Adolescent’s Response to Pain (Ayuste, Boncodin)

- Adolescence is a developmental period where communication about chronic health problems can
become problematic.
- Adolescent patients are likely better able to comment on their subjective pain and can offer their
own distinct impressions about their global pain experience. (2, 36)

In a study by Lagerløv, et.al. entitled “How adolescents experience and cope with pain in daily life: a
qualitative study on ways to cope and the use of over-the-counter analgesics”, 25 adolescents were
interviewed to explore their different management responses to pain with an emphasis on their usage of
over-the-counter analgesics. The study was able to identify four major groups from the participants
classified with varying responses to stress management. The following are:

1. Pain is manageable.
Participants under this group described pain as a “nuisance” to their daily activities; however,
they still view it as something still manageable. When pain is felt, they usually use stepwise
strategies as to what to do (e.g. “If my back hurts, then I have learned some exercises I can do,
and, for instance, if I am to lie flat on the floor, I put a pillow under here…”). Adolescents under
this category are usually involved in sports and active leisure activities and find pain as not
bothersome.
2. Pain is communicable.
Emotional support is an important aspect of pain management among adolescents under this
category. They were bothered by pain and “felt emotionally affected by it”. Thus, they see
communication as an aid in managing their pain as well as receiving inputs from other people
including their peers and family as to what to do.
3. Pain is inevitable.
“When in pain, the goal was to deal with the pain using the remedies offered to them, often
resulting in a trial-and-error approach. The pain is inevitable group might have asked for help
when it was time to give in. These participants would involve their parents during pain, but it was
seldom a topic among peers.”
4. Pain is all over.
Participants under this group had completely resigned to pain and usually felt depressed over the
fact that they have no systematic strategy to manage their pain but would like to be aware of pain
management strategies. They practice passive coping which usually results to helplessness which
goes hand in hand with depression.
Adolescents with chronic pain often report changes in social and physical functioning such as:

 Reduction in the activities that make up every day physical activity such as walking and sitting
unaided, the amount of rest required outside normal sleeping, and disturbances in self-
management behaviour such as eating and washing (Hunfeld et al., 2002).
 Unwelcome changes in social and schooling/occupational activities are also commonly reported
(Reid et al.,1997).
 Negative changes in global affective domains such as depression and anxiety (Andrasik et al.,
1988; Conte, Walco, & Kimura, 2003)
 More specific change in psychosocial functioning such as an anxious sensitivity to a wide range of
physical sensation (Smith, Martin-Herz, Womack, & Marsigan, 2003).

Adolescent Coping

According to the biopsychosocial mode, there is no single factor that can account for the myriad of child
behaviors associated with chronic pain. Instead, the complex interaction between physical, psychological
and social factors all affect the pain experience (Drossman, 1998; Engel, 1977; Gatchel et al., 2007; Wood,
1995).

Erik Erikson’s Psychosocial Theory

REFERENCES:

Andrasik, F., Kabela, E., Quinn, S., Attanasio, V., Blanchard, E. B., & Rosenblum, E. L. (1988). Psychological
functioning of children who have recurrent migraine. Pain, 34(1), 43–52.

Lagerløv P, Rosvold EO, Holager T, et al. How adolescents experience and cope with pain in daily life: a
qualitative study on ways to cope and the use of over-the-counter analgesics. BMJ Open 2016;6:e010184.
doi:10.1136/bmjopen-2015010184
Merlijn, V., Hunfeld, J. A. M., van der Wouden, J. C., Hazelbroek-Kampschreur, A., & Passchier, J. (2002).
Shortening a Quality of Life Questionnaire for adolescents with chronic pain and its psychometric qualities.
Psychological Reports, 90, 753–759.

Reid, G. J., Lang, B. A., & McGrath, P. J. (1997). Primary juvenile fibromyalgia – psychological adjustment,
family functioning, coping, and functional disability. Arthritis and Rheumatism, 40, 752–760.

Smith, M. S., Martin-Herz, S. P., Womack, W. M., & Marsigan, J. L. (2003). Comparative study of anxiety,
depression, somatization, functional disability, and illness attribution in adolescents with chronic fatigue
or migraine. Pediatrics, 111(4, Pt. 1), e376–e381.