Table 1.

Characteristics of included studies (n=16)

Author, year, country	Sample Participants (group, sample size)	Participant Age Range	Family Functioning Measure; Reporter	Study Outcomes
				Group Differences	Pain and Pain-Related Disability
Anttila et al. (2004); Finland	Community based sample Migraine (n=59), Tension HA (n=65), Control group (n=59)	Mean =12.6 yrs (sixth grade)	FAD - General Functioning subscale; Parent report only	Youth with both tension headache and migraine had worse family functioning than healthy controls (p=.02).
Conte et al., (2003); USA	Clinic based sample PJFS (n=16), JIA (n=16), Control group (n=16)	10–17 years	FES; Parent and child report	Compared to arthritis and no pain groups, both children with PJFS (p=.03) and their parents (p=.01) reported less family cohesion. Children with PJFS reported more organization (p=.04), and their parents more conflict (p=.05) and intellectual/cultural orientation (p=.01) than both other groups.
Eccelston et al., (2008); UK	Clinic-based sample Mixed chronic pain sample (n=100)	11–18 years	BAPQ – family functioning subscale; Child report only		Family functioning was correlated with pain specific anxiety (r=.36, p<.001), and social functioning (r=.31, p<.01). Controlling for pain, family functioning was a significant predictor of children’s emotional adjustment (β=−26, p<.01).
Gauntlett – Gilbert & Eccelston, (2007); UK	Clinic-based sample Mixed chronic pain sample (n=110)	11–18 years	BAPQ – family functioning subscale; Child report only		Family functioning was correlated with functional disability (r=.20, p<.05), school attendance (r=.29, p<.05), depression (r=.52, p<.001), and anxiety (r=.43, p<.01). A multivariate model (depression, anxiety and family functioning) accounted for 41% of the variance in functional disability (p<.001).
Iobst et al., (2007); USA	Clinic-based sample Juvenile rheumatic disease (n=82)	6–18 years	FAD – General functioning subscale; Parent report only		Days feeling tired predicted worse family functioning (β=−.55, p<.01) No significant associations between FAD scores and # of pain days.
Kashikar- Zuck et al. (2008); USA	Clinic-based sample PJFS (n=47), Control group (n=46)	12–18 years	FES; Parent and child report	Adolescents with fibromyalgia had significantly lower scores on the Family Relationship Index than healthy controls (p=.0002). Families of adolescents with pain reported a less supportive (p=.018) and more conflicted (p=.002) family environment.	Controlling for pain, the total model (family environment, adolescent and martial variables) accounted for 48.1% of variance in functioning. Family environment variables alone did not predict functioning.
Kaufman et al. (1997); USA	Clinic-based sample Organic RAP (n=25), Non-organic RAP (n=24), Healthy control group (n=19)	12–16 years	FES; Parent and child report	Adolescents with RAP scored below FES normative means on expressiveness, independence, intellectual- cultural orientation (p<.01). Maternal report on moral religious emphasis and control scales by RAP group scored significantly above the normative means (p<.005). No significant differences between organic versus non- organic bowel disease.
Liakopoul ou-Kairis et al., (2002) Greece	Clinic-based sample RAP (n=38), HA (n=31), Control group (n=60)	8–13 years	FAD; Parent report only	Families of children with RAP had worse family functioning compared to controls on all domains (p<.05–.001). Families of children with RAP had lowers scores on domains of Behavior Control and General Functioning (p<.001). Differences between headache and RAP groups were not significant.
Logan, et al. (2006); USA	Clinic-based sample Adolescents with mixed chronic pain and their parents (n=112)	13–18 years	SIPA - Adolescent- parent relationship domain subscale; Parent report only		Greater relationship distress was associated with lower pain intensity scores (r=−.24, p<.01). No relationship between FDI score and adolescent and parent relationship distress.
Logan & Scharff (2005); USA	Clinic-based sample Migraine HA (n=48), RAP (n=30)	7–17 years	FES; Parent report only	Family environment moderated relationship between pain and disability in migraine (p<.001) but not in RAP group	Controlling for pain intensity, family conflict (p<.01), organization (p<.01), independence (p<.05) and conflict (p<.001) predicted functional disability
Mitchell et al. (2007); USA	Clinic-based sample SCD (n=48), Caregivers (n=53)	7–13 years	FAD; Parent report only		No relationship between FAD scores and other medical, pain or health care utilization variables Family functioning was associated with children’s coping strategies and level of negative thinking (r=− .31 to −.37)
Palermo & Putman (2007); USA	Clinic-based sample Recurrent HA (n=49)	11–16 years	FAD; Parent and child report	Adolescents with healthy family functioning had less depressive symptoms (p=.002), functional impairment (p=.01), a trend toward less pain frequency (p=.08) and pain intensity (p=.09) compared to adolescents with unhealthy family functioning	Lower levels of adolescent autonomy (r=.53, p<.01) and worse family functioning (r=−.32, p<.01) were correlated with greater impairment. Adolescent autonomy (β=.38, p<.05) and family functioning (β=.34, p<.051) predicted impairment.
Reid et al., (2005); Canada	Clinic-based sample JIA (n=15), Fibromyalgia (n=15), Control group (n=15)	10–17 years	FACES; Parent and child report	No significant group differences in family functioning	Family functioning is not related to functional disability
Ross et al.; (1993); USA	Clinic-based sample JRA (n=56)	10–17 years	FES; Parent report only		Greater family harmony was associated with higher reports of pain (r=.35, p<.01)
Schanberg et al.; (1998) USA	Clinic-based sample Parents (n=29) of children with JPFS (n=21);	10–20 years	FES; Parent and child report	Parents of children with JPFS reported lower levels of family cohesion (p<.001), and both parents and children reported less conflict (p<.05) compared to healthy parents and adolescents. Compared to distressed group, both parents (p<.01) and children with JPFS (p=.001) reported less conflict.	Child-report of family expressiveness was associated with less pain (r=−.49, p<.02), lower levels of impairment(r=− .55, p<.04), and greater physical function (r=−.46, p<.04). Greater incongruence between parent and child report of family environment was associated with greater impairment (r=.57, p<.003).
Scharff et al. (2005); UAS	Clinic-based sample Mixed chronic pain group (n=117)	8–17 years	FES – cohesion subscale; Parent report only		Neither pain level nor duration was associated with group assignment Youth in Family Dysfunction cluster reported less cohesion (p<.001) and greater responsibility taking (p<.005) that the other two groups.

Note: Sickle Cell Disease = SCD; Headache = HA; RAP= Recurrent Abdominal Pain; Idiopathic Musculoskeletal Pain = IMP; Juvenile Idiopathic Arthritis = JIA; Primary Juvenile Fibromyalgia Syndrome = PJFS; Family Assessment Device = FAD; Functional Disability Inventory = FDI; Stress Index for Parents of Adolescents = SIPA; Family Environment Scale = FES; Family Adaptability and Cohesion Scales = FACES; Bath Adolescent Pain Questionnaire = BAPQ; USA = United States; UK = United Kingdom