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Sarkovich S, Leonardi C, Darlow M, Martin D, Issa P, Soria T, Bronstone A, Clement C. Back pain in adolescent idiopathic scoliosis: frequency and risk factors. Spine Deform 2024; 12:1319-1327. [PMID: 38910187 PMCID: PMC11344019 DOI: 10.1007/s43390-024-00904-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 05/01/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE Although back pain is commonly reported in patients with adolescent idiopathic scoliosis (AIS), factors that influence the presence and severity of back pain in AIS, including curve-specific variables, have not been well studied. This study aims to describe the prevalence and severity of back pain in AIS patients and determine the extent to which patient characteristics, including curve-specific factors, are associated with a higher risk of back pain in AIS. METHODS The study was a retrospective medical records review of adolescents (aged 10-17 years) diagnosed with AIS between 01/01/2018 and 12/31/2021 at an academic tertiary children's hospital. Patients with previous spine surgery were excluded. Variables collected included demographics (age, sex, race, insurance), Lenke classification, major coronal curve, back pain-related information, Risser stage, vitamin D levels, post-diagnosis brace utilization, physical therapy or chiropractic treatment, and surgery. RESULTS A total of 891 AIS patients were included in the analysis. The sample was predominantly female (73.3%) and insured by Medicaid (57.8) with a mean age of 12.8 years. The mean major coronal curve was 26.3 degrees. Most patients had Lenke type 1 (47%) and type 5 (41%) curves. Nearly half of patients reported back pain (48.5%) with average pain severity in the low-to-moderate range (4.7) on FACES pain scale (0-10). Among those who reported back pain, 63.2% specified a location with the majority reporting pain in the lumbar region (56%) and, less commonly, in the thoracic (39%) and scapular (8%) regions. Lumbar pain was associated with significantly higher pain intensity (p = 0.033). Additionally, the location of pain reported was associated with location of major coronal curve (p < 0.0001). No association was observed between pain presence and vitamin D deficiency (p = 0.571, n = 175), major coronal curve magnitude (p = 0.999), Lenke curve type (p = 0.577), and sex (p = 0.069). Older patients, those insured by Medicaid, and those with higher Risser scores were more likely to report pain scores (p = 0.001 for all). CONCLUSION Nearly half (48%) of newly diagnosed AIS patients experience back pain which is higher than the prevalence of 33% seen in the general adolescent population. Pain was more prevalent among patients over the age of 13, with heavier body weight, and those insured by Medicaid. Pain was most commonly reported in the lumbar region, especially among patients with lumbar curves. This information can be helpful in counseling AIS patients, though further investigations are needed, especially to determine the underlying causes of back pain in AIS and to elucidate the discrepancy in pain between patients with Medicaid and commercial insurance. LEVEL OF EVIDENCE Prognostic Study Level II.
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Affiliation(s)
- Stefan Sarkovich
- Graduate Medical Education, HCA Florida Bayonet Point Hospital, 14000 Fivay Rd, Hudson, FL, 34667, USA.
| | - Claudia Leonardi
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
- Behavioral & Community Health, LSU Health Sciences Center, New Orleans, LA, USA
| | - Matthew Darlow
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Davis Martin
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Peter Issa
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Tara Soria
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Amy Bronstone
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Carter Clement
- Department of Orthopaedics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Hanania JW, George JE, Rizzo C, Manjourides J, Goldstein L. Agreement between child self-report and parent-proxy report for functioning in pediatric chronic pain. J Patient Rep Outcomes 2024; 8:88. [PMID: 39120819 PMCID: PMC11315847 DOI: 10.1186/s41687-024-00774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 08/05/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE Accurate assessment of chronic pain and functional disability in children and adolescents is imperative for guiding pain management interventions. Parents have multifaceted roles in their child's pain experience and frequently provide parent-proxy reports of pain-related functioning. However, cross-informant variance is often observed with limited understanding of contributing factors. This study aims to examine the degree of alignment between child and parent-proxy reports for Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference domain among children with chronic pain and to identify factors associated with improved child-parent agreement. METHODS This study includes a sample of 127 youth (66.1% female) with mixed etiology chronic pain, ranging in age from 8 to 17 (M = 12.24; SD = 1.598), and their parent. Data was collected at an interdisciplinary pediatric pain clinic and online peer support groups. Measures of demographic, pain intensity, and functioning were collected. RESULTS Means of parent-proxy reports were significantly lower than child self-reports on the PROMIS (p < 0.05). A statistically significant association between child's pain intensity (β = 0.953, P < 0.05) and the difference between child self-reported and parent-proxy reported PROMIS functional interference scores was found. CONCLUSION Parents underestimated pain-related functional disability relative to children's self-reports. The difference between the paired child self-report and parent-proxy report of functional disability was significantly associated with greater child self-reported pain intensity. Although parent-proxy reports in pediatric chronic pain is often used in research and practice, findings underscore the importance of incorporating child and adolescent self-report, when possible, to comprehensively capture the child's pain experience and best inform clinical interventions.
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Affiliation(s)
- Joan W Hanania
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA.
| | | | - Christie Rizzo
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Justin Manjourides
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Laura Goldstein
- Department of Child and Adolescent Psychiatry, Boston Medical Center, Boston, MA, USA
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Jørgensen JV, Werner MU, Michelsen JS, Tierp-Wong CNE. Assessment of somatosensory profiles by quantitative sensory testing in children and adolescents with and without cerebral palsy and chronic pain. Eur J Paediatr Neurol 2024; 51:32-40. [PMID: 38795436 DOI: 10.1016/j.ejpn.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 10/03/2023] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE We investigated differences in somatosensory profiles (SSPs) assessed by quantitative sensory testing in children and adolescents with cerebral palsy (CCP) with and without chronic pain and compared these differences to those in a group of typically developed children and adolescents (TDC) with and without chronic pain. METHOD All included subjects were consecutively recruited from and tested at the same outpatient orthopedic clinic by the same investigator. The subjects had their reaction times tested. The SSP consisted of the following tests: warmth (WDT), cool (CDT), mechanical (MDT), and vibration (VDT) detection thresholds; heat (HPT), pressure (PPT), and mechanical (MPT) pain thresholds; wind-up ratio (WUR); dynamic mechanical allodynia (DMA) and cold pressor test (CPT) using a conditioned pain modulation (CPM) paradigm. RESULTS We included 25 CCP and 26 TDC. TDC without chronic pain served as controls. In TDC with chronic pain, WDT, HPT, HPT intensity, and PPT were higher than in controls. No differences in SSPs between CCP with and without chronic pain were observed. In CCP, the MDT, WDT, CDT, and HPT intensity were higher than in controls. CCP had longer reaction times than TDC. There were no differences regarding the remaining variables. DISCUSSION In CCP, the SSPs were independent of pain status and findings on MR images. In all CCP the SSPs resembled TDC with chronic pain, compared to TDC without chronic pain. This suggests that CCP do not have the normal neuroplastic adaptive processes that activate and elicit functional changes in the central and peripheral nervous systems.
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Affiliation(s)
| | - Mads Utke Werner
- Multidisciplinary Pain Center, Department of Anesthesia, Pain and Respiratory Support, Neuroscience Center, Rigshospitalet University Hospitals, Copenhagen, Denmark; Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Christian Nai En Tierp-Wong
- Department of Orthopedic Surgery, Hvidovre University Hospital, Copenhagen, Denmark; Department of Orthopedic Surgery 6011, Rigshospitalet University Hospital, Copenhagen, Denmark
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Zhang M, Li J, Su Y, Guo G, Chen N. Effects of a home-based exercise combined yoga and resistance training in enthesitis-related arthritis in China: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e078549. [PMID: 38382959 PMCID: PMC10882405 DOI: 10.1136/bmjopen-2023-078549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Enthesitis-related arthritis (ERA) is a category of juvenile idiopathic arthritis (JIA). The complications of JIA include pain, muscle weakness, limited movement and worsening quality of life. Yoga is an effective exercise therapy for rheumatoid arthritis and may have similar benefits for JIA. Considering the limitation of yoga for strengthening muscles, combined yoga and resistance training (CYRT) may compensate for the shortcomings and provide more benefits for JIA patients. Despite this, there is currently a lack of studies investigating the effectiveness of CYRT for JIA patients. Due to the inaccessibility of traditional exercise therapy, home-based exercise is needed. The study aims to assess the effectiveness of home-based CYRT on JIA. METHODS AND ANALYSIS This is a 12-week randomised single-blind controlled trial study. 60 patients with ERA will be randomised into two groups: the home-based exercise group (HBE) and the health education (HE) group. The HBE group (n=30) will perform the CYRT programme 3 times a week at home for 12 weeks and receive HE. The HE group (n=30) will only receive HE. The outcomes include primary outcome (pain levels) and secondary outcomes (lower limb muscle strength, motion range of joint, aerobic fitness, function ability, fatigue levels, mental health, quality of life and blood biomarkers). The assessments will be conducted at baseline, postintervention (12 weeks) and follow-up (24 weeks). Data will be analysed by intention to treat. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine in December 2023 (approval no. XHEC-C-2023-059-3). This study will require informed consent from all subjects and guardians of children under 18 years of age. The findings will be published in a peer-reviewed journal and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2300073446.
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Affiliation(s)
- Mei Zhang
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jiaoyu Li
- Department of Pediatric Nephrology and Rheumatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yue Su
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guimei Guo
- Department of Pediatric Nephrology and Rheumatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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Scribante A, Pellegrini M, Pulicari F, Ghizzoni M, Modugno FP, Spadari F. Pain Assessment in Oral Medicine through Its Different Dimensions: A Comprehensive Review. Dent J (Basel) 2023; 11:246. [PMID: 37999011 PMCID: PMC10670171 DOI: 10.3390/dj11110246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
Orofacial pain is a complex experience made up of different features and involving various aspects of life. It has demonstrated a connection, especially when chronic, with conditions such as anxiety, depression, and sleep disorders, through paths that still have not been completely clarified. A deep understanding of orofacial pain and its impact on an individual's life is critical for planning accurate diagnostic and therapeutic approaches. This review seeks to provide a comprehensive overview of the components constituting the pain experience, its implications in an individual's life, the different tools for multidimensional pain assessment, and the specific applications for each tool. A comprehensive review was performed using the PubMed, Scopus, and Web of Science electronic databases. Ninety-five studies, including observational studies, clinical trials, case-control studies, and case reports, were included and analyzed in this review. Orofacial pain assessment exploits several methods, ranging from clinical evaluation to rating scales, questionnaires, and daily diaries. The choice of the correct instrument requires an evaluation of the type of pain experienced, of the patient's characteristics and abilities to complete particular tasks, and finally, of the assessment tool features.
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Affiliation(s)
- Andrea Scribante
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.G.); (F.P.M.)
| | - Matteo Pellegrini
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.P.); (F.S.)
| | - Federica Pulicari
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.P.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
| | - Martina Ghizzoni
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.G.); (F.P.M.)
| | - Francesco Paolo Modugno
- Section of Dentistry, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy; (M.G.); (F.P.M.)
| | - Francesco Spadari
- Maxillo-Facial Surgery and Dental Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (F.P.); (F.S.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via della Commenda 10, 20122 Milan, Italy
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Santamaria V, Ai X, Chin K, Dutkowsky JP, Gordon AM, Agrawal SK. Study protocol for a randomised controlled trial to determine the efficacy of an intensive seated postural intervention delivered with robotic and rigid trunk support systems. BMJ Open 2023; 13:e073166. [PMID: 37591642 PMCID: PMC10441060 DOI: 10.1136/bmjopen-2023-073166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/19/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) classified as gross motor function classification system (GMFCS) levels III-IV demonstrate impaired sitting and reaching control abilities that hamper their overall functional performance. Yet, efficacious interventions for improving sitting-related activities are scarce. We recently designed a motor learning-based intervention delivered with a robotic Trunk-Support-Trainer (TruST-intervention), in which we apply force field technology to individualise sitting balance support. We propose a randomised controlled trial to test the efficacy of the motor intervention delivered with robotic TruST compared with a static trunk support system. METHODS AND ANALYSIS We will recruit 82 participants with CP, GMFCS III-IV, and aged 6-17 years. Randomisation using concealed allocation to either the TruST-support or static trunk-support intervention will be conducted using opaque-sealed envelopes prepared by someone unrelated to the study. We will apply an intention-to-treat protocol. The interventions will consist of 2 hours/sessions, 3/week, for 4 weeks. Participants will start both interventions with pelvic strapping. In the TruST-intervention, postural task progression will be implemented by a progressive increase of the force field boundaries and then by removing the pelvic straps. In the static trunk support-intervention, we will progressively lower the trunk support and remove pelvic strapping. Outcomes will be assessed at baseline, training midpoint, 1-week postintervention, and 3-month follow-up. Primary outcomes will include the modified functional reach test, a kinematic evaluation of sitting workspace, and the Box and Block test. Secondary outcomes will include The Segmental Assessment of Trunk Control test, Seated Postural & Reaching Control test, Gross Motor Function Measure-Item Set, Canadian Occupational Performance Outcome, The Participation and Environment Measure and Youth, and postural and reaching kinematics. ETHICS AND DISSEMINATION The study was approved by the Columbia University Institutional Review Board (AAAS7804). This study is funded by the National Institutes of Health (1R01HD101903-01) and is registered at clinicaltrials.gov. TRIAL REGISTRATION NUMBER NCT04897347; clinicaltrials.gov.
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Affiliation(s)
- Victor Santamaria
- Department of Rehabilitation Sciences: Physical Therapy Division, New York Medical College, Valhalla, New York, USA
| | - Xupeng Ai
- Mechanical Engineering Department, Columbia University, New York, New York, USA
| | - Karen Chin
- Biobehavioral Sciences Department, Columbia University, New York, New York, USA
- Burke Neurological Institute, White Plains, New York, USA
| | - Joseph P Dutkowsky
- Department of Orthopaedic Surgery, Columbia University, New York, New York, USA
| | - Andrew M Gordon
- Biobehavioral Sciences Department, Columbia University, New York, New York, USA
| | - Sunil K Agrawal
- Mechanical Engineering Department, Columbia University, New York, New York, USA
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York, USA
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Taib B, Ma Y, Tandon R, Knight R, Gosling M, Gregory K, Sunderland L, Baldrighi C, Oestreich K, Jester A. Utility of a Pediatric Adaptive Sports Clinic: A Case Series Review. Phys Occup Ther Pediatr 2023; 43:645-656. [PMID: 37032436 DOI: 10.1080/01942638.2023.2197046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/19/2023] [Accepted: 03/26/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Limited funding is available for athletes with disabilities in the United Kingdom. This compounds the barriers to participation and development that already exist. METHOD To combat this growing problem, a Multi-Disciplinary Pediatric Adaptive Sports Clinic was formed. RESULT Fifteen athletes with disabilities attended the Clinic from November 2017 to November 2019. In our cohort, there were 10 males and 5 females (age range: 13-18 years). Most athletes participated at a grassroots level (n = 9). The range of diagnoses included cerebral palsy, Ehlers Danlos syndrome and congenital hand differences. Forty-four appointments were made after the initial meeting with a 95% attendance rate. Improvements beyond the minimal clinically important differences (MCID) for the Patient Specific Functional Scale, Numerical Pain Rating Scale, and Medical Research Council Manual Muscle Testing Scale were noted in over half of cases. CONCLUSION With a focus on injury prevention and strength and conditioning techniques, this clinic supported athletes to successfully compete from a recreational to an elite level across all types of sports and adolescent ages by providing patient-specific regimens. Our case series provides preliminary evidence to suggest the formation of similar clinics that can support athletes with disabilities across a range of sports.
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Affiliation(s)
- Bilal Taib
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Yangmyung Ma
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rohan Tandon
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Rebecca Knight
- Physiokinetic Limited, High Performance Centre, University of Birmingham, Birmingham, UK
| | - Michael Gosling
- Physiokinetic Limited, High Performance Centre, University of Birmingham, Birmingham, UK
| | - Kim Gregory
- Queen Elizabeth University Hospital, Birmingham, UK
| | - Laura Sunderland
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Carla Baldrighi
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Kerstin Oestreich
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Andrea Jester
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Wong C. The Relationship between Pain and Spasticity and Tell-Tale Signs of Pain in Children with Cerebral Palsy. Toxins (Basel) 2023; 15:152. [PMID: 36828465 PMCID: PMC9967793 DOI: 10.3390/toxins15020152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Pain and quality of life are closely interrelated in children with cerebral palsy (CCP). Even though 67% of CCP experience pain, it is overlooked and untreated. In this study, our purpose was two-fold: first, to examine the relationship between pain and spasticity by evaluating the effects of AbobotulinumtoxinA/Dysport (BoNT), and second, to describe the symptoms and location of pain in CCP. The subjects were 22 CCP in at least moderate pain. They were evaluated for spasticity by the modified Ashworth and Tardieu scale and for pain by the r-FLACC and the pediatric pain profile. After one injection of BoNT, the subjects were re-evaluated. We found a significant reduction in pain, but no significant relationship between the reduction of pain and spasticity. We found no association between the dose of BoNT and pain or spasticity. Pain in the lower extremity was located primarily in the hip region. The effect of ultrasound-guided intermuscular injections of BoNT suggests that pain in CCP has an extra-articular component. We found that pain in CCP manifests as specific tell-tale signs and problems in daily living. In conclusion, we found no relationship between pain and spasticity. Signs and manifestations of pain are described in detail. Lower extremity (hip) pain seems to have a soft tissue/extra-articular component.
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Affiliation(s)
- Christian Wong
- Department of Orthopedic Surgery, University Hospital of Copenhagen, 2650 Hvidovre, Denmark; ; Tel.: +45-35459411
- Department of Orthopedic Surgery, University Hospital of Copenhagen, Rigshospitalet, 2100 Copenhagen, Denmark
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Miró J, Solé E, Castarlenas E, Ingelmo P, Nolla MDC, Escribano J, Reinoso-Barbero F. The Treatment of Pediatric Pain in Spain: A Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2484. [PMID: 36767850 PMCID: PMC9915536 DOI: 10.3390/ijerph20032484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
Pain is a common experience among children and adolescents, and pain management in this population is a challenge to clinicians. The aims of this study were to increase our understanding of current practices in the management of both acute and chronic pediatric pain in Spain, explore potential barriers to ideal practices, and identify professional needs as perceived by healthcare professionals. A total of 277 healthcare professionals took part, all of whom had wide experience in managing children and adolescents with pain (M [SD] age = 44.85, [10.73]; 75% women). Participants had to respond to a web-based survey with 50 questions related to pain education, organizational characteristics of their pain programs (including the characteristics of the patients treated), and current practices in the assessment and treatment of children and adolescents with pain. Almost all the participants (93%) acknowledged important gaps in their training, and only 47% reported that they had received specific education on the management of pediatric pain during their undergraduate and postgraduate studies. A third (31%) were members of multidisciplinary teams, and almost all (99%) understood that protocols to guide the management of pain in young people were necessary. However, only a few of them used a protocol to assess and treat (56% and 48%, respectively) acute and chronic pain (24% and 23%, respectively). The data also showed that a lack of pain education, coordination of professionals, and guidelines was perceived as an important barrier in the care provided to children and adolescents with pain in Spain. The findings of this study can now be used by healthcare professionals in Spain interested in managing pediatric pain, as well as policymakers concerned to improve the education of professionals and the care given to young people with pain.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Carretera de Valls, 43007 Tarragona, Spain
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
| | - Pablo Ingelmo
- Department of Anesthesia, McGill University, 1001 Boul. Decarie, Montreal, QC H4A 3J1, Canada
| | - Maria del Carme Nolla
- Chair in Pediatric Pain, Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), 43007 Tarragona, Spain
- Xarxa Social i Sanitària, 43003 Tarragona, Spain
| | - Joaquín Escribano
- School of Medicine, Universitat Rovira i Virgili, IISPV, 43201 Reus, Spain
- Department of Pediatrics, Hospital Universitari Sant Joan, Avgda. Dr. Josep Laporte 2, 43204 Reus, Spain
| | - Francisco Reinoso-Barbero
- Pediatric Anesthesiology Service, Hospital Universitario La Paz, P. Castellana 261, 28046 Madrid, Spain
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Sadeq F, DePamphilis MA, Dabek RJ, Bojovic B, Fuzaylov G, Driscoll DN. Evaluation of liposomal bupivacaine infiltration at reconstructive skin graft donor sites in adolescent and young adult burn patients: A retrospective analysis. Burns 2022; 48:1166-1171. [PMID: 34862091 DOI: 10.1016/j.burns.2021.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/12/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Postoperative pain at skin graft donor sites is frequently undertreated in burn patients, which can impair reconstructive outcomes and result in harmful psychological consequences. We find a critical need to explore and promote non-opioid, multimodal analgesics. Donor site infiltration of the local anesthetic liposomal bupivacaine in adolescent and young adult burn patients has not been previously investigated. Therefore, the goal of this study was to evaluate intraoperative liposomal bupivacaine infiltration for postoperative donor site pain control in adolescent and young adult burn patients undergoing reconstructive skin graft procedures. METHODS This retrospective analysis included patients aged 14-25 years, who underwent at least two reconstructive skin graft procedures, one that received donor site infiltration of the standard treatment (bupivacaine hydrochloride) and one that received donor site infiltration of liposomal bupivacaine. The final sample included 30 patients with a total of 44 liposomal bupivacaine cases and 53 standard treatment cases analyzed. RESULTS In the authors' five-year experience, the use of liposomal bupivacaine compared to standard treatment was associated with statistically significant decreases in 0-4 h postoperative pain scores (mean 1.4/10 versus 2.3/10, p = 0.04) and 0-24 h postoperative pain scores (mean 1.7/10 versus 2.4/10, p = 0.02). Neither analgesic was associated with adverse events. Differences in length of stay and inpatient postoperative opioid usage were not regarded as significant. CONCLUSION In this retrospective analysis, the authors report the first results that suggest intraoperative liposomal bupivacaine donor site infiltration may be associated with statistically improved patient outcomes in adolescent and young adult burn patients. However, the reported differences are most likely not clinically significant, establishing the necessity for further evaluation of using liposomal bupivacaine in this unique patient population.
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Affiliation(s)
- Farzin Sadeq
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Matthew A DePamphilis
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Boston University School of Medicine, Boston, MA, United States
| | - Robert J Dabek
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States; Department of Surgery, St. Agnes Hospital, Baltimore, MD, United States
| | - Branko Bojovic
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States
| | - Gennadiy Fuzaylov
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA, United States
| | - Daniel N Driscoll
- Department of Clinical Research, Shriners Hospitals for Children - Boston, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Division of Plastic, Reconstructive, and Laser Surgery, Shriners Hospitals for Children - Boston, Boston, MA, United States.
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11
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Ali S, Rajagopal M, Stinson J, Ma K, Vandermeer B, Felkar B, Schreiner K, Proctor A, Plume J, Hartling L. Virtual reality-based distraction for intravenous insertion-related distress in children: a study protocol for a randomised controlled trial. BMJ Open 2022; 12:e057892. [PMID: 35354617 PMCID: PMC8968513 DOI: 10.1136/bmjopen-2021-057892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/03/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Intravenous (IV) insertions are among the most performed procedures for children seeking medical care; they are often a painful and stressful experience for both children and their caregivers. Paediatric distress and pain that is inadequately treated may lead to a frightened and uncooperative child, repeated IV attempts and overall frustration with care for both the family and clinical team. We hypothesise that distraction via an immersive virtual reality (VR) experience may reduce the associated distress for children undergoing IV insertions. METHODS AND ANALYSIS This two-armed randomised controlled superiority trial will be conducted in a Canadian paediatric emergency department and will aim to enrol 80 children overall. Children will be randomised to receive either departmental standard of care alone or standard of care plus an immersive VR experience. Children 6-17 years of age who are undergoing IV insertion and have topical anaesthetic application will be considered for inclusion. Our primary objective is to compare the reduction of distress between the two study arms. The primary outcome will be the child's observed distress score as measured by the Observational Signs of Behavioral Distress-Revised tool. Secondary outcomes include the child's pain intensity and fear, parental anxiety, satisfaction with the IV procedure, as well as adverse events. Recruitment launched in September 2020 and is expected to end in March 2022. ETHICS AND DISSEMINATION This study has been approved by the Health Research Ethics Board (University of Alberta). Informed consent will be obtained from parents or guardians, and assent from children. Study data will be submitted for publication irrespective of results. This study is funded through a Women and Children's Health Research Institute Innovation grant. Purchase of the VR equipment was facilitated through a Stollery Children's Hospital Foundation small equipment grant. TRIAL REGISTRATION NUMBER NCT04291404Cite Now.
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Affiliation(s)
- Samina Ali
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Manasi Rajagopal
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children and the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Keon Ma
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Bailey Felkar
- London Health Sciences Centre Children's Hospital, London, Ontario, Canada
| | - Kurt Schreiner
- Pediatric Parents' Advisory Group, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Proctor
- Stollery Youth Advisory Council and Patient and Family Centred Care, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jennifer Plume
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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12
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Yasar E, Kavlak E, Turkucar S, Bayraktar D, Acari C, Unsal E. Yoga versus home exercise program in children with enthesitis related arthritis: A pilot study. Complement Ther Med 2021; 58:102696. [PMID: 33636297 DOI: 10.1016/j.ctim.2021.102696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/11/2021] [Accepted: 02/20/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The aim was to compare the effects of yoga and home exercise program on lower extremity functional status, pain, and quality of life in children with enthesitis related arthritis (ERA). METHODS Twenty-one children with ERA were divided into two groups as yoga (n = 11) and home exercise (n = 10). Yoga group performed supervised yoga exercises twice a week for eight weeks. Home exercise group performed video-based exercises for the same period. Pain in rest and activity, lower extremity functional status, and quality of life were evaluated at baseline and following eight weeks. RESULTS The groups were similar at baseline (p > 0.05). All the parameters, except parent reported quality of life, significantly improved in yoga group (p < 0.05), where only stair climb test times significantly improved in home exercise group (p < 0.05). CONCLUSIONS Yoga seems promising for improving lower extremity functional status, pain, and quality of life as an exercise intervention in rehabilitation programs of children with ERA.
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Affiliation(s)
- Ezgi Yasar
- Pamukkale University, Institute of Health Sciences, Department of Physical Therapy and Rehabilitation, Denizli, Turkey.
| | - Erdogan Kavlak
- Pamukkale University, School of Physical Therapy and Rehabilitation, Denizli, Turkey.
| | - Serkan Turkucar
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Izmir, Turkey.
| | - Deniz Bayraktar
- Izmir Katip Celebi University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Izmir, Turkey.
| | - Ceyhun Acari
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Izmir, Turkey.
| | - Erbil Unsal
- Dokuz Eylul University, Faculty of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Izmir, Turkey.
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13
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Ali S, Rajagopal M, Klassen T, Richer L, McCabe C, Willan A, Yaskina M, Heath A, Drendel AL, Offringa M, Gouin S, Stang A, Sawyer S, Bhatt M, Hickes S, Poonai N. Study protocol for two complementary trials of non-steroidal or opioid analgesia use for children aged 6 to 17 years with musculoskeletal injuries (the No OUCH study). BMJ Open 2020; 10:e035177. [PMID: 32565458 PMCID: PMC7311068 DOI: 10.1136/bmjopen-2019-035177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/16/2020] [Accepted: 05/07/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Musculoskeletal (MSK) injuries are a frequent cause for emergency department (ED) visits in children. MSK injuries are associated with moderate-to-severe pain in most children, yet recent research confirms that the management of children's pain in the ED remains inadequate. Clinicians are seeking better oral analgesic options for MSK injury pain with demonstrated efficacy and an excellent safety profile. This study aims to determine the efficacy and safety of adding oral acetaminophen or oral hydromorphone to oral ibuprofen and interpret this information within the context of parent/caregiver preference. METHODS AND ANALYSIS Using a novel preference-informed complementary trial design, two simultaneous trials are being conducted. Parents/caregivers of children presenting to the ED with acute limb injury will be approached and they will decide which trial they wish to participate in: an opioid-inclusive trial or a non-opioid trial. Both trials will follow randomised, double-blind, placebo-controlled, superiority-trial methodology and will enrol a minimum of 536 children across six Canadian paediatric EDs. Children will be eligible if they are 6 to 17 years of age and if they present to the ED with an acute limb injury and a self-reported verbal Numerical Rating Scale pain score ≥5. The primary objective is to determine the effectiveness of oral ibuprofen+oral hydromorphone versus oral ibuprofen+oral acetaminophen versus oral ibuprofen alone. Recruitment was launched in April 2019. ETHICS AND DISSEMINATION This study has been approved by the Health Research Ethics Board (University of Alberta), and by appropriate ethics boards at all recruiting centres. Informed consent will be obtained from parents/guardians of all participants, in conjunction with assent from the participants themselves. Study data will be submitted for publication regardless of results. This study is funded through a Canadian Institutes of Health Research grant. TRIAL REGISTRATION NUMBER NCT03767933, first registered on 07 December 2018.
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Affiliation(s)
- Samina Ali
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Terry Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lawrence Richer
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | | | - Andy Willan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Heath
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluation Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amy L Drendel
- Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Martin Offringa
- Child Health Evaluation Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Serge Gouin
- Pediatrics, Universite de Montreal, Montreal, Québec, Canada
| | - Antonia Stang
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Scott Sawyer
- Pediatrics and Emergency Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Maala Bhatt
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Serena Hickes
- Parent Partner, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Naveen Poonai
- Paediatrics and Internal Medicine, Schulich School of Medicine & Dentistry, London Health Sciences Centre, London, Ontario, Canada
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14
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Baek W, Jang Y, Park CG, Moon M. Factors Influencing Satisfaction with Patient-Controlled Analgesia Among Postoperative Patients Using a Generalized Ordinal Logistic Regression Model. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:73-81. [PMID: 32165329 DOI: 10.1016/j.anr.2020.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The purpose of this study was to identify the factors affecting the satisfaction with patient-controlled analgesia (PCA) of patients using a generalized ordinal logistic regression model and to evaluate the difference in results of the ordinal regression from those of binary regression. METHODS The study design involved secondary analysis of electronic medical records from a single tertiary care hospital in Seoul, Korea. It included 2,409 patients treated with PCA for postoperative pain management after open or laparoscopic abdominal surgery. Binary logistic regression and generalized ordinal logistic regression were used to identify factors affecting satisfaction. RESULTS Binary logistic regression analysis showed that there was insufficient information for analysis. Generalized ordinal logistic regression revealed that sex, age, pain, PCA usage, and side-effects were common factors affecting PCA satisfaction. However, the effect of some factors affecting PCA satisfaction differed with the level of satisfaction. In open surgery patients, the effect of pain at 6 hours after surgery was significantly greater in the group with lower satisfaction. While, in the laparoscopic surgery patients, the effect of pain at 6-24 hours after surgery was significantly greater in the group with lower satisfaction. CONCLUSION Generalized logistic regression may be an appropriate statistical method for analyzing ordinal data. Degree of postoperative pain and assessment interval are the most important factors associated with PCA satisfaction. Because the factors affecting PCA satisfaction were different for the two types of abdominal surgeries, customizing PCA to individual patients may potentially improve pain management and consequently increase PCA satisfaction.
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Affiliation(s)
- Wonhee Baek
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Acute Pain Service Team, Severance Hospital, Seoul, Republic of Korea
| | - Yeonsoo Jang
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea.
| | - Chang Gi Park
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Mir Moon
- College of Nursing, Yonsei University, Seoul, Republic of Korea; Acute Pain Service Team, Severance Hospital, Seoul, Republic of Korea
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15
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Mendonça FT, Pellizzaro D, Grossi BJ, Calvano LA, de Carvalho LS, Sposito AC. Synergistic effect of the association between lidocaine and magnesium sulfate on peri-operative pain after mastectomy. Eur J Anaesthesiol 2020; 37:224-234. [DOI: 10.1097/eja.0000000000001153] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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16
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Zhang XY, Zhang XZ, Lu FY, Zhang Q, Chen W, Ma T, Bai XL, Liang TB. Factors associated with failure of enhanced recovery after surgery program in patients undergoing pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int 2020; 19:51-57. [PMID: 31563597 DOI: 10.1016/j.hbpd.2019.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 09/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The enhanced recovery after surgery (ERAS) protocol is an evidence-based perioperative care program aimed at reducing surgical stress response and accelerating recovery. However, a small proportion of patients fail to benefit from the ERAS program following pancreaticoduodenectomy. This study aimed to identify the risk factors associated with failure of ERAS program in pancreaticoduodenectomy. METHODS Between May 2014 and December 2017, 176 patients were managed with ERAS program following pancreaticoduodenectomy. ERAS failure was indicated by prolonged hospital stay, unplanned readmission or unplanned reoperation. Demographics, postoperative recovery and compliance were compared of those ERAS failure groups to the ERAS success group. RESULTS ERAS failure occurred in 59 patients, 33 of whom had prolonged hospital stay, 18 were readmitted to hospital within 30 days after discharge, and 8 accepted reoperation. Preoperative American Society of Anesthesiologists (ASA) score of ≥III (OR = 2.736; 95% CI: 1.276-6.939; P = 0.028) and albumin (ALB) level of <35 g/L (OR = 3.589; 95% CI: 1.403-9.181; P = 0.008) were independent risk factors associated with prolonged hospital stay. Elderly patients (>70 years) were on a high risk of unplanned reoperation (62.5% vs. 23.1%, P = 0.026). Patients with prolonged hospital stay and unplanned reoperation had delayed intake and increased intolerance of oral foods. Prolonged stay patients got off bed later than ERAS success patients did (65 h vs. 46 h, P = 0.012). Unplanned reoperation patients tended to experience severer pain than ERAS success patients did (3 score vs. 2 score, P = 0.035). CONCLUSIONS Patients with high ASA score, low ALB level or age >70 years were at high risk of ERAS failure in pancreaticoduodenectomy. These preoperative demographic and clinical characteristics are important determinants to obtain successful postoperative recovery in ERAS program.
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Affiliation(s)
- Xiao-Yu Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiao-Zhen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Fang-Yan Lu
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wei Chen
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Tao Ma
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Pancreatic Disease of Zhejiang Province, Hangzhou 310003, China.
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17
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Vent A, Surber C, Graf Johansen NT, Figueiredo V, Schönbächler G, Imhof L, Buset C, Hafner J. Buffered lidocaine 1%/epinephrine 1:100,000 with sodium bicarbonate (sodium hydrogen carbonate) in a 3:1 ratio is less painful than a 9:1 ratio: A double-blind, randomized, placebo-controlled, crossover trial. J Am Acad Dermatol 2020; 83:159-165. [PMID: 31958526 DOI: 10.1016/j.jaad.2019.09.088] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 09/01/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neutralizing (buffering) lidocaine 1%/epinephrine 1:100,000 solution (Lido/Epi) with sodium hydrogen carbonate (NaHCO3) (also called sodium bicarbonate) is widely used to reduce burning sensations during infiltration of Lido/Epi. Optimal mixing ratios have not been systematically investigated. OBJECTIVES To determine whether a Lido/Epi:NaHCO3 mixing ratio of 3:1 (investigational medicinal product 1) causes less pain during infiltration than a mixing ratio of 9:1 (IMP2) or unbuffered Lido/Epi (IMP3). METHODS Double-blind, randomized, placebo-controlled, crossover trial (n = 2 × 24) with 4 investigational medicinal products (IMP1-4). RESULTS The 3:1 mixing ratio was significantly less painful than the 9:1 ratio (P = .044). Unbuffered Lido/Epi was more painful than the buffered Lido/Epi (P = .001 vs IMP1; P = .033 vs IMP2). IMP4 (NaCl 0.9% [placebo]) was more painful than any of the anesthetic solutions (P = .001 vs IMP1; P = .001 vs IMP2; P = .016 vs IMP3). In all cases, the anesthesia was effective for at least 3 hours. LIMITATIONS Results of this trial cannot be generalized to other local anesthetics such as prilocaine, bupivacaine, or ropivacaine, which precipitate with NaHCO3 admixtures. CONCLUSIONS Lido/Epi-NaHCO3 mixtures effectively reduce burning pain during infiltration. The 3:1 mixing ratio is significantly less painful than the 9:1 ratio. Reported findings are of high practical relevance, given the extensive use of local anesthesia today.
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Affiliation(s)
- Alexandra Vent
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Christian Surber
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Verena Figueiredo
- Hospital Pharmacy of the University Hospital Zurich, Schlieren, Switzerland
| | | | - Laurence Imhof
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Caroline Buset
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland.
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18
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Hemberg JL, Pomeranz ES, Rogers AJ, Lo SL, Harrison LE, Donohue Bs LE, Kullgren KA. Functional Impairment Predicts Outcome of Youth With Headache in the Emergency Department. Clin Pediatr (Phila) 2020; 59:62-69. [PMID: 31690099 DOI: 10.1177/0009922819884585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Headache is a common presenting complaint in emergency departments (EDs), with the goal of improving acute pain. However, youth with chronic headaches may demonstrate broad functional impairment in their lives due to headaches. Our objective was to determine if degree of functional impairment predicts ED course for patients with headache as part of a clinical protocol. One hundred and thirty-seven pediatric patients presenting to an ED with headache were included. Patients and parents were administered the Functional Disability Index (FDI) and ED charts were reviewed to evaluate outcomes. Higher child-reported FDI scores were associated with more medications, longer ED stay, and admission. High parent-proxy FDI score was associated with longer ED stay. Both pain score and parent-proxy FDI score were associated with imaging. The FDI was a more useful predictor of visit resources than pain score. FDI scores could be used to help anticipate patients who may require greater time and resources.
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19
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Wong SS, Svingos AM, Heaton SC. Behavioral Therapy for Acute Post‐Surgical Phantom Limb Pain in a Young Adult With Osteosarcoma. Pain Pract 2019; 19:571-572. [DOI: 10.1111/papr.12768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Shan S. Wong
- Department of Social Sciences & Health Policy Wake Forest School of Medicine Winston‐Salem North Carolina U.S.A
| | - Adrian M. Svingos
- Department of Clinical & Health Psychology University of Florida Gainesville Florida U.S.A
| | - Shelley C. Heaton
- Department of Clinical & Health Psychology University of Florida Gainesville Florida U.S.A
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20
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Academy of Oncologic Physical Therapy EDGE Task Force on Cancer: A Systematic Review of Outcome Measures for Pain in Children. REHABILITATION ONCOLOGY 2019. [DOI: 10.1097/01.reo.0000000000000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miró J, Sánchez-Rodríguez E, Brijaldo S, Jensen MP. The Silhouettes Fatigue Scale: comprehensibility and validity in older individuals. Disabil Rehabil 2019; 42:1906-1911. [PMID: 30672341 DOI: 10.1080/09638288.2018.1539129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Fatigue has been shown to be one of the key factors that interfere in the quality of life of elderly individuals. In order to understand its impact and evaluate the efficacy of treatments that target fatigue, researchers and clinicians need psychometrically sound and easy to use assessment instruments. The aim of this work was to address this need by evaluating the comprehensibility and validity of the Silhouettes Fatigue Scale (SFS) in a sample of older individuals.Methods: A total of 70 older individuals participated in the study. Participants were interviewed individually and asked to rate their level of fatigue during the week before the interview using the SFS and the FACIT-Fatigue Scale (to help evaluate convergent validity), and respond to the Pain Catastrophizing Scale (to help evaluate discriminant validity).Results: The results indicate that the SFS is understandable and that the scores have an adequate convergent validity and discriminant validity when used with older adults.Conclusions: The SFS is a valid measure of fatigue that can be used with older adults. It fills the need for a brief and easy to administer and score measure, which can be used in situations where assessment burden is a significant issue.Implications for rehabilitationFatigue is a significant problem among the elderly resulting in significant disability, and psychometrically sound and easy to use questionnaires are needed.The Silhouettes Fatigue Scale (SFS) is a new single-item self-report fatigue rating scale.Results show that the SFS is understandable, and that the scores have discriminant and convergent validity when used with older adults.As it does not use written items, it may be more easily understood by people who have basic or even no literacy level, thus making it easier to use for a wider audience.
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Affiliation(s)
- Jordi Miró
- Department of Psychology, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Tarragona, Spain
| | - Elisabet Sánchez-Rodríguez
- Department of Psychology, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Tarragona, Spain
| | - Solángel Brijaldo
- Department of Psychology, Unit for the Study and Treatment of Pain - ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Tarragona, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
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Galán S, Roy R, Solé E, Racine M, de la Vega R, Jensen MP, Miró J. Committed Action, Disability and Perceived Health in Individuals with Fibromyalgia. Behav Med 2019; 45:62-69. [PMID: 29671691 DOI: 10.1080/08964289.2018.1467370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Committed action, one of the components of psychological flexibility, has been shown to be related with measures of pain-relevant function domains in patients with chronic pain. However, the associations between measures of committed action and of physical health and function in individuals with fibromyalgia (FM) have not yet been examined. The aim of the present cross-sectional study was to better understand the role that committed action plays in (1) pain-related disability and (2) mental and physical health in individuals with FM. One hundred twenty-nine adult females with a diagnosis of FM from a rheumatologist were administered measures of committed action, disability, physical health, and mental health. After controlling for age and pain intensity, committed action explained an additional 24% of the variance of pain disability, 39% of the variance of physical health, and 41% of the variance of mental health. This study provides important new information on the associations between a measure of committed action and perceived health and function in a sample of women with FM. The findings are also consistent with the psychological flexibility model for understanding pain and its impact in patients with FM.
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Affiliation(s)
- Santiago Galán
- a Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili , Catalonia , Spain.,b Research Center for Behavior Assessment (CRAMC), Department of Psychology , Universitat Rovira i Virgili , Catalonia , Spain.,c Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili , Catalonia , Spain
| | - Rubén Roy
- a Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili , Catalonia , Spain.,b Research Center for Behavior Assessment (CRAMC), Department of Psychology , Universitat Rovira i Virgili , Catalonia , Spain.,c Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili , Catalonia , Spain
| | - Ester Solé
- a Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili , Catalonia , Spain.,b Research Center for Behavior Assessment (CRAMC), Department of Psychology , Universitat Rovira i Virgili , Catalonia , Spain.,c Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili , Catalonia , Spain
| | - Mélanie Racine
- d Clinical and Neurological Sciences Department , Schulich School of Medicine & Dentistry, University of Western Ontario , London , ON , Canada
| | - Rocío de la Vega
- a Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili , Catalonia , Spain.,e Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Mark P Jensen
- e Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Jordi Miró
- a Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili , Catalonia , Spain.,b Research Center for Behavior Assessment (CRAMC), Department of Psychology , Universitat Rovira i Virgili , Catalonia , Spain.,c Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili , Catalonia , Spain.,f Chair in Pediatric Pain Universitat Rovira i Virgili-Fudación Grünenthal , Catalonia , Spain
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Miró J, de la Vega R, Gertz KJ, Thong ISK, Jensen MP, Engel JM. Do Commonly Used Measures of Pain Intensity Only Reflect Pain Intensity in Youths With Bothersome Pain and a Physical Disability? Front Pediatr 2019; 7:229. [PMID: 31281805 PMCID: PMC6595400 DOI: 10.3389/fped.2019.00229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 05/21/2019] [Indexed: 12/27/2022] Open
Abstract
The objective of this cross-sectional study was to evaluate the extent to which non-pain intensity factors influence the ratings of pain intensity on two commonly used measures: the Wong-Baker Faces pain rating scale (FACES) and the Verbal Rating Scale (VRS) in a sample of youths with physical disabilities and bothersome pain. Study participants came from a convenience sample of 115 youths (age: X ¯ = 14.4 years; SD = 3.3), who participated in a survey on the impact of pain in young people with a physical disability. They were administered measures of pain intensity, pain catastrophizing, depressive symptoms, pain interference, and pain control beliefs. Zero-order correlation analyses were used to examine the associations among the pain intensity scores, while regression analyses were used to test the influence of the non-pain intensity factors on the pain intensity scores. Although pain intensity scores from all scales were significantly associated with one another, the correlations were moderate. Regression analyses showed that the FACES and VRS also reflect pain interference, in addition to pain intensity. The fact that the FACES and VRS ratings reflect more than pain intensity should be considered when selecting a pain measure. The results of this study also provide information to help interpret results after treatment.
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Affiliation(s)
- Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain
| | - Rocío de la Vega
- Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin J Gertz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Ivan S K Thong
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Joyce M Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, United States
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Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties. Pain 2018; 160:5-18. [DOI: 10.1097/j.pain.0000000000001377] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Vittinghoff M, Lönnqvist PA, Mossetti V, Heschl S, Simic D, Colovic V, Dmytriiev D, Hölzle M, Zielinska M, Kubica-Cielinska A, Lorraine-Lichtenstein E, Budić I, Karisik M, Maria BDJ, Smedile F, Morton NS. Postoperative pain management in children: Guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA Pain Management Ladder Initiative). Paediatr Anaesth 2018; 28:493-506. [PMID: 29635764 DOI: 10.1111/pan.13373] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 12/21/2022]
Abstract
The main remit of the European Society for Paediatric Anaesthesiology (ESPA) Pain Committee is to improve the quality of pain management in children. The ESPA Pain Management Ladder is a clinical practice advisory based upon expert consensus to help to ensure a basic standard of perioperative pain management for all children. Further steps are suggested to improve pain management once a basic standard has been achieved. The guidance is grouped by the type of surgical procedure and layered to suggest basic, intermediate, and advanced pain management methods. The committee members are aware that there are marked differences in financial and personal resources in different institutions and countries and also considerable variations in the availability of analgesic drugs across Europe. We recommend that the guidance should be used as a framework to guide best practice.
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Affiliation(s)
- Maria Vittinghoff
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Per-Arne Lönnqvist
- Paediatric Anaesthesia & Intensive Care, Section of Anaesthesiology & Intensive Care, Department of Physiology & Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Valeria Mossetti
- Department of Anesthesia and Intensive Care, Regina Margherita Children's Hospital, Torino, Italy
| | - Stefan Heschl
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Dusica Simic
- University Children's Hospital, Medical Faculty University of Belgrade, Serbia
| | - Vesna Colovic
- Royal Manchester Children's Hospital, Central Manchester University Hospitals, Manchester, UK
| | - Dmytro Dmytriiev
- Department of Anesthesiology and Intensive Care, Vinnitsa National Medical University, Vinnitsa, Ukraine
| | - Martin Hölzle
- Section of Paediatric Anaesthesia, Department of Anaesthesia, Luzerner Kantonsspital, Luzern, Switzerland
| | - Marzena Zielinska
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Kubica-Cielinska
- Department of Paediatric Anaesthesiology and Intensive Care, Wroclaw Medical University, Wroclaw, Poland
| | | | - Ivana Budić
- Centre for Anesthesiology and Resuscitation, Clinical Centre Nis Department of Anesthesiology, Medical Faculty, University of Nis, Nis, Serbia
| | - Marijana Karisik
- Institute for Children Diseases, Department of Anaesthesiology, Clinical Centre of Montenegro, Podgorica, Montenegro
| | - Belen De Josè Maria
- Department of Pediatric Anesthesia, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Francesco Smedile
- Department of Pediatric Anesthesiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Neil S Morton
- Paediatric Anaesthesia and Pain Management, University of Glasgow, Glasgow, UK
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DE LA VEGA ROCÍO, GROENEWALD CORNELIUS, BROMBERG MAGGIEH, BEALS-ERICKSON SARAHE, PALERMO TONYAM. Chronic pain prevalence and associated factors in adolescents with and without physical disabilities. Dev Med Child Neurol 2018; 60:596-601. [PMID: 29468673 PMCID: PMC5943137 DOI: 10.1111/dmcn.13705] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 12/25/2022]
Abstract
AIM Adolescents with physical disabilities may have co-occurring chronic pain, but the prevalence and specific associated factors are unknown. The aims of this study were to determine (1) the prevalence of chronic pain in adolescents with physical disabilities and (2) whether known correlates of chronic pain in the general population are also present in young people both with physical disability and with chronic pain relative to peers. METHOD We conducted a secondary analysis of cross-sectional nationally representative data from the National Longitudinal Study of Adolescent to Adult Health. Multivariate linear regression analysis was used to identify demographic and psychosocial factors associated with chronic pain. RESULTS A total of 989 (4.3%) adolescents reported physical disabilities. They had a significantly higher rate of pain (27.2%) compared with able-bodied peers (15.6%, χ2 =86.3550, p<0.001). There was no significant interaction between physical disability status and chronic pain in relation to depressive symptoms, anxiety, or insomnia. INTERPRETATION Adolescents with physical disabilities experience chronic pain at a significantly higher rate than able-bodied peers, but the comorbidity of physical disability and chronic pain is not related to depression, anxiety, or insomnia. Evaluation of chronic pain and tailored pain interventions need to be developed for this population. WHAT THIS PAPER ADDS Chronic pain and its correlates are important problems for adolescents with physical disabilities. These adolescents present with higher rates of chronic pain than other young people. Chronic pain is associated with increased levels of depressive symptoms, anxiety, and insomnia regardless of disability status.
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Affiliation(s)
- ROCÍO DE LA VEGA
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA,Center for Child Health, Behavior & Development, Seattle Children’s Research InstituteSeattle, WA
| | - CORNELIUS GROENEWALD
- Center for Child Health, Behavior & Development, Seattle Children’s Research InstituteSeattle, WA,Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA
| | - MAGGIE H BROMBERG
- Center for Child Health, Behavior & Development, Seattle Children’s Research InstituteSeattle, WA
| | - SARAH E BEALS-ERICKSON
- Department of Developmental and Behavioral Sciences, Children’s Mercy Hospital-Kansas City, Kansas City, MO,Department of Pain Management, Children’s Mercy Hospital-Kansas City, Kansas City, MO
| | - TONYA M PALERMO
- Center for Child Health, Behavior & Development, Seattle Children’s Research InstituteSeattle, WA,Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA,Department of Pediatrics, University of Washington, Seattle, WA,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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27
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Effectiveness of Massage Therapy and Abdominal Hypopressive Gymnastics in Nonspecific Chronic Low Back Pain: A Randomized Controlled Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:3684194. [PMID: 29681973 PMCID: PMC5842706 DOI: 10.1155/2018/3684194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 01/03/2018] [Accepted: 01/23/2018] [Indexed: 11/20/2022]
Abstract
Background There are a great number of interventions in physiotherapy, but with little evidence of their effectiveness in chronic low back pain. Therefore, this study assesses effectiveness of Massage Therapy and Abdominal Hypopressive Gymnastics and the combination of both to decrease pain and lumbar disability while increasing joint mobility and quality of life in patients with chronic nonspecific low back pain. Methods A randomized, single-blinded, controlled, clinical trial with sample (n = 27) was comprised of patients between 20 and 65 years, diagnosed with pain of mechanical origin characterized by having a duration of at least 12 weeks and no serious complications. Each group received 8 interventions of 30 minutes. Results Friedman ANOVA test obtained statistically significant differences of Oswestry, NRS, and Schober variables (p < 0.05) in the three measurements (pretest, posttest 1, and posttest 2), in each individual group. ANOVA Kruskal-Wallis test was used for comparison between groups, and Oswestry Disability values were significantly higher (p = 0.024) in the group receiving both treatments. Conclusion Both individual groups reduce pain levels, improve disability, and increase the flexibility of the lumbar spine. The combination therapy provides greater benefits in terms of lumbar disability. This study is registered on March 8, 2016, with NCT02721914.
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What Determines Whether a Pain is Rated as Mild, Moderate, or Severe? The Importance of Pain Beliefs and Pain Interference. Clin J Pain 2017; 33:414-421. [PMID: 27584819 DOI: 10.1097/ajp.0000000000000429] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Reliable and valid measures of pain intensity are needed to accurately evaluate the efficacy of pain treatments. Perhaps with the exception of faces pain intensity scales, which are thought to reflect both pain intensity and pain affect, the other most commonly used pain intensity scales-Numerical Rating Scales (NRSs), Visual Analog Scales, and Verbal Rating Scales (VRSs)-are all thought to reflect primarily pain intensity or the magnitude of felt pain. However, to our knowledge, this assumption has not been directly tested for VRSs. METHODS We evaluated whether VRS pain severity ratings are influenced by pain beliefs, catastrophizing, or pain interference over and above any effects of pain intensity, as measured by a NRS, in 4 samples of individuals with physical disabilities and chronic pain. RESULTS As hypothesized, and while controlling for pain intensity as measured by a NRS, higher scores on factors representing pain interference with function, pain catastrophizing, and a number of pain-related beliefs were all associated with a tendency for the study participants to rate their pain as more severe on a VRS. DISCUSSION These findings indicate VRSs of pain severity cannot necessarily be assumed to measure only pain intensity; they may also reflect patient perceptions about pain interference and beliefs about their pain. Clinicians and researchers should take these findings into account when selecting measures and when interpreting the results of studies using VRSs as outcome measures.
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29
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Miró J, de la Vega R, Gertz KJ, Jensen MP, Engel JM. The role of perceived family social support and parental solicitous responses in adjustment to bothersome pain in young people with physical disabilities. Disabil Rehabil 2017; 41:641-648. [PMID: 29130816 DOI: 10.1080/09638288.2017.1400594] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Family social support and parental solicitous responses have been hypothesised to play an important role in paediatric pain. However, research testing the hypothesised associations between these social domains and measures of adjustment to pain in youths with disabilities and chronic pain is non-existent. METHODS About 111 youths with physical disabilities and bothersome pain were interviewed and asked to complete measures of average pain intensity, pain interference, family social support, parent solicitous responding, and catastrophising. RESULTS Children's perceptions of pain-related solicitous responses from their parent/guardian were associated both with more pain interference and greater pain-related catastrophising; perceived social support was negatively associated with pain interference. CONCLUSIONS The findings provide new information regarding the role that psychosocial factors have in predicting function and adjustment, and have important implications as to how youth with physical disabilities with pain might be most effectively treated. Implications for rehabilitation Little is known about the role of perceived family social support or parental solicitous responses in the adjustment to chronic pain in young people with physical disabilities. This study provides new and important findings that have significant theoretical and practical implications that could help to understand and manage function in these patients. Results show that it matters how parents respond to their children with disabilities who have pain, and raise the possibility that interventions which target these responses may result in significant benefits for the children.
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Affiliation(s)
- Jordi Miró
- a Unit for the Study and Treatment of Pain - ALGOS, Pediatric Pain Division , Tarragona , Catalonia , Spain.,b Department of Psychology , Research Center for Behavior Assessment (CRAMC) , Tarragona , Spain.,c Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili , Tarragona , Catalonia , Spain
| | - Rocío de la Vega
- a Unit for the Study and Treatment of Pain - ALGOS, Pediatric Pain Division , Tarragona , Catalonia , Spain.,d Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Kevin J Gertz
- d Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Mark P Jensen
- d Department of Rehabilitation Medicine , University of Washington , Seattle , WA , USA
| | - Joyce M Engel
- e Department of Occupational Science and Technology , University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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30
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Miró J, Solé E, Gertz K, Jensen MP, Engel JM. Pain Beliefs and Quality of Life in Young People With Disabilities and Bothersome Pain. Clin J Pain 2017; 33:998-1005. [PMID: 28118258 PMCID: PMC5522362 DOI: 10.1097/ajp.0000000000000482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Pain beliefs have been hypothesized to play an important role in pediatric pain. However, research examining the associations between pain-related beliefs and measures of function in youths with disabilities is limited. METHODS In total, 84 youths (mean age, 14.26 y; SD, 3.27) with physical disabilities who indicated they also had bothersome pain were interviewed and asked to rate their average pain intensity in the past week and to complete measures of pain-related beliefs and health-related quality of life. RESULTS A number of pain beliefs were associated with different physical and psychosocial function domains, although different beliefs appeared to play different roles, depending on the function domain examined. Across all of the health-related quality-of-life domains studied, a belief that pain is influenced by one's emotions was associated with lower levels of function. No differences were found in pain beliefs related to age. In addition, a small difference in pain beliefs was found for sex; specifically, girls were more likely than boys to endorse the belief that pain is influenced by emotions. DISCUSSION The findings provide new information regarding the role that pain beliefs have in predicting function and have important clinical implications regarding how youth with physical disabilities and pain might be most effectively treated.
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Affiliation(s)
- Jordi Miró
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain - ALGOS
- Research Center for Behavior Assessment (CRAMC), Department of Psychology
- Institut d’Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain - ALGOS
- Research Center for Behavior Assessment (CRAMC), Department of Psychology
- Institut d’Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Kevin Gertz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joyce M. Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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31
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Miró J, de la Vega R, Solé E, Racine M, Jensen MP, Gálan S, Engel JM. Defining mild, moderate, and severe pain in young people with physical disabilities. Disabil Rehabil 2017; 39:1131-1135. [PMID: 27291566 PMCID: PMC5553452 DOI: 10.1080/09638288.2016.1185469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 04/09/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study is to identify the cutoffs that are most suitable for classifying average and worst pain intensity as being mild, moderate, or severe in young people with physical disabilities. METHOD Survey study using a convenience sample of 113 young people (mean age = 14.19; SD = 2.9; age range: 8-20) with physical disabilities (namely, spinal cord injury, cerebral palsy, spina bifida, limb deficiency (acquired or congenital), or neuromuscular disease). RESULTS The findings support a non-linear association between pain intensity and pain interference. In addition, the optimal cutoffs for classifying average and worst pain as mild, moderate, or severe differed. For average pain, the best cutoffs were the following: 0-3 for mild, 4-6 for moderate, and 7-10 for severe pain, whereas the optimal classification for worst pain was 0-4 for mild, 5-6 for moderate, and 7-10 for severe pain. CONCLUSIONS The findings provide important information that may be used to help make decisions regarding pain treatment in young people with disabilities and also highlight the need to use different cutoffs for classifying pain intensity in young people with disabilities than those that have been suggested for adults with chronic pain. Implications for rehabilitation Most clinical guidelines make treatment recommendations based on classifications of pain intensity as being mild, moderate, and severe that do not have a clear cut association with pain intensity ratings. Cutoffs that are deemed to be the most appropriate for classifying pain intensity as mild, moderate, and severe appear to depend, at least in part, on the pain population that is being studied and pain domain that is being used. This work helps to advance our knowledge regarding the meaning of pain intensity ratings in young people with physical disabilities. Clinicians can use this information to make empirically guided decisions regarding when to intervene in young people with disabilities and chronic pain.
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Affiliation(s)
- Jordi Miró
- Unit for the Study and Treatment of Pain – ALGOS, Catalonia,
Spain
- Research Center for Behavior Assessment (CRAMC), Department of
Psychology, Catalonia, Spain
- Institut d’Investigació Sanitària Pere
Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Rocío de la Vega
- Unit for the Study and Treatment of Pain – ALGOS, Catalonia,
Spain
- Research Center for Behavior Assessment (CRAMC), Department of
Psychology, Catalonia, Spain
- Institut d’Investigació Sanitària Pere
Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain – ALGOS, Catalonia,
Spain
- Research Center for Behavior Assessment (CRAMC), Department of
Psychology, Catalonia, Spain
- Institut d’Investigació Sanitària Pere
Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mélanie Racine
- Clinical and Neurological Sciences Department, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, ON,
Canada
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington,
Seattle, WA, USA
| | - Santiago Gálan
- Unit for the Study and Treatment of Pain – ALGOS, Catalonia,
Spain
- Research Center for Behavior Assessment (CRAMC), Department of
Psychology, Catalonia, Spain
- Institut d’Investigació Sanitària Pere
Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Joyce M. Engel
- Department of Occupational Science and Technology, University of
Wisconsin-Milwaukee, Milwaukee, WI, USA
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Psychometric Properties of the Numerical Rating Scale to Assess Self-Reported Pain Intensity in Children and Adolescents. Clin J Pain 2017; 33:376-383. [DOI: 10.1097/ajp.0000000000000406] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miró J, de la Vega R, Tomé-Pires C, Sánchez-Rodríguez E, Castarlenas E, Jensen MP, Engel JM. Pain extent and function in youth with physical disabilities. J Pain Res 2017; 10:113-120. [PMID: 28115871 PMCID: PMC5221720 DOI: 10.2147/jpr.s121590] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The aim of this study was to increase our understanding of the role that spatial qualities of pain (location and extent) play in functioning, among youths with disabilities and chronic pain. Methods One-hundred and fifteen youths (mean age 14.4 years; SD ±3.3 years) with physical disabilities and chronic pain were interviewed and were asked to provide information about pain locations and their average pain intensity in the past week, and to complete measures of pain interference, psychological function and disability. Most of the participants in this sample were males (56%), Caucasian (68%), and had a cerebral palsy (34%) or muscular dystrophy (25%) problem. Most participants did not report high levels of disability (
X¯=12.7, SD ±9.5, range 0–60) or global pain intensity (
X¯=3.2, SD ±2.4, range 0–10). Results Pain at more than one body site was experienced by 91% of participants. There were positive associations between pain extent with pain interference (r = 0.30) and disability (r = 0.30), and a negative association with psychological function (r = –0.38), over and above average pain intensity. Additionally, pain intensity in the back (as opposed to other locations) was associated with more pain interference (r = 0.29), whereas pain intensity in the shoulders was associated with less psychological function (r = –0.18), and pain intensity in the bottom or hips was associated with more disability (r = 0.29). Conclusion The findings support the need to take into account pain extent in the assessment and treatment of youths with physical disabilities and chronic pain, call our attention about the need to identify potential risk factors of pain extent, and develop and evaluate the benefits of treatments that could reduce pain extent and target pain at specific sites.
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Affiliation(s)
- Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain; Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain; Universitat Rovira i Virgili, Catalonia, Spain; Chair in Pediatric Pain, Universitat Rovira i Virgili-Fundación Grünenthal, Catalonia, Spain
| | - Rocío de la Vega
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain; Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Catarina Tomé-Pires
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain; Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain; Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain; Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain; Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain; Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Catalonia, Spain; Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joyce M Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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de la Vega R, Racine M, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Engel J, Miró J. Psychometric properties of the short form of the Children's Depression Inventory (CDI-S) in young people with physical disabilities. J Psychosom Res 2016; 90:57-61. [PMID: 27772560 PMCID: PMC5651516 DOI: 10.1016/j.jpsychores.2016.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Depression is a significant issue for young people with physical disabilities. Efficient and reliable questionnaires are needed to evaluate and monitor the efficacy of depression treatments in this population. The aim of this study was to evaluate the reliability and validity of the 10-item version of the Children's Depression Inventory (CDI-S) in a sample of young people with physical disabilities. METHODS A convenience sample of young people with physical disabilities (N=97) was recruited and interviewed. Reliability was evaluated using the Cronbach's α and examining the item-total correlations. Validity was evaluated by computing Pearson correlations between scores on the CDI-S and measures of pain and psychological functioning (anxiety and depression). RESULTS The CDS-I items loaded on a single factor. The internal consistency of the scale was good (Cronbach's α=0.84) and the CDI-S showed moderate significant correlations with pain intensity (r=0.29), pain interference (r=0.46) and psychological functioning (r=-0.57). Two of the items, however, did not perform well (i.e., item-total correlations <0.3, and Cronbach's α improved when they were deleted). CONCLUSION The findings support the reliability and validity of the CDI-S scores for use in young people with physical disabilities. The measure's psychometric properties should be studied in larger samples. In addition, there is a new brief version of the CDI (CDI-S 2) that needs to be evaluated in order to determine which of the two scales is better for assessing depression in young people with physical disabilities.
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Affiliation(s)
- Rocío de la Vega
- Unit for the Study and Treatment of Pain — ALGOS, Universitat Rovira i Virgili, Catalonia, Spain,Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Mélanie Racine
- Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain — ALGOS, Universitat Rovira i Virgili, Catalonia, Spain,Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain,Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain — ALGOS, Universitat Rovira i Virgili, Catalonia, Spain,Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain,Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Unit for the Study and Treatment of Pain — ALGOS, Universitat Rovira i Virgili, Catalonia, Spain,Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain,Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joyce Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain; Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain; Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain; Universitat Rovira i Virgili-Fudación Grünenthal, Catalonia, Spain.
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Sánchez-Rodríguez E, Castarlenas E, de la Vega R, Roset R, Miró J. On the electronic measurement of pain intensity: Can we use different pain intensity scales interchangeably? J Health Psychol 2016; 22:1658-1667. [DOI: 10.1177/1359105316633284] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this work was to study the agreement between four pain intensity scales when administered electronically: the Numerical Rating Scale-11, the Faces Pain Scale-Revised, the Visual Analogue Scale and the Coloured Analogue Scale. In all, 180 schoolchildren between 12 and 19 years old participated in the study. They had to report the maximum intensity of their most frequent pain using the electronic versions of the four scales. Agreement was calculated using the Bland–Altman method. Results show that the electronic versions of Numerical Rating Scale-11, Coloured Analogue Scale and Visual Analogue Scale can be used interchangeably.
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Telephone Problem-Solving Treatment Improves Sleep Quality in Service Members With Combat-Related Mild Traumatic Brain Injury. J Head Trauma Rehabil 2016; 31:147-57. [DOI: 10.1097/htr.0000000000000221] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Green A, Kabbouche M, Kacperski J, Hershey A, O'Brien H. Managing Migraine Headaches in Children and Adolescents. Expert Rev Clin Pharmacol 2016; 9:477-82. [PMID: 26824175 DOI: 10.1586/17512433.2016.1135050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The diagnosis and management of migraine headaches can be challenging in children and adolescents. The description of migraine in this population may include symptoms that are not typically described in adults. Treatment options for pediatric migraine is increasing, however remain limited. This article will go through the key components to diagnosing migraine in pediatric patients as well as give options for short and long-term management.
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Affiliation(s)
- Antoinette Green
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA
| | - Marielle Kabbouche
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,b UC Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| | - Joanne Kacperski
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,b UC Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| | - Andrew Hershey
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,b UC Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
| | - Hope O'Brien
- a Department of Neurology , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.,b UC Department of Pediatrics , University of Cincinnati College of Medicine , Cincinnati , Ohio , USA
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