Pain self-management in adolescents: a psychosocial approach to understanding the acquisition of knowledge, attitudes and behaviors

Hatchette, Jill Elizabeth (2004) Pain self-management in adolescents: a psychosocial approach to understanding the acquisition of knowledge, attitudes and behaviors. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Objective: Adolescents independently self-medicate for a variety of recurrent pain types (e.g. muscle pain, headache, back pain and menstrual pain). Over-the-counter analgesic use is high among this age group and some research suggests that use is sometimes inappropriate and knowledge is poor. To date, no known research has specifically addressed how adolescents acquire attitudes about pain and pain management and how attitudes affect pain management practices. Two qualitative studies and one quantitative study were designed to address these questions. -- Participants: Study 1 participants were 24 junior high school students from Halifax, Nova Scotia (11 male: M = 13.45 yrs, SD = .93, range= 12-15 yrs; 13 female: M= 13.31 yrs, SD = .85, range 12- 15 yrs). Study 2 participants were 20 parent-adolescent dyads, from St. John's Newfoundland, composed of 20 mothers (M = 42.72 yrs, SD = 5.42, range 29-52 yrs), 10 male adolescents (M = 13.6 yrs, SD = 1.43, range 12- 16 yrs) and 10 female adolescents (M = 13.4 yrs, SD = 1.07, range 12- 15 yrs). Study 3 participants were also recruited in St. John's Newfoundland and consisted of 139 adolescents (50 male, M = 14.24 yrs, SD = .89 yrs, range = 13- 16 years; 89 female, M = 13.83 yrs, SD = .99 yrs, range = 12 - 16 years,) and their parents (6 male, M = 46 yrs, SD = 2.61, range = 41-48 yrs; 133 female, M = 41.85 yrs, SD = 3.26 years, range = 34-50 yrs). -- Method: Qualitative methods were used in both studies 1 and 2. Study 1 employed focus groups in order to determine pain and pain management issues relevant to adolescents, with a focus on peer influences. Study 2 employed semi-structured face-to-face interviews with parent-child dyads in order to determine the parental influences on pain and pain management attitudes and practices. Study 3 employed a survey method delivered via telephone. Adolescent-parent dyads were recruited for studies 2 and 3 in order to assess direct links in attitude and practice, providing evidence for the intergenerational transmission of pain-related attitudes and behaviors. -- Main Outcome Measures: Demographic data were collected from all participants in all three studies (e.g. age, grade, pain type, frequency, intensity, treatment choice) using the Pain Incident Questionnaire. These data were subject to descriptive data analysis. For studies 1 and 2, primary outcome measures were the textual data from focus group and interview sessions. Qualitative content analysis was used to reduce textual data to the central themes that emerged most prominently from focus group and interview sessions. For study 3, the Pain Management Questionnaire was developed to assess pain occurrences (type, frequency and intensity), attitudes toward over-the-counter medications and knowledge about over-the-counter medications. An additional focus of Study 3 was to develop and assess a measurement tool assessing attitudes toward over-the-counter medications. -- Results: Pain complaints reported by adolescents were mainly headache, muscle/joint ache, menstrual pain, sprains and short-term pain associated with acute episodes such as falls or bumps. For adolescents, peers were influential in the expression of pain; gender differences in children's socialization of appropriate pain responses are discussed. In the qualitative studies, mothers were particularly influential in transmitting information about pain and pain management through verbal communications and their own pain and pain management behaviors. Mothers emerged as essential facilitators of their children's independent pain management. The intergenerational transmission of information about pain and pain management strategies was apparent in textual data, but less clear in quantitative data. -- Conclusions: The findings from these studies provide a fuller understanding of the adolescent recurrent pain experience. How adolescents learn about, and develop attitudes toward pain, pain, pain behaviors and pain management strategies are presented in a socio-communications model that stresses the influence of peers and mothers. Contributions to the current pain literature as well as study limitations and future directions are discussed.

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