September is Pain Awareness Month.
A 2015 NIH analysis shows that Americans are in pain, with most adults having experienced acute to longer-lasting pain, and an estimated 25.3 million American adults having had pain, every day, for the preceding three months before the survey. A new study published in the journal Pain suggests that chronic pain may have familial origins, with parents passing down the risk of chronic pain to their offspring.
Pain is a very complicated discussion, because individuals experience pain differently. If you use the pain scale to rate a person’s pain, the same trauma or surgical procedure may bring very different responses from two individuals. One person may rank the pain after surgery as a four to five (moderate), while another individual may rank it as a full ten (meaning unspeakable or unbearable pain). Persistent lower back pain could be a nuisance to one person, but interfer with another’s day-to-day functioning. Pain is subjective, and chronic pain can be very subjective.
The 2014 HUNT study established a strong link between parents suffering with chronic pain and heightened risk of substance abuse among their offspring. One of the findings in that study was that “parental chronic pain has been associated with increased levels of internalizing symptoms in offspring, which in turn is linked to adolescent substance abuse.” Substance abuse included smoking, alcohol intoxication and drug use. The question that was not completely answered by the study was whether or not the children were actually at risk of inheriting chronic pain from a parent?
The new study suggests that there appear to be five possible mechanisms at play that heighten the risk of developing pain, if your parent suffers with chronic pain:
Among the many traits that children can inherit, children of parents who suffer with chronic pain may be at increased risk for the sensory and psychological components of pain. The study adds to other research that suggests that genetic factors may be responsible for close to 50 percent of chronic pain found in adults.
Early neurobiological development
If a parent or both parents have ongoing chronic pain, it may affect features and functioning of the nervous system during critical periods of development, in utero and after pregnancy. A mother’s level of stress, associated with ongoing chronic pain, or her state of health, can impact certain physical and mental aspects of a baby’s development.
Pain-specific social learning
Children clearly pattern after many of a parent’s behaviors, including food preferences, physical activities and even social skills. So it comes as no surprise that children can also learn maladaptive pain behaviors from a very young age. If mom has exaggerative and dramatic responses to pain, and constantly obsesses or worries about pain, then the child may also begin to show these behaviors and responses. Some children exhibit overwhelming fear of vaccinations, which may be rooted in this mechanism.
Parenting and health habits
Parents who aren’t verbally or physically empathic or demonstrative, or parents who are incredibly permissive, may be setting a child up for unhealthy pain responses. Parents who are not physically active (never fall, get scratched or have mild trauma) may over-react when a child falls or sustains an injury, and that response may condition the child to over-react to pain.
Children who grow up in a household where there is a constant percolating level of adult stress related to chronic pain (such as financial challenges because the impaired parent can’t work), may sustain adverse outcomes including risk of developing chronic pain or poor management of pain.
These five theories help to explain the “why” and “under what specific circumstances” a child may be at risk of developing chronic pain when exposed to a parent or parents struggling with chronic pain. In addition to the five mechanisms, three other potential elements can help to heighten or reduce the impact of the chronic pain on offspring:
- Presence of chronic pain in the second parent
- The timing, course and location of the primary parent’s pain
- Attributes of the child, including gender, developmental stage, race, ethnicity, and inborn temperament of the child.
The researchers hope to develop strategies and therapies to help a child born into a family where chronic pain is a risk factor. The treatment plan would likely have to involve the family unit and focus on cognitive behavioral modification for the parents as well as intervention strategies to help the child during formative years. Prevention strategies could also be developed so that the pregnant mother’s chronic pain issues are less likely to affect the developing child.
Suffering with chronic pain can be incredibly challenging and debilitating, compromising quality of life. Intergenerational efforts that can limit the risk beginning life with a heightened risk for that burden should be a major focus of adult and pediatric healthcare, as well as a focus if prenatal and postnatal care.
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Amy Hendel, also known as The HealthGal, is a Physician Assistant, nutritionist and fitness expert. As a health media personality, she's been reporting and blogging on lifestyle issues and health news for over 20 years. Author of The 4 Habits of Healthy Families, her website offers daily health reports, links to her blogs, and a library of lifestyle video segments.