Family- and Adolescent-level Predictors and Moderators of Treatment Compliance and Functional Impairment in Pediatric Chronic Pain

Abstract

Pediatric chronic pain is a common developmental health problem with negative effects that can influence youth throughout their lives. Cognitive behavioral therapy is an efficacious treatment for pain management; however, treatment compliance among adolescents is a major problem. Emerging research suggests that some family-level factors play a role in treatment engagement and outcomes. Moreover, adolescents with greater coping and resilience strategies are more likely to benefit from treatment. However, it is not clear to what extent (a) other family factors predict short-term (3-month) and long-term (6-month) treatment compliance among adolescents with chronic pain, (b) adolescent-level factors predict treatment compliance, and (c) family-level factors interact with adolescent-level factors to predict treatment compliance (i.e., through moderating pathways). In addition, the association of family-level risk factors and adolescent-level resilience factors with functional impairment needs to be further investigated. To address these gaps, the current study explored factors that may predict treatment compliance and functional impairment within a multidisciplinary pediatric pain management program. Sixty-four adolescents (M = 15.00 ± 1.69 years; 85.9% female; 84.4% Caucasian, 6.3% African American/Black, 1.6% Hispanic/Latino, 1.6% Asian, 4.7% Mixed Race, 1.6% “Other”) diagnosed with chronic pain and their primary caregivers were assessed at three time points: their initial intake in the program (N=64), 3-months post-intake (n=62), and 6-months post-intake (n=61). Most family-level and adolescent-level factors, as well as the interaction of these factors, did not predict improved treatment compliance. However, consistent with prior research, several family-level and adolescent-level factors were associated with increased functional impairment among this sample. Study limitations and statistical concerns warrant that these findings be interpreted with caution. Results contribute to our understanding of the importance of family-level factors within the developmental context of adolescence, while also highlighting the need for investigating other relevant influences towards treatment compliance and functional impairment. Delineating such characteristics can inform assessment, as well as tailor treatment targets, recommendations, and outcomes among adolescents with chronic pain within a multidisciplinary treatment setting.