An estimated 25% of children and adolescents report having pain that persists for more than 3 months, with severe and disabling pain affecting 8% of this population.1 As is the case in other age groups with chronic pain, these individuals face a number of physiological, psychological, and social challenges with varying degrees of resilience.
In a review published in Pain Research and Management, Annina Riggenbach, PhD, of the Family and Development Center at the University of Lausanne, Switzerland, and colleagues examined the evidence regarding the role of 3 basic psychological needs — autonomy, competence, and relatedness — in the modulation of disease-related disability in adolescents with chronic pain.1
According to the Self-Determination Theory proposed by the review authors, the satisfaction of these needs “would be essential for psychological growth, subjective well-being, and optimal human functioning, whereas their frustration would lead to maladjustment and the development of psychopathology.” Some researchers have postulated that need frustration may be associated with reduced motivation.2
Other studies indicate that environmental factors play an important role in modulating need satisfaction and well-being. For pediatric patients, these factors include parenting style. Studies support the notion that autonomy-supportive parenting may predict need satisfaction, and that controlling parenting may predict need frustration.1
The frustration of basic needs “may explain why chronic pain is predictive of diminished goal pursuit, disability, and functional diﬃculties, hence playing a mediating role,” according to the review authors. “At the same time, the contextual support of [the patients’] needs may play a moderating role…. [as a] …resilience factor that explains why some adolescents do well… even under conditions of high pain.”
Conclusions from studies in which factors that underlie adaptive functioning in adolescents were examined and are summarized below.
Autonomy. The Self-Determination Theory defines autonomy as “volitional functioning” rather than independence. In a 2014 study, teachers’ support of autonomy in adolescent patients with chronic pain was linked with higher school functioning (ie, greater attendance, better grades, and fewer instances of being bullied by peers).3 In other research, support of autonomy by partners and healthcare providers was associated with positive effects on adjustment, treatment adherence, and treatment outcomes in adults with chronic pain.1
Competence. As reported in a review published in 2016, feelings of incompetence in “adolescents with chronic pain were associated with increased activity avoidance and disability and limited the development of adequate strategies to manage pain.”1,4
“Prolonged avoidance and absenteeism might in turn intensify the feeling of incompetence and decrease the motivation to attend school or any other activity, thus creating a downward spiral,” noted the current review authors.
In addition, self-efficacy, an aspect of competence, has been linked with higher quality of life and self-esteem, lower levels of pain, and fewer behavioral and psychological symptoms.5,6 Overall, support of adolescents’ need for competence by teachers, parents, and peers is thought to be associated with fewer somatic symptoms, better functioning, higher school attendance, a lower likelihood of avoidance mechanisms use, and reduced disability.