Abstract
Introduction
We aimed to understand connections between pain, caregiving, physical and behavioral health treatment needs, and motivations for prescription opioid use among child caregiving women with chronic pain.
Methods
We conducted in-depth, semi-structured interviews with 12 women (average age 48 years; 58% Black) in child caregiving roles, including women who were pregnant or trying to become pregnant and were caring for children or grandchildren < 18 years, and who received treatment at an outpatient pain management clinic. We used thematic text analysis to identify qualitative themes related to caregiving, pain, treatment, substance use, coping strategies, and sources of support.
Results
A diverse sample of women reported high levels of stress and pain, substance use, interpersonal violence, depression, and financial strain. Most described difficulties at work, interacting with children or grandchildren, and engaging routine, daily activities due to their pain. Most indicated that they spent less time with family and friends due to their pain and had limited sources of support to help them navigate both caregiving and pain. Many described barriers to receiving appropriate healthcare, including prescription opioids, due to stigma or logistics, though most also reported positive healthcare experiences. Women also reported added daily-life, physical, mental health, and interpersonal stressors and difficulty navigating the healthcare system to receive needed care.
Discussion
For women with chronic pain in child caregiver roles, results highlight the importance of care tailored to the physical needs of child caregiving and of trauma-informed approaches given the prevalence of comorbid conditions and trauma.
Keywords: Women, Caregiving, Relationships, Pain, Trauma, Opioids
Introduction
More than 1 in 5 adult women in the U.S. experience chronic pain (Dahlhamer et al., 2018). Women with chronic pain often have comorbid mental and physical health conditions that exacerbate pain, including posttraumatic stress disorder, depression, and anxiety (Lerman et al., 2015; Shapiro et al., 2022). Moreover, > 80% have experienced a traumatic event, such as sexual assault or childhood abuse (Linnemørken et al., 2020). This combination of trauma, physical and mental health conditions and pain contributes to unique and complex healthcare needs (Austin & Short, 2020).
Women bear a disproportionate burden of child caregiving roles across the life course, encompassing pregnancy, parenting, and caring for grandchildren (Hopps et al., 2017). While many derive positive benefits from this role, child caregiving can place demands on physical and mental health and pose barriers to engaging in healthcare (Feder et al., 2018; Hopps et al., 2017). For example, chronic pain can reduce women’s ability to participate in physical activities with their children and negatively affect their emotional responses to their children (Wilson & Fales, 2015). Opioid and other substance use may also be a concern for child caregiving women with chronic pain, given the potential for child protective services involvement (Kepple, 2018). Few studies have examined connections between women’s child caregiving roles and chronic pain, trauma, mental health, and substance use. Even fewer have obtained women’s own perspectives on their experiences and needs in this context which is critical to informing treatment options and intervention priorities.
The aims of this study were to explore: (1) experiences of pain and child caregiving, (2) physical and behavioral health treatment needs, and (3) motivations for prescription opioid use among women across a range of child caregiving roles receiving care in an outpatient chronic pain clinic.
Methods
Procedure
We recruited a purposive, convenience sample of adult (ages ≥ 18 years) women. Participants were eligible if they were seeking treatment for chronic pain at a university-affiliated pain clinic, completed a pain psychology intake assessment between July 2020-December 2021, and were trying to become or were currently pregnant or had recently cared for children or grandchildren age < 18 years. We included women who were trying to become or were pregnant and women who cared for grandchildren to capture the full continuum of experiences and child caregiving roles that may be impacted by chronic pain. Women also have more frequent healthcare system contact and may be more amenable to health behavior change during periods of pregnancy and trying to conceive (Krans et al., 2015; Rizk et al., 2019), offering opportunities for research-informed care and intervention early in their child caregiving role. Further, women of color are more likely than white women to serve in intergenerational and kinship caregiver roles (Burton & Anderson, 1991), underscoring the importance of inclusively assessing a variety of child caregiving roles.
Trained research assistants reviewed electronic health record data to identify eligible women and then contacted potential participants by phone using a standardized script to confirm eligibility, explain the purpose of the study, determine interest in participating, and schedule an interview. In total, 40 potential participants were contacted to reach a sample size of 12. We were unable to reach 23 potential participants (e.g., did not answer the phone or call back). Three declined without stating a reason, and two scheduled an interview but did not attend or return calls to reschedule.
We completed interviews via telephone in late 2021 and early 2022 using a semi-structured interview guide (Supplemental Material 1). We conducted 45–60 min interviews in private offices and recorded them with an audio recording device. We associated recordings only with a random participant ID, uploaded them to a secure server, and deleted them from the recording device. Transcriptions were provided by a professional service and were de-identified and stored on the secure server. Interviewers were two women researchers with PhDs in clinical psychology and public health and experience in clinical and/or semi-structured interviewing. All participants provided electronic written informed consent and received $30 Visa gift cards. We recruited 12 participants because existing research indicates thematic saturation can be reached with 6–9 interviews (Guest et al., 2020; Hennink & Kaiser, 2022).
Data Analysis
We used thematic analysis to guide review of the interview transcripts in Dedoose (Braun & Clarke, 2006; Clarke & Braun, 2013). The coding team included the two interviewers and one additional team member. Each coder first independently reviewed two transcripts for a priori and emergent themes. The coders then met to discuss identified themes and to generate an initial codebook (Braun & Clarke, 2006; Clarke & Braun, 2013). Next, each coder independently reviewed and coded three interviews using the initial codebook and met to discuss additional emergent themes, organize codes for context and relationships to one another (Willms et al., 1990), and refine the codebook. We ensured thematic and sample saturation through a process known as “code meaning” (i.e., the point at which no new aspects of a theme are identified) before finalizing the codebook (Supplemental Material 2) (Hennink & Kaiser, 2022; Saldaña, 2021). Given that thematic saturation was reached after the three coders independently reviewed and coded five interview transcripts, we determined our sample size of 12 was sufficient. The coders double-coded all seven remaining transcripts, meeting to discuss discrepancies and reach consensus. We used intercoder agreement as a method of triangulation to enhance internal monitoring (Nowell et al., 2017). Intercoder agreement ranged from 88 to 93% with a median of 92%, falling within the “excellent” range (Boyatzis, 1998).
This study was reviewed and approved by the Institutional Review Board at the University of North Carolina at Chapel Hill.
Results
Demographics
Most participants were parenting children age < 18 years (58%) (Table 1). The remaining had adult children and grandchildren age < 18 years (25%), were trying to become pregnant (8%), or were recently a caregiver to now adult children (8%). Participants were, on average, 48 years of age. Most identified as Black (67%) and were divorced (42%) or married (33%) and insured through Medicaid/Medicare (83%). Comorbid mental illness and chronic conditions were common (75%).
Table 1.
Participant characteristics (N = 12)
| N (%) | |
|---|---|
|
| |
| Caregiver status | |
|
| |
| Trying to become pregnant | 1 (8%) |
| Caregiving to child < 18 years | 7 (58%) |
| Grandparent or to child ≥ 18 years | 3 (25%) |
| Recent parent to child < 18 years | 1 (8%) |
| Pain type | |
| Head/neck | 12 (100%) |
| Back | 12 (100%) |
| Lower extremity | 12 (100%) |
| Upper extremity | 9 (75%) |
| Abdominal | 8 (67%) |
| Race | |
| Black | 8 (67%) |
| White | 3 (25%) |
| Asian | 1 (8%) |
| Age in years (mean (range)) | 48 (35–66) |
| Marital status | |
| Married | 4 (33%) |
| Divorced | 5 (42%) |
| Single | 2 (17%) |
| Widowed | 1 (8%) |
| Insurance type | |
| Medicare/Medicaid | 10 (83%) |
| Private insurance | 1 (8%) |
| Other | 1 (8%) |
Key themes from the qualitative interviews included experiences of pain and trauma; the impact of pain on emotional and mental health, daily life, and relationships; healthcare experiences; use of prescription opioids; and sources of support.
Experiences of Pain
All participants described pain as affecting their physical health (Table 2). One described this as a “layer upon layer of different issues” (P11). Descriptions of the severe and all-encompassing nature of pain were common with terms such as “pain was like a 10” (P4) and “through my entire body” (P5).
Table 2.
Emergent and a priori themes among pregnant and parenting women with chronic pain (N = 12)
| N | % | |
|---|---|---|
|
| ||
| Experiences of pain | ||
| Cycle of stress and paina | 11 | 92% |
| Cycle of activity and paina | 4 | 33% |
| Experiences of trauma | ||
| Interpersonal violence (intimate partner violence, sexual assault)b | 8 | 67% |
| Accidents b | 4 | 33% |
| Child abuse or neglect b | 3 | 25% |
| Suicide attempts b | 2 | 17% |
| Other type of hardshipa | 8 | 67% |
| Impact of pain of emotional and mental health | ||
| Depression b | 7 | 58% |
| Angera | 6 | 50% |
| Absolute language | 6 | 50% |
| Anxiety b | 5 | 42% |
| Shame/pridea | 3 | 25% |
| Experiencing lossa | 3 | 25% |
| Powering througha | 9 | 75% |
| Impact of pain on daily life | ||
| Difficulties at work, including job loss due to paina | 9 | 75% |
| Difficulties with choresa | 7 | 58% |
| General slowing downa | 7 | 58% |
| Difficulties with sleepa | 5 | 42% |
| Impact of pain on relationships | ||
| Less time spent with family or friendsb | 8 | 67% |
| Difficulties interacting or playing with children or grandchildren b | 7 | 58% |
| Family or friends do not believe paina | 5 | 42% |
| Strain on marriage/partnership b | 2 | 17% |
| Healthcare experiences | ||
| Psychological therapy/behavioral health treatment b | 10 | 83% |
| Surgerya | 7 | 58% |
| Physical therapy a | 5 | 42% |
| Emergency Department visita | 4 | 33% |
| Psychiatric hospitalizationa | 1 | 8% |
| Other healthcare services | 8 | 67% |
| Negative experiences of stigma (e.g., treated like a “drug seeker”) b | 8 | 67% |
| Negative experiences with racial biasa | 1 | 8% |
| Negative experiences with logistics (e.g., long wait times)b | 5 | 42% |
| Other negative experiences (e.g., “shuffling” between providers, providers or treatment not helpful) a | 11 | 92% |
| Positive experiences with providers (e.g., provider was empathetic) a | 10 | 83% |
| Positive experiences with logistics (e.g., easy to get an appointment) a | 5 | 42% |
| Prescription opioids | ||
| Prescription opioids use b | 12 | 100% |
| Prescription opioid misuse b,c | 0 | 0% |
| Motivations for not using or misusing opioidsa | 8 | 67% |
| Barriers to obtaining prescriptions for opioidsa | 7 | 58% |
| Consequences of not getting or using prescription opioidsa | 4 | 33% |
| General awareness of the overdose crisis and the role of opioidsa | 7 | 58% |
| Saving prescription opioids or other medication for when needed mosta | 2 | 17% |
| Sources of support | ||
| Family or friends provide supportb | 7 | 58% |
| Time with or talk to friends/family (to cope) a | 2 | 17% |
| Limited sources of supportb | 9 | 75% |
| Additional supports needed b | 9 | 75% |
| Coping strategies | ||
| Substance use other than prescription opioidsb | 9 | 75% |
| Meditation/mindfulness/deep breathinga | 4 | 33% |
| Resta | 4 | 33% |
| Religiona | 4 | 33% |
| Tried everything/multiple different strategiesa | 4 | 33% |
| Othera | 9 | 75% |
Emergent themes
A priori themes
Response to the question, “Have you ever taken prescription opioids, such as Vicodin, OxyContin, Percocet, Demerol, Percodan, or Tylenol with codeine, that were not prescribed for you, in larger amounts, more often, or for longer periods than prescribed, or only for the feeling or experience they caused?
Almost all participants described cycles of stress and pain. Participant 11 stated, “As my stress level goes up, so does my pain.” Pain symptoms were also cited as a cause of stress, with Participant 14 noting that she “couldn’t sleep at night, because of the pain, so it really had an effect on my mood, my stress, and my everyday function.”
Many participants described a relationship between physical activity and pain. They discussed having to “ration” their activities to minimize the pain that would follow (P4). Participant 14 described how these cycles are impacted by and impact caregiving, “especially on the weekends…when my son is home, I know that on the weekends I’m going to push it harder. I’m going to be in immense pain on the weekend.”
Experiences of Trauma
All participants described a history of trauma. Interpersonal violence, including experiences of intimate partner violence and sexual assault, was the most common, followed by motor vehicle crashes and child abuse or neglect.
Most participants described experiences of other types of hardships, including financial difficulties, family death, divorce, and loss of housing. These hardships, particularly financial difficulties, often impacted their pain and caregiving. Many shared a common goal of putting their children and family first, despite these hardships and their pain. Participant 9 captured these sentiments, stating “Maybe as a mother, always, you want to put others first.”
Impact of pain on Emotional and Mental Health
Almost all participants described emotions related to their pain, including depression, anger, anxiety, and shame. These emotions were often described in absolute language, with participants noting that “pain changes everything” (P9). Participants described shame due to not wanting to “become a burden” (P5) and anger as to “why you’re the one having to deal with this” (P10). Some participants also described a sense of loss, including loss of identity, independence, and a sense of purpose due to their pain. Participant 2 stated, “I was really independent. I’m a single mom and I was able to take care of my kids without any help…I really don’t have my independence anymore.”
Most participants described feeling as though they had to “power through” their pain, mainly for the sake of their children and family. These included descriptions of “putting on a face every day” (P6), and “fighting through the pain” (P11). Participant 6 stated, “To me, that’s the hard part because you don’t want them to always see and know that you’re hurting. That’s the hardest thing, to hide it and keep going” (P6).
Impact of Pain on Daily Life
Pain significantly impacted most participants’ ability to engage in work, and routine, daily activities. Most described an overall “slowing down” due to their pain. Participant 14 shared that she would often “feel it’s taking me longer to get things done or just little things that cause me, because of the pain, to really slow down a little bit…” Many participants lost or left jobs because of pain complications. Participant 5 stated, “Me as a patient in pain trying to work, keep my job…it got to the point where I wasn’t able to work…” With respect to daily activities, many described challenges with house and yard maintenance due to their pain.
Impact of Pain on Relationships
More than half of participants described foregoing meaningful interactions with their children or grandchildren because of their pain. One participant decided to “sit [and watch] instead of partake” (P9) and another stopped “following [her son] around on a bike” after it caused “pain flares” (P15). Participant 4 captured how pain affects physical aspects of parenting, “Trying to lift them up and prepare a meal because you want to, you’re still a parent. You’re in pain. Your child wants to be held. You still got to provide a meal. Sometimes you just have to make do.”
Most participants reported reduced time spent with family and friends and described difficulties making plans with others due to pain that “varies day to day” (P4). Participants also described relationship strain due to friends or family not believing their pain or not understanding the impact of their pain on their physical and mental health. Participant 5 shared, “My family was just basically like, ‘Suck it up and deal with it’, not realizing the toll of the physical pain and how it was impacting me mentally.”
Healthcare Experiences
All participants were receiving care at an outpatient pain management clinic. Almost all engaged in psychological therapy, and many received physical therapy or had had surgery. Some described periods of extreme pain when they sought care in emergency departments.
Almost all participants described a history of negative healthcare interactions, most notably related to experiences of stigma and bias. Participant 5 noted inherent gender bias with, “I was told by doctors, most commonly male doctors, ‘Oh, you’re just having bad cramps.’ It’s just like, ‘No, I know my body, this is not bad cramps.’” (P5). Participant 8 described the impact of racial bias on her pain management, stating, “I do believe that there is a racial bias and we tend to believe in this day and age that Black people don’t experience the same pain level as white people…” Almost all participants also described other types of negative experiences, many related to feeling as though providers did not take their pain seriously (e.g., “…a lot of doctors said that it was in my head, and I know how my body is” (P9)), that they were not receiving clear information, or that they were not receiving adequate treatment.
Participants also detailed logistical barriers to engaging in healthcare, including long wait times and drive times for appointments and strict requirements for patients in pain management. Many felt they had to “shuffle” between providers who misdiagnosed them (P4) or did not accept their insurance (P8) and meet strict requirements to remain in pain management. As Participant 2 stated, “There’s all these reasons for them to kick you off the program and not give pain medicine…I’m just going to have to suffer or jump through the hoops to get medicine…it’s extreme.”
All participants who cited negative healthcare interactions also cited positive interactions. Most indicated they eventually found a provider who listened to them, believed their pain, and offered helpful treatment. Several mentioned the importance of feeling that their provider understood their unique context and needs. Participant 5 described this as “finding someone that you trust.”
Prescription Opioids
All participants had been prescribed opioids at some point and acknowledged that this was effective in treating their pain. However, many described a strong motivation to not use prescription opioids including a desire to avoid side-effects like nausea or feeling “groggy” and not wanting to develop dependence.
Most participants described difficulties obtaining prescription opioids when needed, from a perceived lower-than-normal dose prescribed following surgery (P2), pharmacist denial at prescription pick-up (P13), and Participant 6’s description of her “primary care doctor… he don’t do opioids.” Participant 8 also described her prior medical history interfering, “because of my psychiatric admission, they used that as another excuse to say that I was not a candidate for opioids.” Several also discussed consequences of not getting prescriptions for opioids, including poorly managed pain and increased stress. As Participant 2 shared, “My goal is not to get high and stay high all day, it’s just to get through the day without pain.”
Many participants were aware of the role of opioids in the ongoing overdose crisis and the potential for prescription opioid-related harms. While none explicitly acknowledged misuse of prescription opioids, a few described behaviors that would likely be considered by healthcare providers as misuse. For example, participants described “saving up” their prescription opioids for periods when they knew they would experience more pain. Participant 2 shared, “I try to stretch them out…I’ll hold onto what I do have, since on the weekend I know that I’ll be in more pain.” and acknowledged that she “could see why people would try to find other ways to get it…because you got to go through all the stuff you got to do to get it.”
Sources of Support
More than half of participants cited friends and family as a significant source of practical and emotional support, particularly for childcare and household chores. Participant 9 said, “[My family] helped me with games, programs that she was in, I wanted to keep her social… It was a village.”
Even with cited supports, many indicated that support was limited and additional support was needed. Support was often limited because family and friends could not always be available to help or grew tired of helping. Participant 8 shared that her son’s attitude was, “ ‘We’ve helped you before and it just keeps getting the same way and we’re not going to do it anymore.’”.
Coping Strategies
All participants described strategies to cope with pain. Most used substances other than prescription opioids, including marijuana and alcohol for temporary pain relief or to cope with depression or anxiety stemming from pain. As Participant 7 noted, “My pain was terrible, anxiety up. The drinking, I did all that.” Participants also used other coping strategies, such as meditation/mindfulness, rest, and religion. Some stated that they had tried “everything” to cope with little success.
Discussion
Results from this in-depth qualitative study of 12 child caregiving women with chronic pain highlight complex intersections between pain and trauma, mental and physical health, relationships and supports, and healthcare needs and experiences. Consistent with previous research, participants reported substantial negative impacts of their pain on their overall functioning, including as a child caregiver; bidirectional associations between pain and mental health; significant histories of trauma; multiple healthcare barriers; and frustration with the current system of pain management (Driscoll et al., 2018; Sanmartin, Ali, Chen et al., 2019a). More than half identified as Black, which is important considering inequities in pain experiences and treatment (Meints et al., 2019) and lack of equitable representation in research (National Academies of Sciences, 2022).
Most participants described significant impacts of pain on their daily lives, citing difficulties with work, chores, caring for children and grandchildren, and interpersonal relationships. This aligns with prior studies showing that chronic pain negatively impacts functioning and quality of life (Driscoll et al., 2018; Kepple, 2018) and is highlighted by participant reports that “pain changed everything”. Our results suggest many women with chronic pain “power through” their pain and associated mental health symptoms to care for their families, which may ultimately lead to exacerbation of both. Participants stressed a desire to put their family first, despite their pain, but also acknowledged that their pain limited their ability to engage with their children, grandchildren, and other family members. This is consistent with research suggesting that women with chronic pain report substantial impacts of caregiving responsibilities on their ability to engage in self-care (Ziadni et al., 2020).
All participants described a history of trauma, most commonly interpersonal violence, in alignment with existing research showing a high co-occurrence of trauma and chronic pain (Zlotnick et al., 2017). Almost all described comorbid mental health conditions, and all endorsed negative emotions, such as depression, anxiety, shame, and anger, related to their pain and trauma history. Consistent with prior research, these comorbid mental health conditions exacerbated pain symptoms for many women (Lerman et al., 2015). This underscores cyclical relationships between trauma, mental health symptoms, and pain, and suggests that patients themselves are aware of the importance of attending to all these factors to improve wellbeing (Tidmarsh et al., 2022).
Most participants described a history of negative healthcare experiences, including experiences of stigma and bias. Several felt that they “shuffled” between providers before finding one that listened empathetically and offered helpful treatment. All participants also reported receiving prescription opioids at some point during pain management. None explicitly endorsed prescription opioid misuse behaviors (Han et al., 2017). However, two described behaviors that healthcare providers would likely consider misuse, such as saving prescription opioids for times they would be in more pain. Importantly, these participants viewed these behaviors as necessary to manage their pain and engage in caregiving and other responsibilities. The finding that two of 12 women reported behaviors that would likely be considered misuse aligns with nationally representative data suggesting that 10% of parenting women who use prescription opioids engage in misuse behaviors, often to relieve physical pain and cope with negative emotions (Sanmartin, Ali, Chen et al., 2019a; Sanmartin, Ali, Novak et al., 2019b).
Participants were aware of the role of opioids in the ongoing overdose crisis and the potential harms (e.g., dependence, overdose) associated with prescription opioid use. Notably, while participants acknowledged potential harms, they often described adequately managing their pain as a more immediate and salient concern (Frank et al., 2016). Several shared that it was difficult to obtain prescription opioids and that they felt they had to “jump through hoops” to obtain them. Many turned to other substances, most commonly alcohol and marijuana, to cope.
Implications for Practice
Results highlight a potential need to streamline access to appropriate healthcare services and improve provider training regarding chronic pain given that participants had several negative healthcare experiences before finding a helpful, trusted provider. The high prevalence of trauma and comorbid mental health conditions emphasizes the importance of incorporating trauma-informed care principles, including shared patient-provider decision-making and transparency about treatment options (Huang et al., 2014). An individualized, patient-centered approach to opioid prescribing, with clear communication on eligibility for opioid prescriptions, may help prevent both potential opioid-related harms and adverse effects of inadequate pain management. Aligned with a trauma-informed approach, understanding women’s own goals for their treatment outcomes (e.g., relief from pain so they can play with children) will be a critical component (Huang et al., 2014). Ideally, an interdisciplinary team of providers, including social workers who can assist with connections to basic needs and mental health practitioners who can address depression, anxiety, and other symptoms, will work together to implement a biopsychosocial approach to address complex comorbidities, coordinate care, and communicate with each other and the patient.
Given that more than half of participants were Black women, results also underscore the importance of considering the intersecting impacts of race and gender on chronic pain and treatment experiences. Existing research shows both racial and gender bias in provider perceptions and treatment of pain, with Black patients and women more likely to be perceived as exaggerating their pain and less likely to receive adequate treatment than white patients or men (Samulowitz et al., 2018; Hoffman et al., 2016; Morales & Yong, 2021; Schäfer et al., 2016). This aligns with our results showing that many women reported that others, including providers, did not believe their pain and that they had to “power through” through their pain with little treatment or support while still attending to their child caregiving responsibilities. In provider training on chronic pain, it will be important to address common biases that contribute to inequities in treatment, particularly for Black women with chronic pain.
Limitations
This study has limitations. First, the purposive and convenience sample limits generalizability. All participants were receiving care at a single outpatient pain management clinic. Their experiences are not representative of all women seeking chronic pain treatment and do not reflect those of women with chronic pain who are unable to access care or avoid care due to stigma and other negative experiences. Second, of 40 potential participants, we were unable to reach 23. This may be due to the complexity of both caregiving responsibilities and pain management demands. Third, due to concerns about stigma, participants may have under-reported prescription opioid misuse. Fourth, data were collected at one time point. Incorporating multiple time points across the life course would be valuable in uncovering possible temporal changes in identified connections.
Conclusion
The results from this qualitative study of a diverse sample of 12 caregiving women with chronic pain highlight intersections between chronic pain, child caregiving, trauma, and substance use. Results emphasize the substantial impact of pain on overall functioning and mental health and the need for timely receipt of appropriate care. In a novel contribution, these results show that caregiving women desire pain management strategies that will allow them to engage more freely with their children and grandchildren. Future research is needed to examine whether trauma-informed care can reduce pain, improve mental health, and support women in child caregiving roles.
Supplementary Material
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10995-024-03915-5.
Significance.
What is already known on this subject?
There are complex associations between chronic pain, trauma, mental health, and opioid and other substance use which may be exacerbated in the context of child caregiving.
What this study adds?
Few studies have obtained women’s own perspectives on their experiences and needs in the context of child caregiving and chronic pain which is critical to informing treatment options and intervention priorities. Qualitative interviews revealed unique and combined impacts of child caregiving and chronic pain on mental health, relationship quality, coping capabilities and strategies, prescription opioid misuse and the overlap of traumatic experiences with each of the themes.
Funding
The study was supported through the University of North Carolina (UNC) Injury Prevention Research Center (IPRC) under exploration grant (R49CE003092-04). The funder played no role in the study design, collection, analysis, and interpretation of data, writing of the manuscript, or decision to submit the manuscript for publication.
Footnotes
Conflict of Interest The authors have no conflicts of interest to report.
Ethical Approval This study was reviewed and approved by the Institutional Review Board at the University of North Carolina at Chapel Hill.
Consent to Participate All participants provided written informed consent.
Consent for Publication Not applicable.
Data Availability
Available upon request.
Code Availability
Codebook for qualitative coding provided in the supplement.
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Available upon request.