Pain Catastrophizing in Youths With Physical Disabilities and Chronic Pain

Pain catastrophizing can be defined as excessively negative thoughts related to pain, its impact, and one’s ability to cope with pain (Sullivan et al., 2001). Recent research suggests that catastrophizing in children with chronic pain is associated with pain intensity (Crombez et al., 2003), psychological distress, and physical functioning (Kashikar-Zuck, Goldschneider, Powers, Vaught, & Hershey, 2001). When excessive attention is paid to pain, an individual may avoid activities that could potentially be painful, and therefore experience a decrease in functioning (Vlaeyen & Linton, 2000). However, none of this research has been conducted using samples of children with physical disabilities. Cerebral palsy (CP), spina bifida (SB), and neuromuscular disease (NMD) are distinct conditions; however, they all have, or have the potential for, musculoskeletal, neurological, and cognitive impairments. Furthermore, pain is a common experience among children with CP (Engel, Petrina, Dudgeon, & McKearnan, 2005; Parkinson, Gibson, Dickinson, & Colver, 2010; Tuzun, Guven, & Eker, 2010), SB (Wood, Watts, Hauser, Rouhani, & Frias, 2009), and NMD (Engel, Kartin, Carter, Jensen, & Jaffe, 2009). The experience of pain has also been found to be related to decreased quality of life in children with CP (Tuzun et al., 2010) and SB (Oddson, Clancy, & McGrath, 2006) and severity of physical impairment in children with CP (Parkinson et al., 2010). It is important to consider other variables that are related to functioning in this population. The purpose of this study is to determine whether the significant associations found between catastrophizing and adjustment in samples of youths without physical disabilities replicate in youths with physical disabilities. Lazarus and Folkman’s stress-coping model provides a theoretical framework for understanding how appraisal processes—of which catastrophizing can be a key component—impact coping and emotional responses (Lazarus & Folkman, 1984). In their model, a person’s ongoing evaluations of his or her situation directly influence how one responds to that situation, and explains how different people can respond in many ways to the same situation. They distinguish between primary appraisals (the implications of the situation for one’s well-being), and secondary appraisals (thoughts related to what can be done to address the situation). Catastrophizing cognitions are stress evaluations that have both primary (e.g., “It is terrible and I feel it is never going to get any better.”) and secondary (e.g., “I feel I can’t go on.”) components. The fear-avoidance model of chronic pain states that individuals with these negative expectancies about pain and the consequences of pain are likely to avoid activities in anticipation of pain. Avoiding physical and social activities results in a significant increase in functional disability and deconditioning of one’s body over time, which can lead to further painful experiences (Asmundson, 1999; Vlaeyen & Linton, 2000). Children with chronic pain report higher levels of catastrophizing than children without chronic pain (Hermann, Hohmeister, Zohsel, Ebinger, & Flor, 2007). Moreover, catastrophizing has been found to be positively correlated with pain severity in a number of samples of youths with chronic pain. For example, Schanberg and colleagues found that youths with juvenile chronic arthritis who reported infrequent catastrophizing rated their pain significantly lower than did those who catastrophized frequently (Schanberg, Lefebvre, Keefe, Kredich, & Gil, 1997). Similarly, Thastum and colleagues and Walker and colleagues found that catastrophizing responses were associated with higher pain in a sample of youths with juvenile idiopathic arthritis and abdominal pain, respectively (Thastum, Herlin, & Zachariae, 2005; Walker, Smith, Garber, & Van Slyke, 1997). Catastrophizing predicts pain intensity in children with chronic pain above and beyond the effects of sex, age (Crombez et al., 2003), and negative affectivity (Vervoort, Goubert, Eccleston, Bijttebier, & Crombez, 2006). Furthermore, a longitudinal study found that catastrophizing predicts pain intensity 6 months later, controlling for initial pain intensity and level of disability (Vervoort, Eccleston, Goubert, Buysse, & Crombez, 2010). In addition to pain intensity, Walker et al. (1997) also found that catastrophizing predicted depressive symptoms. Finally, Kashikar-Zuck et al., (2001) found that catastrophizing was related to both depression and functional impairment in youths with a variety of chronic pain conditions, although they did not find that catastrophizing cognitions predicted functional ability over and above the contribution of depression, as has previous research in adults with chronic pain (Keefe et al., 2000). Vervoort et al. (2006), however, found that catastrophizing did predict disability beyond sex, age, and negative affectivity in both community and clinical samples of children. Despite some inconsistency regarding which domains are most useful in predicting future pain, the consistent findings that catastrophizing and important functioning domains are related in both pediatric and adult chronic pain samples (e.g., Severeijns, Vlaeyen, van den Hout, & Picavet, 2004; Sullivan, Stanish, Waite, Sullivan, & Tripp, 1998; Vervoort et al., 2006, 2010), as well as theory hypothesizing strong links between catastrophizing and important outcomes, suggest the possibility that catastrophizing may play a critical role in the extent to which pain impacts functioning in children with physical disabilities and chronic pain. We expected that, consistent with previous research in samples of youths with chronic pain as a primary presenting problem, pain intensity would be positively associated with pain catastrophizing, and psychological adjustment, functional ability, and community participation would be negatively associated with pain catastrophizing regardless of age, sex, and disability type. The aim of the current study was to determine the associations between catastrophizing and pain intensity, psychological adjustment, and functional ability in youths with physical disabilities and chronic pain. The sample comprised youths with CP, NMD, and SB who reported persistent bothersome pain. The primary difference between the current study and previously published studies is the focus on catastrophizing and pain in youths with physical disabilities. We expected that, consistent with previous research in samples of youths with chronic pain as a primary presenting problem, pain intensity would be positively associated with pain catastrophizing, and psychological adjustment, functional ability, and community participation would be negatively associated with pain catastrophizing regardless of age, sex, and disability type.