CHILDREN’S MEMORY FOR PAIN: EXPERIMENTAL INVESTIGATIONS OF THE ROLE OF ANXIETY IN CHILDREN’S PAIN MEMORIES AND THE INFLUENCE OF PAIN MEMORIES ON SUBSEQUENT PAIN EXPERIENCE
Noel, Melanie Elizabeth
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Children are often required to repeatedly undergo painful medical procedures (e.g. immunizations) and their memories for pain are predictive of their health behaviours across the lifespan. Although trait anxiety has been shown to influence pain memories, little is known about the impact of state anxiety, and the influence of stable anxiety-related variables (e.g., anxiety sensitivity), on children’s memories for pain. Furthermore, although memory is often implicated in children’s reactions to future pain, there is a dearth of research directly examining the relationship between the two. The current dissertation project involved two studies. The first study investigated the impact of experimentally manipulated state anxiety, and the influence of anxiety-related variables, on children’s memories for a novel pain experience. The second study examined the influence of children’s pain memories on a subsequent pain experience. In Study 1, one hundred ten children (60 boys; 50 girls) between the ages of 8 and 12 years (Mage = 9.45 years, SD = 1.35) were randomly assigned to complete either a state anxiety induction task or a control task. Then, children completed a laboratory pain task (the cold pressor task) and provided pain ratings. Children also completed measures of state anxiety and stable anxiety-related variables. Two weeks following the laboratory visit, children were contacted by telephone and provided pain ratings based on their memories of the initial pain experience, as well as their expectancies about future pain. Results showed that children in the state anxiety induction group did not have more negative pain memories (i.e., they did not recall higher levels of pain) than children in the control group. However, irrespective of group assignment, children who had higher levels of state anxiety had more negative memories of pain intensity and pain-related fear than children with lower levels of state anxiety. Furthermore, state anxiety was a unique predictor of children’s pain memories over and above the influences of sex, stable anxiety-related variables, and experienced pain intensity and pain-related fear. Stable anxiety-related variables (anxiety sensitivity and trait anxiety) were also significant predictors of recalled pain-related fear. In Study 2, the same children once again completed the pain task and provided pain ratings one month following the initial laboratory visit. Results revealed that children’s memory of pain intensity was a better predictor of subsequent pain reporting than their actual initial experience of pain intensity; in fact, children’s pain memories mediated the relationship between reporting of pain intensity at Lab Session 1 and Lab Session 2. Children who had negatively estimated pain memories developed expectations of greater pain prior to a subsequent pain experience and showed greater increases in pain ratings over time than children who had accurate and positively estimated pain memories. Overall, these data highlight the importance of anxiety in the development of children’s memories for pain and present a model of acute pain memories that add to the growing literature on pain memories across development. Results also highlight the powerful influence of pain memories on healthy children’s pain expectancies and subsequent pain experiences, and extend predictive models of subsequent pain reporting to childhood.