Darlington A.S.E., Verhulst F.C., De Winter A., Ormel J., Passchier J., Hunfeld J.A.M. (2011). The influence of maternal vulnerability and parenting stress on chronic pain in adolescents in a general population sample: the TRAILS study. Eur J Pain (2012), 16(1): 150-159
Chronic pain (i.e. suffering from pain in the last 3 months) in children and adolescents is widespread, with prevalences of up to 25% (Perquin et al., 2000; Huguet and Miro, 2008; Stanford et al., 2008). A majority of them report pain in the absence of an underlying physical condition. Investigating possible pychosocial predictors of unexplained chronic pain in adolescents is crucial in understanding its development and prevention. A general population sample of adolescents (n=2230) from the TRAILS cohort study was investigated longitudinally to assess the influence of maternal vulnerability, in terms of anxiety, depression, stress, and parenting stress at age 10-12 years, on the presence of chronic pain at age 12-15 years. Of these adolescents, 269 (12.9%) reported experiencing chronic pain, of which 77% reported severe chronic pain (> 50 mm on a Visual Analogue Scale). Logistic regression analyses showed that mothers with high levels of anxiety, stress or parenting stress were more likely to have a child with chronic pain than those with low levels. Mediation analyses indicated that parenting stress mediates the effect between maternal anxiety, stress, and chronic pain.
One of the limitations of the study is that even if the data represent a longitudinal investigation we cannot be completely sure of cause and effect relationships, since chronic pain was not measured at both time points in the same way. Further, the role of the father has not been examined in this study, as a potential source of influence on chronic pain.
The strength of the study lies in the large number of adolescents questioned, the longitudinal nature and the elaborate questions posed to them regarding pain. Future studies should thoroughly explore additional factors relating to maternal vulnerability, such as the specific parenting behavior.
Concerning its potential for clinical practice, the findings suggest that interventions to diminish anxiety complaints and parenting stress in the mother may prevent chronic pain in later phases of adulthood.
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Janssens K.A.M., Oldehinkel A.J., Verhulst F.C., Hunfeld J.A.M., Ormel J., Rosmalen J.G.M. (2012). Symptom-specific associations between low cortisol responses and functional somatic symptoms: The TRAILS study. Psychoneuroendocrinology. 2012 Mar;37(3):332-40
Background: Functional somatic symptoms (FSS), like chronic pain and overtiredness, are often assumed to be stress-related. Altered levels of the stress hormone cortisol could explain the association between stress and somatic complaints. We hypothesized that low cortisol levels after awakening and low cortisol levels during stress are differentially associated with specific FSS. Methods: This study is performed in a subsample of TRAILS (Tracking Adolescents’ Individual Lives Survey) consisting of 715 adolescents (mean age: 16.1 years, SD = 0.6, 51.3% girls). Adolescents’ cortisol levels after awakening and during a social stress task were assessed. The area under the curve with respect to the ground (AUCg) and the area under the curve above the baseline (AUCab) were calculated for these cortisol levels. FSS were measured using the Youth Self-Report and pain questions. Based upon a factor analysis, FSS were divided into two clusters, one consisting of headache and gastrointestinal symptoms and the other consisting of overtiredness, dizziness and musculoskeletal pain. Results: Regression analyses revealed that the cluster of headache and gastrointestinal symptoms was associated with a low AUCg of cortisol levels during stress (b = -0.09, p = .03) and the cluster of overtiredness, dizziness and musculoskeletal pain with a low AUCg of cortisol levels after awakening (b = -0.15, p = .008). All these analyses were adjusted for the potential confounders smoking, physical activity level, depression, corticosteroid use, oral contraceptive use, gender, body mass index and, if applicable, awakening time. Conclusion: Two clusters of FSS are differentially associated with the stress hormone cortisol.
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