Potential Mechanisms of Transmission of Chronic Pain from Parents to Children

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Reinforcement by parents of pain behaviors like activity avoidance in their children, a factor underlying transmission of chronic pain.
Reinforcement by parents of pain behaviors like activity avoidance in their children, a factor underlying transmission of chronic pain.

An estimated 10-40% of adults have chronic pain not associated with disease, and children of parents with chronic pain have increased risk for pain and adverse health outcomes such as disability and psychological dysfunction. Despite the established link, there is little data on the processes underlying it. In a new review published in Pain, researchers at Vanderbilt University and Oregon Health & Science University proposed a “conceptual model for the intergenerational transmission of chronic pain from parents to offspring with the goal of setting an agenda for future research and the development of preventive interventions,” they wrote.1


Their model describes 5 potential mechanisms:

Genetics. In the limited data on genetic influences on pediatric chronic pain, heritability estimates vary based on age and type of pain. Adult studies show genetic factors contribute to approximately 50% of chronic pain risk and influence co-occurring sensory and psychological factors that might influence chronic pain development.

Alterations in early neurobiological development. Having parents with chronic pain could contribute to neurobiological changes that “may increase vulnerability to chronic pain, particularly pain processing and ability to process and regulate emotions,” according to the paper. For example, maternal stress during pregnancy is linked with impaired stress response in infants.

Pain-specific social learning. Parental modeling of pain behaviors –like activity avoidance– and reinforcement of children's similar behaviors may influence their pain beliefs and risk. Pain catastrophizing could further influence parental behaviors and is associated with outcomes such as increased functional disability and depressive symptoms.

General Parenting and Health Habits. Parents may influence chronic pain development in children through certain types of parenting behaviors –for example, difficulty responding to child distress or providing warmth. Parents with chronic pain may not be able to model physical activity, low levels of which are connected with increased pain.

Exposure to stressful environment. Because chronic pain is influenced by stress, family functioning and stress –from financial or marital problems, for instance– may increase children's risk.  

The review also describes 3 moderators of these risks:

Moderator 1: Pain status and the presence of second parent. When both parents have chronic pain, children are more at risk than those who have 1 affected parent, as the healthy co-parent may be a buffer and source of support.

Moderator 2: Timing, course, and location of parental chronic pain. Longer duration of parental chronic pain may provide more exposure for children to learn pain-related fears and behaviors. Some evidence also shows a “relation between parent and child chronic pain for a specific congruent body location (eg, head pain),” the authors reported.

Moderator 3: Children's characteristics. Child characteristics –such as sex, race or ethnicity, developmental stage, and temperament– may moderate the association between parental and pediatric chronic pain.  

The authors say future research should focus on biological factors that influence the development of chronic pain in children, as well potentially preventive factors and effective family interventions.

Reference

 1.  Stone AL, Wilson AC. Transmission of risk from parents with chronic pain to offspring: an integrative conceptual  model. Pain. 2016; DOI: 10.1097/j.pain.0000000000000637

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