain explanations, validation, and messages of uncertainty, influence youth’s and parents’ experiences of DU, which has implications for youth’s engagement in treatment. Results also suggest that parent and youth intolerance of uncertainty contribute to increases in youth pain interference over time through increased pain catastrophizing, parent protectiveness, and youth fear of pain. Conclusions: This dissertation characterized the multifaceted nature of DU among youth with CPP, their parents, and clinicians, and demonstrated that it is common and often debilitating. Further, parent and youth intolerance of uncertainty play important roles as risk factors in the maintenance of pediatric chronic pain over time.