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Joe Speer demonstrates how study participants drank water for the study published in Pain. Photo courtesy of Lynn Walker, Ph.D.

Distraction beats attention at easing kidsí pain

BY: JESSICA HOWARD ENNIS

5/26/2006 - Parents who give extra attention to children who suffer from chronic abdominal pain may actually be making their child feel worse than parents who try to distract them, according to a study at the Monroe Carell Jr. Children's Hospital at Vanderbilt.

Lynn Walker, Ph.D., director of Adolescent Medicine and Behavioral Science, was the lead author of “Parent attention versus distraction: Impact on symptom complaints by children with and without chronic functional abdominal pain,” published recently in the journal Pain.

“Chronic abdominal pain is one of the most frequent reasons that children are referred to the Pediatric Gastroenterology Clinic at Children's Hospital,” Walker said. “In most cases, the medical evaluation shows no evidence of organic disease that can be treated effectively with medication. Instead, the symptoms are ‘functional’ — the pain signaling system between the brain and the gut is not working normally, so minor sensations are amplified and become painful.”

Walker's research aims to identify ways parents can help children cope with chronic pain. This study's objective was to determine whether distracting or paying attention to the symptoms of children with functional chronic abdominal pain would have different outcomes.

The results were dramatic — complaints by both pain patients and well children nearly doubled when parents responded to them with sympathetic attention, and were reduced by half when parents distracted them.

“We found that when parents were sympathetic and reassuring, children complained of the most discomfort,” Walker said. “When parents talked about something else, children got involved in the conversation and seemed to forget about how they were feeling.”

According to Walker, the study's results show that pain is not simply a matter of tissue damage due to disease or injury.

“Attention influences our experience of pain,” Walker said. “The conscious mind can focus on only so much, so when parents distract their children from pain they may actually reduce their children's suffering.”

Study participants included 104 “pain” patients seen at the Pediatric Gastroenterology Clinic and 119 “well” children from Cheatham County public schools. The children ranged from 8 to 16 years of age. Each child was accompanied by a parent who also participated in the study.

The children were instructed to drink water out of a tube connected to a hidden reservoir until they were completely full. This typically produces abdominal discomfort similar to, but not as intense, as what chronic abdominal pain patients experience.

The parent participants were randomly assigned to one of three groups — attention, distraction and no instruction. Without children knowing, parents in the attention and distraction groups were trained with a videotape and role-playing to respond to their children's symptom complaints once the children drank the water.

Shortly after the children ingested the water, their parents interacted with them.

Parents in the attention group made statements to their children such as: “What does it feel like?” and “I'm so sorry, but you'll feel better soon.” The distraction group made statements including: “Let's talk about something else to get your mind off it.” and “What would you like to do this evening?” The conversations were audiotaped, coded and analyzed.

After interacting with their parents, children rated the extent to which their parents had made them feel better. Children whose parents were in the distraction group gave their parents significantly higher ratings than children whose parents were in the attention group.

“Parents who know about the power of distraction can use it to help their children cope with pain” Walker said. “Our study showed that parents can learn distraction techniques fairly easily. In the future, we'd like to teach parents of children with chronic pain to use these techniques in real-life situations.”

In addition to the study finding that participants who were distracted by their parents complained of less discomfort, girls in the chronic pain group who received attention made more symptom complaints than boys of the same group.

“In our culture, it is more acceptable for girls than boys to complain of aches and pains,” Walker said. “In fact, based on the audiotapes from the study, it appeared that some of the older boys were irritated by their parents' attention.”

Parent participants included almost all mothers, and Walker would like to do another study in which mothers and fathers were more equally represented.

“We'd like to see whether attention and distraction from fathers has the same impact as from mothers, and whether girls and boys respond differently to parents of the same or opposite gender,” Walker said.

Other authors of the study, which was funded by a grant from the National Institute of Child Health and Development, were Sara Williams, graduate student; Craig Smith, Ph.D.; Judy Garber, Ph.D.; Deborah Van Slyke, Ph.D.; and Tricia Lipani, graduate student.

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