Several limitations of this study should also be mentioned. The population included in the study was composed of children referred by primary care providers to a tertiary care center. This is a "treated" population and does not necessarily reflect the status of those children who may have similar complaints yet not present for treatment, or present only to a primary care setting. Another limitation concerns the measures used. An important aspect of QOL that has emerged in the literature is that of life satisfaction ( Dew & Huebner, 1994). In addition to emotional well-being and social competence, measures of personal happiness with life circumstances are important subjective indicators of QOL. This type of measure was not included in the current study. Both of these limitations can be addressed in future research efforts.
Results of the present study suggest that a QOL perspective is more appropriate than the traditional functional versus organic dualism in the assessment of recurrent pain in children. First, by recognizing both biological and psychosocial components of health, a QOL approach provides a broad, multidimensional perspective from which to evaluate the patient, and thus is consistent with recent theoretical and empirical literature on the multidimensional nature of pain ( Dworkin et al., 1992; Karoly & Jensen, 1987; McGrath, 1990; Turk & Rudy, 1992). Second, a QOL approach assumes that psychosocial factors are important aspects of health status regardless of the extent of measurable pathophysiology, and thus does not risk neglecting the potentially significant contribution of psychosocial factors to the pain experience of patients with an organic diagnosis who might benefit from treatment addressing psychosocial factors. Third, a QOL approach appreciates the subjective component of patient well-being and is consistent with the notion that pain is a subjective experience (cf. McGrath, 1990). Finally, a QOL approach treats psychosocial factors as correlates rather than causes of illness and focuses not only on psychopathology, but also on adaptive functioning. Therefore, the assessment process is less likely to be viewed as implicitly blaming the patient and his or her family, and thus may be more acceptable to them than an approach grounded in a functional versus organic perspective.
This work was supported by a grant to the first author from the National Institute of Child Health and Human Development (HD23264).
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