It's all relative: parent pain-related distress and acceptance as predictors of youth outcomes in chronic pain dyads

Parent emotional and behavioral responses play a critical role in shaping youth pain-related outcomes, yet little research has examined these processes day-to-day overtime. This study investigated the contemporaneous and temporal associations between child pain intensity, pain-related distress, and child functional impairment and parent pain-related distress, protective behaviors, and pain acceptance in a sample of youth with chronic pain and their parents. Daily assessments were collected from 68 youth-parent dyads participating in a study investigating a multimodal intervention for chronic pain. Longitudinal Actor-Partner Interdependence Models were used to examine within-day and next-day associations for child and parent variables. Within the same day, higher parent pain-related distress was associated with greater child pain-related distress (β = 0.10, P = 0.001), as well as increased parent protective behaviors (β = 0.44, P < 0.001). Increased parent pain acceptance was associated with decreased child functional impairment (β = 0.15, P <0.001) and protective behaviors (β = -0.09, P = 0.03). Next-day analyses revealed that higher parent pain acceptance predictors lower child pain-related distress and parent protective behaviors. Child pain reductions predicted lower functional impairment and fewer parent protective behaviors the next day. Findings highlight the importance of targeting parent psychological processes, particularly distress and pain acceptance, in pediatric chronic pain interventions. Addressing parent distress and fostering pain acceptance may lead to improvements in both child and parent outcomes, reinforcing the value of dyadic, acceptance-based approaches in pediatric pain treatment.