151
|
Williams-Reade JM, Tapanes D, Distelberg BJ, Montgomery S. Pediatric Chronic Illness Management: A Qualitative Dyadic Analysis of Adolescent Patient and Parent Illness Narratives. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:135-148. [PMID: 30725488 DOI: 10.1111/jmft.12377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self-management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient-parent illness responses and how parental illness meanings play a role in adolescent self-management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.
Collapse
|
152
|
Factors Related to Agreement Between Child and Caregiver Report of Child Functioning With Chronic Pain. Clin J Pain 2019; 36:203-212. [DOI: 10.1097/ajp.0000000000000794] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
153
|
Pediatric pain treatment and prevention for hospitalized children. Pain Rep 2019; 5:e804. [PMID: 32072099 PMCID: PMC7004501 DOI: 10.1097/pr9.0000000000000804] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/23/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction: Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. Objectives: To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. Methods: This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable “Factsheet Pain in Children: Management” and reviews best evidence and practice. Results: Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind–body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. Conclusion: Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
Collapse
|
154
|
Jaaniste T, Noel M, Yee RD, Bang J, Tan AC, Champion GD. Why Unidimensional Pain Measurement Prevails in the Pediatric Acute Pain Context and What Multidimensional Self-Report Methods Can Offer. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E132. [PMID: 31810283 PMCID: PMC6956370 DOI: 10.3390/children6120132] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/22/2019] [Accepted: 11/22/2019] [Indexed: 11/29/2022]
Abstract
Although pain is widely recognized to be a multidimensional experience and defined as such, unidimensional pain measurement focusing on pain intensity prevails in the pediatric acute pain context. Unidimensional assessments fail to provide a comprehensive picture of a child's pain experience and commonly do little to shape clinical interventions. The current review paper overviews the theoretical and empirical literature supporting the multidimensional nature of pediatric acute pain. Literature reporting concordance data for children's self-reported sensory, affective and evaluative pain scores in the acute pain context has been reviewed and supports the distinct nature of these dimensions. Multidimensional acute pain measurement holds particular promise for identifying predictive markers of chronicity and may provide the basis for tailoring clinical management. The current paper has described key reasons contributing to the widespread use of unidimensional, rather than multidimensional, acute pediatric pain assessment protocols. Implications for clinical practice, education and future research are considered.
Collapse
Affiliation(s)
- Tiina Jaaniste
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Alberta Children’s Hospital Research Institute, Calgary, AB T3B 6A8, Canada
- Hotchkiss Brain Institute, Calgary, AB T2N 1N4, Canada
| | - Renee D. Yee
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Joseph Bang
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| | | | - G. David Champion
- Department of Pain and Palliative Care, Sydney Children’s Hospital, Randwick, NSW 2031, Australia; (R.D.Y.); (J.B.); (G.D.C.)
- School of Medicine, University of New South Wales, Sydney, NSW 2052, Australia;
| |
Collapse
|
155
|
Huffhines L, Jackson Y. Child Maltreatment, Chronic Pain, and Other Chronic Health Conditions in Youth in Foster Care. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:437-445. [PMID: 32318213 PMCID: PMC7163823 DOI: 10.1007/s40653-019-0248-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Childhood maltreatment is associated with chronic pain in adults. The goals of this study were 1) to examine this relation in youth placed in foster care with high levels of maltreatment exposure, and 2) to investigate the relation between maltreatment frequency and acute pain, and maltreatment frequency and general chronic health condition. Participants included 403 youth ages 8-19 who resided in foster or residential/group homes. Youth with more maltreatment events had higher odds of chronic pain in a dose response fashion. There was no significant relation between maltreatment type and pain diagnosis, or maltreatment and general chronic health condition. This study examined both self- and case file report of maltreatment frequency and type in association with chronic pain, acute pain, and general chronic health condition in a sample of youth in foster care, providing evidence that more maltreatment exposure increases the likelihood of chronic pain, even in youth. This suggests that it may not take decades for the overloaded stress response system to lead to a serious pain condition, but that this process may occur much earlier in the lifespan. The findings have important implications for professionals working to prevent and treat the effects of child maltreatment or chronic pain.
Collapse
Affiliation(s)
- Lindsay Huffhines
- Clinical Child Psychology Program, University of Kansas, 1000 Sunnyside Avenue, Lawrence, KS 66045 USA
| | - Yo Jackson
- Department of Psychology, Pennsylvania State University, State College, PA USA
| |
Collapse
|
156
|
Hynes L, Saetes S, McGuire B, Caes L. Child and Family Adaptation to Juvenile Idiopathic Arthritis-A Systematic Review of the Role of Resilience Resources and Mechanisms. Front Psychol 2019; 10:2445. [PMID: 31749744 PMCID: PMC6848885 DOI: 10.3389/fpsyg.2019.02445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Juvenile Idiopathic Arthritis (JIA) is the most common rheumatic disease in childhood, with chronic pain being a main symptom. JIA symptoms can lead to substantial disability in children and their families. While preliminary evidence reveals the potential beneficial role of resilience in dealing with chronic pain, research on the role of resilience in how families of a child with JIA cope with pain-related symptoms is scant and dispersed. Objectives: Using the framework of the Ecological Resilience-Risk Model, this review aims to identify (1) family characteristics that are associated with both risk and resilience in children with JIA and (2) the contribution of individual and parental resilience mechanisms and resources to resilience outcomes in children with JIA and their families. Methods: MEDLINE, EMBASE, EBSCO, Psycharticles, and PsycINFO were systematically searched. Longitudinal, cross-sectional, and treatment studies written in English with a focus on resilience resources and/or mechanisms in families of a child (6–18 years) with JIA were included. The original search (July 2016) produced 415 articles, with a final sample of 6 articles remaining after screening. An updated search (July 2018) did not identify new articles, but identified one extra article through personal communications. The 7 articles were included in a narrative review and study quality was assessed. Results: Limited research was available on the role of family characteristics, with just one study revealing how family dysfunction is related to reduced child resilience. Studies evaluating the role of individual resilience mechanisms and resources most commonly assessed resilience outcomes in terms of recovery and sustainability outcomes, such as health-related quality of life (HRQL) and functional disability. The findings revealed that children's psychological flexibility, self-efficacy, adherence, pain acceptance, and perceived social support contribute to resilience outcomes. Findings were inconclusive for the influence of coping strategies, such as seeking social support. Conclusions: While our knowledge is growing, a better understanding of how familial and individual resilience resources and mechanisms influence adjustment to chronic pain as part of JIA is needed and can stimulate development of targeted interventions to enhance outcomes for children with JIA.
Collapse
Affiliation(s)
- Lisa Hynes
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Sophia Saetes
- School of Psychology and Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Brian McGuire
- School of Psychology and Centre for Pain Research, National University of Ireland, Galway, Ireland
| | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, United Kingdom
| |
Collapse
|
157
|
Palermo TM, Murray C, Aalfs H, Abu-El-Haija M, Barth B, Bellin MD, Ellery K, Fishman DS, Gariepy CE, Giefer MJ, Goday P, Gonska T, Heyman MB, Husain SZ, Lin TK, Liu QY, Mascarenhas MR, Maqbool A, McFerron B, Morinville VD, Nathan JD, Ooi CY, Perito ER, Pohl JF, Schwarzenberg SJ, Sellers ZM, Serrano J, Shah U, Troendle D, Zheng Y, Yuan Y, Lowe M, Uc A. Web-based cognitive-behavioral intervention for pain in pediatric acute recurrent and chronic pancreatitis: Protocol of a multicenter randomized controlled trial from the study of chronic pancreatitis, diabetes and pancreatic cancer (CPDPC). Contemp Clin Trials 2019; 88:105898. [PMID: 31756383 DOI: 10.1016/j.cct.2019.105898] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/14/2019] [Accepted: 11/15/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Abdominal pain is common and is associated with high disease burden and health care costs in pediatric acute recurrent and chronic pancreatitis (ARP/CP). Despite the strong central component of pain in ARP/CP and the efficacy of psychological therapies for other centralized pain syndromes, no studies have evaluated psychological pain interventions in children with ARP/CP. The current trial seeks to 1) evaluate the efficacy of a psychological pain intervention for pediatric ARP/CP, and 2) examine baseline patient-specific genetic, clinical, and psychosocial characteristics that may predict or moderate treatment response. METHODS This single-blinded randomized placebo-controlled multicenter trial aims to enroll 260 youth (ages 10-18) with ARP/CP and their parents from twenty-one INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In search for a cuRE) centers. Participants will be randomly assigned to either a web-based cognitive behavioral pain management intervention (Web-based Management of Adolescent Pain Chronic Pancreatitis; WebMAP; N = 130) or to a web-based pain education program (WebED; N = 130). Assessments will be completed at baseline (T1), immediately after completion of the intervention (T2) and at 6 months post-intervention (T3). The primary study outcome is abdominal pain severity. Secondary outcomes include pain-related disability, pain interference, health-related quality of life, emotional distress, impact of pain, opioid use, and healthcare utilization. CONCLUSIONS This is the first clinical trial to evaluate the efficacy of a psychological pain intervention for children with CP for reduction of abdominal pain and improvement of health-related quality of life. Findings will inform delivery of web-based pain management and potentially identify patient-specific biological and psychosocial factors associated with favorable response to therapy. Clinical Trial Registration #: NCT03707431.
Collapse
Affiliation(s)
- Tonya M Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, USA; Center for Child Health, Behavior & Development, Seattle Children's Research Institute, USA.
| | - Caitlin Murray
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, USA
| | - Homer Aalfs
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, USA
| | - Maisam Abu-El-Haija
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Bradley Barth
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Melena D Bellin
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Kate Ellery
- Children's Hospital; of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas S Fishman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | | | | | | | | | - Melvin B Heyman
- University of California San Francisco, San Francisco, CA, USA
| | | | - Tom K Lin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Quin Y Liu
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Asim Maqbool
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian McFerron
- Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Jaimie D Nathan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Chee Y Ooi
- School of Women's and Children's Health, Medicine, University of New South Wales and Sydney Children's Hospital Randwick Sydney, Australia
| | - Emily R Perito
- University of California San Francisco, San Francisco, CA, USA
| | | | | | | | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD, USA
| | - Uzma Shah
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - David Troendle
- University of Minnesota Masonic Children's Hospital, Minneapolis, MN, USA
| | - Yuhua Zheng
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ying Yuan
- The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Lowe
- Washington University School of Medicine, Iowa City, IA, USA
| | - Aliye Uc
- University of Iowa, Stead Family Children's Hospital, Iowa City, IA, USA
| | | |
Collapse
|
158
|
Maternal Protective Parenting Accounts for the Relationship Between Pain Behaviors and Functional Disability in Adolescents. Clin J Pain 2019; 34:1089-1095. [PMID: 30020087 DOI: 10.1097/ajp.0000000000000638] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION A variety of factors influence parent responses to pain behaviors they observe in their adolescents with chronic pain. Certain parental responses to pain, such as attention or overprotection, can adversely impact adolescent adaptive functioning and correspond to poor clinical outcomes. OBJECTIVES It was hypothesized that the relationship between adolescent pain behaviors and functional disability was mediated by maladaptive parenting (protective, monitoring, solicitousness) responses. MATERIALS AND METHODS Participants were 303 adolescents and their mothers presenting to a pain clinic. Adolescents completed measures of functional disability and pain intensity; mothers completed measures assessing adolescent pain behaviors, their own catastrophizing about their adolescent's pain, and responses to pain. A path model tested the direct and indirect associations between pain behaviors and disability via 3 parenting responses, controlling for average pain intensity and parent pain catastrophizing. RESULTS Greater pain behavior was associated with increased protective responses (α path, P<0.001); greater protective behavior was associated with increased disability (β path, P=0.002). Including parenting responses in the model, the path between pain behaviors and disability remained significant (c' path, P<0.001). The indirect path between pain behaviors and disability via parenting responses was significant for protective responses (P<0.02), controlling for pain intensity and parent pain catastrophizing. The indirect effect of protective responses explained 18% of the variance between pain behaviors and disability. DISCUSSION Observing adolescent pain behaviors may prompt parents to engage in increased protective behavior that negatively impacts adolescents' functioning, even after controlling for the effects of parental pain catastrophizing.
Collapse
|
159
|
Beeckman M, Simons LE, Hughes S, Loeys T, Goubert L. Investigating How Parental Instructions and Protective Responses Mediate the Relationship Between Parental Psychological Flexibility and Pain-Related Behavior in Adolescents With Chronic Pain: A Daily Diary Study. Front Psychol 2019; 10:2350. [PMID: 31681125 PMCID: PMC6811655 DOI: 10.3389/fpsyg.2019.02350] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Parental behavior can influence how well adolescents cope with chronic pain. Previous research has largely focused on how parents negatively impact adolescent functioning. Yet more recent work suggests that parents - and particularly parental psychological flexibility - can foster better adolescent pain-related functioning. In this study we examined if parental protective responses and instructions to engage in activities in the presence of pain mediate the impact of parental psychological flexibility and acceptance of adolescent pain on adolescents' daily pain-related behavior. METHOD Fifty-six adolescents with chronic pain (M age = 14.5 years, 86% girls) and one of their parents (93% mothers) were recruited at initial evaluation at two pediatric pain clinics in the US. Parents completed baseline questionnaires assessing psychologically flexible parenting and acceptance of adolescent pain. Next, parents and adolescents completed a 14-day self-report diary assessing adolescent activity-avoidance and activity-engagement in the presence of pain (adolescent report), and parental protective responses and instructions for their adolescent to engage in activities (parent report). RESULTS Psychologically flexible parenting and acceptance of adolescent pain in parents were indirectly related to lower daily adolescent activity-avoidance, via their negative association with daily parental protective responses. Positive associations also emerged between baseline psychologically flexible parenting and overall levels of adolescent activity-engagement via its negative association with overall levels of parental protectiveness across the 14-day period. Psychologically flexible parenting and parental acceptance of adolescent pain were also indirectly related to daily decreases in adolescent activity-avoidance via their association with daily increases in parental activity-engagement instructions. These baseline parental resilience factors were also positively related to overall levels of parental engagement instructions, a route via which an indirect association with both higher overall activity-engagement as well as higher overall activity-avoidance in the adolescent was observed. CONCLUSION Our findings suggest an (indirect) adaptive role of parental psychological flexibility on adolescent daily pain-related behavior via its impact on parental protective behavior. If our findings replicate, they would suggest that these parental behaviors could be targeted in pain treatments that include both adolescents and their parents. Future research could further examine the impact of parental instructions on pain-related behavior in adolescents with chronic pain.
Collapse
Affiliation(s)
- Melanie Beeckman
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Sean Hughes
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Tom Loeys
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Liesbet Goubert
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| |
Collapse
|
160
|
Interpersonal Dyadic Influences of Pain Catastrophizing Between Caregivers and Children With Chronic Pain. Clin J Pain 2019; 36:61-67. [DOI: 10.1097/ajp.0000000000000773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
161
|
Murray CB, de la Vega R, Loren DM, Palermo TM. Moderators of Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Chronic Pain: Who Benefits From Treatment at Long-Term Follow-Up? THE JOURNAL OF PAIN 2019; 21:603-615. [PMID: 31606398 DOI: 10.1016/j.jpain.2019.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/27/2019] [Accepted: 10/06/2019] [Indexed: 02/06/2023]
Abstract
Cognitive behavioral therapy (CBT) is effective for pediatric chronic pain, but little is understood about which youth are most likely to benefit. The current study aimed to identify individual characteristics for which CBT yielded the greatest (and least) clinical benefit among adolescents with chronic pain participating in a multicenter randomized controlled trial of Internet-delivered CBT (WebMAP2). A total of 273 adolescents ages 11 to 17 with chronic pain (M age = 14.7; 75.1% female) were randomly assigned to Internet-delivered CBT or Internet-delivered pain education and evaluated at pretreatment, post-treatment, and 2 longer term follow-up periods (6 and 12 months). Multilevel growth models tested several adolescent- and parent-level moderators of change in pain-related disability including 1) adolescent age, sex, pain characteristics, distress, and sleep quality and 2) parent education level, distress, and protective parenting behavior. Younger adolescents (ages 11-14; vs older adolescents ages 15-17) and those whose parents experienced lower levels (vs higher levels) of emotional distress responded better to Internet CBT treatment, showing greater improvements in disability up to 12 months post-treatment. This study expands knowledge on who benefits most from Internet-delivered psychological treatment for youth with chronic pain in the context of a large multicenter randomized controlled trial, suggesting several avenues for maximizing treatment efficacy and durability in this population. PERSPECTIVE: This study identified adolescent- and parent-level predictors of treatment response to Internet-based CBT for pediatric chronic pain up to 12 months later. Younger adolescents and those whose parents had lower levels of distress may particularly benefit from this intervention. Older adolescents and those whose parents exhibit higher distress may require alternative treatment approaches.
Collapse
Affiliation(s)
| | | | - Dorothy M Loren
- Seattle Children's Research Institute, Seattle, Washington; Loyola University Chicago, Chicago, Illinois
| | - Tonya M Palermo
- Seattle Children's Research Institute, Seattle, Washington; University of Washington, Seattle, Washington
| |
Collapse
|
162
|
Birnie KA, Dib K, Ouellette C, Dib MA, Nelson K, Pahtayken D, Baerg K, Chorney J, Forgeron P, Lamontagne C, Noel M, Poulin P, Stinson J. Partnering For Pain: a Priority Setting Partnership to identify patient-oriented research priorities for pediatric chronic pain in Canada. CMAJ Open 2019; 7:E654-E664. [PMID: 31699686 PMCID: PMC6839970 DOI: 10.9778/cmajo.20190060] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Chronic pain affects 1-3 million Canadian children and adolescents and their families. The primary objective of the Partnering For Pain project was to collaboratively identify the top 10 research priorities in pediatric chronic pain. METHODS Partnering For Pain took a patient-oriented research approach and followed a modified James Lind Alliance Priority Setting Partnership (PSP) to identify the top research priorities in pediatric chronic pain according to people with lived experience (patients), family members and health care providers (clinicians). The PSP was completed in 4 phases between May and December 2018: 1) national survey of stakeholders, including those with lived experience with pediatric chronic pain, family members and clinicians who treat children with chronic pain, to gather priorities, 2) data processing, 3) interim prioritization by invited patients, family members and clinicians (former research participants or identified through pediatric chronic pain programs, patient partner organizations and steering committee member networks) and 4) in-person priority-setting workshop involving patients, family members and clinicians identified via steering committee networks and partner organizations, with evaluation of patient engagement. The process was led by a national steering committee of patient and parent partners, researchers and clinicians engaged in codesign, analysis and translation of project findings. RESULTS In phase 1, 215 Canadians (86 patients [40.0%], 56 family members [26.0%] and 73 clinicians [34.0%]) submitted 540 potential priorities that were developed into 112 unique research questions (phase 2). Of the 112 questions, 63 were rated for importance by 57 participants (19 patients [33%], 17 family members [30%] and 21 clinicians [37%]) in phase 3. In phase 4, 20 participants (6 patients [30%], 6 family members [30%] and 8 clinicians [40%]) discussed the 25 most highly rated questions and reached consensus on the final top 10. INTERPRETATION The final priorities address pediatric chronic pain prevention, impact and treatment, as well as delivery, access and coordination of care. The priorities reflect a directed and collaborative call to action to improve existing pediatric pain research and care. PLAIN LANGUAGE SUMMARY Chronic pain affects 1 in 5 children and teens. This means that 1-3 million Canadian youth deal with pain lasting months to years. This pain gets in the way of being active, sleeping, going to school, and getting along with friends and family. Youth with chronic pain and their families are experts on what it's like to live with pain, but, until now, research has not asked what issues they care about most. The goal of the Partnering For Pain project was to develop a list of the 10 most important things we still need to learn about chronic pain during childhood according to people who live with it, their families and health care providers. We did this in 4 steps: 1) a survey with 215 people who shared 540 concerns they have about chronic pain in childhood, 2) turning those concerns into questions that can be answered by research, 3) a survey with 57 people who ranked how important each research question was and 4) an in-person discussion with 20 people who chose the top 10 research priorities. Each step included Canadians who have had chronic pain during childhood, their families and health care providers. The final top 10 list has questions about how to better prevent and care for children and teens with chronic pain. These priorities make sure that future research focuses on what is most important to people who will use it in their everyday lives. Project video: https://youtu.be/wA-RwrFiSPk. Project website: www.partneringforpain.com.
Collapse
Affiliation(s)
- Kathryn A Birnie
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont.
| | - Katherine Dib
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Carley Ouellette
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Mary Anne Dib
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Kimberly Nelson
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Dolores Pahtayken
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Krista Baerg
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Jill Chorney
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Paula Forgeron
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Christine Lamontagne
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Melanie Noel
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Patricia Poulin
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| | - Jennifer Stinson
- University of Toronto and The Hospital for Sick Children (Birnie, Stinson), Toronto, Ont.; patient partner (K. Dib, M. Dib), Halifax, NS; patient partner (Ouellette), McMaster University, Hamilton, Ont.; parent partner (Nelson), Windsor, Ont.; parent partner (Pahtayken), Onion Lake, Sask.; Department of Pediatrics (Baerg), University of Saskatchewan, Saskatoon, Sask.; Dalhousie University and IWK Health Centre (Chorney), Halifax, NS; University of Ottawa (Forgeron, Lamontagne, Poulin); Children's Hospital of Eastern Ontario (Lamontagne), Ottawa, Ont.; University of Calgary (Noel), Calgary, Alta.; The Ottawa Hospital (Poulin), Ottawa, Ont
| |
Collapse
|
163
|
Ertem DH, Bingol A, Ugurcan B, Mercan Ö, Simsek I, Sağlam H, Ozge A, Uluduz D. The impact of parental attitudes toward children with primary headaches. Clin Child Psychol Psychiatry 2019; 24:767-775. [PMID: 30895815 DOI: 10.1177/1359104519838571] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
There is a lack of data on parental attitudes toward children with primary headaches. The aim of this study is to determine whether there is a relationship between primary headaches and parental attitudes in the pre-adolescent pediatric population. In this cross-sectional study, 195 children with primary headache and 43 healthy children aged 9-16 years were included. A questionnaire for sociodemographic variables, visual analog scale (VAS), Social Anxiety Scale and Depression Inventory for Adolescents and Children, and Parental Attitudes Determining Scale (PATS), which is an attitude measure specifically designed to evaluate psychological adjustment, were administered. Of 195 children (female/male ratio: 89/106, mean age: 12.59 ± 1.09 years), episodic migraine (n = 90), chronic migraine (n = 25), and tension-type headache (n = 80) were evaluated. There was no significant difference among headache groups and healthy subjects in terms of depression, anxiety, and fathers' attitude scale scores. However, there were significant differences in mean mothers' attitude scale scores and VAS scores (p = .002, p = .000). Mean oppressive-authoritarian attitude subscale scores of mothers' was significantly higher in children with chronic migraine (p = .000). A relationship between depression and VAS scores among all patient groups was detected (p = .000). Parental age was negatively related to PATS scores of children with episodic migraine and tension-type headache (p = .037 and p = .036). Parental attitudes may elevate psychiatric symptoms and influence children's perception of pain intensity and result in chronification of headache. Our findings support that mothers' attitude toward children with chronic migraine has strong impacts on the child's pain experience.
Collapse
Affiliation(s)
- Devrimsel Harika Ertem
- Department of Neurology, Şişli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Turkey
| | - Ayhan Bingol
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Busra Ugurcan
- Department of Guidance and Counseling, Bahçeşehir University, Turkey
| | - Özlem Mercan
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Ismail Simsek
- Department of Neurosurgery, Pendik Research and Training Hospital, Marmara University, Turkey
| | - Hanife Sağlam
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| | - Aynur Ozge
- Department of Neurology, School of Medicine, Mersin University, Turkey
| | - Derya Uluduz
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University, Turkey
| |
Collapse
|
164
|
Boselie JJLM, Goossens MEJB, Muris P, Vancleef LMG. The relation between parental chronic pain, pain-related attention and interpretation biases in pain-free adolescents. Eur J Pain 2019; 23:1663-1673. [PMID: 31231930 PMCID: PMC6790560 DOI: 10.1002/ejp.1444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/11/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Children of chronic pain patients run greater risk for developing chronic pain themselves. Exposure to chronic pain of the parent might install cognitive (e.g., pain catastrophizing, interpretation and attentional bias) and affective (e.g., pain anxiety) vulnerability which increase the risk for the development of chronic pain complaints in offspring. This study examines whether pain-free offspring of parents with chronic pain complaints make more health-threatening interpretations and display a stronger pain-related attentional bias compared to the offspring of pain-free parents. We furthermore examined differences between both groups on pain catastrophizing, pain anxiety and somatic symptoms and explored the relations between parental pain catastrophizing and aforementioned pain vulnerability measures in offspring. METHODS Offspring of parents with chronic pain complaints (n = 24) and pain-free parents (n = 27) completed measures of attentional bias (i.e., pictorial dot probe), interpretation bias (i.e., ambiguous word association task), pain catastrophizing, pain anxiety and somatic symptoms. Parents completed measures of pain catastrophizing and psychological distress. RESULTS No differences between offspring of parents with and without pain complaints were observed on pain catastrophizing, pain anxiety and somatic symptoms. Both groups of healthy adolescents predominantly showed benign, non-health-threatening interpretations. Children of pain-free parents showed an attention bias for pain stimuli, while offspring of parents with pain complaints showed no such bias. CONCLUSIONS Future research is needed to further elucidate the precise role of parental pain in the development of pain-related biases and the significance of these biases in the onset and/or maintenance of a chronic pain condition in children and adolescents. SIGNIFICANCE Parental chronic pain may install psychological vulnerability for developing chronic pain and associated complaints in offspring. This study did not show differences in pain-directed attentional and interpretation bias between offspring of parents with chronic pain complaints and offspring of pain-free parents. Further (longitudinal) research is needed to elucidate the precise role of parental pain factors in the development of pain-related vulnerability in offspring of chronic pain parents, thereby identifying important targets for the prevention and early intervention of chronic pain.
Collapse
Affiliation(s)
| | - Mariëlle E. J. B. Goossens
- Clinical Psychological ScienceMaastricht UniversityMaastrichtThe Netherlands
- Rehabilitation Reseach & Clinical Psychological SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Peter Muris
- Clinical Psychological ScienceMaastricht UniversityMaastrichtThe Netherlands
| | | |
Collapse
|
165
|
Evans S, Moloney C, Seidman LC, Zeltzer LK, Tsao JCI. Parental Bonding in Adolescents With and Without Chronic Pain. J Pediatr Psychol 2019; 43:276-284. [PMID: 29048481 DOI: 10.1093/jpepsy/jsx110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/10/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Parental responses influence children's pain; however, the specific role of parental bonding in pediatric pain has not been examined. Depressive symptomology is frequently reported in children with chronic pain (CP) and may play a role in the relationship between parental bonding and pain. This study examined the connections between maternal/paternal bonding (perceived care and control) and symptoms of pain and depression in adolescents with CP and in healthy adolescents. Method Participants included 116 adolescents (aged 12-17) with CP (n = 55) and without (n = 61). Adolescents completed the Parental Bonding Instrument separately for their mother and father, as well as measures of depression and pain. Results Significant associations between parental bonding and adolescent pain and depression emerged in the pain group, but not in the healthy group. There were no differences in the impact of maternal versus paternal bonding on adolescent pain and depression. Mediation analyses revealed adolescent depression was a mediator of the relationship between maternal care and adolescent pain, and paternal control and adolescent pain in the group with CP. Conclusions This study highlights the importance of considering parental bonding and adolescent depression in pediatric CP, suggesting that high paternal control and low maternal care contribute to increased pain in adolescents through heightened adolescent depressive symptoms. The findings emphasize the need for family-based treatment for CP that addresses parent behaviors and adolescent mental health.
Collapse
Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Laura C Seidman
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Lonnie K Zeltzer
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennie C I Tsao
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
| |
Collapse
|
166
|
Stone AL, Karlson CW, Heathcote LC, Rosenberg AR, Palermo TM. Topical Review: Pain in Survivors of Pediatric Cancer: Applying a Prevention Framework. J Pediatr Psychol 2019; 43:237-242. [PMID: 29048571 DOI: 10.1093/jpepsy/jsx114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/17/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To apply a biopsychosocial framework to understand factors influencing pain in survivors of pediatric cancer to inform pain prevention efforts and highlight the need for interdisciplinary care. Method This topical review draws from both pediatric cancer survivorship research and chronic noncancer pain research to illustrate how components of a preventative model can be applied to pain in survivorship. Results Pain is a common experience among long-term survivors of pediatric cancer. The pain experience in survivorship can be conceptualized in terms of biological disease and treatment factors, cognitive and affective factors, and social and contextual factors. We review literature pertinent to each of these biopsychosocial factors and tailor an existing public health prevention framework for pain in survivors of pediatric cancer. Conclusions Classifying survivors of pediatric cancer into pain risk categories based on their daily experiences of pain, pain-related functional impairment, and distress could help guide the implementation of pain-related prevention and intervention strategies in this population. Future research is needed to establish the efficacy of screening measures to identify patients in need of psychosocial pain and pain-related fear management services, and interdisciplinary pediatric chronic pain management programs in survivors of pediatric cancer.
Collapse
Affiliation(s)
- Amanda L Stone
- Department of Pediatrics, Hematology/Oncology, University of Mississippi Medical Center
- Department of Pediatrics, Oregon Health & Science University
| | - Cynthia W Karlson
- Department of Pediatrics, Hematology/Oncology, University of Mississippi Medical Center
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington
- Treuman Katz Center for Pediatric Bioethics, Center for Clinical and Translational Research, Seattle Children's Research Institute, and
| | - Tonya M Palermo
- Departments of Anesthesiology and Pain Medicine, Psychiatry, and Pediatrics, University of Washington School of Medicine
| |
Collapse
|
167
|
Law EF, Palermo TM, Zhou C, Groenewald CB. Economic Impact of Headache and Psychiatric Comorbidities on Healthcare Expenditures Among Children in the United States: A Retrospective Cross-Sectional Study. Headache 2019; 59:1504-1515. [PMID: 31520418 DOI: 10.1111/head.13639] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the annual healthcare expenditures associated with childhood headache in the United States, and to evaluate whether psychiatric comorbidities increase the impact of headache on expenditures. BACKGROUND Headache is prevalent in childhood and co-occurs with anxiety disorders, depressive disorders, and attention deficit/hyperactivity disorder (ADHD), which may increase cost of illness. METHODS We conducted a secondary data analysis using a nationally representative sample of 34,633 children ages 2-17 from the 2012-2015 Medical Expenditure Panel Surveys (MEPS), of which 779 (weighted 2.6%) were identified as having headache based on health service use associated with headache. Using a comprehensive cost-of-illness approach, we assessed the incremental expenditures associated with headache and determined excess expenditures associated with psychiatric comorbidities using standard adjusted 2-part expenditure models. RESULTS Annual total healthcare expenditures were estimated to be 24.3% higher, 95% CI [1,55], in our headache group ($3036, 95% CI [2374,3699] vs $2350, 95% CI [2140,2559]). Total national expenditures associated with pediatric headache in the United States were estimated at $1.1 billion annually, 95% CI [.04, 2.2 billion]. Depression and ADHD were associated with higher incremental expenditures for the headache group (depression: $1815, 95% CI[676,2953] vs $1409, 95% CI[697,2112]; ADHD: $4742, 95% CI[1659,7825] vs $2935, 95% CI[1977,3894]); however, interactions between psychiatric comorbidities and headache did not reach statistical significance. CONCLUSION Youth with headache exert a considerable economic burden on families, healthcare systems, and society. Due to the limitations in methods used to classify youth with headache in MEPS, our findings may underestimate the true prevalence and cost of pediatric headache in the United States. Further research with larger sample sizes is needed to understand the impact of psychiatric comorbidities on healthcare expenditures in this population.
Collapse
Affiliation(s)
- Emily F Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Chuan Zhou
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Cornelius B Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA.,Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA, USA
| |
Collapse
|
168
|
Kanstrup M, Jordan A, Kemani MK. Adolescent and Parent Experiences of Acceptance and Commitment Therapy for Pediatric Chronic Pain: An Interpretative Phenomenological Analysis. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E101. [PMID: 31500227 PMCID: PMC6770081 DOI: 10.3390/children6090101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Abstract
Pediatric chronic pain is common and can be related to reduced functioning in many domains for the young person and their parents. Existing psychological treatments such as Acceptance and Commitment Therapy (ACT) have shown to be effective, but improvements are needed. Qualitative approaches can help improve our understanding of treatment processes and outcomes. The aim of the present qualitative interview study was to explore the lived experiences of young people and parents who had participated in ACT for pediatric chronic pain. Four young persons and four parents were interviewed, and data was analyzed using Interpretative Phenomenological Analysis (IPA). Three themes were generated, each comprising two subthemes: (1) 'Warning system', which included experiences from being offered this psychological intervention, and the alternative explanations provided for pain; (2) 'Change and challenges', which suggested the importance of the values-based work, and of individual adaptation; and (3) 'A common language' in which the interaction with others and new ways to communicate around the pain experience were described. Findings highlight the importance of pain education, formulating and acting in line with personal values, and communication around the pain experience, as well as the need for developmental and individual adaptations of interventions.
Collapse
Affiliation(s)
- Marie Kanstrup
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Abbie Jordan
- Centre for Pain Research, University of Bath, Bath, BA2 7AY, UK.
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Mike K Kemani
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| |
Collapse
|
169
|
Improving Distress and Behaviors for Parents of Adolescents With Chronic Pain Enrolled in an Intensive Interdisciplinary Pain Program. Clin J Pain 2019; 35:772-779. [DOI: 10.1097/ajp.0000000000000737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
170
|
Liang R, Chan SHS, Ho FKW, Tang OC, Cherk SWW, Ip P, Lau EYY. Health-related quality of life in Chinese boys with Duchenne muscular dystrophy and their families. J Child Health Care 2019; 23:495-506. [PMID: 31220930 DOI: 10.1177/1367493519857423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aims to assess the family functioning and health-related quality of life (HRQOL) in Chinese boys with Duchenne muscular dystrophy (DMD) and their parents using Pediatric Quality-of-Life Family Impact Module (PedsQL FIM) and Pediatric Quality-of-Life Inventory (PedsQL) 4.0. Findings from 15 families with DMD were compared with 15 unaffected families. The HRQOL, as measured by the mean PedsQL 4.0 Generic Core Scale scores for the boys with DMD were significantly lower than those of age-matched healthy boys, for overall (p < 0.05, parent-report; p <0.001, self-report), physical (p < 0.001, parent-report and self-report), and social (p < 0.05, parent-report) functioning, but the emotional functioning is not affected. The parent-child concordance of our affected DMD families was generally in the moderate-to-good agreement range (intraclass correlation coefficients from 0.51 to 0.73), except for emotional (0.28) and social (0.31) functioning. The PedsQL FIM total score showed an inverse relationship with the affected child's age (correlation coefficient: -0.55; p < 0.01) and the disease stage (correlation coefficient: -0.63; p < 0.01) confirming that parental HRQOL and overall family functioning worsened as the child increased in age with advancing disease stage.
Collapse
Affiliation(s)
- Rui Liang
- 1 Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, HKSAR
| | - Sophelia Hoi Shan Chan
- 1 Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, HKSAR
| | - Frederick Ka Wing Ho
- 1 Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, HKSAR
| | - Oi Ching Tang
- 2 Department of Psychology, The University of Hong Kong, Hong Kong, HKSAR
| | | | - Patrick Ip
- 1 Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, HKSAR
| | - Esther Yuet Ying Lau
- 4 Department of Psychology, The Education University of Hong Kong, Hong Kong, HKSAR.,5 Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong, HKSAR
| |
Collapse
|
171
|
Reader SK, Rockman LM, Okonak KM, Ruppe NM, Keeler CN, Kazak AE. Systematic Review: Pain and Emotional Functioning in Pediatric Sickle Cell Disease. J Clin Psychol Med Settings 2019; 27:343-365. [PMID: 31414278 DOI: 10.1007/s10880-019-09647-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective of this systematic review was to assess the relationship between pain (frequency/intensity/duration, impairment, coping) and emotional functioning in pediatric Sickle Cell Disease, and evaluate the state of the literature. Studies were included if they met each of the following criteria: (a) primarily pediatric sample of youth or young adults up to age 21 years with SCD, (b) examined emotional functioning including anxiety and/or depressive and/or internalizing symptoms, and/or affect, (c) examined pain intensity/frequency/duration and/or pain-related impairment and/or pain coping as it relates to emotional functioning, as defined above. Using the established guidelines for systematic reviews, we searched PsycINFO, PubMED, and CINAHL databases for studies published through June 2018. Screening resulted in 33 studies meeting inclusion criteria. Study data were extracted and evaluated for scientific merit, resulting in four studies being removed. 29 studies were included in the final synthesis. Studies provide strongest evidence of a relationship between increased pain frequency and higher depressive and anxiety symptoms. There are moderate-to-strong associations between pain-related impairment and depressive symptoms, and small-to-strong associations between pain-related impairment and anxiety. When examining pain-coping strategies, maladaptive cognitive strategies show the strongest association with emotional functioning. There is a need for more adequately powered, prospective studies based on theoretical frameworks in order to advance our understanding of the relationship between pain and emotional functioning in pediatric SCD.
Collapse
Affiliation(s)
- Steven K Reader
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA. .,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
| | | | - Katherine M Okonak
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA
| | - Nicole M Ruppe
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA
| | - Colleen N Keeler
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, The Nemours Children's Health System, 1701 Rockland Road, Suite 160, Wilmington, DE, 19803, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
172
|
Lee RR, Rashid A, Ghio D, Thomson W, Cordingley L. "Seeing Pain Differently": A Qualitative Investigation Into the Differences and Similarities of Pain and Rheumatology Specialists' Interpretation of Multidimensional Mobile Health Pain Data From Children and Young People With Juvenile Idiopathic Arthritis. JMIR Mhealth Uhealth 2019; 7:e12952. [PMID: 31267979 PMCID: PMC6632104 DOI: 10.2196/12952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/28/2019] [Accepted: 03/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background In contrast to the use of traditional unidimensional paper-based scales, a mobile health (mHealth) assessment of pain in children and young people (CYP) with juvenile idiopathic arthritis (JIA) enables comprehensive and complex multidimensional pain data to be captured remotely by individuals. However, how professionals use multidimensional pain data to interpret and synthesize pain reports gathered using mHealth tools is not yet known. Objective The aim of this study was to explore the salience and prioritization of different mHealth pain features as interpreted by key stakeholders involved in research and management of pain in CYP with JIA. Methods Pain and rheumatology specialists were purposively recruited via professional organizations. Face-to-face focus groups were conducted for each specialist group. Participants were asked to rank order 9 static vignette scenarios created from real patient mHealth multidimensional pain data. These data had been collected by a researcher in a separate study using My Pain Tracker, a valid and acceptable mHealth iPad pain communication tool that collects information about intensity, severity, location, emotion, and pictorial pain qualities. In the focus groups, specialists discussed their decision-making processes behind each rank order in the focus groups. The total group rank ordering of vignette scenarios was calculated. Qualitative data from discussions were analyzed using latent thematic analysis. Results A total of 9 pain specialists took part in 1 focus group and 10 rheumatology specialists in another. In pain specialists, the consensus for the highest pain experience (44%) was poorer than their ranking of the lowest pain experiences (55%). Conversely, in rheumatology specialists, the consensus for the highest pain experience (70%) was stronger than their ranking of the lowest pain experience (50%). Pain intensity was a high priority for pain specialists, but rheumatology specialists gave high priority to intensity and severity taken together. Pain spread was highly prioritized, with the number of pain locations (particular areas or joints) being a high priority for both groups; radiating pain was a high priority for pain specialists only. Pain emotion was challenging for both groups and was only perceived to be a high priority when specialists had additional confirmatory evidence (such as information about pain interference or clinical observations) to validate the pain emotion report. Pain qualities such as particular word descriptors, use of the color red, and fire symbols were seen to be high priority by both groups in interpretation of CYP pain reports. Conclusions Pain interpretation is complex. Findings from this study of specialists’ decision-making processes indicate which aspects of pain are prioritized and weighted more heavily than others by those interpreting mHealth data. Findings are useful for developing electronic graphical summaries which assist specialists in interpreting patient-reported mHealth pain data more efficiently in clinical and research settings.
Collapse
Affiliation(s)
- Rebecca Rachael Lee
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Amir Rashid
- NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Daniela Ghio
- Primary Care and Population Science, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Wendy Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Lis Cordingley
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| |
Collapse
|
173
|
Associations Between Physical Activity and Chronic Pain Severity in Youth With Chronic Abdominal Pain. Clin J Pain 2019; 35:618-624. [DOI: 10.1097/ajp.0000000000000716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
174
|
Abstract
Having a child with chronic pain impacts a parent's life. Reciprocally, parent cognitive, affective, and behavioral responses to the child's chronic pain can influence the child's pain experience. The purpose of this study is to develop a brief self-report screening tool (Parent Risk and Impact Screening Measure [PRISM]) of parent psychosocial functioning and behavioral responses to child pain. This measure assesses parents' reports of their own stress, health, psychosocial functioning, and disruption in activities due to their child's pain and related disability. In an effort to preliminarily validate this screening tool, we examined the PRISM in relation to existing measures of parent distress, parent behavior, and child functioning. An initial 30-item PRISM was administered to 229 parents of children with persistent pain. Parents also reported on distress, protectiveness, pain catastrophizing and family impact, and youth completed measures of pain, pain-related disability, and quality of life. Item refinement resulted in a final 12-item PRISM tool. The PRISM demonstrates strong internal consistency, and initial support for construct validity was shown by associations with parent distress, protectiveness, and catastrophizing. Results also revealed higher PRISM scores are associated with higher child pain intensity, greater functional disability, and poorer quality of life. Cutoff scores were determined to identify parents at differing levels of risk. The PRISM is a brief and clinically important means of screening parent distress and behaviors associated with child pain-related dysfunction. Further validation will use PRISM in longitudinal studies, particularly testing PRISM scores as a predictor of parent and child outcomes over time.
Collapse
|
175
|
Family Strain, Depression, and Somatic Amplification in Adults with Chronic Pain. Int J Behav Med 2019; 26:427-436. [DOI: 10.1007/s12529-019-09799-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
176
|
Haraldstad K, Kvarme LG, Christophersen KA, Helseth S. Associations between self-efficacy, bullying and health-related quality of life in a school sample of adolescents: a cross-sectional study. BMC Public Health 2019; 19:757. [PMID: 31200763 PMCID: PMC6570837 DOI: 10.1186/s12889-019-7115-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background To better understand health-related quality of life (HRQOL) in adolescents, it is important to gain knowledge about factors associated with HRQOL. Being involved in bullying is a significant threat to health, and social and psychological well-being; further, such problems can last into adulthood. The aim of this study was to explore the role of general self-efficacy (GSE) and bullying in relation to HRQOL. We specifically sought to study the prevalence of bullying, as well as the associations between both bullying and self-efficacy and HRQOL in a sample of adolescents. Methods This was a cross-sectional study of 723 adolescents (12–18 years) attending schools selected using randomized cluster sampling. HRQOL was measured using the KIDSCREEN-52, self-efficacy was measured with the GSE scale, and bullying was measured using the two global questions from the Olweus bullying questionnaire. Multiple regression analyses were performed to explore how being bullied, bullying, and GSE were associated with variations in self-reported HRQOL. Results Of the 723 adolescents, 13% reported being bullied; there were no gender differences within this finding. However, more boys than girls reported that they had bullied others. Both being bullied, and bullying others, were associated with lower HRQOL; however, being bullied was associated with the lowest scores. Higher self-efficacy was associated with better HRQOL. Self-efficacy contributed significantly to predicting variation in HRQOL. Conclusions Being involved in bullying, as a victim or a bully, is associated with lower HRQOL. The association between GSE and HRQOL indicates that self-efficacy might be a resource for increasing HRQOL among adolescents. Our findings highlight the importance of targeting self-efficacy beliefs as an intervention strategy to improve GSE and HRQOL in adolescents involved in bullying.
Collapse
Affiliation(s)
- Kristin Haraldstad
- Faculty of Health- and Sport Sciences, University of Agder, P.O box 422, 4604, Kristiansand, Norway.
| | - Lisbeth G Kvarme
- Faculty of Health, OsloMet, Oslo Metropolitan University, P.O box 4, St Olavs Plass, 0130, Oslo, Norway
| | | | - Sølvi Helseth
- Faculty of Health- and Sport Sciences, University of Agder, P.O box 422, 4604, Kristiansand, Norway.,Faculty of Health, OsloMet, Oslo Metropolitan University, P.O box 4, St Olavs Plass, 0130, Oslo, Norway
| |
Collapse
|
177
|
Abstract
BACKGROUND AND OBJECTIVES The opioid crisis in America affects both adults and children. However, knowledge about the epidemiology of the opioid crisis, opioid prescribing patterns, and the link between opioid prescribing and problematic opioid behaviors remain limited. Thus, children are often excluded from health care policies and guidelines aimed at curbing the opioid crises. The primary aim of this topical review is to provide a brief overview of the opioid crises affecting children, followed by a synopsis of recent research on opioid prescribing patterns and data on the links between legitimate opioid use and risk for problematic opioid use behaviors. METHODS This is a narrative review. RESULTS Opioid misuse is a public health crisis facing children and adolescents in the United States and serves as a key antecedent for other problematic opioid behaviors, including opioid use disorder, heroin use, and opioid overdose. Furthermore, the United States experienced a significant increase in opioid prescribing to children and adolescents as compared with prescribing rates before the year 2000. Yet, data on the associations between opioid prescribing patterns and risk for problematic opioid use remains limited. DISCUSSION There exist an urgent need to identify adolescents at increased risk for problematic opioid use behaviors following a receipt of medically prescribed opioids. The article closes with some general guidelines that providers may follow to reduce the risk of opioids in pediatric patients.
Collapse
Affiliation(s)
- Cornelius B Groenewald
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
| |
Collapse
|
178
|
Nelson S, Logan D. What’s the right answer? Parent and youth perceptions of teacher responses to pain behaviors in the classroom. CHILDRENS HEALTH CARE 2019. [DOI: 10.1080/02739615.2019.1603995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Deirdre Logan
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
179
|
Benjamin JZ, Harbeck-Weber C, Sim L. Pain is a family matter: Quality of life in mothers and fathers of youth with chronic pain. Child Care Health Dev 2019; 45:440-447. [PMID: 30866054 DOI: 10.1111/cch.12662] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 03/01/2019] [Accepted: 03/09/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Most research on family impacts of paediatric chronic pain has been conducted with mothers, and therefore, little is known about fathers' adjustment. However, it is well established that caring for a child with chronic pain takes a toll on caregiver well-being. Parents of children with chronic pain have been found to experience high levels of anxiety, depression, and parenting stress. As such, the goal of this study was to examine differences between mothers and fathers of youth with chronic pain, explore interaction effects between parent gender and child variables, and compare parents' scores to national norms. METHODS Participants included 160 matched mothers and fathers of youth with chronic pain participating in an interdisciplinary pain rehabilitation programme. At admission, parents completed the Center for Epidemiological Studies-Depression scale and SF-36 to assess depression and health-related quality of life. T tests and analysis of variance were used to explore differences between mothers and fathers and population norms. RESULTS Mothers reported experiencing significantly poorer functioning than did fathers in the domains of emotional role interference, social functioning, and vitality. Differences remained significant when controlling for other psychosocial variables using multiple regression. Child gender and depression level were found to be significant predictors of parent mental health, with mothers' mental health more negatively influenced by child depression. Additionally, mothers' scores in mental health domains were significantly lower than population norms. CONCLUSIONS These findings highlight the importance of identifying the ways in which chronic pain in youth may affect parents differently in order to enhance caregiver support and interventions.
Collapse
Affiliation(s)
- Julia Z Benjamin
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | | |
Collapse
|
180
|
Palermo TM, Kashikar-Zuck S, Friedrichsdorf SJ, Powers SW. Special considerations in conducting clinical trials of chronic pain management interventions in children and adolescents and their families. Pain Rep 2019; 4:e649. [PMID: 31583334 PMCID: PMC6749908 DOI: 10.1097/pr9.0000000000000649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/21/2018] [Accepted: 03/03/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Disabling chronic pain is a common experience for children and adolescents. However, the evidence base for chronic pain interventions for youth is extremely limited, which has hindered the development of evidence-based practice guidelines for most pediatric chronic pain conditions. OBJECTIVES To review and provide recommendations on clinical trial design and evaluation in children and adolescents with chronic pain. METHODS In this article, we summarize key issues and provide recommendations for addressing them in clinical trials of chronic pain interventions in children and adolescents and their families. RESULTS To stimulate high-quality trials of pediatric chronic pain management interventions, attention to key issues including sample characterization, trial design and treatment administration, outcome measurement, and the ethics of intervening with children and adolescents, as opposed to adults with chronic pain, is needed. CONCLUSION Future research to develop interventions to reduce or prevent childhood chronic pain is an important priority area, and requires special considerations in implementation and evaluation in clinical trials.
Collapse
Affiliation(s)
- Tonya M. Palermo
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stefan J. Friedrichsdorf
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| |
Collapse
|
181
|
Higginson A, Forgeron P, Harrison D, Finley GA, Dick BD. Moving on: Transition experiences of young adults with chronic pain. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2019; 3:85-97. [PMID: 35005397 PMCID: PMC8730586 DOI: 10.1080/24740527.2019.1587707] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: The purpose of this study was to explore the transition experience of young adults with chronic pain in Canada from the pediatric health care setting to the adult health care setting. Materials and Methods: A qualitative descriptive approach using semistructured interviews was used to capture the transition experiences of young people with chronic pain who have recently transferred from the pediatric setting to the adult health care setting. Participants were recruited from west, central, and the east coast of Canada to situate the findings within the context of Canada. Interviews were transcribed and analyzed using qualitative inductive content analysis. Results: Nine participants were interviewed, three from each part of Canada (west, central, and east). Five common categories were determined to describe the transition experience of young adults with chronic pain which include (1) independence (I can do it, maybe?), (2) pain trajectory (stress and pain along for the ride), (3) social support networks (need a shoulder to lean on), (4) parental support (obviously they are there), and (5) collaborative systems (the bridge). Conclusion: Young people with chronic pain experience unique challenges when faced with transitioning to the adult health care setting. Supporting the young person and his or her family in preparation and readiness and collaboration between the pediatric and adult health care settings are essential to ensure a smooth transition and avoid negative transition outcomes. Further research is needed to determine the best ways to prepare young people for transition and the care activities required in both pediatric and adult health care settings to improve pain-related outcomes posttransition.
Collapse
Affiliation(s)
- Andrea Higginson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Forgeron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anaesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Denise Harrison
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - G. Allen Finley
- Department of Anesthesia & Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Canada
| | - Bruce D. Dick
- Depts. of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, Faculties of Medicine and Dentistry & Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
182
|
Khair K, Klukowska A, Myrin Westesson L, Kavakli K, Escuriola C, Uitslager N, Santoro C, Holland M, von Mackensen S. The burden of bleeds and other clinical determinants on caregivers of children with haemophilia (the BBC Study). Haemophilia 2019; 25:416-423. [PMID: 30925018 DOI: 10.1111/hae.13736] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Revised: 02/19/2019] [Accepted: 02/19/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Treatment burden for the people with haemophilia has been documented, as has the burden of caring for a child with a common chronic disease such as asthma or diabetes. However, there remains a paucity of data about caregiver burden in haemophilia. AIMS The aim of this study was to evaluate the impact of bleeding on caregivers of children with haemophilia. Caregiver burden was stratified by the clinical status of their child. METHODS A multinational, non-interventional study of caregivers of children with severe or moderate haemophilia, using the HEMOCABquestionnaire to evaluate caregiver burden. RESULTS A total of 144 caregivers from seven EU countries participated in the study. Differences in caregiver burden were identified based on the clinical situation of the child. Greater burden was seen in caregivers of children who experienced joint bleeding in the preceding 12 months, or had target joints or reduced range of motion in most domains of the HEMOCAB. Caring for a child with a current inhibitor also caused significantly higher burden for caregivers when compared to caring for a child with tolerized inhibitor or without inhibitor. Caregivers of children with chronic pain reported significantly higher burden in all domains of the HEMOCAB except for "interaction with the father." CONCLUSION Caregiver burden can be affected by the child's haemophilia status, particularly if joint health is impacted (eg bleeds, decreased mobility) or if the child suffers from chronic pain which was moderately correlated with joint bleeds.
Collapse
Affiliation(s)
- Kate Khair
- Centre for Outcomes and Experience Research in Childhood Health, Illness and Disability (ORCHID) Great Ormond Street Hospital for Children NHS Trust, London, UK.,Haemophilia Centre, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Anna Klukowska
- Department of Paediatrics, Haematology Oncology, Warsaw Medical University, Warsaw, Poland
| | - Linda Myrin Westesson
- Department of Medicine/Haematology and Coagulation Disorders, Coagulation Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Carmen Escuriola
- Haemophilia Centre Rhein Main (HZRM), Mörfelden-Walldorf, Germany
| | - Nanda Uitslager
- Van Creveldkliniek, Division of Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Sylvia von Mackensen
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
183
|
Third Wave Treatments for Functional Somatic Syndromes and Health Anxiety Across the Age Span: A Narrative Review. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i1.32217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Functional disorders (FD) are present across the age span and are commonly encountered in somatic health care. Psychological therapies have proven effective, but mostly the effects are slight to moderate. The advent of third wave cognitive behavioural therapies launched an opportunity to potentially improve treatments for FD.A narrative review of the literature on the application of mindfulness-based therapies (MBT) and Acceptance & Commitment Therapy (ACT) in children and adult populations with FD.There were very few and mainly preliminary feasibility studies in children and adolescents. For adults there were relatively few trials of moderate to high methodological quality. Ten MBT randomised trials and 15 ACT randomised trials of which 8 were internet-delivered were identified for more detailed descriptive analysis. There was no evidence to suggest higher effects of third wave treatments as compared to CBT. For MBT, there seemed to be minor effects comparable to active control conditions. A few interventions combining second and third wave techniques found larger effects, but differences in outcomes, formats and dosage hamper comparability.Third wave treatments are getting established in treatment delivery and may contribute to existing treatments for FD. Future developments could further integrate second and third wave treatments across the age span. Elements unambiguously targeting specific illness beliefs and exposure should be included. The benefit of actively engaging close relatives in the treatment not only among younger age groups but also in adults, as well as the effect of more multimodal treatment programmes including active rehabilitation, needs to be further explored.The methodological quality of third wave interventions for FD should be improved, especially in younger age groups.The effect of ACT interventions may be comparable to CBT in adults with FD.The evidence for third wave interventions in young people with FD is still very limited.Newer studies combining second and third wave treatments show some promise.Agreement on, and for child populations further development of, core outcomes, could help determine effect across studies.The methodological quality of third wave interventions for FD should be improved, especially in younger age groups.The effect of ACT interventions may be comparable to CBT in adults with FD.The evidence for third wave interventions in young people with FD is still very limited.Newer studies combining second and third wave treatments show some promise.Agreement on, and for child populations further development of, core outcomes, could help determine effect across studies.
Collapse
|
184
|
Law E, Fisher E, Eccleston C, Palermo TM. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database Syst Rev 2019; 3:CD009660. [PMID: 30883665 PMCID: PMC6450193 DOI: 10.1002/14651858.cd009660.pub4] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Psychological therapies for parents of children and adolescents with chronic illness aim to improve parenting behavior and mental health, child functioning (behavior/disability, mental health, and medical symptoms), and family functioning.This is an updated version of the original Cochrane Review (2012) which was first updated in 2015. OBJECTIVES To evaluate the efficacy and adverse events of psychological therapies for parents of children and adolescents with a chronic illness. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and trials registries for studies published up to July 2018. SELECTION CRITERIA Included studies were randomized controlled trials (RCTs) of psychological interventions for parents of children and adolescents with a chronic illness. In this update we included studies with more than 20 participants per arm. In this update, we included interventions that combined psychological and pharmacological treatments. We included comparison groups that received either non-psychological treatment (e.g. psychoeducation), treatment as usual (e.g. standard medical care without added psychological therapy), or wait-list. DATA COLLECTION AND ANALYSIS We extracted study characteristics and outcomes post-treatment and at first available follow-up. Primary outcomes were parenting behavior and parent mental health. Secondary outcomes were child behavior/disability, child mental health, child medical symptoms, and family functioning. We pooled data using the standardized mean difference (SMD) and a random-effects model, and evaluated outcomes by medical condition and by therapy type. We assessed risk of bias per Cochrane guidance and quality of evidence using GRADE. MAIN RESULTS We added 21 new studies. We removed 23 studies from the previous update that no longer met our inclusion criteria. There are now 44 RCTs, including 4697 participants post-treatment. Studies included children with asthma (4), cancer (7), chronic pain (13), diabetes (15), inflammatory bowel disease (2), skin diseases (1), and traumatic brain injury (3). Therapy types included cognitive-behavioural therapy (CBT; 21), family therapy (4), motivational interviewing (3), multisystemic therapy (4), and problem-solving therapy (PST; 12). We rated risk of bias as low or unclear for most domains, except selective reporting bias, which we rated high for 19 studies due to incomplete outcome reporting. Evidence quality ranged from very low to moderate. We downgraded evidence due to high heterogeneity, imprecision, and publication bias.Evaluation of parent outcomes by medical conditionPsychological therapies may improve parenting behavior (e.g. maladaptive or solicitous behaviors; lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.28, 95% confidence interval (CI) -0.43 to -0.13; participants = 664; studies = 3; SMD -0.21, 95% CI -0.37 to -0.05; participants = 625; studies = 3; I2 = 0%, respectively, low-quality evidence), chronic pain post-treatment and follow-up (SMD -0.29, 95% CI -0.47 to -0.10; participants = 755; studies = 6; SMD -0.35, 95% CI -0.50 to -0.20; participants = 678; studies = 5, respectively, moderate-quality evidence), diabetes post-treatment (SMD -1.39, 95% CI -2.41 to -0.38; participants = 338; studies = 5, very low-quality evidence), and traumatic brain injury post-treatment (SMD -0.74, 95% CI -1.25 to -0.22; participants = 254; studies = 3, very low-quality evidence). For the remaining analyses data were insufficient to evaluate the effect of treatment.Psychological therapies may improve parent mental health (e.g. depression, anxiety, lower scores are better) in children with cancer post-treatment and follow-up (SMD -0.21, 95% CI -0.35 to -0.08; participants = 836, studies = 6, high-quality evidence; SMD -0.23, 95% CI -0.39 to -0.08; participants = 667; studies = 4, moderate-quality evidence, respectively), and chronic pain post-treatment and follow-up (SMD -0.24, 95% CI -0.42 to -0.06; participants = 490; studies = 3; SMD -0.20, 95% CI -0.38 to -0.02; participants = 482; studies = 3, respectively, low-quality evidence). Parent mental health did not improve in studies of children with diabetes post-treatment (SMD -0.24, 95% CI -0.90 to 0.42; participants = 211; studies = 3, very low-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent mental health.Evaluation of parent outcomes by psychological therapy typeCBT may improve parenting behavior post-treatment (SMD -0.45, 95% CI -0.68 to -0.21; participants = 1040; studies = 9, low-quality evidence), and follow-up (SMD -0.26, 95% CI -0.42 to -0.11; participants = 743; studies = 6, moderate-quality evidence). We did not find evidence for a beneficial effect for CBT on parent mental health at post-treatment or follow-up (SMD -0.19, 95% CI -0.41 to 0.03; participants = 811; studies = 8; SMD -0.07, 95% CI -0.34 to 0.20; participants = 592; studies = 5; respectively, very low-quality evidence). PST may improve parenting behavior post-treatment and follow-up (SMD -0.39, 95% CI -0.64 to -0.13; participants = 947; studies = 7, low-quality evidence; SMD -0.54, 95% CI -0.94 to -0.14; participants = 852; studies = 6, very low-quality evidence, respectively), and parent mental health post-treatment and follow-up (SMD -0.30, 95% CI -0.45 to -0.15; participants = 891; studies = 6; SMD -0.21, 95% CI -0.35 to -0.07; participants = 800; studies = 5, respectively, moderate-quality evidence). For the remaining analyses, data were insufficient to evaluate the effect of treatment on parent outcomes.Adverse eventsWe could not evaluate treatment safety because most studies (32) did not report on whether adverse events occurred during the study period. In six studies, the authors reported that no adverse events occurred. The remaining six studies reported adverse events and none were attributed to psychological therapy. We rated the quality of evidence for adverse events as moderate. AUTHORS' CONCLUSIONS Psychological therapy may improve parenting behavior among parents of children with cancer, chronic pain, diabetes, and traumatic brain injury. We also found beneficial effects of psychological therapy may also improve parent mental health among parents of children with cancer and chronic pain. CBT and PST may improve parenting behavior. PST may also improve parent mental health. However, the quality of evidence is generally low and there are insufficient data to evaluate most outcomes. Our findings could change as new studies are conducted.
Collapse
Affiliation(s)
- Emily Law
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | | | | | | |
Collapse
|
185
|
Kapadia M, Scheid A, Fine E, Zoffness R. Review of the Management of Pediatric Post-Concussion Syndrome-a Multi-Disciplinary, Individualized Approach. Curr Rev Musculoskelet Med 2019; 12:57-66. [PMID: 30758705 PMCID: PMC6388574 DOI: 10.1007/s12178-019-09533-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Post-concussion syndrome (PCS), when the patient's concussion symptoms last longer than 4-6 weeks, affects 10-30% of concussion patients. PCS presents a significant source of morbidity to patients and a management challenge to providers. In this review, we present the current evidence and best management approaches for pediatric PCS. RECENT FINDINGS There is limited high-quality evidence in pediatric PCS. There is some evidence supporting pharmaceutical management of post-traumatic headaches, cognitive symptoms, and emotional symptoms. Vestibular-ocular dysfunction should be evaluated and managed appropriately. Neuropsychological recovery is expected, but requires appropriate attention to Return to Learn. Emotional symptoms are common in PCS and the evidence supports treatment with cognitive behavioral therapy. PCS presents a unique therapeutic challenge affecting multiple domains for patients-physical, sleep, cognitive, and emotional. Successful management of PCS requires a multi-disciplinary and individualized approach. There remains a significant need for further research, specifically looking into the outcomes and effective interventions in pediatric PCS.
Collapse
Affiliation(s)
- Mitul Kapadia
- Division of Pediatric Rehabilitation Medicine, Mission Hall, UCSF Benioff Children's Hospital, Box 0110, 550 16th Street, 4th Floor, San Francisco, CA, 34143, USA.
- University of California, San Francisco, CA, USA.
| | - Alison Scheid
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Eric Fine
- Department of Neurology, University of California, San Francisco, CA, USA
| | | |
Collapse
|
186
|
Pain and quality of life in youth with inflammatory bowel disease: the role of parent and youth perspectives on family functioning. Pain Rep 2019; 4:e715. [PMID: 31041418 PMCID: PMC6455693 DOI: 10.1097/pr9.0000000000000715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/28/2018] [Accepted: 12/29/2018] [Indexed: 12/22/2022] Open
Abstract
Introduction Daily pain experiences are a common feature of pediatric inflammatory bowel disease (IBD), which can negatively influence their health-related quality of life (HRQOL). A holistic, family systems approach is needed to further our understanding of daily pain experiences in youth with IBD and their influence on youth's HRQOL. Objectives The study's objectives were to (1) provide a detailed description of daily pain experiences in youth with IBD, (2) investigate the relative contribution of family functioning and pain in explaining youth's HRQOL, and (3) explore differences in parental and youth perspectives. Methods Sixty youth with IBD (8-17 years) and a parent completed questionnaires to assess family functioning, HRQOL, and pain experiences within the past week. A subsample of 16 youth completed an online diary (7 days) about their pain experiences. Results When including any pain experiences, higher youth-reported family satisfaction and lower pain intensity were related to better HRQOL, whereas higher parent-reported family cohesion and satisfaction indirectly related to youth HRQOL through lower pain intensity. When only accounting for abdominal pain, pain intensity related negatively with HRQOL, and only parent-reported cohesion showed an indirect relation with HRQOL through pain intensity. Diary data revealed large heterogeneity: abdominal pain, described as cramping, sharp, and/or stinging was most frequent, but other pain symptoms (eg, back pain and headache) often co-occurred. Conclusion The findings provide a rich picture of the daily pain experiences of youth with IBD and underscore the importance of a family systems approach to understand how family functioning and pain symptoms influence HRQOL.
Collapse
|
187
|
Abstract
Introduction: Pediatric chronic pain affects 15%–39% of children. Chronic pain can have significant negative effects on a child’s physical functioning, psychological and cognitive functioning, quality of life, and social functioning. Parents of children with chronic pain have reported being affected by their child’s condition. There have been few studies exploring the experiences of parents of children with chronic pain through a qualitative descriptive lens. Methods: Thirteen parents from a pediatric chronic pain clinic participated in semistructured interviews. Concurrent data collection and analysis occurred to allow for follow-up of ideas that emerged during analysis. Three phases of analysis occurred: coding, categorizing, and developing themes. Results: Three themes were developed: (1) Parents’ emotional journey; (2) chronic pain affects the entire family; and (3) social support is critical. Parents described emotions caused by the arduous process of obtaining a chronic pain diagnosis, followed by difficulties finding strategies to help their child manage the pain. Family life was affected because special accommodations often had to be made. Families were affected financially, incurring costs due to time off of work or additional therapies. Finally, parents stressed the importance of a strong social support network to provide assistance and flexibility for the changing needs of their child. Discussion: This research identified a better understanding of the impact of pediatric chronic pain on parents. These findings can be used to provide and promote more effective treatments and education to improve the psychological, physical, and social well-being of children with pediatric chronic pain and their families.
Collapse
Affiliation(s)
- Anne Le
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Bruce R Dick
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jude Spiers
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathy Reid
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
188
|
Dyadic analysis of siblings' relationship quality, behavioural responses, and pain experiences during experimental pain. Pain 2019; 159:1569-1579. [PMID: 29672448 DOI: 10.1097/j.pain.0000000000001244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research on family factors in paediatric pain has primarily focused on parents; the role of siblings has been largely ignored. This study examined whether sibling relationship quality was related to siblings' behaviours during experimental pain, and whether the behaviours of an observing sibling were related to children's pain outcomes. Ninety-two sibling dyads between 8 and 12 years old completed both observational and questionnaire measures of sibling relationship quality. Children took turns completing the cold-pressor task (CPT) in a counterbalanced order with their sibling present. Pain outcomes (intensity, fear, and tolerance) were recorded for each sibling, and the behaviour of the observing and participating siblings during the CPT were coded as attending, nonattending, and coping/encouragement. Structural equation modelling, using the actor-partner interdependence model, was conducted to analyse the dyadic data. While participating in the CPT with their sibling present, greater levels of warmth and positivity in the sibling relationship were related to children engaging in more nonattending behaviours and less attending behaviours. Greater levels of attending behaviours by the observing child was related to the sibling having a lower pain tolerance, and greater levels of coping/encouragement behaviours by the observing child was related to the sibling reporting greater pain intensity and fear during the CPT. Children with warmer/positive sibling relationships were more likely to respond to acute pain by shifting the focus away from their pain experience (eg, through distraction) when a sibling was present. Pain-focused behaviours by an observing sibling are related to greater child pain and fear during experimental pain.
Collapse
|
189
|
Poppert Cordts KM, Stone AL, Beveridge JK, Wilson AC, Noel M. The (Parental) Whole Is Greater Than the Sum of Its Parts: A Multifactorial Model of Parent Factors in Pediatric Chronic Pain. THE JOURNAL OF PAIN 2019; 20:786-795. [PMID: 30658175 DOI: 10.1016/j.jpain.2019.01.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/19/2018] [Accepted: 01/11/2019] [Indexed: 12/13/2022]
Abstract
Parents play a critical role in children's experience of, and recovery from, chronic pain. Although several parental factors have been linked to child pain and functioning, these factors are typically examined in isolation or as moderators or mediators. Structural equation modeling affords the opportunity to examine the extent to which parental factors are interrelated, and if there are differential associations among parental factors and child outcomes. Based on extant literature, a unified model of parental factors, including chronic pain status, physical functioning, responses to child pain, and psychological factors, and their effect on child pain and functioning, was conceptualized. This model was evaluated using structural equation modeling based on data from 146 dyads recruited from a multidisciplinary pain clinic. Modifications to model iterations were made based on theoretical and statistical justification. The final model revealed associations among all parental factors, with significant loadings on child pain and functioning. Findings indicated the conceptual model was supported, with the exception of parent responses to child pain. Findings support the inclusion of parent chronic pain status and physical and psychological functioning as part of a comprehensive assessment of youth with chronic pain and may inform new parental intervention targets to improve child outcomes. PERSPECTIVE: A unified structural equation model indicated parents' own chronic pain characteristics and physical and psychological functioning represent important factors associated with child pain and functioning. Current family-based interventions that often primarily focus on parent responses to child pain may need to be adapted to more comprehensively address parental factors.
Collapse
Affiliation(s)
- Katrina M Poppert Cordts
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon; Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
| | - Amanda L Stone
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jaimie K Beveridge
- Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Anna C Wilson
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon
| | - Melanie Noel
- Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
| |
Collapse
|
190
|
Hurtubise K, Brousselle A, Noel M, Camden C. What really matters in pediatric chronic pain rehabilitation? Results of a multi-stakeholder nominal group technique study. Disabil Rehabil 2019; 42:1675-1686. [DOI: 10.1080/09638288.2018.1532462] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Karen Hurtubise
- Facility of Medicine and Health Sciences, Univeristy of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Astrid Brousselle
- Facility of Medicine and Health Sciences, Univeristy of Sherbrooke, Sherbrooke, Quebec, Canada
- School of Public Administration, University of Victoria, Victoria, BC, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Chantal Camden
- Facility of Medicine and Health Sciences, Univeristy of Sherbrooke, Sherbrooke, Quebec, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada
| |
Collapse
|
191
|
Topical Review: Basic Psychological Needs in Adolescents with Chronic Pain-A Self-Determination Perspective. Pain Res Manag 2019; 2019:8629581. [PMID: 30723533 PMCID: PMC6339741 DOI: 10.1155/2019/8629581] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/10/2018] [Indexed: 12/16/2022]
Abstract
This topical review outlines the resilience pathway to adaptive functioning in pediatric pain within a developmental perspective. Self-Determination Theory proposes that the satisfaction of one's basic psychological needs (for autonomy, relatedness, and competence) is crucial for understanding human flourishing and healthy development. However, the role of the basic psychological needs received little attention in a pediatric-pain population. Yet, we propose that need satisfaction may be a resilience factor and need frustration a risk factor, for living with chronic pain. In this topical review, we first discuss two major models that have been developed to understand pain-related disability: the fear-avoidance model of pain and the ecological resilience-risk model in pediatric chronic pain. Both models have been used with children and adolescents but do not include a developmental perspective. Therefore, we introduce Self-Determination Theory and highlight the potentially moderating and mediating role of the basic needs on pain-related disability in children and adolescents. Taken together, we believe that Self-Determination Theory is compatible with the fear-avoidance model of pain and the ecological resilience-risk model in pediatric chronic pain and may deepen our understanding of why some adolescents are able to live adaptively in spite of chronic pain.
Collapse
|
192
|
Carroll S, Chalder T, Hemingway C, Heyman I, Bear H, Sweeney L, Moss-Morris R. Adolescent and parent factors related to fatigue in paediatric multiple sclerosis and chronic fatigue syndrome: A comparative study. Eur J Paediatr Neurol 2019; 23:70-80. [PMID: 30455131 DOI: 10.1016/j.ejpn.2018.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 08/03/2018] [Accepted: 10/28/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fatigue is a disabling, poorly understood symptom in children and adolescents with multiple sclerosis (caMS), for which effective treatments are lacking. In paediatric Chronic Fatigue Syndrome (CFS), effective psychological interventions have been developed based on psychosocial factors associated with fatigue. This study aimed to identify potentially modifiable factors of fatigue in caMS by comparing caMS, adolescents with CFS, healthy adolescents and their parents on measures of fatigue, psychosocial factors, and neurocognitive functioning. METHODS 175 participants including 30 caMS (15 fatigued, 15 non-fatigued), 30 adolescents with CFS, 30 healthy controls, and their parents were compared on measures of self- and parent-reported fatigue, adolescent and parent cognitive behavioural responses to symptoms, sleep, psychological difficulties, parental distress and objectively measured neurocognitive functioning. RESULTS Fatigue severity, functional impairment and cognitive behavioural responses to symptoms were equivalent in fatigued caMS and adolescents with CFS, and were significantly higher than in healthy controls and non-fatigued caMS. Neurocognitive functioning was impaired in both caMS groups, but was normal in adolescents with CFS and healthy controls. No between-group differences were identified in adolescent sleep behaviour or psychological difficulties. Parents of all illness groups had more unhelpful cognitions than parents of healthy controls. Psychological distress was elevated in parents of both fatigued groups. CONCLUSIONS Fifty percent of caMS reported clinically significant fatigue. Similarities between adolescent and parent cognitive behavioural factors in fatigued caMS and adolescents with CFS suggest important potential targets for intervention. Both fatigued and non-fatigued caMS had cognitive difficulties, suggesting that fatigue may need targeted intervention.
Collapse
Affiliation(s)
- Susan Carroll
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK; UCL, Institute of Child Health, Guildford Street, London, UK
| | - Isobel Heyman
- Department of Psychological Medicine, Great Ormond Street Hospital for Children, London, UK; UCL, Institute of Child Health, Guildford Street, London, UK
| | - Holly Bear
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Louise Sweeney
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK.
| |
Collapse
|
193
|
Meints SM, Edwards RR. Evaluating psychosocial contributions to chronic pain outcomes. Prog Neuropsychopharmacol Biol Psychiatry 2018; 87:168-182. [PMID: 29408484 PMCID: PMC6067990 DOI: 10.1016/j.pnpbp.2018.01.017] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 12/12/2022]
Abstract
The biopsychosocial model of pain dominates the scientific community's understanding of chronic pain. Indeed, the biopsychosocial approach describes pain and disability as a multidimensional, dynamic integration among physiological, psychological, and social factors that reciprocally influence one another. In this article, we review two categories of studies that evaluate the contributions of psychosocial factors to the experience of chronic pain. First, we consider general psychosocial variables including distress, trauma, and interpersonal factors. Additionally, we discuss pain-specific psychosocial variables including catastrophizing, expectations, and pain-related coping. Together, we present a diverse array of psychological, social, and contextual factors and highlight the need to consider their roles in the development, maintenance, and treatment of chronic pain conditions.
Collapse
Affiliation(s)
- S M Meints
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA.
| | - R R Edwards
- Department of Anesthesiology, Pain Management Center, Brigham and Women's Hospital, Harvard Medical School, Chestnut Hill, MA, USA
| |
Collapse
|
194
|
Pielech M, Wallace DP, Fitzgerald M, Hoffart CM. Parent Responses to Child Pain During Intensive Interdisciplinary Pain Treatment and 1-Year Follow-Up. THE JOURNAL OF PAIN 2018; 19:1275-1284. [DOI: 10.1016/j.jpain.2018.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/18/2018] [Accepted: 05/05/2018] [Indexed: 02/01/2023]
|
195
|
Nijhof LN, Nap-van der Vlist MM, van de Putte EM, van Royen-Kerkhof A, Nijhof SL. Non-pharmacological options for managing chronic musculoskeletal pain in children with pediatric rheumatic disease: a systematic review. Rheumatol Int 2018; 38:2015-2025. [PMID: 30155667 PMCID: PMC6208689 DOI: 10.1007/s00296-018-4136-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/14/2018] [Indexed: 02/08/2023]
Abstract
In patients with a pediatric rheumatic disease (PRD), chronic musculoskeletal pain (CMP) can have a major impact on functioning and social participation. Because CMP is not always alleviated solely by the use of pharmacological approaches, the aim was to systematically review the available evidence regarding non-pharmacological treatment options for reducing CMP in patients with PRD. PubMed, Embase, PsycINFO, and the Cochrane Library were systematically searched for (non-)randomized trials investigating non-pharmacological treatments for CMP in PRD published through October 25, 2017. The GRADE approach was used to assess the quality of evidence. The search yielded 11 studies involving 420 children 5-18 years of age. All studies were relatively small and short-term, and the quality of evidence ranged from very low to moderate. The main modalities within non-pharmacology therapy were psychological interventions and exercise-based interventions. Some studies show modest positive short-term results for psychological and exercise-based interventions. Psychological and exercise-based interventions can have a modest positive result in PRD, with no evidence of side effects. Non-pharmacological therapies are a promising option to alleviate pain in PRD and improve functioning, which can be used as an alternative for or in addition to pharmacological therapies. Because chronic pain can differ etiologically from acute pain in PRD, non-pharmacological therapies might have different effects in patients with or without active inflammation. To best determine the effect of non-pharmacological therapies, future studies should take this difference into account.
Collapse
Affiliation(s)
- Linde N. Nijhof
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, HP KE.04.133.1, Post box 85090, 3508 AB Utrecht, The Netherlands
| | - Merel M. Nap-van der Vlist
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, HP KE.04.133.1, Post box 85090, 3508 AB Utrecht, The Netherlands
| | - Elise M. van de Putte
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, HP KE.04.133.1, Post box 85090, 3508 AB Utrecht, The Netherlands
| | - Annet van Royen-Kerkhof
- Department of Pediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne L. Nijhof
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, HP KE.04.133.1, Post box 85090, 3508 AB Utrecht, The Netherlands
| |
Collapse
|
196
|
Abstract
Objective Early childhood is a time of rapid development, particularly of the central nervous system, and can set a foundation for the entire life course. Complex pain in young children can impact the quality of life through limiting physical and social development, compromising psychological well-being, and disrupting sleep. The aim of this review is to identify the needs of young children who present to a tertiary-level pain service, what services they require, and their treatment outcomes. There are limited data on this vulnerable population, which may be due to small numbers represented and the complexities of pain assessment in this age group. Methods A retrospective chart review recorded demographics, gender, pain location and etiology, treatment, and outcomes of 28 children younger than age eight years attending a pediatric pain clinic over a three-year period. Results All but two young children had an obvious physical pathology as an explanation for pain; this is in contrast to studies of pain clinics servicing adolescents. A diverse range of conditions, some rare, were identified, requiring a high level of pediatric understanding of the disease process and an ability to work with primary teams with expertise in disease-modifying strategies.
Collapse
Affiliation(s)
- Natasha Haynes
- Department of Pain Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - John Collins
- Department of Pain Medicine, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics & Child Health, Sydney Medical School, Sydney, Australia
| |
Collapse
|
197
|
Edmonds J, Twycross A. Mothers' experiences of managing their child's pain before and during attendance at the emergency department. J Clin Nurs 2018; 27:2003-2013. [PMID: 29493831 DOI: 10.1111/jocn.14322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 01/25/2023]
Abstract
AIMS AND OBJECTIVES To explore mothers' experiences of managing their child's pain before and during attendance at the emergency department. BACKGROUND Pain accounts for 50%-80% of all visits to the emergency department. Historically paediatric pain has been poorly managed in the emergency department and there remains variability in practice. It is mothers who usually bring their child to the emergency department and as such it is important to explore their perspectives of how pain is managed. DESIGN Exploratory qualitative study. METHODOLOGY Semi-structured interviews were carried out with mothers (n = 10) of children who have attended the emergency department in one hospital in the East of England during April 2015. RESULTS Most mothers felt able to assess their child's pain and reported attending the emergency department when their normal pain-relieving strategies failed following an injury. Several mothers sought advice from elsewhere before bringing their child to the emergency department. The advice received was usually to take their child to the emergency department. Mothers welcomed the professional approach to pain management in the emergency department and valued being kept informed about their child's care. Mothers rated the care provided in the emergency department as good or very good. CONCLUSIONS Mothers attended the emergency department when their normal pain-relieving strategies failed. This suggests there is a need to provide additional resources to support parents in this context. Mothers often brought their child to the emergency department rather than their General Practitioner or other primary healthcare providers. The reasons for this need exploring further. RELEVANCE TO CLINICAL PRACTICE The results suggest that mothers need additional resources to enable them to manage their child's pain at home following an injury. The reasons mothers attend the emergency department rather than other healthcare providers need exploring in more depth.
Collapse
Affiliation(s)
- Jenny Edmonds
- Children's Emergency Department, Norfolk & Norwich University Hospital, Colney Lane, Norwich, UK
| | - Alison Twycross
- Department of Children's Nursing, London South Bank University, London, UK
| |
Collapse
|
198
|
Fisher E, Law E, Dudeney J, Palermo TM, Stewart G, Eccleston C. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev 2018; 9:CD003968. [PMID: 30270423 PMCID: PMC6257251 DOI: 10.1002/14651858.cd003968.pub5] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND This is an update of the original Cochrane review first published in Issue 1, 2003, and previously updated in 2009, 2012 and 2014. Chronic pain, defined as pain that recurs or persists for more than three months, is common in childhood. Chronic pain can affect nearly every aspect of daily life and is associated with disability, anxiety, and depressive symptoms. OBJECTIVES The aim of this review was to update the published evidence on the efficacy of psychological treatments for chronic and recurrent pain in children and adolescents.The primary objective of this updated review was to determine any effect of psychological therapy on the clinical outcomes of pain intensity and disability for chronic and recurrent pain in children and adolescents compared with active treatment, waiting-list, or treatment-as-usual care.The secondary objective was to examine the impact of psychological therapies on children's depressive symptoms and anxiety symptoms, and determine adverse events. SEARCH METHODS Searches were undertaken of CENTRAL, MEDLINE, MEDLINE in Process, Embase, and PsycINFO databases. We searched for further RCTs in the references of all identified studies, meta-analyses, and reviews, and trial registry databases. The most recent search was conducted in May 2018. SELECTION CRITERIA RCTs with at least 10 participants in each arm post-treatment comparing psychological therapies with active treatment, treatment-as-usual, or waiting-list control for children or adolescents with recurrent or chronic pain were eligible for inclusion. We excluded trials conducted remotely via the Internet. DATA COLLECTION AND ANALYSIS We analysed included studies and we assessed quality of outcomes. We combined all treatments into one class named 'psychological treatments'. We separated the trials by the number of participants that were included in each arm; trials with > 20 participants per arm versus trials with < 20 participants per arm. We split pain conditions into headache and mixed chronic pain conditions. We assessed the impact of both conditions on four outcomes: pain, disability, depression, and anxiety. We extracted data at two time points; post-treatment (immediately or the earliest data available following end of treatment) and at follow-up (between three and 12 months post-treatment). MAIN RESULTS We identified 10 new studies (an additional 869 participants) in the updated search. The review thus included a total of 47 studies, with 2884 children and adolescents completing treatment (mean age 12.65 years, SD 2.21 years). Twenty-three studies addressed treatments for headache (including migraine); 10 for abdominal pain; two studies treated participants with either a primary diagnosis of abdominal pain or irritable bowel syndrome, two studies treated adolescents with fibromyalgia, two studies included adolescents with temporomandibular disorders, three were for the treatment of pain associated with sickle cell disease, and two studies treated adolescents with inflammatory bowel disease. Finally, three studies included adolescents with mixed pain conditions. Overall, we judged the included studies to be at unclear or high risk of bias.Children with headache painWe found that psychological therapies reduced pain frequency post-treatment for children and adolescents with headaches (risk ratio (RR) 2.35, 95% confidence interval (CI) 1.67 to 3.30, P < 0.01, number needed to treat for an additional beneficial outcome (NNTB) = 2.86), but these effects were not maintained at follow-up. We did not find a beneficial effect of psychological therapies on reducing disability in young people post-treatment (SMD -0.26, 95% CI -0.56 to 0.03), but we did find a beneficial effect in a small number of studies at follow-up (SMD -0.34, 95% CI -0.54 to -0.15). We found no beneficial effect of psychological interventions on depression or anxiety symptoms.Children with mixed pain conditionsWe found that psychological therapies reduced pain intensity post-treatment for children and adolescents with mixed pain conditions (SMD -0.43, 95% CI -0.67 to -0.19, P < 0.01), but these effects were not maintained at follow-up. We did find beneficial effects of psychological therapies on reducing disability for young people with mixed pain conditions post-treatment (SMD -0.34, 95% CI -0.54 to -0.15) and at follow-up (SMD -0.27, 95% CI -0.49 to -0.06). We found no beneficial effect of psychological interventions on depression symptoms. In contrast, we found a beneficial effect on anxiety at post-treatment in children with mixed pain conditions (SMD -0.16, 95% CI -0.29 to -0.03), but this was not maintained at follow-up.Across all pain conditions, we found that adverse events were reported in seven trials, of which two studies reported adverse events that were study-related.Quality of evidenceWe found the quality of evidence for all outcomes to be low or very low, mostly downgraded for unexplained heterogeneity, limitations in study design, imprecise and sparse data, or suspicion of publication bias. This means our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect, or we have very little confidence in the effect estimate; or the true effect is likely to be substantially different from the estimate of effect. AUTHORS' CONCLUSIONS Psychological treatments delivered predominantly face-to-face might be effective for reducing pain outcomes for children and adolescents with headache or other chronic pain conditions post-treatment. However, there were no effects at follow-up. Psychological therapies were also beneficial for reducing disability in children with mixed chronic pain conditions at post-treatment and follow-up, and for children with headache at follow-up. We found no beneficial effect of therapies for improving depression or anxiety. The conclusions of this update replicate and add to those of a previous version of the review which found that psychological therapies were effective in reducing pain frequency/intensity for children with headache and mixed chronic pain conditions post-treatment.
Collapse
Affiliation(s)
- Emma Fisher
- Pain Research Unit, Churchill HospitalCochrane Pain, Palliative and Supportive Care GroupOxfordUK
| | - Emily Law
- University of WashingtonAnesthesiology and Pain MedicineSeattleWashingtonUSA
| | - Joanne Dudeney
- Seattle Children's Research InstituteCenter for Child Health, Behavior, and Development2001 8th Avenue, Suite 400SeattleWashingtonUSA
| | - Tonya M Palermo
- University of WashingtonAnesthesiology and Pain MedicineSeattleWashingtonUSA
| | | | | | | |
Collapse
|
199
|
Khu M, Soltani S, Neville A, Schulte F, Noel M. Posttraumatic stress and resilience in parents of youth with chronic pain. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1514606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Melanie Khu
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Sabine Soltani
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Alexandra Neville
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Fiona Schulte
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Melanie Noel
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
200
|
Intergenerational examination of pain and posttraumatic stress disorder symptoms among youth with chronic pain and their parents. Pain Rep 2018; 3:e667. [PMID: 30324168 PMCID: PMC6172823 DOI: 10.1097/pr9.0000000000000667] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/28/2018] [Accepted: 06/05/2018] [Indexed: 02/04/2023] Open
Abstract
Introduction Posttraumatic stress disorder (PTSD) symptoms are prevalent among youth with chronic pain, and associated with poorer pain outcomes and health-related quality of life (HRQoL). Conceptual models suggest that parent factors, including parents' own chronic pain, may be linked to higher co-occurring pain and PTSD symptoms and lower HRQoL in children. However, this has not been empirically examined. Objectives The aim of this study was to examine the relationship between parental chronic pain and (1) parent PTSD symptoms, (2) child PTSD symptoms, (3) child pain outcomes, and (4) child HRQoL in a sample of treatment-seeking youth with chronic pain and their parents. Methods Youth (n = 173) aged 8 to 18 years and parents (n = 204) recruited from a tertiary-level pediatric chronic pain program completed psychometrically-sound measures of pain and PTSD symptoms. Youth also completed measures of pain interference and HRQoL. Results Half of the parents in this sample reported chronic pain. A series of analyses of covariances revealed that parents with vs without chronic pain reported significantly higher PTSD symptoms, and children of parents with vs without chronic pain reported significantly higher PTSD symptoms and pain interference and lower HRQoL. Conclusion Findings from this study suggest that having a parent with chronic pain may confer additional risk for children with chronic pain experiencing higher PTSD symptoms, poorer pain outcomes, and lower HRQoL than having a parent without chronic pain. This could be due to genetics or social learning. Future longitudinal research is needed to understand how parental pain influences co-occurring pain and PTSD symptoms, and HRQoL, in children.
Collapse
|