RT Journal
A1 Palermo TM, Holley A
T1 THe importance of the family environment in pediatric chronic pain
JF JAMA Pediatrics
JO JAMA Pediatrics
YR 2013
FD January 1
VO 167
IS 1
SP 93
OP 94
DO 10.1001/jamapediatrics.2013.428
UL http://dx.doi.org/10.1001/jamapediatrics.2013.428
AB 
The impact of chronic pain during childhood and adolescence has been well described (eg, see Palermo1). Some youths with chronic pain also have high levels of anxiety and depressive symptoms, a poor quality of life, and difficulties participating in school and other activities.2- 4 Moreover, this chronic pain has an effect on the entire family. Parents of children with chronic pain report increased parenting stress, anxiety, and depressive symptoms; financial strain; and family dysfunction.5- 6 Parents also play a critical role in their child's ability to adapt to living with chronic pain, both in terms of their child's emotional functioning and in terms of their child's ability to participate in activities of daily life. For example, increased psychological distress in parents is recognized as a risk factor for poorer outcomes in youths with chronic pain.5,7 A bidirectional relationship between family environment (eg, parental responses to pain behavior) and children's pain experience has been described in Palermo and Chambers,8 who found that parent and family factors may increase the risk for pain and disability, and, in turn, pain and disability may impact the parents and family life.