Patient Versus Parental Perceptions about Pain and Disability in Children and Adolescents with a Variety of Chronic Pain Conditions

Thomas R Vetter,Avi Madan-Swain,Cynthia L Bridgewater,Lee I Ascherman,Gerald L Mcgwin

doi:10.1155/2014/736053

Abstract

Cross-informant variance is often observed in patient self-reports versus parent proxy reports of pediatric chronic pain and disability. To assess the relationship and merit of the child versus parent perspective. A total of 99 patients (eight to 17 years of age [mean 13.2 years]; 71% female, 81% Caucasian) and parents completed the Pediatric Pain Questionnaire and Functional Disability Inventory at their initial clinic visit. Patients' and parents' pain intensity and disability scores were analyzed using an intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland-Altman plot and Spearman's correlation coefficient. The association between clinical⁄demographic variables and differences in patient⁄parent pain intensity and disability scores was assessed using multivariable regression. There was significant agreement between patients' self-reports and parents' proxy reports of their child's pain intensity (ICC=0.52; P<0.001) and disability (ICC=0.57; P=0.004) at the individual level. There were no significant group differences in patient versus parent-proxy pain intensity scores (P=0.40) and disability scores (P=0.54). The difference between patient and parent-proxy pain intensity was associated with patients' self-reported pain intensity (P<0.001). The difference between patient and parent-proxy disability was associated with patient's self-reported pain disability (P<0.001). Bland-Altman plots revealed major inter-rater variation in the Pediatric Pain Questionnaire and Functional Disability Inventory across their score ranges. A significant relationship (r=0.38; P<0.001) was observed between patients' self-reported pain intensity and disability. While equal merit should ideally be given to pediatric chronic pain patients' self-reports and their parents' proxy reports of pain intensity and disability, it would appear that, as needed, pediatric patients or parents can offer a clinically valid, single clinical perspective.

Highlights

Cross-informant variance is often observed in patient self-reports versus parent proxy reports of pediatric chronic pain and disability
Based on the present and previous samples of patients, there may be a lack of complete agreement within the parent-child dyad regarding pain intensity and functional disability
While each offers an important and valid perspective on the pediatric pain experience, children and adolescents successfully communicating an appraisal of their own chronic pain and its adverse personal impact can be vitally therapeutic [19,52]

Summary

Introduction

Cross-informant variance is often observed in patient self-reports versus parent proxy reports of pediatric chronic pain and disability. The association between clinical/demographic variables and differences in patient/parent pain intensity and disability scores was assessed using multivariable regression. There were no significant group differences in patient versus parent-proxy pain intensity scores (P=0.40) and disability scores (P=0.54). Bland-Altman plots revealed major inter-rater variation in the Pediatric Pain Questionnaire and Functional Disability Inventory across their score ranges. Conclusions: While equal merit should ideally be given to pediatric chronic pain patients’ self-reports and their parents’ proxy reports of pain intensity and disability, it would appear that, as needed, pediatric patients or parents can offer a clinically valid, single clinical perspective

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