The influence of psychological, social, and neurobiological factors on ‘everyday’ childhood pain experiences
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Introduction: The Early Years period (0-5 years) is a critical time of physical, social, and emotional development. During this period, acute ‘everyday’ pain incidents, such as those leading to bumps, scrapes, and cuts, are some of the most frequent pain experiences for pre-school-aged children (2-5 years of age), and parents typically guide their children through these experiences by offering comfort and support. The biopsychosocial model of pain posits that pain experiences are constructed from the interaction of biological, psychological, and social influences, and this model has previously been used to explore parental influences during child pain experiences in clinical contexts. However, similar research exploring parental influences on their child’s experiences with everyday pains is lacking, and more specifically, research describing everyday pain experiences during the preschool period is sparse, despite the frequency of everyday pains for pre-school-aged children and the opportunities these provide for investigating mutual biopsychosocial influences between parent and child. This thesis explored the association between parental social support and the experience of their pre-school-aged children during ‘everyday’ pain incidents. Studies 1 and 2 explored psychosocial influences during everyday pain in parent-child pairs using novel observational and diary methodologies, while Study 3 employed preclinical laboratory methods to explore the biological mechanisms associated with pain experienced in juvenile rats across different social contexts. Methods: In Study 1, 12 families were video recorded within their own home either with or without a researcher present, to capture the natural context for everyday pains. These methods were evaluated against an existing method for capturing everyday pain behaviour, a behavioural checklist used in day-care centres. In Study 2, the use of diary-keeping to report on their child’s everyday pains was explored in a sample of 21 parents, and a novel EMA (ecological momentary assessment) was trialled in 9 parent-child pairs to capture real-time insights into their child’s everyday pain events. In Study 3, two cohorts of juvenile female rats (10 in each group) underwent a series of pain and nociceptive tests, either in the presence or absence of the mother (“dam”). Behavioural data was analysed, and brain tissue samples were compared against a behaviourally-naïve control group (N = 10). Results: Findings from Study 1 established that children respond differently to everyday pain experiences when alone with their parent versus when a researcher was also present. The presence of researchers and video-recording equipment proved disruptive to the family’s natural environment, affecting the frequency of pain events, the distress that children demonstrated, and the parent’s ability to act naturally. In Study 2, the diary proved an acceptable method of capturing everyday pain events, without disrupting the natural environment. Contextual factors such as parental levels of distress and catastrophizing were a strong influence on parental responses to their child’s everyday pain experience. Parental expectations of their behaviours and thoughts during their child’s pain experiences were not strongly associated with their actual behaviours and thoughts. The EMA revealed that parent and child ratings of pain diverge significantly, with children giving substantially higher ratings than their parents. Study 3 revealed that juvenile female rats isolated from the dam demonstrated blunted responding to thermal and mechanical testing but demonstrated hyper-sensitivity to cold and inflammatory pain testing, compared to rats experiencing pain in the presence of the dam. Social support from the dam was associated with reduced levels of anandamide in the prefrontal cortex, while the experience of pain itself resulted in decreased expression of CB2 receptors, compared to the control group. This suggests that pain may be expressed within the brain through alterations to the endocannabinoid system within the prefrontal cortex. Conclusions: These findings confirm that a child’s everyday pain experiences are heavily influenced by psychosocial factors present in their environment during the pain incident. Parental behaviours are a particularly strong indicator of their child’s response to pain, with adaptive behaviours and responses being generally regarded to improve the experience of pain for their child and the psychological wellbeing of both parent and child. Finally, social support during pain experiences is associated with biological changes within the brain. These findings are consistent with previous literature indicating that parents can influence their child’s behaviour during painful experiences in clinical settings. Further investigation is needed to confirm whether parent-child interactions are consistent between different types of pain and between pain experiences in different contexts (e.g., everyday versus clinical experiences; longitudinal observations; cultural values). The continued integration and translation of knowledge between preclinical and clinical research is vital to enriching the study of pain in pre-schoolers.
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