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Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Miró J. Immigration background as a risk factor of chronic pain and high-impact chronic pain in children and adolescents living in Spain: differences as a function of age. Pain 2024; 165:1372-1379. [PMID: 38189183 DOI: 10.1097/j.pain.0000000000003142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024]
Abstract
ABSTRACT The number of people immigrating from one country to another is increasing worldwide. Research has shown that immigration background is associated with chronic pain (CP) and pain disability in adults. However, research in this issue in children and adolescents has yielded inconsistent results. The aims of this study were to examine (1) the association between immigration background, CP, high-impact chronic pain (HICP) in a community sample of children and adolescents; and (2) the extent these associations differed as a function of sex and age. Participants of this cross-sectional study were 1115 school children and adolescents (mean age = 11.67; 56% girls). Participants were asked to provide sociodemographic information and respond to a survey including measures of pain (location, extension, frequency, intensity, and interference). Results showed that having an immigration background was associated with a greater prevalence of CP (OR = 1.91, p <.001) and HICP (OR = 2.55, p <. 01). Furthermore, the association between immigration background and CP was higher in children (OR = 6.92, p <.001) and younger adolescents (OR = 1.66, p <.05) than in older adolescents. Children and adolescents with an immigration background are at higher risk for having CP -especially younger children- and HICP. More resources should be allocated in the prevention of CP and HICP in children and adolescents with an immigration background.
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Affiliation(s)
- Josep Roman-Juan
- Unit for the Study and Treatment of Pain-ALGOS, 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
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, 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, 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, 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, United States
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, 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
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Solé E, Roman-Juan J, Sánchez-Rodríguez E, Castarlenas E, Jensen MP, Miró J. School bullying and peer relationships in children with chronic pain. Pain 2024; 165:1169-1176. [PMID: 38015633 DOI: 10.1097/j.pain.0000000000003118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/10/2023] [Indexed: 11/30/2023]
Abstract
ABSTRACT Preliminary evidence suggests that there are significant associations between bullying and chronic pain, as well as between the quality of peer relationships and psychological function in youth with chronic pain. However, these findings have yet to be replicated, and the role that bullying plays in anxiety in children and adolescents with chronic pain has not yet been examined. This study sought to expand our understanding of the associations between measures of bullying and quality of peer relationships and pain-related function domains in a community sample of schoolchildren with chronic pain. One thousand one hundred fifteen schoolchildren participated in this study; 57% were girls, the mean age of the study sample was 11.67 years (SD = 2.47), and 46% reported having chronic pain. Participants completed measures of pain characteristics, pain interference, anxiety, and depressive symptoms, bullying (past and current), and quality of peer relationships. Youth with chronic pain reported a significantly higher percentage of being bullied in the past compared with youth without chronic pain. In the group of youth with chronic pain, the measures of past and current bullying, and quality of peer relationships, were not significantly associated with pain intensity, pain interference, or anxiety. However, having a history of being bullied and the quality of peer relationships were significantly associated with depressive symptom severity. The findings indicate that research to evaluate the potential causal role of bullying and the quality of peer relationships on pain-related function domains in youth with chronic pain is warranted.
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Affiliation(s)
- Ester Solé
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Josep Roman-Juan
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), 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, United States
| | - Jordi Miró
- Department of Psychology, Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
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Bissoto JR, Silva Júnior JURD, Alvares GP, Santos FH, Len CA. Acupuncture for pediatric chronic pain: A systematic review. J Pediatr (Rio J) 2024:S0021-7557(24)00055-X. [PMID: 38697213 DOI: 10.1016/j.jped.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVES To survey, analyze and discuss the scientific evidence supporting the use of acupuncture and related techniques in the management of chronic pain in the pediatric population. SOURCES A survey of databases (MEDLINE, Scopus and Scielo) was carried out with search strategies, following the PRISMA statement, without limits on publication dates and languages. Clinical studies (clinical trials, single-arm, and case series) were accepted for review if they included participants aged up to 22 years. Study quality was assessed by MMAT, and the randomized clinical trial was analyzed under the STRICTA criteria. SUMMARY OF THE FINDINGS 2369 articles were retrieved. After excluding repetitions, 1335 underwent the initial selection. Only 16 articles were selected for full reading, of which 5 were included in the review, being two case series, two single-arm studies, and one randomized clinical trial. The articles were considered of good quality by the adopted criteria. CONCLUSION The analyzed studies showed important clinical results such as the reduction of pain intensity, and improvement in school attendance and social life. However, there are many limitations in study design and sample size. Therefore, there is weak evidence to support the use of acupuncture in the context of pediatric chronic pain, but the positive results reinforce the need for further investigation of the topic with the conduct of larger and well-designed studies, to obtain more data and greater scientific conviction of the findings.
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Affiliation(s)
- João Roberto Bissoto
- Departamento de Pediatria, Grupo de Reumatologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Departamento de Ortopedia e Traumatologia, Grupo de Acupuntura, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
| | | | - Gabrielle Pignoli Alvares
- Departamento de Psicologia, Campus Bauru, Universidade Estadual Paulista Julio de Mesquita Filho, Bauru, SP, Brazil
| | - Flávia H Santos
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Claudio Arnaldo Len
- Departamento de Pediatria, Grupo de Reumatologia Pediátrica, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Humberg C, Rau LM, Claus BB, Könning A, Stahlschmidt L, Wager J. Risk of Unfavorable Trajectories of Chronic Pain Severity-Results of a Longitudinal Study in School Children. THE JOURNAL OF PAIN 2024:104528. [PMID: 38588760 DOI: 10.1016/j.jpain.2024.104528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
Chronic pain is a common burden among children and adolescents associated with impairments in many aspects of life. Higher pain severity increases this burden. Subsequently, it is important to identify factors predicting the course of pain severity, classified by the chronic pain grading (CPG). In a 1-year longitudinal assessment of a general school-age population (N = 2,280), we aimed to identify biopsychosocial factors associated with CPG trajectories. We focused on children and adolescents who reported chronic pain at the start of the year (N = 689). Using longitudinal latent class analysis, we identified 3 classes of CPG trajectories over 1 year: 1) the "pain recovery group" exhibited initially moderate CPG scores that rapidly and consistently declined to a pain-free level, 2) the "continuously moderate pain severity group" displayed initially high CPG levels with a mild decline over time, and 3) the "continuously low pain severity group" had initially moderate CPG levels, which only slightly declined. In comparison to the pain recovery group, the continuously moderate pain severity group presented with heightened levels of anxiety (odds ratio [OR] = 1.12, 95% confidence interval [CI] [1.02, 1.24], P = .023), depression (OR = 1.10, 95% CI [1.01, 1.19], P = .029), and affective pain perception (OR = 1.10, 95% CI [1.02, 1.18], P = .010) and were more likely to be female (OR = 2.14, 95% CI [1.05, 4.35], P = .036). The continuously low pain severity group was predominantly female (OR = 1.65, 95% CI [1.10, 2.49], P = .016) compared to the pain recovery group. In conclusion, girls and individuals with impaired psychological well-being more often exhibit unfavorable trajectories of chronic pain severity. PERSPECTIVE: Pediatric chronic pain patients, particularly females and those exhibiting elevated anxiety or depression scores or heightened affective pain perception warrant special attention in health care. These individuals have a greater risk of an unfavorable trajectory of chronic pain severity and might need more urgent and specialized treatment.
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Affiliation(s)
- Clarissa Humberg
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lisa-Marie Rau
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Benedikt B Claus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Anna Könning
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany; Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany; PedScience Research Institute, Datteln, Germany.
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Grothus S, Sommer A, Stahlschmidt L, Hirschfeld G, Höfel L, Linder R, Zernikow B, Wager J. Pediatric chronic pain grading-a revised classification of the severity of pediatric chronic pain. Pain 2024:00006396-990000000-00570. [PMID: 38595202 DOI: 10.1097/j.pain.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 02/08/2024] [Indexed: 04/11/2024]
Abstract
ABSTRACT In this study, we describe the development and validation of a revised Pediatric Chronic Pain Grading (P-CPG) for children aged 8 to 17 years that adds emotional impairment to previously used measures of pain intensity and functional impairment. Such a measure enables the assessment of chronic pain severity in different epidemiological and clinical populations, the stratification of treatment according to pain severity, and the monitoring of treatment outcome. The P-CPG was developed using a representative sample of school children with chronic pain (n = 454; Mage = 12.95, SD = 2.22). Construct validity and sensitivity to change were examined within a sample of N = 2448 children and adolescents (Mage = 12.71, SD = 2.47) comprising 3 subsamples (school n = 1562, primary care n = 129, and tertiary care n = 757) affected by chronic pain to varying extents. Results showed that P-CPG grades differed significantly among the 3 subsamples, with school children being least affected by chronic pain and tertiary care patients being most affected. As P-CPG grade increased, so did pain intensity, functional impairment, pain-related school absence, and emotional impairment. Convergent validity was demonstrated by significant positive correlations between the P-CPG and global ratings of pain severity as well as objective claims data; the latter reflects greater health care costs with increasing P-CPG scores. Sensitivity to change was supported by a significant reduction in baseline P-CPG grades 3 and 6 months after intensive interdisciplinary pain treatment in tertiary care sample. In conclusion, the P-CPG is an appropriate measure of pain severity in children and adolescents with chronic pain in clinical as well as epidemiological settings.
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Affiliation(s)
- Susanne Grothus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Ariane Sommer
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Gerrit Hirschfeld
- Faculty of Business, CareTech OWL University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Lea Höfel
- Center for Pain Therapy for Young People, Garmisch-Partenkirchen, Germany
| | | | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
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Gerhold K, Al-Azazi S, El-Matary W, Katz LY, Lim LSH, Marks SD, Lix LM. Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study. J Pediatr 2024; 271:114046. [PMID: 38582149 DOI: 10.1016/j.jpeds.2024.114046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/30/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES To understand the burden associated with pediatric chronic pain (CP) on the health care system compared with other costly chronic diseases prior to subspecialty care. STUDY DESIGN In this retrospective cohort study, we assessed all-cause health care utilization and direct health care costs associated with pediatric CP (n = 91) compared with juvenile arthritis (n = 135), inflammatory bowel disease (n = 90), type 1 diabetes (n = 475) or type 2 diabetes (n = 289), anxiety (n = 7193), and controls (n = 273) 2 and 5 years prior to patients entering subspecialty care in Manitoba, Canada. Linked data from physician encounters, emergency department visits, hospitalizations, and prescriptions were extracted from administrative databases. Differences in health care utilization and direct health care costs associated with CP vs the other conditions were tested using negative binomial and zero-inflated negative binomial regression models, respectively. RESULTS After adjustment for age at diagnosis, sex, location of residence, and socioeconomic status, CP continued to be associated with the highest number of consulted physicians and subspecialists and the highest number of physician billings compared with all other conditions (P < .01, respectively). CP was significantly associated with higher physician costs than juvenile arthritis, inflammatory bowel disease, type 1 diabetes, type 2 diabetes, or controls (P < .01, respectively); anxiety was associated with the highest physician and prescription costs among all cohorts (P < .01, respectively). CONCLUSION Compared with chronic inflammatory and endocrinologic conditions, pediatric CP and anxiety were associated with substantial burden on the health care system prior to subspecialty care, suggesting a need to assess gaps and resources in the management of CP and mental health conditions in the primary care setting.
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Affiliation(s)
- Kerstin Gerhold
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba, CA; Mississippi Center for Advanced Medicine, Madison, MS.
| | - Saeed Al-Azazi
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Manitoba, CA
| | - Wael El-Matary
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Laurence Y Katz
- Rady Faculty of Health Sciences, Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Lily S H Lim
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, Children's Hospital Research Institute of Manitoba, University of Manitoba, Manitoba, CA
| | - Seth D Marks
- Rady Faculty of Health Sciences, Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
| | - Lisa M Lix
- Rady Faculty of Health Sciences, Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Manitoba, CA
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Donovan E, Green V, Feldman G, Tachdjian R, Curry C, Rice C, Zeltzer LK. The acceptability of Songs of Love for youth living with chronic pain. Int J Adolesc Med Health 2024; 36:161-168. [PMID: 38332697 DOI: 10.1515/ijamh-2023-0176] [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: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Music is helpful to young people in healthcare contexts, but less is known about the acceptability of music-based interventions for youth living at home with chronic pain who may be struggling to attend school and participate in social activities. The Songs of Love (SOL) foundation is a national nonprofit organization that creates free, personalized, original songs for youth facing health challenges. The aims of this study were (1) to assess acceptability of SOL from the perspective of youth with chronic pain receiving a song and singer-songwriters who created the songs, and (2) to explore the role of music more generally in the lives of young people living with pain. METHODS Twenty-three people participated. Fifteen youth (mean age 16.8) were interviewed and received a song, and six singer-songwriters were interviewed about creating the songs. (Two additional people participated in pilot interviews.) Acceptability was assessed by (1) proportion of youth who participated in a second interview about their song and (2) results of reflexive thematic analysis (RTA) to determine acceptability. Themes addressing the role of music in the lives of youth with pain were also explored using RTA. RESULTS The program was acceptable as 12 of 15 youth (80 %) participated in second interviews and themes met the definition of acceptability. Three themes addressing the role of music in the lives of youth living with pain were identified. CONCLUSIONS This is the first report of the acceptability and experience of SOL and contributes to research on the benefits of music for pain management.
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Affiliation(s)
| | - Vanya Green
- Creative Healing for Youth in Pain, Los Angeles, CA, USA
| | - Greg Feldman
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Raffi Tachdjian
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Children's Music Fund, Los Angeles, CA, USA
| | - Caitlin Curry
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Charlotte Rice
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Lonnie K Zeltzer
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Creative Healing for Youth in Pain, Los Angeles, CA, USA
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Wager J, Zernikow B. [Pediatric inpatient interdisciplinary multimodal pain treatment in Germany]. Schmerz 2024; 38:99-106. [PMID: 37642788 PMCID: PMC10959830 DOI: 10.1007/s00482-023-00744-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Severely disabling chronic pain affects approximately half a million children in Germany. If there is a lack of response to unimodal treatment, an inpatient interdisciplinary multimodal pain treatment (IMPT) can be considered. OBJECTIVE This review article describes the supply situation of pediatric inpatient IMPT in Germany and presents the current evidence on the effectiveness. MATERIAL AND METHODS Based on a systematic literature search, studies addressing the effectiveness of pediatric inpatient IMPT in Germany were identified. In addition, further sources were used to extract information on pediatric IMPT treatment centers in Germany in order to describe the treatment approaches, the qualification of personnel and characteristics of patients. RESULTS There are four pediatric pain centers in Germany that are specialized in inpatient IMPT for children and adolescents. Treatment duration ranges between 3 and 4 weeks. The multimodal treatment is carried out by a multiprofessional team and is generally available for patients up to 18 years. The majority of patients are female. The effectiveness of pediatric IMPT in Germany was investigated up to 4 years after treatment. Positive effects were shown for pain characteristics and also for the emotional burden. Additional treatment modules can facilitate further optimization of treatment effects. CONCLUSION Further research on the effectiveness of IMPT in Germany is important in order to refine and optimize the available treatment programs.
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Affiliation(s)
- Julia Wager
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik Datteln, Datteln, Deutschland.
- Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland.
| | - Boris Zernikow
- Deutsches Kinderschmerzzentrum, Vestische Kinder- und Jugendklinik Datteln, Datteln, Deutschland
- Lehrstuhl für Kinderschmerztherapie und Pädiatrische Palliativmedizin, Fakultät für Gesundheit, Department für Humanmedizin, Universität Witten/Herdecke, Witten, Deutschland
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Weiss KE, Li R, Chen D, Palermo TM, Scheurich JA, Groenewald CB. Sexual Orientation/Gender Identity Discrimination and Chronic Pain in Children: A National Study. Am J Prev Med 2024:S0749-3797(24)00100-4. [PMID: 38508423 DOI: 10.1016/j.amepre.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION This study provides national estimates of parental perceived child sexual orientation or gender minority (SGM) discrimination and examines associations between SGM discrimination and chronic pain in children. METHODS Cross-sectional analysis of the 2020 and 2021 National Survey of Children's Health (N=47,213). Caregivers of children ages 6-17 years old reported whether their child had ever been treated or judged unfairly (i.e., discrimination) because of their SGM identity. Chronic pain in children was defined as frequent or chronic difficulty with repeated or chronic physical pain during the past 12 months, as reported by caregivers. Weighted prevalence estimates for discrimination were calculated for the whole sample and sociodemographic subgroups. Associations between SGM discrimination and chronic pain were estimated using multivariable Poisson regression models adjusting for sociodemographic factors. Analyses were conducted 2022-2023. RESULTS Within this nationally representative sample, parents reported 1.4% (95% CI 1.2%-1.6%) of children have experienced SGM-related discrimination. The prevalence was higher among adolescents, females at birth, and those living in suburban areas. Children who experienced discrimination had a higher prevalence of chronic pain (20.2%) compared to those who did not (7.0%, p<0.0001), with an adjusted prevalence rate ratio of 2.0 (95% CI 1.5-2.5, p<0.0001). CONCLUSIONS Based on parent report, about 0.6 million children in the U.S. have experienced SGM-based discrimination; these children are twice as likely to have chronic pain. Findings highlight the importance of assessment and intervention for chronic pain in children who may experience marginalization and discrimination due to their sexual orientation and gender identity.
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Affiliation(s)
- Karen E Weiss
- Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
| | - Rui Li
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Diane Chen
- Potocsnak Family Division and Adolescent and Young Adult Medicine, & Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Departments of Psychiatry & Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jennifer A Scheurich
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Cornelius B Groenewald
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Schwerdt H, Christe G, Pate JW, Blake C, Smart KM. The prevalence of chronic pain in adolescents in Central Switzerland: A cross- sectional school-based study protocol. PLoS One 2024; 19:e0297088. [PMID: 38330041 PMCID: PMC10852288 DOI: 10.1371/journal.pone.0297088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/23/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Chronic pain is associated with substantial personal suffering and societal costs and is a growing healthcare concern worldwide. While chronic pain has been extensively studied in adults, limited data exists on its prevalence and impact in adolescents. Understanding the prevalence and impact of chronic pain and pain beliefs in adolescents is crucial for developing effective prevention and treatment strategies. This study aims to estimate the prevalence, characteristics, and impact of chronic pain, and explore adolescents' knowledge and beliefs about pain. METHODS This is an observational cohort study of school-going adolescents aged 11 to 17 years in Central Switzerland. The study will estimate the point prevalence, characteristics (location, intensity, frequency, duration) and impact (PROMIS Pediatric Short Form v2.0 -Pain Interference Scale, PPIS) of chronic pain in school-going adolescents. We will also measure and investigate pupils' beliefs about pain (Concept of Pain Inventory (COPI)). Data will be collected through manual and digital self-report questionnaires and from participants in primary, secondary, and high schools between September 2023 and January 2024. ANALYSES The primary analyses will utilise descriptive statistics to estimate the point prevalence, characteristics, and impact of chronic pain. Secondary analyses will analyse associations and correlations between chronic pain, impact of pain and beliefs about pain. OUTCOMES This study will provide an estimate of the prevalence, characteristics and impact of chronic pain in adolescents in Central Switzerland and a measure of adolescents' understanding and beliefs about pain. In doing so, this study will provide insights into the scale of chronic pain as a public health concern. By understanding adolescents' pain beliefs and their influence on pain experience, this study can contribute to the development of educational approaches to enhance adolescents' knowledge and understanding of pain in order to optimise the prevention and treatment of chronic pain in adolescents. The findings may be useful to healthcare professionals and funders, policymakers, and researchers involved in the prevention, assessment, and treatment of pain in adolescents.
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Affiliation(s)
- Helen Schwerdt
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Guillaume Christe
- Department of Physiotherapy, HESAV School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Joshua W. Pate
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Catherine Blake
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
- Physiotherapy Department, St. Vincent’s University Hospital, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
| | - Keith M. Smart
- UCD School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
- Physiotherapy Department, St. Vincent’s University Hospital, Dublin, Ireland
- UCD Centre for Translational Pain Research, University College Dublin, Dublin, Ireland
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Singleton H, Mahato P, Arden-Close E, Thomas S, Ersser S, Holley D, Yang X, Roberts A. Virtual reality used to distract children and young people with long-term conditions from pain or pruritus: A scoping review using PAGER. J Clin Nurs 2024; 33:469-480. [PMID: 37962251 DOI: 10.1111/jocn.16928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/13/2023] [Accepted: 10/18/2023] [Indexed: 11/15/2023]
Abstract
AIMS AND OBJECTIVES To map out the primary research studies relating to how virtual reality (VR) has been used to distract children and young people with long-term conditions from pain or pruritus. BACKGROUND Pharmacologic treatment of chronic pain and pruritus may have side effects; hence, non-invasive non-pharmacological treatments are being sought. DESIGN The scoping review followed the methodology recommended by the Joanna Briggs Institute, PAGER framework and PRISMA-ScR checklist. The protocol was registered with the Open Science Registration on 14 February 2022 https//doi.org/10.17605/OSF.IO/K2R93. METHODS Five databases (Medline, CINAHL, PsycINFO, Web of Science and Scopus) were searched. Data were extracted from primary research studies published between 2000 and 2022 involving children and adolescent populations (<21 years) with a long-term condition that had an element of enduring pruritus and/or pain. RESULTS Of 464 abstracts screened, 35 full-text papers were assessed with 5 studies meeting the eligibility criteria. Three main themes emerged from the included studies: (1) Improvements in pain and daily functioning; (2) positive perceptions of VR and (3) accessibility and feasibility of VR. No papers were found on the effect of VR on alleviating pruritus. CONCLUSION VR is feasible, acceptable, and safe for children and adolescents with chronic pain in a range of long-term conditions and offers promise as an adjunctive treatment for improving chronic pain and quality of life. No studies were identified that targeted pruritis or measured pruritis outcomes; thus, the effects of VR for pruritis are unknown. There is a need for rigorously designed, randomised controlled trials to test the clinical and cost-effectiveness of VR interventions for chronic pain and pruritis in children and adolescents. The use of the PAGER (Patterns, Advances, Gaps, Evidence for Practice and Research Recommendations) framework for scoping reviews helped to structure analysis and findings and identify research gaps. RELEVANCE TO CLINICAL PRACTICE VR interventions offer promise in improving chronic pain related to long-term conditions.
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Affiliation(s)
| | | | | | | | | | | | | | - Amanda Roberts
- Nottingham Support for Carers of Children with Eczema, Nottingham, UK
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12
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Junghans-Rutelonis A, Sim L, Harbeck-Weber C, Dresher E, Timm W, Weiss KE. Feasibility of wearable activity tracking devices to measure physical activity and sleep change among adolescents with chronic pain-a pilot nonrandomized treatment study. FRONTIERS IN PAIN RESEARCH 2024; 4:1325270. [PMID: 38333189 PMCID: PMC10850299 DOI: 10.3389/fpain.2023.1325270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
Purpose Personal informatics devices are being used to measure engagement in health behaviors in adults with chronic pain and may be appropriate for adolescent use. The aim of this study was to evaluate the utilization of a wearable activity tracking device to measure physical activity and sleep among adolescents attending a three-week, intensive interdisciplinary pain treatment (IIPT) program. We also assessed changes in physical activity and sleep from baseline to the treatment phase. Methods Participants (57.1% female, average age 15.88, SD = 1.27) wore an activity tracking device three weeks prior to starting and during the treatment program. Results Of 129 participants contacted, 47 (36.4%) agreed to participate. However, only 30 (64%) complied with the instructions for using the device prior to programming and during program participation. Preliminary analyses comparing averages from 3-weeks pre-treatment to 3-weeks during treatment indicated increases in daily overall activity minutes, daily step counts, and minutes of moderate to vigorous physical activity (by 353%), as well as a corresponding decrease in sedentary minutes. There was more missing data for sleep than anticipated. Conclusions Wearable activity tracking devices can be successfully used to measure adolescent physical activity in-person, with more difficulty obtaining this information remotely. Adolescents with chronic pain experience improvements in objective measurements of physical activity over the course of a 3-week IIPT program. Future studies may want to spend more time working with pediatric patients on their understanding of how to use trackers for sleep and physical activity.
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Affiliation(s)
- Ashley Junghans-Rutelonis
- AJR & Co Consulting and Mental Health, St. Paul, MN, United States
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Leslie Sim
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Cynthia Harbeck-Weber
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Emily Dresher
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Wendy Timm
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Karen E. Weiss
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
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13
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Scheurich JA, Sim LA, Gonzalez CA, Weiss KE, Dokken PJ, Willette AT, Harbeck-Weber C. Gender Diversity Among Youth Attending an Intensive Interdisciplinary Pain Treatment Program. J Clin Psychol Med Settings 2024:10.1007/s10880-023-09997-7. [PMID: 38265699 DOI: 10.1007/s10880-023-09997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/25/2024]
Abstract
Transgender and gender diverse (TGD) youth with chronic pain may be at unique risk for psychological distress and associated functional impairment, yet research on the intersection of chronic pain and gender identity is lacking. In a retrospective chart review of 491 participants admitted to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States over an approximately 4-year period, 6.11% were TGD. TGD participants who completed the IIPT program reported significant and large improvements in anxiety, depression, pain catastrophizing, and functional ability. At baseline, TGD participants presented as more emotionally distressed and functionally impaired compared to age-matched, cisgender peers. When accounting for baseline scores, TGD participants who completed the IIPT program reported similar scores to cisgender peers at discharge, yet TGD youth were significantly less likely than cisgender peers to complete the IIPT program. Future directions and implications for clinical practice are discussed.
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Affiliation(s)
- Jennifer A Scheurich
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Cesar A Gonzalez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen E Weiss
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Peggy J Dokken
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Amber T Willette
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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14
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Pavlova M, Beveridge JK, Soltani S, Maunder L, Salomons TV, Katz J, Noel M. The Sensitivity to Pain Traumatization Scale-Child Version (SPTS-C): Development and preliminary validation. Can J Pain 2024; 8:2298769. [PMID: 38486938 PMCID: PMC10939150 DOI: 10.1080/24740527.2023.2298769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/19/2023] [Indexed: 03/17/2024]
Abstract
Background Sensitivity to pain traumatization is defined as the propensity to develop cognitive, affective, and behavioral responses to pain that resemble a traumatic stress reaction. To date, sensitivity to pain traumatization has been assessed in adults (Sensitivity to Pain Traumatization Scale [SPTS-12]) and parents of youth with chronic pain (Sensitivity to Pain Traumatization Scale-Parent version [SPTS-P]). SPT may be relevant in the context of pediatric chronic pain given the substantial comorbidity between posttraumatic stress symptoms and pain. Aims This prospective study aimed to adapt the SPTS-12 for use in youth and to evaluate the psychometric properties of the new scale. Methods Participants included 175 youth with chronic pain (Mage = 14.31 years, 73% girls) referred to outpatient chronic pain programs. At baseline, youth self-reported the levels of their sensitivity to pain traumatization (Sensitivity to Pain Traumatization Scale-Child version [SPTS-C]), as well as their pain symptoms, pain-related anxiety, posttraumatic stress symptoms, and attentional control. Three months later, youth self-reported their pain symptoms and completed the SPTS-C. Results The SPTS-C had a one-factor structure that explained 48% of variance and demonstrated good reliability and construct validity. SPTS-C baseline scores predicted follow-up levels of pain interference but not pain intensity or pain unpleasantness. Conclusions The results provide preliminary evidence for the psychometric properties of the SPTS-C and the potential role of SPT in pediatric chronic pain outcomes.
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Affiliation(s)
- Maria Pavlova
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | | | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Larah Maunder
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Tim V. Salomons
- Department of Psychology, Queen’s University, Kingston, Ontario, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, Alberta, Canada
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15
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Simons LE, Harrison LE, Boothroyd DB, Parvathinathan G, Van Orden AR, O’Brien SF, Schofield D, Kraindler J, Shrestha R, Vlaeyen JW, Wicksell RK. A randomized controlled trial of graded exposure treatment (GET living) for adolescents with chronic pain. Pain 2024; 165:177-191. [PMID: 37624900 PMCID: PMC10840960 DOI: 10.1097/j.pain.0000000000003010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/16/2023] [Indexed: 08/27/2023]
Abstract
ABSTRACT Graded exposure treatment (GET) is a theory-driven pain treatment that aims to improve functioning by exposing patients to activities previously feared and avoided. Combining key elements of GET with acceptance-based exposure, GET Living (GL) was developed for adolescents with chronic pain (GL). Based on robust treatment effects observed in our single-case experimental design pilot trial of GL (NCT01974791), we conducted a 2-arm randomized clinical trial comparing GL with multidisciplinary pain management (MPM) comprised of cognitive behavioral therapy and physical therapy for pain management (NCT03699007). A cohort of 68 youth with chronic musculoskeletal pain (M age 14.2 years; 81% female) were randomized to GL or MPM. Owing to COVID-19 restrictions, 54% of participants received zoom video delivered care. Assessments were collected at baseline, discharge, as well as at 3-month and 6-month follow-up. Primary outcomes were self-reported pain-related fear and avoidance. Secondary outcomes were child functional disability and parent protective responses to child pain. As hypothesized, GL improved in primary and secondary outcomes at 3-month follow-up. Contrary to our superiority hypothesis, there was no significant difference between GL and MPM. Patients reported both GL and MPM (in person and video) as credible and were highly satisfied with the treatment experience. Next steps will involve examining the single-case experimental design data embedded in this trial to facilitate an understanding of individual differences in treatment responses (eg, when effects occurred, what processes changed during treatment within the treatment arm). The current findings support GET Living and MPM for youth with chronic pain.
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Affiliation(s)
- Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Lauren E. Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Derek B. Boothroyd
- Quantitative Statistical Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Gomathy Parvathinathan
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Amanda R. Van Orden
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Shannon F. O’Brien
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA
| | - Deborah Schofield
- Center for Economic Impacts of Genomic Medicine, Department of Economics, Macquarie University, Sydney, Australia
| | - Joshua Kraindler
- Center for Economic Impacts of Genomic Medicine, Department of Economics, Macquarie University, Sydney, Australia
| | - Rupendra Shrestha
- Center for Economic Impacts of Genomic Medicine, Department of Economics, Macquarie University, Sydney, Australia
| | - Johan W.S. Vlaeyen
- Center for Economic Impacts of Genomic Medicine, Department of Economics, Macquarie University, Sydney, Australia
| | - Rikard K. Wicksell
- Research group Behavior Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden & Pain Clinic, Capio St Goran Hospital, Stockholm, Sweden
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16
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Kupin AAH, Banerjee S, Banerjee N, Roy SH, Kline JC, Shiwani B. System Architecture for VR Yoga Therapy Platform with 6-DoF Whole-Body Avatar Tracking. ... IEEE INTERNATIONAL CONFERENCE ON ARTIFICIAL INTELLIGENCE AND VIRTUAL REALITY. IEEE INTERNATIONAL CONFERENCE ON ARTIFICIAL INTELLIGENCE AND VIRTUAL REALITY 2024; 2024:360-366. [PMID: 38737316 PMCID: PMC11086690 DOI: 10.1109/aixvr59861.2024.00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Chronic pain is a leading cause of morbidity among children and adolescents affecting 35% of the global population. Pediatric chronic pain management requires integrative health methods spanning physical and psychological subsystems through various mind-body interventions. Yoga therapy is one such method, known for its ability to improve the quality of life both physically and psychologically in chronic pain conditions. However, maintaining the clinical outcomes of personalized yoga therapy sessions at-home is challenging due to fear of movement, lack of motivation, and boredom. Virtual Reality (VR) has the potential to bridge the gap between the clinic and home by motivating engagement and mitigating pain-related anxiety or fear of movement. We developed a multi-modal algorithmic architecture for fusing real-time 3D human body pose estimation models with custom developed inverse kinematics models of physical movement to render biomechanically informed 6-DoF whole-body avatars capable of embodying an individual's real-time yoga poses within the VR environment. Experiments conducted among control participants demonstrated superior movement tracking accuracy over existing commercial off-the-shelf avatar tracking solutions, leading to successful embodiment and engagement. These findings demonstrate the feasibility of rendering virtual avatar movements that embody complex physical poses such as those encountered in yoga therapy. The impact of this work moves the field one step closer to an interactive system to facilitate at-home individual or group yoga therapy for children with chronic pain conditions.
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17
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Dandekar S, Caru M, Schmitz KH. Behavioral physical activity intervention coupled with standard post-cancer directed treatment care to mitigate chronic pain in childhood cancer survivors: A protocol for a single-center, pilot randomized controlled trial. Contemp Clin Trials Commun 2023; 36:101216. [PMID: 37842319 PMCID: PMC10569955 DOI: 10.1016/j.conctc.2023.101216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 09/05/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023] Open
Abstract
Background Long term survivors of childhood cancer have a high prevalence of chronic pain. Novel, multidisciplinary approaches to manage pain, are needed to allow for a reduction in the use of opioids for pain management. Physical activity is highly effective in managing chronic pain in children and adolescents, however, evidence about the combination of physical activity intervention and pain medications in chronic pain management in childhood cancer survivors is lacking. The aim of this study is to investigate the feasibility, acceptability and preliminary effects of a behavioral physical activity intervention integrated into standard post cancer directed treatment care to mitigate chronic pain in this unique population. Methods This is a single site pilot randomized controlled trial of a 16-week physical activity intervention coupled with standard care. The primary aim is to assess the feasibility and acceptability of the physical activity intervention in childhood cancer survivors with chronic pain. Secondary aims include evaluating the differences in functional and psychosocial outcomes along with self-reported pain scores and cumulative dose of pain medications between the exercise group and standard cancer care group. The physical activity intervention is a home-based program structured to increase patients' physical activity behavior and to favor low intensity bodily movement using aerobic exercise and resistance training. Conclusions This study will demonstrate that behavioral supportive measures like physical activity may be a novel means to improve cancer related chronic pain in young survivors of childhood cancer and decrease medication usage for pain along with improvement in functional and psychosocial outcomes.
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Affiliation(s)
- Smita Dandekar
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, Hershey, PA, USA
| | - Maxime Caru
- Department of Pediatrics, Division of Hematology and Oncology, Pennsylvania State Health Children's Hospital, Hershey, PA, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Kathryn H. Schmitz
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Division of Hematology and Oncology, University of Pittsburgh, Pittsburgh, PA, USA
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18
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Gargya A, Zats A, Lake T. Peripheral Nerve Stimulation for the Management of Pediatric Neuropathic Pain. Pediatrics 2023; 152:e2023061843. [PMID: 37946580 DOI: 10.1542/peds.2023-061843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/12/2023] Open
Abstract
The management of neuropathic pain in children poses an enormous challenge for pediatricians and pain management physicians. Current treatment options include physical therapy and medication management. Peripheral nerve stimulation/neuromodulation is a novel and minimally invasive treatment that can be initiated and monitored in an outpatient setting. This new technology can be a useful tool for treating pain secondary to pediatric neuropathy and chronic refractory pain after conservative management. Our case report describes the use of a peripheral nerve stimulator in the successful management of pediatric neuropathic leg pain.
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Affiliation(s)
- Akshat Gargya
- Department of Anesthesiology, Division of Interventional Pain, The University of Vermont Health Network, South Burlington, Vermont
| | - Alan Zats
- Department of Anesthesiology, Division of Interventional Pain, The University of Vermont Health Network, South Burlington, Vermont
| | - Tiffini Lake
- Department of Anesthesiology, Division of Interventional Pain, The University of Vermont Health Network, South Burlington, Vermont
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Roman-Juan J, Solé E, Sánchez-Rodríguez E, Castarlenas E, Jensen MP, Miró J. Adverse Childhood Events and Chronic Pain in Adolescents: The Role of Sleep Disturbance. J Pediatr Psychol 2023; 48:931-939. [PMID: 37743052 DOI: 10.1093/jpepsy/jsad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023] Open
Abstract
OBJECTIVES This study aimed to (1) examine the extent to which the association between exposure to adverse childhood events (ACEs) and having chronic pain in adolescents is explained by the association between exposure to ACEs and sleep disturbance and (2) explore the role of sleep disturbance in the association between exposure to ACEs and anxiety and depressive symptoms in adolescents with chronic pain. METHODS Cross-sectional data from 469 adolescents aged 13-18 years old were drawn from an epidemiological study on pediatric chronic pain conducted in Catalonia (Spain). Participants provided self-reports of demographic characteristics, exposure to ACEs, pain characteristics, sleep disturbance, anxiety, and depressive symptoms. Mediation and moderation models were conducted. RESULTS Sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and the presence of chronic pain. Moreover, sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and depressive symptoms and moderated the association between exposure to ACEs and anxiety in adolescents with chronic pain. CONCLUSION The study findings suggest the possibility that addressing sleep disturbance in adolescents exposed to ACEs may help to prevent the development of chronic pain, anxiety, and depressive symptoms in those adolescents who already have chronic pain.
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Affiliation(s)
- Josep Roman-Juan
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, USA
| | - Jordi Miró
- Universitat Rovira i Virgili, Spain
- Department of Psychology, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Spain
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20
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Themelis K, Tang NKY. The Management of Chronic Pain: Re-Centring Person-Centred Care. J Clin Med 2023; 12:6957. [PMID: 38002572 PMCID: PMC10672376 DOI: 10.3390/jcm12226957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.
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Affiliation(s)
- Kristy Themelis
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
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21
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Roman-Juan J, Solé E, Sánchez-Rodríguez E, Castarlenas E, Jensen MP, Miró J. Validation of the pediatric version of the Graded Chronic Pain Scale Revised in school-aged children and adolescents. Pain 2023; 164:2606-2614. [PMID: 37463221 DOI: 10.1097/j.pain.0000000000002965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/13/2023] [Indexed: 07/20/2023]
Abstract
ABSTRACT The Graded Chronic Pain Scale (GCPS) was originally developed to grade the severity of chronic pain conditions in adults. A revised version of this instrument (ie, GCPS-R) has been developed for use with adults to account for advances in pain metrics and new operational definitions of chronic pain and high-impact chronic pain. The purpose of the current study was to adapt the GCPS-R for use with pediatric samples (P-GCPS-R) and evaluate the adapted measure's concurrent validity. One thousand five hundred sixty-four school-aged children and adolescents (55% girls; 8-18 years) completed the P-GCPS-R and provided responses to measures of physical health, anxiety and depressive symptoms, maladaptive pain coping strategies, and activity limitations. Results showed that 14% of participants had chronic pain, of which 37% (5% of the whole sample) had mild chronic pain, 45% (6% of the whole sample) bothersome chronic pain, and 18% (3% of the whole sample) high-impact chronic pain. Participants without chronic pain and those with mild chronic pain showed no significant between-group differences in any of the study measures. Participants with bothersome chronic pain and high-impact chronic pain reported worse physical health, more anxiety and depressive symptoms, pain catastrophizing, and activity limitations than those with mild chronic pain. Participants with high-impact chronic pain reported more activity limitations than those with bothersome chronic pain. The findings support the concurrent validity of the P-GCPS-R for use with pediatric samples.
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Affiliation(s)
- Josep Roman-Juan
- Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - 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
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22
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Soltani S, Killackey T, Birnie KA, Brennenstuhl S, Kopala-Sibley DC, Choiniere M, Pagé MG, Dassieu L, Lacasse A, Lalloo C, Poulin P, Ingelmo P, Ali S, Battaglia M, Campbell F, Smith A, Benayon M, Jordan I, Marianayagam J, Harris L, Mohabir V, Stinson J, Noel M. Pain, mental health and healthcare utilization: Impact of the COVID-19 pandemic on youth with chronic pain, parents and siblings. Eur J Pain 2023; 27:1249-1265. [PMID: 37435883 DOI: 10.1002/ejp.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 04/25/2023] [Accepted: 06/22/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Paediatric chronic pain was a public health emergency before the novel coronavirus (COVID-19) pandemic, and this problem is predicted to escalate. Pain tends to occur intergenerationally in families, and youth with chronic pain and their parents have high rates of mental health issues, which can further exacerbate pain. Siblings of youth with chronic pain have been largely overlooked in research, as well as the impact of the pandemic on posttraumatic stress disorder (PTSD) symptoms and healthcare utilization. METHODS This cross-sectional study examined pain, mental health and healthcare utilization in three groups: youth with chronic pain (n = 357), parents of youth with chronic pain (n = 233) and siblings of youth with chronic pain (n = 156) during the COVID-19 pandemic in Canada. RESULTS More so than with pain symptoms, the results revealed high levels of mental health symptoms (i.e. anxiety, depressive, and PTSD), particularly in individuals more personally impacted by the pandemic. The largest effect was seen on PTSD symptoms for all groups. For parents with chronic pain, greater personal COVID-19 impact was related to worse pain interference. Reported rates of healthcare utilization were strikingly high, with youth with chronic pain, parents (reporting on behalf of their children with chronic pain), and siblings of youth with chronic pain reporting that most consultations were due to pain. CONCLUSIONS Longitudinal research assessing these outcomes across continued waves of the pandemic is needed to ensure timely, tailored and equitable access to pain and mental health assessment and treatment. SIGNIFICANCE This study examined pain, mental health, substance use and healthcare utilization in youth with chronic pain, siblings and parents during the COVID-19 pandemic. Greater personal impact of the pandemic was not largely associated with poorer pain outcomes; however, it was associated with mental health, with the largest effect on PTSD symptoms. The high rates and significant association of COVID-19 impact with PTSD symptoms underscore the importance of including PTSD assessment as part of routine screening practices in pain clinics.
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Affiliation(s)
- Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Tieghan Killackey
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Daniel C Kopala-Sibley
- Department of Psychiatry, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Manon Choiniere
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - M Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Psychology, Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Lise Dassieu
- Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Poulin
- Department of Anesthesiology & Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Pablo Ingelmo
- Anesthesia and Chronic Pain Management, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Samina Ali
- Departments of Pediatrics & Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- CYEA Programme, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, University of Toronto, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Smith
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Myles Benayon
- Internal Medicine Residency Program, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Lauren Harris
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vina Mohabir
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Melanie Noel
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
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23
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Tiwari D, Naidoo K, Eddy EZ, Chatiwala N, Kaur M. Development and validation of the activities and participation children and adolescents -neck (APCAN) measure. J Patient Rep Outcomes 2023; 7:107. [PMID: 37902895 PMCID: PMC10616032 DOI: 10.1186/s41687-023-00648-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Neck pain is the fourth leading cause of years lost to disability in children warranting a comprehensive assessment of neck pain and its impact on activities and participation. Hence, the purpose of this study was to develop a new measure (i.e., Activities and Participation Children and Adolescents -neck [APCAN]) specific to evaluating activity limitation and participation restrictions in children and adolescents and to establish its content validity. METHODS Development and content validation of the APCAN was completed in four steps: (1) item development, (2) item evaluation by content experts, (3) content validity calculation, and (4) cognitive testing via interviews to ensure readability and comprehension of the items on the APCAN. RESULTS An initial pool of 52 items was created that was revised to 20 items after modified Delphi process and cognitive interviews. Each item was rated on a 0-10 numeric rating scale (0 = not difficult at all, 10 = extremely difficult) with higher scores indicating higher perceived disability secondary to neck pain. All 20 items retained the content validity ratio critical value and the overall content validity index was 0.88 indicating excellent content validity. CONCLUSION The APCAN provides an easy to use, comprehensive assessment of functional limitations associated with neck pain in children.
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Affiliation(s)
- Devashish Tiwari
- Department of Physical Therapy, MGH Institute of Health Professions, 36, 1st Ave, 02129, Boston, MA, USA.
| | - Keshrie Naidoo
- Department of Physical Therapy, MGH Institute of Health Professions, 36, 1st Ave, 02129, Boston, MA, USA
| | - Emily Z Eddy
- Department of Physical Therapy, MGH Institute of Health Professions, 36, 1st Ave, 02129, Boston, MA, USA
| | - Naseem Chatiwala
- Department of Physical Therapy, MGH Institute of Health Professions, 36, 1st Ave, 02129, Boston, MA, USA
| | - Maninderjit Kaur
- Department of Physical Therapy, MGH Institute of Health Professions, 36, 1st Ave, 02129, Boston, MA, USA
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [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: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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25
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Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Miró J. Psychological factors and pain medication use in adolescents with chronic pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1183-1188. [PMID: 37341626 DOI: 10.1093/pm/pnad075] [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: 01/03/2023] [Revised: 05/20/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this study was to examine (1) the associations of anxiety, depressive symptoms, and pain catastrophizing with pain medication use in adolescents with chronic pain and (2) the extent to which these associations differed as a function of adolescents' sex. METHODS Cross-sectional data from 320 adolescents 12-18 years of age with chronic pain were drawn from an epidemiological study on pediatric chronic pain conducted in Reus (Catalonia, Spain). Participants were asked to provide sociodemographic information and respond to measures assessing pain (location, frequency, intensity, and interference), pain medication use, anxiety, depressive symptoms, and pain catastrophizing. Point biserial correlations were conducted to examine univariate associations between the psychological variables and pain medication use. Hierarchical logistic regression analysis was used to examine these associations while controlling for demographic characteristics, pain intensity, and pain interference. RESULTS Anxiety, depressive symptoms, and pain catastrophizing were significantly associated with pain medication use in univariate analyses. Regression analysis identified pain catastrophizing as a unique independent predictor of pain medication use after controlling for the effect of demographic variables (sex and age), pain intensity, and pain interference (odds ratio = 1.1, P < .05). No moderating effect of adolescents' sex on the associations between psychological factors and pain medication use was found. CONCLUSIONS Adolescents with chronic pain with higher levels of pain catastrophizing use pain medications more often. Research to examine the impact of interventions targeting pain catastrophizing on pain medication use among adolescents with chronic pain would be an important next step.
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Affiliation(s)
- Josep Roman-Juan
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, United States
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
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26
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Gudmundsdottir DB, Brynjolfsdottir B, Halldorsdottir SB, Halldórsdóttir HR, Thorsteinsdottir S, Valdimarsdottir H. Psychometric evaluation of an Icelandic translation of the adolescent and parent report versions of the BATH pain questionnaires and investigation of the psychosocial impact of pain on adolescents with chronic disease. Scand J Psychol 2023; 64:609-617. [PMID: 36872592 DOI: 10.1111/sjop.12910] [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: 04/12/2022] [Revised: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 03/07/2023]
Abstract
Adolescents commonly experience chronic pain, which can have considerable multidimensional effects on their lives, impacting, for example, their school functioning, leisure activities, sleep, and emotional functioning. Therefore, valid and reliable measurements of these multidimensional and potentially adverse effects, reflecting both the adolescents' and parents' perceptions, are essential. At present, no such measures are available in Iceland. The primary aim of the current study was to translate the Bath Adolescent Pain Questionnaire (BAPQ) and the Bath Adolescent Pain Questionnaire parent version (BAPQ-P) and evaluate the psychometric qualities of the Icelandic translation. The study's secondary aim was to investigate the multidimensional impact of chronic pain on adolescents with chronic illness using these instruments. Participants were 45 adolescents (11-16 years old) registered in the medical records of the National University Hospital of Iceland with one of the following diagnoses: (1) Crohn's or colitis (IBD); (2) migraine; or (3) arthritis. Sixty-nine parents of the diagnosed adolescents also participated (a total of 41 adolescent and parent dyads). To establish the psychometric qualities of the BAPQ and BAPQ-P, participants were asked to complete several questionnaires online. The preliminary results showed that the Icelandic translations of the BAPQ and BAPQ-P scales have good psychometric qualities, providing valid and reliable measures to assess the multidimensional effects of chronic pain in adolescents in both clinical and research settings. Moreover, the results showed that chronic pain impacts various domains in the adolescents' lives and that the prevalence of anxiety and depression was quite high among them.
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27
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Hale AE, Bujoreanu S, LaVigne TW, Coakley R. Rapid Mobilization of an Evidence-Based Psychological Intervention for Pediatric Pain during COVID-19: The Development and Deployment of the Comfort Ability ® Program Virtual Intervention (CAP-V). CHILDREN (BASEL, SWITZERLAND) 2023; 10:1523. [PMID: 37761484 PMCID: PMC10529482 DOI: 10.3390/children10091523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The gold standard of treatment for chronic pain is a multidisciplinary approach in which psychology plays a leading role, but many children and caregivers do not gain access to this treatment. The Comfort Ability® Program (CAP) developed a CBT-oriented group intervention for adolescents and caregivers designed expressly to address access to evidence-based psychological care for pediatric chronic pain. Before the COVID-19 disruption of in-person services, the CAP workshop had been disseminated to a network of 21 children's hospitals across three countries. In March 2020, a virtual (telehealth) format was needed to ensure that children with chronic pain could continue to access this clinical service throughout the CAP Network. METHODS A model of knowledge mobilization was used to adapt the CAP workshop to a virtual format (CAP-V) and disseminate it to network sites. A pilot study assessing participant and clinician perceptions of acceptability, feasibility, and treatment satisfaction included baseline, post-sessions, and post-program questionnaires. RESULTS A knowledge mobilization framework informed the rapid development, refinement, and mobilization of CAP-V. Data from a pilot study demonstrated feasibility and high acceptability across participants and clinicians. CONCLUSIONS A knowledge mobilizationframework provided a roadmap to successfully develop and deploy a virtual behavioral health intervention for adolescents with chronic pain and their caregivers during a worldwide pandemic. While CAP-V has demonstrated preliminary clinical feasibility and acceptability at the CAP hub, ongoing research is needed.
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Affiliation(s)
- Amy E. Hale
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
- Division of Gastroenterology, Hepatology & Nutrition, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Simona Bujoreanu
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
| | - Timothy W. LaVigne
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
| | - Rachael Coakley
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
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28
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Wittmeier K, Brown C, Diaz F, Pylypjuk H, Restall G, Anang P, Gerhold K. Collaborating with a Youth Council to Improve Chronic Pain Resources. Can J Pain 2023; 7:2254358. [PMID: 37908591 PMCID: PMC10614709 DOI: 10.1080/24740527.2023.2254358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/29/2023] [Indexed: 11/02/2023]
Abstract
Background There is a recognized need to involve people with lived experience of chronic pain when developing chronic pain resources. Aims The aim of this study was to develop, implement, and evaluate a short-term youth council focused on eliciting youths' recommendations for key features of chronic pain informational resources. Methods In this mixed methods instrumental case study, demographic data were collected via Survey Monkey®. Select Patient-Reported Outcomes Measurement Information System® brief measures were used to provide context regarding pain impact within this group. Participants completed an initial interview, which informed youth council workshop delivery. Over two youth council workshops, participants reviewed select informational resources and identified key features of chronic pain resources. Participants evaluated their involvement experience during a second interview. Qualitative data were transcribed and analyzed using directed content analysis. Member-checking occurred during a third workshop, held virtually. Results Seven youth self-identifying as girl/woman or demi-girl participated. The youth were satisfied with the youth council experience, highlighting the importance of meeting others, a relaxed environment, and participating in valuable work. A list of youth-identified key features for informational resources was created through the workshops, which includes considerations for audience groups, content, and presentation. Conclusion Participants' input into youth council development and meeting others with lived experience contributed to a safe and supportive involvement experience. Youth council involvement supported the development of preliminary recommendations for chronic pain informational resources.
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Affiliation(s)
- Kristy Wittmeier
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cara Brown
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Francis Diaz
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Heidi Pylypjuk
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Gayle Restall
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Polina Anang
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kerstin Gerhold
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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29
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Corser J, Caes L, Bateman S, Noel M, Jordan A. 'A whirlwind of everything': The lived experience of adolescents with co-occurring chronic pain and mental health symptoms. Eur J Pain 2023; 27:981-994. [PMID: 37211969 DOI: 10.1002/ejp.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Co-occurring chronic pain and mental health issues are prevalent in adolescents, costly to society and can lead to increased risk of complications throughout the lifespan. While research has largely examined paediatric chronic pain and mental health in isolation, little is known about the unique challenges faced by adolescents who experience these co-occurring symptoms. This idiographic study examined the lived experience of adolescents with co-occurring chronic pain and mental health symptoms to identify salient issues for this population. METHODS Semi-structured telephone interviews were conducted with seven adolescents (11-19 years) self-reporting diagnoses of both pain and mental health issues for a duration of 3 months or longer. Participants were recruited from UK-based schools, pain clinics and charities. Interview transcripts were analysed using interpretative phenomenological analysis. RESULTS Analyses generated two themes 'a whirlwind of everything' and 'putting up fronts', which describe how the experience of co-occurring chronic pain and mental health symptoms typically disrupted adolescents' ability to regulate their physical, psychological and social wellbeing and identity. Adolescents described their symptom experience as like an internal storm over which they had no control. Such experiences required adolescents to embrace a variety of symptom management strategies, with adolescents reporting deliberate efforts to minimize their symptoms to external individuals. CONCLUSION Co-occurring pain and mental health symptoms may be experienced in similar ways to individually experienced pain or mental health symptoms, but together, the experience may be both more difficult to manage and more socially isolating. SIGNIFICANCE Adolescents with co-occurring chronic pain and mental health symptoms describe the experience as if there was a storm inside of them disrupting their sense of physical, emotional and social wellbeing. This inner chaos interferes with their self-identity and relationships with others. Challenges articulating their experiences, and negative encounters associated with their symptoms, further impact feelings of isolation and difficulties accessing support.
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Affiliation(s)
- Jenny Corser
- Department of Psychology, University of Bath, Bath, UK
| | - Line Caes
- Division of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
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Cunico D, Rossi A, Verdesca M, Principi N, Esposito S. Pain Management in Children Admitted to the Emergency Room: A Narrative Review. Pharmaceuticals (Basel) 2023; 16:1178. [PMID: 37631093 PMCID: PMC10459115 DOI: 10.3390/ph16081178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Pain is a biopsychosocial experience characterized by sensory, physiological, cognitive, affective, and behavioral components. Both acute and chronic pain can have short and long-term negative effects. Unfortunately, pain treatment is often inadequate. Guidelines and recommendations for a rational approach to pediatric pain frequently differ, and this may be one of the most important reasons for the poor attention frequently paid to pain treatment in children. This narrative review discusses the present knowledge in this regard. A literature review conducted on papers produced over the last 8 years showed that although in recent years, compared to the past, much progress has been made in the treatment of pain in the context of the pediatric emergency room, there is still a lot to do. There is a need to create guidelines that outline standardized and easy-to-follow pathways for pain recognition and management, which are also flexible enough to take into account differences in different contexts both in terms of drug availability and education of staff as well as of the different complexities of patients. It is essential to guarantee an approach to pain that is as uniform as possible among the pediatric population that limits, as much as possible, the inequalities related to ethnicity and language barriers.
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Affiliation(s)
- Daniela Cunico
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | - Arianna Rossi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | - Matteo Verdesca
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy; (D.C.); (A.R.); (M.V.)
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Nascimento Leite M, Kamper SJ, O'Connell NE, Michaleff ZA, Fisher E, Viana Silva P, Williams CM, Yamato TP. Physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents. Cochrane Database Syst Rev 2023; 7:CD013527. [PMID: 37439598 PMCID: PMC10339856 DOI: 10.1002/14651858.cd013527.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
BACKGROUND Chronic pain is a major health and socioeconomic burden, which is prevalent in children and adolescents. Among the most widely used interventions in children and adolescents are physical activity (including exercises) and education about physical activity. OBJECTIVES To evaluate the effectiveness of physical activity, education about physical activity, or both, compared with usual care (including waiting-list, and minimal interventions, such as advice, relaxation classes, or social group meetings) or active medical care in children and adolescents with chronic musculoskeletal pain. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PEDro, and LILACS from the date of their inception to October 2022. We also searched the reference lists of eligible papers, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared physical activity or education about physical activity, or both, with usual care (including waiting-list and minimal interventions) or active medical care, in children and adolescents with chronic musculoskeletal pain. DATA COLLECTION AND ANALYSIS Two review authors independently determined the eligibility of the included studies. Our primary outcomes were pain intensity, disability, and adverse events. Our secondary outcomes were depression, anxiety, fear avoidance, quality of life, physical activity level, and caregiver distress. We extracted data at postintervention assessment, and long-term follow-up. Two review authors independently assessed risk of bias for each study, using the RoB 1. We assessed the overall certainty of the evidence using the GRADE approach. We reported continuous outcomes as mean differences, and determined clinically important differences from the literature, or 10% of the scale. MAIN RESULTS We included four studies (243 participants with juvenile idiopathic arthritis). We judged all included studies to be at unclear risk of selection bias, performance bias, and detection bias, and at high risk of attrition bias. We downgraded the certainty of the evidence for each outcome to very low due to serious or very serious study limitations, inconsistency, and imprecision. Physical activity compared with usual care Physical activity may slightly reduce pain intensity (0 to 100 scale; 0 = no pain) compared with usual care at postintervention (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -0.82 to -0.08; 2 studies, 118 participants; recalculated as a mean difference (MD) -12.19, 95% CI -21.99 to -2.38; I² = 0%; very low-certainty evidence). Physical activity may slightly improve disability (0 to 3 scale; 0 = no disability) compared with usual care at postintervention assessment (MD -0.37, 95% CI -0.56 to -0.19; I² = 0%; 3 studies, 170 participants; very low-certainty evidence). We found no clear evidence of a difference in quality of life (QoL; 0 to 100 scale; lower scores = better QoL) between physical activity and usual care at postintervention assessment (SMD -0.46, 95% CI -1.27 to 0.35; 4 studies, 201 participants; very low-certainty evidence; recalculated as MD -6.30, 95% CI -18.23 to 5.64; I² = 91%). None of the included studies measured adverse events, depression, or anxiety for this comparison. Physical activity compared with active medical care We found no studies that could be analysed in this comparison. Education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. Physical activity and education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. AUTHORS' CONCLUSIONS We are unable to confidently state whether interventions based on physical activity and education about physical activity are more effective than usual care for children and adolescents with chronic musculoskeletal pain. We found very low-certainty evidence that physical activity may reduce pain intensity and improve disability postintervention compared with usual care, for children and adolescents with juvenile idiopathic arthritis. We did not find any studies reporting educational interventions; it remains unknown how these interventions influence the outcomes in children and adolescents with chronic musculoskeletal pain. Treatment decisions should consider the current best evidence, the professional's experience, and the young person's preferences. Further randomised controlled trials in other common chronic musculoskeletal pain conditions, with high methodological quality, large sample size, and long-term follow-up are urgently needed.
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Affiliation(s)
- Mariana Nascimento Leite
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven J Kamper
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Neil E O'Connell
- Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, UK
| | - Zoe A Michaleff
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | | | | | - Tiê P Yamato
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Dass R, Kalia M, Harris J, Packham T. Understanding the Experience and Impacts of Brain Fog in Chronic Pain: A Scoping Review. Can J Pain 2023; 7:2217865. [PMID: 37441085 PMCID: PMC10334862 DOI: 10.1080/24740527.2023.2217865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 07/15/2023]
Abstract
Introduction Approximately 15% to 40% of persons with chronic pain as a primary disorder experience brain fog. Prior research has investigated the etiology of "brain fog" in conditions in which pain presents as a key feature (e.g., fibromyalgia). However, it remains understudied in the context of chronic 10 musculoskeletal pain. Following current scoping review guidelines, we obtained stakeholder input from patient and health care professionals (HCPs) to define this phenomenon. Specific aims of this review were to (1) identify factors contributing to brain fog, (2) identify the functional correlates of brain fog and assessments used to measure them, and (3) establish a definition of brain fog that can be employed by researchers and HCPs to advance research and care. Methods A scoping review was conducted using recommendations of the Joanna Briggs Institute methodology of scoping reviews and the Levac et al methodology. Embase, Cinahl, PsycINFO, and Medline was searched to identify relevant sources. Findings were verified with patient and healthcare professionals. Results We identified four 15 key features of brain fog: perceived variability, subjective cognitive dysfunction, participation limitations, and changes in functional activities. We developed a model of brain fog illustrating the overlapping categories of contributors to brain fog in chronic musculoskeletal pain: (1) neuroanatomical and neurophysiological, (2) mental health/emotional, and (3) environmental/lifestyle. Conclusion The results of this scoping review conclude that the inconsistency in research regarding brain fog in 20 chronic musculoskeletal pain is obstructing a clear understanding of the phenomenon and therefore may be impeding persons with chronic pain and brain fog from receiving optimal care.
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Affiliation(s)
- Ronessa Dass
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Mohini Kalia
- Faculty of Sciences, Carleton University, Ottawa, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
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Pugh SJ, Murray C, Groenewald CB. Positive Childhood Experiences and Chronic Pain Among Children and Adolescents in the United States. THE JOURNAL OF PAIN 2023; 24:1193-1202. [PMID: 36775002 PMCID: PMC10330007 DOI: 10.1016/j.jpain.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Positive childhood experiences (PCEs) are associated with better mental and physical health outcomes and moderate the negative effects of adverse childhood experiences (ACEs). However, knowledge of the associations between PCEs and childhood chronic pain is limited. We conducted a cross-sectional analysis of 2019 to 2020 National Survey of Children's Health (NSCH) to evaluate associations between PCEs and childhood chronic pain. Parents of 47,514 children ages 6 to 17 years old reported on their child's exposure to 7 PCEs and 9 ACEs. Associations between PCEs and chronic pain were evaluated using weighted, multivariate logistic regression analyses adjusted for sociodemographic factors. We found that PCEs had dose-dependent associations with pediatric chronic pain; children exposed to higher numbers of PCEs (5-7 PCEs) had the lowest reported rate of chronic pain (7.1%), while children exposed to 2 or fewer PCEs had the highest rate of chronic pain (14.7%). The adjusted analysis confirmed that children experiencing 5 to 7 PCEs had significantly lower odds of chronic pain relative to children experiencing 0 to 2 PCEs (adjusted odds ratio (aOR): .47, 95% confidence interval (CI): .39-.61, P < .0001). PCEs moderated associations between ACEs and chronic pain: among children reporting 2 or more ACEs, those reporting 5 to 7 PCEs were significantly less likely to report chronic pain as compared to children only reporting 0 to 2 PCEs (aOR: .64, 95%CI: .45-.89, P = .009). In conclusion, children with greater PCEs exposure had lower prevalence rates of chronic pain. Furthermore, PCEs was associated with reduced prevalence of chronic pain among children exposed to ACEs. PERSPECTIVE: This article estimates associations between survey-measured PCEs and pediatric chronic pain among children in the United States. Promoting PCEs could improve pediatric pain outcomes.
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Affiliation(s)
- Sarah J Pugh
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Caitlin Murray
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Department of Anesthesiology & Pain Medicine, Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Cornelius B Groenewald
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Department of Anesthesiology & Pain Medicine, Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington.
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Menés Fernández L, Salvat I, Adillón C. Expressed Beliefs about the Cause of Pain in a Pediatric Population: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1007. [PMID: 37371238 DOI: 10.3390/children10061007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: The aims of this study are to explore what beliefs children and adolescents manifest about the cause of the pain they describe, to compare whether there are differences between beliefs by age and the persistence of pain, and to relate the explanations of the cause of pain with current scientific evidence. (2) Methods: a cross-sectional qualitative study was used. The primary endpoint of the study was obtaining explanations of the cause of pain recorded by means of an open-ended question. The participants were school-age children attending a charted school in the province of Barcelona. (3) Results: The children and adolescents proposed a diverse range of explanations for the cause of pain that they reported in their responses. The most frequent explanation for the cause of pain were pathologies and injuries (45.95%), ergonomic issues (22.60%) and psychological issues (15.95%). (4) Conclusions: There is a lot of variety in the explanations that young people give about the cause of their pain in schoolchildren aged between 10 and 16 years old. There exists a high prevalence of explanations non-associated with tissue damage (ENAD) concerning the causes of pain described. It is necessary that future health prevention programs dedicated to early ages consider which beliefs about the cause of pain are the most frequent in the pediatric population.
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Affiliation(s)
- Laura Menés Fernández
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Isabel Salvat
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Cristina Adillón
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
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Alsaggaf F, Coyne I. Participation in everyday life for young people with chronic pain in Saudi Arabia: "you feel lacking in life and you feel that time is flying by". FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1099345. [PMID: 37275401 PMCID: PMC10235783 DOI: 10.3389/fresc.2023.1099345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 04/25/2023] [Indexed: 06/07/2023]
Abstract
Introduction Chronic pain is a common health problem that can have a significant impact on children and young people's daily life. Although research on pediatric chronic pain has been a priority globally, little is known about young people's experience of chronic pain in Saudi Arabia. Thus, this article reports on young people's experience of chronic pain and the impact on their lives in Saudi Arabia which forms part of a larger study. Methods Multiple case study design following Yin's (2018) approach was used. Purposeful and theoretical sampling were used to recruit young people aged 12 to 18 who had experienced chronic pain for at least three months, their parents, and their school personnel. The young people and their parents were recruited from a tertiary hospital located on the western side of Saudi Arabia while school personnel were recruited from the schools that young people attended. Data were collected through in-depth semi-structured face-to-face (n = 15) and telephone interviews (n = 25) from 40 participants (10 young people, 10 parents, and 20 school personnel). Interviews were recorded, transcribed verbatim, and translated from Arabic to English. Data were analyzed following two phases: (1) constant comparative analysis; and (2) cross-case analysis based on the work of Charmaz (2014) and Yin (2018) respectively. Findings Young people's experiences of chronic pain were categorized into three themes: (1) experiencing chronic pain; (2) impact of pain on quality of life; and (3) everyday strategies to manage chronic pain. All young people reported that their pain was caused by a chronic condition, where the most prevalent pains were musculoskeletal/joint pain, abdominal pain, and headache/migraine. Most young people had encountered challenges with misdiagnosis or delayed diagnosis as to the cause of their chronic pain. They described how their chronic pain interfered with their physical, psychological, and social functioning. They primarily managed their pain with medications and through self-care techniques. The findings also indicated that young people's generally positive attitude to their pain reflected their beliefs in Allah's power and the belief that such suffering should be borne according to their Islamic culture. Conclusion Chronic pain is a significant health phenomenon that tends to restrict the participation of young people in everyday life. However young people used a range of strategies to normalize the pain so that they could continue with their everyday activities like their peers.
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Affiliation(s)
- Fatimah Alsaggaf
- Nursing College, King Abdulaziz University, Jeddah, Saudi Arabia
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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Wickering L, Lautwein C, Nitsche H, Schneider M, Hechler T. Know Pain, No Pain? Preliminary Testing and Application of a New Tool to Assess Biopsychosocial Pain Concepts in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050814. [PMID: 37238362 DOI: 10.3390/children10050814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
To deliver tailored pain science education, assessing children's biopsychosocial pain concepts is necessary. As validated tools are lacking, a new tool is presented, the biopsychosocial pain concept matrix (BiPS matrix), which assesses children's biological, psychological, and social pain concepts in five domains according to the Common-Sense Model of Self-Regulation (Hagger and Orbell, 2003): (1) illness identity, (2) causes, (3) consequences, (4) duration, and (5) treatment. The present preliminary study aims to (1) assess the items' readability and understandability in cognitive interviews with N = 9 healthy children (9 to 19 years, M = 13.78 years, SD = 3.05; 44% female) and (2) pre-test the BiPS matrix within an online survey of N = 27 healthy children (9 to 19 years, M = 13.76 years, SD = 3.03; 56% female). Results revealed difficulties in understanding some items. Children's understanding increased with age. Age, chronic pain status, and pain in the social environment were positively associated with the BiPS total score, whereas the latter explained the most variance in pain concepts of children. Patient-focused methods such as cognitive interviews proved essential in testing the readability and understanding of items in children. Future studies are warranted to further validate the BiPS matrix.
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Affiliation(s)
- Linda Wickering
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, 54296 Trier, Germany
| | - Catherina Lautwein
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, 54296 Trier, Germany
| | - Hanna Nitsche
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, 54296 Trier, Germany
| | - Michael Schneider
- Department of Educational Psychology, University of Trier, 54296 Trier, Germany
| | - Tanja Hechler
- Department of Clinical Psychology for Children and Adolescents, University of Münster, 48149 Münster, Germany
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Caru M, Alberts NM, Freeman MC, Dandekar SC, Rao P, McKeone DJ, Brown VI, McGregor LM, Schmitz KH. Chronic pain in children and adolescents diagnosed with cancer: the challenge of mitigating the pain and the potential of integrating exercise into pain management. Support Care Cancer 2023; 31:228. [PMID: 36952029 DOI: 10.1007/s00520-023-07695-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/16/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Pain is one of the most common and distressing symptoms experienced by children and adolescents diagnosed with cancer. It is vital that children and adolescents receive adequate pain management early on in their cancer treatments to mitigate pain and cancer-related symptoms. Exercise training shows particular promise in the management of acute and chronic pain among children and adolescents diagnosed with cancer. METHODS This position paper comes to outline the challenge of mitigating pain in children and adolescents diagnosed with cancer, and the potential benefits of integrating exercise training to the management of chronic pain in this population in need. RESULTS Integrating exercise training into the care and pain management of children and adolescents diagnosed with cancer who have chronic pain would have the advantage of addressing several shortcomings of pain medication. Pain medication aims to temporarily manage or reduce pain; it does not have the potential to directly improve a patient's physical condition in the way that exercise training can. The current paucity of data available on the use of exercise training as a complementary treatment to pain medications to reduce chronic pain in children and adolescents diagnosed with cancer allows only for hypotheses on the effectiveness of this pain management modality. CONCLUSION More research on this important topic is necessary and mitigating pain effectively while also reducing the use of opioid pain medication is an important goal shared by patients, their families, clinicians, and researchers alike. Future research in this area has great potential to inform clinical care, clinical care guidelines, and policy-making decisions for pain management in children and adolescents diagnosed with cancer who experience chronic pain.
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Affiliation(s)
- Maxime Caru
- Division of Hematology and Oncology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Nicole M Alberts
- Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Michelle C Freeman
- Division of Complex and Palliative Care, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Smita C Dandekar
- Division of Hematology and Oncology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Pooja Rao
- Division of Hematology and Oncology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Daniel J McKeone
- Division of Hematology and Oncology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Valerie I Brown
- Division of Hematology and Oncology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Lisa M McGregor
- Division of Hematology and Oncology, Department of Pediatrics, Penn State College of Medicine, Hershey, PA, USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Onyeka TC, de la Vega R, Fisher E, Finley GA. Editorial: Highlights in pediatric pain 2021/22. FRONTIERS IN PAIN RESEARCH 2023; 4:1152194. [PMID: 37006414 PMCID: PMC10064117 DOI: 10.3389/fpain.2023.1152194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Affiliation(s)
- Tonia C. Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Nigeria
| | - Rocio de la Vega
- Faculty of Psychology, University of Malaga, Malaga, Spain
- Biomedical Research Institute of Málaga (IBIMA), Malaga, Spain
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - G. Allen Finley
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
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Alonso-Prieto M, Pujol D, Angustias Salmerón M, de-Ceano Vivas-Lacalle M, Ortiz Villalobos A, Martínez Moreno M, González Morán G, Torres-Luna R, Miró J, Reinoso-Barbero F. Clinical differences in a multidisciplinary pediatric pain unit between primary and secondary chronic pain. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:148-155. [PMID: 36842690 DOI: 10.1016/j.redare.2021.12.004] [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: 08/18/2021] [Accepted: 12/19/2021] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Chronic pain affects an important part of the pediatric population in developed countries. secondary chronic pain (SCP) can have a well-defined medical cause, but primary chronic pain (PCP) can have an unknown etiology. In Spain, there is as yet no information on the clinical differences between patients treated in multidisciplinary units. METHODS Retrospective analysis of the clinical records of patients seen in 2018 at the Children's Chronic Pain Unit in University La Paz Hospital. RESULTS A total of 92 patients were included, (age between 3 and 19 years), with a mean age of 12.4 (SD = 4.1) years, mostly female (55%), with a mean duration of pain of 11.3 (SD = 10.4) months. A comparison of patients with PCP (n = 31) and SCP (n = 61) showed that both groups, on average, presented intense pain (X = 5.9; SD = 2.2; range = 0-10), with similar duration and functional repercussions, although PCP was less likely to be associated with neuropathic descriptors than SCP (p = 0.040), and was more extensive (p < 0.001). Both groups received similar treatment, based on rehabilitation, psychotherapy, invasive techniques and analgesic medication, although patients in the PCP group received less analgesic medication (gabapentinoids and opioids) than the SCP (p = 0.011). CONCLUSION Patients treated in a multidisciplinary Child Pain Unit for PCP or SCP present a very similar clinical profile, though with differences in the number and type of analgesic drugs used. This shows the importance of etiologic diagnosis for adequate pharmacological treatment.
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Affiliation(s)
- M Alonso-Prieto
- Unidad de Dolor Infantil-->, Servicio de Anestesiología-Reanimación Infantil, Hospital Universitario La Paz-->, Madrid, Spain
| | - D Pujol
- Servicio de Anestesiología-Reanimación-->, Hospital Universitario CEMIC, Buenos Aires, Argentina
| | | | | | - A Ortiz Villalobos
- Unidad de Psiquiatría Infantil y del adolescente-->, Servicio de Psiquiatría-->, Hospital Universitario La Paz-->, Madrid, Spain
| | - M Martínez Moreno
- Unidad de Rehabilitación Infantil-->, Servicio de Rehabilitación y Fisioterapia-->, Hospital Universitario La Paz-->, Madrid, Spain
| | - G González Morán
- Servicio de Ortopedia-->, Hospital Universitario La Paz-->, Madrid, Spain
| | - R Torres-Luna
- Unidad de Dolor Infantil-->, Servicio de Anestesiología-Reanimación Infantil, Hospital Universitario La Paz-->, Madrid, Spain
| | - J Miró
- Cátedra del Dolor Infantil de la Universidad Rovira i Virgili de Tarragona-->, Spain
| | - F Reinoso-Barbero
- Unidad de Dolor Infantil-->, Servicio de Anestesiología-Reanimación Infantil, Hospital Universitario La Paz-->, Madrid, Spain; Fundación de Investigación IdiPaz-->, Hospital Universitario La Paz-->, Madrid, Spain.
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Killackey T, Soltani S, Noel M, Birnie KA, Choinière M, Pagé MG, Dassieu L, Lacasse A, Lalloo C, Poulin P, Ali S, Baerg K, Battaglia M, Campbell F, Mohabir V, Nishat F, Kelly R, Lund T, Isaac-Bertrand A, Benayon M, Jordan I, Stinson J. "We survived the pandemic together": The impact of the COVID-19 pandemic on Canadian families living with chronic pain. Can J Pain 2023; 7:2157251. [PMID: 36760709 PMCID: PMC9904303 DOI: 10.1080/24740527.2022.2157251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction Pediatric chronic pain is a significant problem in Canada, affecting one in five youth. This study describes the impact of the pandemic on the experiences of Canadian families living with chronic pain through interviews with youth living with chronic pain, parents, and siblings. Methods Employing a qualitative descriptive design, in-depth semistructured interviews were completed with Canadian youth living with pain, as well as parents and siblings. Participants were not required to be related. Interviews were analyzed using a reflexive thematic analysis approach. Results Forty-four interviews were completed with 14 parents, 19 youth with chronic pain, and 11 siblings from across the country. Three key themes were developed: (1) absorbing and shifting: the toll of the pandemic on the family system (e.g., loss of coping mechanisms, shifting roles to respond to the pandemic), (2) social ambiguity and abandonment (e.g., social sacrifice and abandonment by the health care system), and (3) building community resilience: familial adaptation to the pandemic (e.g., family cohesion, confidence, and self-management). Discussion/Conclusions Youth, parents, and siblings reported that the pandemic impacted coping strategies across the family system. These results outline the challenges youth experienced managing their pain and overall health throughout the pandemic and the resilience built within families during this time. Going forward, it would be relevant to examine how racialized and structurally marginalized youth with chronic pain and their families experienced the pandemic. Future research should examine how unexpected benefits of the pandemic (e.g., increased confidence and self-management) may be sustained into the future.
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Affiliation(s)
- Tieghan Killackey
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,CONTACT Tieghan Killackey Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ONM5G 0A4, Canada
| | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada,Department of Psychology, Alberta Children’s Hospital, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Kathryn A. Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada,Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - M. Gabrielle Pagé
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada,Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada,Department of Psychology, Université de Montréa, Montreal, Quebec, Canada
| | - Lise Dassieu
- Research Center of the Centre hospitalier de l’Université de Montréal, Montreal, Quebec, Canada,Department of Biomedical Sciences, Université de Montréal, Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Department of Health Sciences, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia Poulin
- Department of Anesthesiology & Pain Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada,Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Samina Ali
- Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada,Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada,Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Krista Baerg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada,Department of Pediatrics, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada,Centre for Addiction and Mental Health CYEA programme, Toronto, Ontario, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada,Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vina Mohabir
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fareha Nishat
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel Kelly
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tatiana Lund
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ariane Isaac-Bertrand
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Summer Research Student, Child Health Evaluative Sciences, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Myles Benayon
- Internal Medicine Residency Program, McMaster University, Hamilton, Ontario, Canada
| | | | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Pei JH, Wang X, Ma T, Du Y, Dou X. Alexithymia in a Chinese Patient with Chronic Pain and Associated Factors: A Cross-Sectional Study. Pain Manag Nurs 2023:S1524-9042(23)00024-3. [PMID: 36774311 DOI: 10.1016/j.pmn.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/27/2022] [Accepted: 01/14/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Alexithymia is more prevalent among those with patients living with chronic pain. Information on the prevalence of alexithymia in Chinese patients with chronic pain and associated factors is limited. AIM The primary objective of this study was to determine the prevalence of alexithymia, as defined by a score of 61 or greater in the 20-item Toronto Alexithymia Scale (TAS-20), in a Chinese patient with chronic pain. The secondary objective was to investigate the relationship between alexithymia and the clinical and psychological aspects of chronic pain. METHODS A cross-sectional observational study used the TAS-20 to assess alexithymia of Chinese patients with chronic pain. Sociodemographic and clinical information were obtained and participants filled in the Fear Avoidance Beliefs Questionnaire, Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, and General Self-efficacy Scale. RESULTS Of the 346 patients screened, 321 patients living with chronic pain were enrolled into the study. The prevalence of alexithymia among the study population (TAS-20 score ≥61) was 19.6% (95% confidence interval [CI]: 15.3-24.0). The findings showed anxiety (odds ratio [OR] = 2.474; 95% CI, 1.241-4.935), pain catastrophizing (2.649; 1.014-6.921), and self-efficacy (0.952; 0.908-0.988) as independent predictors of alexithymia in patients living with chronic pain. CONCLUSIONS Patients with chronic pain exhibiting alexithymia were at higher risk of pain catastrophizing, anxiety, and lower self-efficacy, compared with patients without alexithymia. It is important to identify and pay a special attention in clinical practice to patients with chronic pain exhibiting alexithymia, as these individuals are unable to properly express their emotions.
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Affiliation(s)
- Ju-Hong Pei
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China; The first clinical medical college, Lanzhou University, Lanzhou, Gansu, China
| | - Xinglei Wang
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Tong Ma
- Spine minimally invasive orthopedics, Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, Gansu, China
| | - Yehui Du
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Xinman Dou
- Department of Nursing, Lanzhou University Second Hospital, Lanzhou, Gansu, China; School of nursing, Lanzhou University, Lanzhou, Gansu, China.
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42
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Salberg S, Yamakawa GR, Beveridge JK, Noel M, Mychasiuk R. A high-fat high-sugar diet and adversity early in life modulate pain outcomes at the behavioural and molecular level in adolescent rats: The role of sex. Brain Behav Immun 2023; 108:57-79. [PMID: 36403882 DOI: 10.1016/j.bbi.2022.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022] Open
Abstract
Given that adolescence is a significant period of brain plasticity and development, early life factors have the potential to alter long term outcomes. For instance, adversities such as consumption of a high-fat high-sugar (HFHS) diet and adverse childhood experiences (ACEs; e.g., neglect), and their resulting inflammation and microglial activation can influence pain outcomes by priming the neuroimmune system to overrespond to stressors. Chronic pain is highly prevalent amongst the adolescent population, with the prevalence and manifestation being sexually dimorphic. Although clinical studies show that females are twice as likely to report pain problems compared to males, the majority of pre-clinical work uses male rodents. Therefore, our aim was to examine the effects of sex, a HFHS diet, and an ACE on chronic pain outcomes following a stressor in adolescence. Rat dams were randomly assigned to a Standard or HFHS diet, with pups maintained on their respective diets then randomly allocated to a No Stress or ACE paradigm, and a Sham or Injury condition as a stressor. Results showed that early life adversities increased nociceptive sensitivity, inflammation, and microglial activation systemically and within the brain. Behaviourally, pain outcomes were more prominent in females, however the neuroimmune response was exacerbated in males. These results demonstrate the sexual dimorphism of chronic pain outcomes following early life adversities and provide insight into the mechanisms driving these changes, which will inform more targeted and effective treatment strategies for youth living with chronic pain.
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Affiliation(s)
- Sabrina Salberg
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Glenn R Yamakawa
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia
| | - Jaimie K Beveridge
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, AB, Canada
| | - Melanie Noel
- Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, AB, Canada
| | - Richelle Mychasiuk
- Department of Neuroscience, Monash University, Melbourne, VIC, Australia; Department of Psychology, Alberta Children's Hospital Research Institute, Hotchkiss Brain Institute, The University of Calgary, Calgary, AB, Canada.
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43
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Hurtubise K, Brousselle A, Noel M, Caldwell K, Rayner L, Dawson M, Rasic N, Camden C. The effect domains, measures, and methods reported in pediatric-specialized multidisciplinary outpatient rehabilitation programs: An integrated review. Pain Pract 2023; 23:185-203. [PMID: 36251412 DOI: 10.1111/papr.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Specialized pain rehabilitation is recognized as the treatment of choice for youth with pain-related disability. Appropriate outcomes for program evaluation are critical. This study aimed to summarize the effect domains and methods used to evaluate pediatric-specialized outpatient pain rehabilition programs, map them to the PedIMMPACT statement, and highlight future directions. METHODS An integrated review framework, incorporating stakeholders, was used. Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar were searched for studies published in 1999-2021 featuring the treatment effects of specialized outpatient pain rehabilitation on youth with pain-related disability and their parents. Selected studies were critically appraised using the Quality Assessment Tool for Studies of Diverse Design, organized by study characteristics, and analyzed using constant comparison. RESULTS From the 1951 potentially relevant titles, 37 studies were selected. Twenty-five effects targeted youth and 24 focused on parents, with a maximum of 15 youth and 11 parent effect domains (median = 5 domains per study). Although most studies measured a combination of effect domains and were inclusive of some recommended in the PedIMMPACT statement, no effect was measured consistently across studies. Youth physical functioning and parent emotional functioning were measured most often. Eighty-five instruments were used to assess youth outcomes and 59 for parents, with self-report questionnaires dominating. DISCUSSION A lack of standardization exists associated with the domains and methods used to evaluate the effects of pediatric-specialized outpatient pain rehabilitation programs, hindering comparisons. Future program evaluations should be founded on their theory, aim, and anticipated outcomes.
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Affiliation(s)
- Karen Hurtubise
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Québec, Québec, Canada.,Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, British Columbia, Canada
| | - Melanie Noel
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Heritage Medical Research Building, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Health Research Innovation Centre, Calgary, Alberta, Canada
| | - Kathleen Caldwell
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Rayner
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Matthew Dawson
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Nivez Rasic
- Alberta Children's Hospital Research Institute, Heritage Medical Research Building, Calgary, Alberta, Canada.,Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Chantal Camden
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Québec, Québec, Canada
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44
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Pate JW, Harrison LE, Hess CW, Moseley GL, Rush G, Heathcote LC, Simons LE. Targeting Pain Science Education in Youth With Chronic Pain: What Are the Sticking Points for Youth and Their Parents? Clin J Pain 2023; 39:60-67. [PMID: 36453624 DOI: 10.1097/ajp.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES An important part of providing pain science education is to first assess baseline knowledge and beliefs about pain, thereby identifying misconceptions and establishing individually-tailored learning objectives. The Concept of Pain Inventory (COPI) was developed to support this need. This study aimed to characterize the concept of pain in care-seeking youth and their parents, to examine its clinical and demographic correlates, and to identify conceptual gaps. MATERIALS AND METHODS Following an initial interdisciplinary evaluation, a cohort of 127 youth aged 8 to 18 years, and their parents, completed a series of questionnaires. RESULTS Parents had slightly higher COPI scores than youth did, reflecting parents' greater alignment with contemporary pain science. The moderate positive association with older age among youth ( r =.32) suggests that COPI is sensitive to cognitive development and life experiences. Youth and parent COPI responses were weakly associated ( r =0.24), highlighting the importance of targeting the concept of pain in both groups. For both parents and youth, 'Learning about pain can help you feel less pain' was the least endorsed concept. This conceptual 'gap' is a key point of intervention that could potentially lead to greater engagement with multidisciplinary pain treatment. DISCUSSION The COPI appears useful for identifying conceptual gaps or 'sticking points'; this may be an important step to pre-emptively address misconceptions about pain through pain science education. Future research should determine the utility of COPI in assessing and treating youth seeking care for pain. The COPI may be a useful tool for tailoring pain science education to youth and their parents.
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Affiliation(s)
- Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, NSW
| | - Lauren E Harrison
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Courtney W Hess
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - G Lorimer Moseley
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gillian Rush
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Laura E Simons
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
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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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Shipton E, Steketee C, Visser E. The Pain Medicine Curriculum Framework-structured integration of pain medicine education into the medical curriculum. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2023; 3:1057114. [PMID: 36700142 PMCID: PMC9869177 DOI: 10.3389/fpain.2022.1057114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023]
Abstract
Medical practitioners play an essential role in preventing pain, conducting comprehensive pain assessments, as well as promoting evidence-based practices. There is a need for the development of innovative, interprofessional and integrated pain medicine curricula for medical students. The Pain Medicine Curriculum Framework (PMCF) was developed to conceptualise a purposeful approach to the complex process of curriculum change and to prioritise the actions needed to address the gaps in pain medicine education. The PMCF comprises four dimensions: (1) future healthcare practice needs; (2) competencies and capabilities required of graduates; (3) teaching, learning and assessment methods; and (4) institutional parameters. Curricula need to meet the requirements of registration and accreditation bodies, but also equip graduates to serve in their particular local health system while maintaining the fundamental standards and values of these institutions. The curriculum needs to connect knowledge with experience and practice to be responsive to the changing needs of the increasingly complex health system yet adaptable to patients with pain in the local context. Appropriate learning, teaching and assessment strategies are necessary to ensure that medical practitioners of the future develop the required knowledge, skills and attitudes to treat the diverse needs of patients' experiencing pain. The historical, political, social and organisational values of the educational institution will have a significant impact on curriculum design. A more formalised approach to the development and delivery of a comprehensive pain medicine curriculum is necessary to ensure that medical students are adequately prepared for their future workplace responsibilities.
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Affiliation(s)
- Elspeth Shipton
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia,Correspondence: Elspeth Shipton
| | - Carole Steketee
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Eric Visser
- School of Medicine, University of Notre Dame Australia, Fremantle, WA, Australia
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Pain Widespreadedness, and Not Primary Pain Location, is Associated With Comorbid Symptoms in Children With Chronic Pain. Clin J Pain 2023; 39:1-7. [PMID: 36524767 DOI: 10.1097/ajp.0000000000001083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Pediatric chronic pain represents heterogeneous diagnoses; often, primary pain location informs research classifications and treatment. In contrast, recent research has highlighted the role of widespread pain and this perspective has been adopted in assessments in specialty pediatric pain clinics. The lack of direct comparison between these 2 methods of categorizing pediatric chronic pain may hinder the adoption of evidence-based practices across the spectrum of care. Therefore, this study aimed to compare whether primary pain location or pain widespreadedness is more informative for pain-related symptoms in pediatric chronic pain. METHODS Youth (n=223) between the ages of 8 to 23 years (M=15.93, SD=2.11, 83% female) completed surveys upon intake at the pediatric chronic pain clinic. Free-text entries of primary pain location were coded into categories: headache, abdominal pain, and musculoskeletal pain. Additional domains assessed included widespread pain, pain interference, kinesiophobia, catastrophizing, anxiety, depression, sleep, and fatigue. RESULTS Differences based on primary pain location only emerged for kinesiophobia, F(2150)=8.20, P<0.001, with the highest scores among those with musculoskeletal pain. In contrast, controlling for sex, age, and pain intensity, pain widespreadedness was associated with pain interference, pain catastrophizing, fatigue, anxiety, and depression (P<0.05). DISCUSSION Pain widespreadedness was more consistently associated with pain-related outcomes among pediatric chronic pain patients than primary pain location, and body maps may be useful in determining a nociplastic pain mechanism to inform treatment. Improved assessment of pediatric pain mechanisms may help advance more precise treatment delivery.
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48
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Liu A, Anang P, Harling D, Wittmeier K, Gerhold K. Chronic pain in children and adolescents in Manitoba: A retrospective chart review to inform the development of a provincial service for pediatric chronic pain. Can J Pain 2022; 6:124-134. [PMID: 35990169 PMCID: PMC9389926 DOI: 10.1080/24740527.2022.2094228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background In the absence of an interdisciplinary service for pediatric chronic pain in Manitoba, pain management has been offered through a single provider outpatient setting with consultative services from physiotherapy, occupational therapy, and psychiatry since October 2015. Aims The aim of this study was to characterize the patient population of this clinic to understand needs and inform future service development for pediatric chronic pain. Methods Demographics and disease characteristics of all patients seen in this clinic between October 1, 2015, and February 28, 2019, were analyzed retrospectively from electronic medical records. Results A total of 157 patients, mean age 13.1 (sd ±3.0) years, 75.2% female, with a median duration of pain of 20.5 (interquartile range [IQR] = 10.0–45.8) months at their first visit were included in the study. At baseline, 74.0% of patients experienced insomnia, 76.6% fatigue, 86.5% symptoms of anxiety, and 58.69% symptoms of depression; 80.1% showed withdrawal from physical activity, 67.1% missed school, and 10.2% reported opioid usage. Throughout their care in clinic, 83.4% of patients received physiotherapy, 17.8% occupational therapy, 49.7% mental health support, and 51.6% care from multiple services. The clinic experienced a significant increase in median referrals from 1.0 to 5.0 (IQR = 2.0–9.0) per month and wait time from 35.0 to 97.0 (IQR = 88.0–251.0) days during the observation period. Conclusions Developing an interdisciplinary service for pediatric chronic pain will provide an opportunity to improve access, coordination, and comprehensiveness of care and to employ culturally sensitive services to improve care for children and youth living with chronic pain in Manitoba and possibly other jurisdictions with similar demographics and needs.
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Affiliation(s)
- Anna Liu
- Department of Pediatrics and Child Health and Children’s Hospital Research Institute of Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Polina Anang
- Max Rady College of Medicine, Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Danielle Harling
- Occupational Therapy, Child Health, Shared Health, Winnipeg, Manitoba, Canada
| | - Kristy Wittmeier
- Department of Pediatrics and Child Health and Children’s Hospital Research Institute of Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kerstin Gerhold
- Department of Pediatrics and Child Health and Children’s Hospital Research Institute of Manitoba, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Mississippi Center for Advanced Medicine, Madison, Mississippi, USA
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49
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Miró J, Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP. Chronic Pain and High Impact Chronic Pain in Children and Adolescents: A Cross-Sectional Study. THE JOURNAL OF PAIN 2022; 24:812-823. [PMID: 36577459 DOI: 10.1016/j.jpain.2022.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/26/2022]
Abstract
The aims of this study were to: 1) estimate the prevalence of chronic pain (CP) and high impact chronic pain (HICP) in a community sample of children and adolescents; and 2) compare groups (those without CP, those with CP but no HICP, and those with HICP) with respect to demographic variables, pain variables, and physical, psychological, and school-related function. One thousand one hundred and fifteen children and adolescents participated (56% girls; age: ߂ = 11.67; SD = 2.47; range = 8-18 years). The prevalence of CP and HICP was 46% and 5%, respectively, and was higher in girls and increased with age. Participants with HICP reported greater pain intensity and higher pain frequency than those with CP but no HICP. In addition, participants with HICP reported lower mobility, greater fatigue, worst sleep quality, more anxiety and depression symptoms, worst cognitive function, missing more school days, and worse perceived school performance. HICP is a prevalent condition in children and adolescents and is associated with many negative consequences. Stakeholders must be aware of this and ensure that treatment programs are available to reduce the individual and societal impact of HICP in young individuals. PERSPECTIVE: This article provides information on CP and HICP prevalence and impact in children and adolescents. By better understanding the nature and score of these conditions, we will be able to develop more effective early interventions to help this population and thereby reduce their long-term negative impact.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain.
| | - Josep Roman-Juan
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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The declaration of lima on pain in childhood. Pain Rep 2022; 7:e1055. [PMID: 36570738 PMCID: PMC9771156 DOI: 10.1097/pr9.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
The Declaration of Lima on Pain in Childhood is a call into action to improve the care provided to children and adolescents with pain.
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