Schmerzbezogene Copingstrategien von Kindern und Jugendlichen mit chronischen Schmerzen

Large-scale real-world data on a multidisciplinary approach to spinal cord stimulation for persistent spinal pain syndromes: first evaluation of the Neuro-Pain® nationwide screening and follow-up interactive register

Introduction

Spinal cord stimulation is a common treatment option for neuropathic pain conditions. Despite its extensive use and multiple technological evolutions, long term efficacy of spinal cord stimulation is debated. Most studies on spinal cord stimulation include a rather limited number of patients and/or follow-ups over a limited period. Therefore, there is an urgent need for real-world, long-term data.

Methods

In 2018, the Belgian government initiated a nationwide secure platform for the follow-up of all new and existing spinal cord stimulation therapies. This is a unique approach used worldwide. Four years after the start of centralized recording, the first global extraction of data was performed.

Results

Herein, we present the findings, detailing the different steps in the centralized procedure, as well as the observed patient and treatment characteristics. Furthermore, we identified dropouts during the screening process, the reasons behind discontinuation, and the evolution of key indicators during the trial period. In addition, we obtained the first insights into the evolution of the clinical impact of permanent implants on the overall functioning and quality of life of patients in the long-term.

Discussion

Although these findings are the results of the first data extraction, some interesting conclusions can be drawn. The long-term outcomes of neuromodulation are complex and subject to many variables. Future data extraction will allow us to identify these confounding factors and the early predictors of success. In addition, we will propose further optimization of the current process.

Development and Validation of the Scale for Pain Self-Efficacy (SPaSE) in German and English Languages for Children and Adolescents

No validated measure for pain self-efficacy in children and adolescents is currently available in the German language, and existing English versions have limitations. This study used a thorough development process to create the Scale for Pain Self-Efficacy (SPaSE) in both German and English languages. Scale development was based on self-efficacy theory, adapting items from existing self-efficacy measures, and review of patients' perspectives. The final version of the 11-item SPaSE was created with expert discussions and testing of content validity, comprehensibility, and construct validity. The validation process consisted of exploratory factor analysis, testing of item characteristics, internal consistency, and sensitivity to change in 2 German samples of children and adolescents with chronic pain (study 1: outpatient sample N = 150, inpatient sample N = 31). Cross-validation in a U.S. sample (study 2: N = 98) confirmed the 1-factor structure, the sound psychometric properties and reliability of the SPaSE. Sum scores of the SPaSE were negatively correlated with pain-related disability, pain intensity, passive pain coping strategies, and emotional distress, in line with previous research. The valid and reliable SPaSE can be used in clinical practice to monitor pain treatment progress, advances the field of pain self-efficacy research in Germany, and opens the door to comparative research in German and English samples. PERSPECTIVE: This article presents psychometric properties of a newly developed measure of pain self-efficacy in children and adolescents that is available in both German and English language. This measure could be used in both research and clinical practice to measure treatment progress and outcome.

Intensive interdisciplinary pain treatment for children and adolescents with chronic noncancer pain: a preregistered systematic review and individual patient data meta-analysis

ABSTRACT

Chronic noncancer pain in children and adolescents can be impairing and results in substantial health care costs. Intensive interdisciplinary pain treatment (IIPT), an inpatient or day hospital treatment delivered by a team of 3 or more health professionals, may be an effective intervention for these children and adolescents. Based on previous reviews and meta-analyses, we updated findings regarding the description of available treatments and estimated the effectiveness of IIPT, overcoming methodological shortcomings of previous work by requesting and analyzing individual participant data. On June 26, 2021, we searched 5 literature databases (PubMed, PsycINFO, Web of Science, Cochrane Library, and PubPsych) for studies examining the effectiveness of IIPT. Included studies used a pre-post design, assessed patients younger than 22 years, and presented their results in English, German, French, or Spanish. We used standard methodological procedures expected by Cochrane to pool treatment effects and assess risk of bias. We identified 13 different treatment sites with similar treatment inclusion criteria and treatment components, but the descriptions of those treatments varied widely. Regarding treatment effectiveness, IIPT may result in large improvements in the mean pain intensity ( g = -1.28), disability ( g = -1.91), and number of missed school days at the 12-month follow-up ( g = -0.99), as well as moderate improvements in anxiety ( g = -0.77) and depression ( g = -0.76). The certainty of the evidence, however, was graded from very low to low. We recommend that future researchers use more scientific rigor to increase the certainty of the evidence for IIPT and standardize treatment outcomes for children and adolescents with chronic pain.

The Measurement and Conceptualization of Coping Responses in Pediatric Chronic Pain Populations: A Scoping Review

Background: Pediatric chronic pain is a prevalent condition that requires significant coping to encourage optimal functioning; however, relevant research is vast, heterogeneous, and difficult to interpret. To date, no attempt has been made to map and summarize the measurement and conceptualization of coping responses in the context of pediatric chronic pain. Objectives: A scoping review was conducted to map and summarize the participant characteristics, methodologies, theoretical frameworks, and measures used to assess coping responses in youth with chronic pain. The extent to which authors used definitions and examples of coping responses (conceptual clarity) as well as consistently used measures (measurement consistency) and their corresponding conceptualizations (conceptual consistency) relative to how they were intended to be used were assessed. Methods: Searches were conducted through MEDLINE (PubMed) and PsycINFO. Following title/abstract screening, full-text extractions were performed on 125 English-language publications on coping in youth with chronic pain. Results: Of the 125 studies, only 12.8% used a theoretical framework to explain the coping responses assessed, and even fewer (7.2%) used theory to guide measure selection. Conceptual clarity was rated "low/very low" (i.e., no definitions and/or examples) for 47.2% of studies. The majority of studies were conducted in the United States (67%) and a preponderance of White and female participants was sampled. The research primarily used quantitative methods (85%) and cross-sectional designs (67%). Parent- or self-report questionnaires were the most common methods for assessing coping (86%). Of the 95 studies that utilized one of the 14 questionnaires with known psychometric properties, 33.7 and 55.8% had one or more discrepancies for conceptual and measurement consistency, respectively. Conclusions: This review highlights the lack of clear descriptions and theoretical frameworks of coping responses for pediatric chronic pain. Inconsistencies in the measurement and conceptualization of coping responses limit research and clinical advancements. As a field, we need to strive toward using well-developed theory to create fewer, more well-established standardized measures with clearly defined coping responses. Opportunities for qualitative and observational research in more diverse patient populations should be considered for theory construction and measure validation. Clinical Trial Registration: https://osf.io/xvn2a/?view_only=eff04e0c0b9649be89d403b10e9ff082.

Do Children With Functional Abdominal Pain Benefit More From a Pain-Specific Cognitive-Behavioral Intervention Than From an Unspecific Attention Control Intervention? Results of a Randomized Controlled Trial

INTRODUCTION

We aimed to compare the efficacy of cognitive-behavioral therapy (CBT) among children with functional abdominal pain with an attention control (AC), hypothesizing the superiority of CBT group intervention regarding pain intensity (primary outcome), pain duration and frequency (further primary outcomes), functional disability, and quality of life and coping strategies (key secondary outcomes).

METHODS

We conducted a prospective, multicenter, randomized controlled efficacy trial (RCT) with 4 time points (before intervention, after intervention, 3-month follow-up, and 12-month follow-up). One hundred twenty-seven children aged 7-12 years were randomized to either the CBT (n = 63; 55.6% girls) or the AC (n = 64; 57.8% girls).

RESULTS

Primary endpoint analysis of the logarithmized area under the pain intensity curve showed no significant difference between groups (mean reduction = 49.04%, 95% confidence interval [CI] -19.98%-78.36%). Treatment success rates were comparable (adjusted odds ratio = 0.53, 95% CI 0.21-1.34, number needed to treat = 16). However, time trend analyses over the course of 1 year revealed a significantly greater reduction in pain intensity (40.9%, 95% CI 2.7%-64.1%) and pain duration (43.6%, 95% CI 6.2%-66.1%) in the CBT compared with the AC, but not in pain frequency per day (1.2, 95% CI -2.7 to 5.2). In the long term, children in the CBT benefitted slightly more than those in the AC with respect to functional disability, quality of life, and coping strategies.

DISCUSSION

Both interventions were effective, which underlines the role of time and attention for treatment efficacy. However, in the longer term, CBT yielded more favorable results.

The efficacy of an educational movie to improve pain and dysfunctional behavior in school children: A randomized controlled trial

BACKGROUND

Chronic pain in children is a serious issue, therefore calling for effective prevention/intervention measures. This study aimed to evaluate the efficacy of an educational movie on pain knowledge in school children in general and on pain-related behaviours and pain intensity in those who are affected by chronic pain. Regarding those affected, the association between pain knowledge and intensity, as well as the potential mediating effect of pain-related behaviours, were investigated.

METHODS

Recruited from four schools, N = 381 students (51.7% female; M_age  = 11.4, SD = 0.95) participated, of which n = 108 reported chronic pain. Each school was randomly allocated to the intervention or control group (cluster-randomization). At two time points spaced 4-5 weeks apart, students provided information on their pain knowledge, pain-related behaviour (passive pain coping, pain-related disability, missed school days, medication use) and pain intensity. After the first assessment, students in the intervention group watched an educational movie. Multilevel linear models for all outcomes were calculated as well as a mediation analysis.

RESULTS

Pain knowledge increased significantly in the intervention group (β = 2.76 [95% CI 2.20, 3.31]). However, no significant time-by-group interactions were found for pain-related behaviour or pain intensity. The mediation model identified that the indirect effect of pain knowledge on pain intensity was mediated by pain-related behaviour (β = -0.18, p = 0.014 and β = 0.38, p < 0.001, respectively).

CONCLUSIONS

Educational movies may be an effective tool for educating students about pain management. However, the knowledge gained may not be sufficient to improve pain behaviour and intensity overall.

SIGNIFICANCE

A 10-min educational movie on chronic pain management was tested in school children (N = 381). Following the intervention, knowledge of chronic pain concepts was statistically greater in the intervention group compared to the control group not watching the movie. Furthermore, a mediation model theoretically determined whether an association between pain knowledge and pain intensity exists, and whether this is explained by level of dysfunctional pain-related behaviorisms. Full mediation was confirmed.

Readiness to Change among Adolescents with Chronic Pain and Their Parents: Is the German Version of the Pain Stages of Change Questionnaire a Useful Tool?

The Pain Stages of Change Questionnaire (PSOCQ) measures patients’ willingness to engage in active self-management of their pain. The present study aimed to create validated German short versions of the PSOCQ for adolescents (PSOCQ-A) and their parents (PSOCQ-P). Additionally, an investigation of stages of change regarding pain characteristics and treatment outcomes was undertaken. In Study 1, the data of adolescents aged 11 to 18 years and their parents were collected prior to intake (N = 501) and at admission (N = 240) to specialist inpatient pain treatment. Confirmatory factor analyses indicated a poor fit of the full PSOCQ measures prior to intake, but an acceptable fit at admission. Short PSOCQ-A and PSOCQ-P versions were identified. In Study 2, these results were cross-validated with data from an additional N = 150 patients and their parents, collected during and 3 months after interdisciplinary inpatient pain treatment. Model fits for both short versions were acceptable, although low internal consistency for the PSOCQ-A Precontemplation and Contemplation subscales was identified. During treatment, both patients’ and their parents’ readiness to change increased. Stage of change at discharge did not predict treatment non-response 3 months later. This study indicates that the PSOCQ is neither meaningful prior to admission nor predictive of non-response to treatment. While some value may exist in monitoring treatment progress, based on the results of this study, it is not recommended that the PSOCQ-A and PSOCQ-P be used as a measure of stage of change in German pediatric pain populations.

Somatic symptom and related disorders in children and adolescents: evaluation of a naturalistic inpatient multidisciplinary treatment

BACKGROUND

This naturalistic study assesses the effectiveness of inpatient multidisciplinary treatment of children and adolescents with somatic symptom disorders (SSD) and investigates the role of pain coping strategies and psychiatric comorbidity (anxiety, depression).

METHODS

Sixty children and adolescents (mean age 14.4 years) with SSD who underwent inpatient multidisciplinary treatment were assessed regarding their school attendance, levels of discomfort, coping strategies and psychiatric comorbidity (depression, anxiety) at pretreatment, discharge and 6 months following treatment.

RESULTS

At discharge, the children and adolescents reported improvements in their level of discomfort, psychiatric comorbidities (anxiety, depression) and pain coping strategies, with medium to large effect sizes. Six months following treatment, the improvements remained stable, including significantly higher school attendance rates (d = 1.6; p < 0.01). Improvement in pain coping was associated with increased school attendance.

CONCLUSION

Inpatient multidisciplinary treatment is effective in reducing levels of discomfort, psychiatric comorbidity (anxiety, depression), and school absence and in improving coping strategies.

[Definition, diagnostics and therapy of chronic widespread pain and the (so-called) fibromyalgia syndrome in children and adolescents : Updated guidelines 2017]

BACKGROUND

The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017.

METHODS

The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n = 8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for case series (cross-sectional- and longitudinal studies) for the topics diagnosis, etiology and pathophysiology and for randomised controlled trials (RCT) for treatment modalities from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines.

RESULTS AND CONCLUSION

No consensus was achieved in the guideline group on whether the diagnostic label "juvenile fibromyalgia" should be used in the management of children and adolescents with chronic widespread pain. There was consensus in the guideline group that antidepressants and anticonvulsants should not be used to treat pain in the so-called juvenile fibromyalgia syndrome.

[Chronic primary pain disorders in children and adolescents]

AIM

Chronic and debilitating pediatric pain has a prevalence of 5% and as such constitutes a considerable health problem. The aim of this article is to provide an overview of current research activities on pediatric pain, available health care for children with chronic pain and education and training programs for health professionals.

METHOD

This overview is based on the authors' personal experience, information available from medical, research and professional associations, as well as a PubMed literature search for the time period 2012-2015 using "children";"pain" and "Germany" as search terms.

RESULTS

There are numerous research activities in Germany focusing on the epidemiology, the underlying psychobiological mechanisms and on the multimodal treatment of chronic pediatric pain. This research is internationally widely acknowledged and makes a significant contribution to current developments in pediatric pain research. By contrast, health services and basic science research is clearly lacking in Germany. Moreover, specialized health care for youth with chronic pain is far less institutionalized when compared to adults suffering from chronic pain. Indeed, primary and secondary care services have rarely been studied or even evaluated.

CONCLUSION

Similar to international trends, research on chronic pediatric pain has also grown and advanced in Germany. Indeed, not only the amount of research has increased but also its scope. Nonetheless, there is clearly a need for more research efforts with regard to the understanding of (pediatric) pain mechanisms, clinical studies and, especially, investigations on health care services. It is particularly important to focus on the implementation, improvement and systematic evaluation of specialized health care services which would be available and accessible for children and adolescents with chronic pain and not be restricted to tertiary care.

Stop the pain: study protocol for a randomized-controlled trial

BACKGROUND

Functional abdominal pain (FAP) is not only a highly prevalent disease but also poses a considerable burden on children and their families. Untreated, FAP is highly persistent until adulthood, also leading to an increased risk of psychiatric disorders. Intervention studies underscore the efficacy of cognitive behavioral treatment approaches but are limited in terms of sample size, long-term follow-up data, controls and inclusion of psychosocial outcome data.

METHODS/DESIGN

In a multicenter randomized controlled trial, 112 children aged 7 to 12 years who fulfill the Rome III criteria for FAP will be allocated to an established cognitive behavioral training program for children with FAP (n = 56) or to an active control group (focusing on age-appropriate information delivery; n = 56). Randomization occurs centrally, blockwise and is stratified by center. This study is performed in five pediatric gastroenterology outpatient departments. Observer-blind assessments of outcome variables take place four times: pre-, post-, 3- and 12-months post-treatment. Primary outcome is the course of pain intensity and frequency. Secondary endpoints are health-related quality of life, pain-related coping and cognitions, as well as self-efficacy.

DISCUSSION

This confirmatory randomized controlled clinical trial evaluates the efficacy of a cognitive behavioral intervention for children with FAP. By applying an active control group, time and attention processes can be controlled, and long-term follow-up data over the course of one year can be explored.

TRIAL REGISTRATION

DRKS00005038 (date: 25 July 2013); NCT02030392 (date: 7 January 2014).

Health-related quality of life in children with abdominal pain due to functional or organic gastrointestinal disorders

OBJECTIVE

Comparing health-related quality of life (HRQOL) in children suffering from functional and organic gastrointestinal disorders and to identify predictors for HRQOL.

METHODS

Children with functional (n = 70) and organic (n = 100) gastrointestinal disorders, aged 8-18 years and referred to a pediatric gastroenterologist, completed questionnaires assessing pain severity, coping, and HRQOL.

RESULTS

The sample reported low HRQOL scores, even significantly lower compared with reference values of chronically ill children, derived from normative data of KINDL-R, a generic QOL questionnaire. HRQOL was not significantly associated with age, gender, duration of pain, and diagnosis (functional gastrointestinal disorder vs. organic gastrointestinal disorder). Pain severity and catastrophizing were significantly associated with HRQOL, with catastrophizing fully mediating the relationship between pain and HRQOL.

CONCLUSION

The emotional burden associated with chronic abdominal pain-regardless of its cause-is enormous. Interventions should target the children's coping strategies, as catastrophizing seems to be the causal link between pain and HRQOL.

[Definition, diagnosis and therapy of chronic widespread pain and so-called fibromyalgia syndrome in children and adolescents. Systematic literature review and guideline]

BACKGROUND

The scheduled update to the German S3 guidelines on fibromyalgia syndrome (FMS) by the Association of the Scientific Medical Societies ("Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften", AWMF; registration number 041/004) was planned starting in March 2011.

MATERIALS AND METHODS

The development of the guidelines was coordinated by the German Interdisciplinary Association for Pain Therapy ("Deutsche Interdisziplinären Vereinigung für Schmerztherapie", DIVS), 9 scientific medical societies and 2 patient self-help organizations. Eight working groups with a total of 50 members were evenly balanced in terms of gender, medical field, potential conflicts of interest and hierarchical position in the medical and scientific fields. Literature searches were performed using the Medline, PsycInfo, Scopus and Cochrane Library databases (until December 2010). The grading of the strength of the evidence followed the scheme of the Oxford Centre for Evidence-Based Medicine. The formulation and grading of recommendations was accomplished using a multi-step, formal consensus process. The guidelines were reviewed by the boards of the participating scientific medical societies.

RESULTS AND CONCLUSION

The diagnosis FMS in children and adolescents is not established. In so-called juvenile FMS (JFMS) multidimensional diagnostics with validated measures should be performed. Multimodal therapy is warranted. In the case of severe pain-related disability, therapy should be primarily performed on an inpatient basis. The English full-text version of this article is available at SpringerLink (under "Supplemental").

Schmerzkatastrophisieren bei Kindern und Jugendlichen

Zusammenfassung. Zahlreiche Untersuchungen sowohl bei Erwachsenen wie bei Kindern und Jugendlichen haben gezeigt, dass Schmerzkatastrophisieren im Vergleich zu anderen Schmerzbewältigungsstrategien die größte klinische Relevanz besitzt. Unter Schmerzkatastrophisieren versteht man die überdauernde Tendenz, Schmerz als ein besonders aversiv-bedrohliches Ereignis zu erleben, dem man mehr oder weniger hilflos ausgesetzt ist und über das man wiederholt und intensiv grübelt. Um die Maladaptivität von Schmerzkatastrophisieren nachvollziehbar zu machen, werden in dieser Übersicht verschiedene theoretische Modelle (Aufmerksamkeitsmodell, Bewertungsmodell, Kommunikationsmodell) und ihre Implikationen speziell für das Verständnis des Schmerzerlebens bei Kindern und Jugendlichen vorgestellt. Außerdem werden vorhandene Fragebogeninstrumente beschrieben und miteinander verglichen. Ein besonderes Augenmerk liegt dabei auf Instrumenten, die im deutschsprachigen Raum einsetzbar sind. Die klinische Relevanz von Schmerzkatastrophisieren wird schließlich exemplarisch anhand der Zusammenhänge mit der erlebten Schmerzintensität, der funktionalen Beeinträchtigung und der Schmerzchronifizierung aufgezeigt.

Paroxysmal Hemicrania in Children—Symptoms, Diagnostic Criteria, Therapy and Outcome

Whereas paroxysmal hemicrania (PH) is studied extensively in adults, even case reports of PH in children are rare. We present the first prospective follow-up study on PH in children. Our aim was to investigate whether differences exist between paediatric and adult patients. We assessed all children with chronic headache who were referred to our paediatric out-patient pain clinic within 3 years based on interviews and validated questionnaires. Among 628 patients we found five children with PH (0.8%) and three with probable PH (0.5%), in total 1.3%. Pain characteristics, autonomic symptoms and treatment response to indomethacin were similar to adult PH patients. Our results demonstrate that the International Headache Society classification of PH is also applicable to children. We suspect that PH has been underdiagnosed in children and therefore suboptimally treated thus far.