How does caregiver protectiveness change between pain states and across different contexts? A vignette study of expected responses to pain.

Greater caregiver protectiveness is often associated with poorer outcomes in children and adolescents with pain. However, there is a lack of understanding about the specific contexts of where protectiveness might be higher or lower, depending on the pain state or activity the child is participating in. This study aimed to disentangle caregiver protectiveness between pain state (acute, chronic, and no pain) and context (sports, schoolwork, chores, social events). We recruited 159 caregivers of children between 12 and 18 years of age via Prolific to an online vignette study. Caregivers were presented with vignettes describing sports, schoolwork, chores, and social events and asked to rate how likely they were to stop their child from participating in the described activity. Caregivers responded to vignettes three times; when considering their child had no pain, acute pain, and chronic pain. They also completed questionnaires on anxiety, depression, catastrophising, and fear of pain. Vignettes describing sports elicited significantly greater caregiver protectiveness compared to chores, schoolwork, or social events. Regarding pain type, while caregiver protectiveness significantly differed between instances of imagined no pain and experienced pain, no significant differences were observed between imagined experiences of acute and chronic pain. Contrary to hypotheses, higher caregiver anxiety was associated with lower caregiver protectiveness. This study provides more context about situations when caregiver protectiveness increases. PERSPECTIVE: Caregiver protectiveness is higher for imagined pain vs non-pain contexts but does not differ between acute and chronic pain. Caregivers reported higher protectiveness for vignettes describing sport, followed by chores, social events, and were least protective of children doing schoolwork.