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Mirzadegan IA, Lewis EM, Cole SL, Meyer A. Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents. J Pediatr Psychol 2024:jsae040. [PMID: 38857450 DOI: 10.1093/jpepsy/jsae040] [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: 01/14/2024] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE This mixed-methods study examined perceived acceptability and appropriateness of a novel digital mental health program targeting anxiety risk (i.e., perfectionism or error sensitivity) in 5-to-7-year-old children and their parents. METHODS Parent-child dyads participated in a modular, web-based cognitive-behavioral program targeting negative overreactions to making mistakes. The program, "Making Mistakes", consisted of a 6-month series of short video clips, journaling activities, and weekly reminders, and modules were delivered to caregivers and children separately. 86 dyads completed self-report measures, 18 of whom participated in semi-structured interviews, following completion of the primary program module. A standard thematic analysis was used to elucidate themes from the parent and child interview content. RESULTS Our quantitative and qualitative results were generally aligned. Children and parents viewed the novel digital mental health program as acceptable and appropriate, favoring the cognitive behavioral strategies such as modeling positive reactions to mistakes, responding positively to child mistakes, and emphasizing effort over outcome. Participants also provided helpful feedback related to program content, delivery, and engagement, as well as suggestions to enhance the program. CONCLUSIONS Findings have implications for design and content features of parent-based and dyad-based programs, as well as digital mental health programs focused on reducing anxiety risk.
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Affiliation(s)
- Isaac A Mirzadegan
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Ericka M Lewis
- School of Social Work, University of Maryland, Baltimore, MD, United States
| | - Sally L Cole
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Alexandria Meyer
- School of Education and Counseling Psychology, Santa Clara University, Santa Clara, CA, United States
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2
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Santucci NR, Velasco-Benitez CA, Cunningham N, Li J, Fei L, Sun Q, Saps M. Psychological distress and coping efficacy in children with disorders of gut-brain interaction. Neurogastroenterol Motil 2024; 36:e14724. [PMID: 38072996 PMCID: PMC10842907 DOI: 10.1111/nmo.14724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 10/12/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Multiple psychological factors influence disorders of gut-brain interaction (DGBIs). We aimed to evaluate psychological distress in Colombian schoolchildren with and without DGBIs. METHODS We included children ages 8-18 years without organic medical conditions from largest regional public schools in Colombia. Children completed Spanish versions of Rome III diagnostic questionnaire for DGBIs, State Trait Anxiety Inventory for Children (STAIC), Children's Somatization Inventory (CSI), and a measure of coping efficacy. These data, demographic and socioeconomic characteristics, were compared between children with DGBIs and healthy peers. Exploratory analyses investigated differences between youth with symptoms of functional abdominal pain disorders (FAPDs) compared with healthy peers. KEY RESULTS Of 1496 children, 281 (mean age 12.9 ± 2.2 years, 49.8% females) self-reported criteria for DGBIs and 125 reported (44.5%) FAPDs. Children with DGBIs had higher trait anxiety, emotional sensitivity, somatization including GI, non-GI, pain-related, and non-pain-related subscales (p < 0.001 each) and lower coping efficacy (p = 0.02) compared to healthy peers. Females had higher trait anxiety and somatization (p = 0.04 and p = 0.005, respectively). State and trait anxiety and coping efficacy differed based on location in children with DGBIs (p = 0.02, p = 0.03, and p < 0.001, respectively). Children with FAPDs had higher trait anxiety (p = 0.02) and somatization (p < 0.001) compared to healthy youth. CONCLUSIONS & INFERENCES Children with DGBIs had higher anxiety, emotional sensitivity, and somatization, and lower coping efficacy compared with healthy youth. This highlights the importance of appraising psychological distress characteristics as well as incorporating conflict resolution, assertiveness training, and resilience building during the treatment of DGBIs.
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Affiliation(s)
- Neha R Santucci
- Pediatric Gastroenterology, Cincinnati Children’s Hospital Medical Center, OH, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | | | - Natoshia Cunningham
- Department of Family Medicine, Michigan State University, East Lansing, MI, United States
| | - Jesse Li
- Pediatric Gastroenterology, Cincinnati Children’s Hospital Medical Center, OH, United States
| | - Lin Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Qin Sun
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Miami School of Medicine, Miami, FL, United States
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3
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Serbic D, Friedrich C, Murray R. Psychological, social and academic functioning in university students with chronic pain: A systematic review. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2894-2908. [PMID: 34871522 DOI: 10.1080/07448481.2021.2006199] [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: 03/31/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Chronic pain is a prevalent health issue among young adults; however, there is limited understanding on how it affects university students. This is the first systematic review of evidence relating to the association between chronic pain and psychological, social and academic functioning in university students. Participants: Four databases were searched for relevant published studies. Data from 18 studies including 10,069 university students, of which 2895 reported having chronic pain, were included in the synthesis. Methods: Due to heterogeneity of data and methodologies, meta-analysis was not possible; therefore, data were synthesized narratively. Results: Our findings showed that students with chronic pain have poorer psychological, social and academic functioning and quality of life, compared to students without chronic pain. Conclusions: These findings suggest that chronic pain presents a challenge in university settings. Research is urgently needed to enable an understanding of how universities can support students who experience chronic pain.
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Affiliation(s)
- Danijela Serbic
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
| | - Claire Friedrich
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
| | - Romany Murray
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK
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4
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Flett GL, Hewitt PL, Nepon T, Sherry SB, Smith M. The destructiveness and public health significance of socially prescribed perfectionism: A review, analysis, and conceptual extension. Clin Psychol Rev 2022; 93:102130. [DOI: 10.1016/j.cpr.2022.102130] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/18/2022] [Accepted: 01/23/2022] [Indexed: 11/16/2022]
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5
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Perfectionism, maladaptive beliefs and anxiety in women with fibromyalgia. An explanatory model from the conflict of goals. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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6
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Clementi MA, Gray LS, Bento SP, Jervis K, Fletcher AA, Borner K, Randall ET. Perfectly Tired: Perfectionism and Sleep in Adolescents With Chronic Pain. J Pediatr Psychol 2021; 46:570-577. [PMID: 33515037 DOI: 10.1093/jpepsy/jsaa129] [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: 05/20/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Conceptual links between perfectionism and chronic pain have been proposed yet minimal empirical data exists. Poor sleep is associated with high levels of perfectionism and is common among youth with chronic pain. This study explores associations between perfectionism and sleep quality in adolescents with chronic pain while considering levels of functional disability. METHODS Adolescents (ages 12-18) with chronic pain (N = 423) completed baseline measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), sleep quality, and functional disability as part of routine clinical care at an outpatient chronic pain clinic and a pain rehabilitation day treatment program. Multivariate multiple regression assessed associations between perfectionism (SOP and SPP) and sleep (falling asleep/reinitiating sleep, returning to wakefulness, and going to bed). Two moderation models explored how relations between perfectionism (SOP and SPP) and sleep quality (total score) varied depending on level of functional disability. All analyses controlled for clinic setting. RESULTS Results indicated SPP was associated with more difficulties across all sleep subdomains in adolescents with chronic pain, while SOP was unrelated to sleep quality. Associations between perfectionism and sleep quality were dependent on functional disability; perfectionism was most strongly associated with worse sleep quality for adolescents with less functional disability. CONCLUSIONS This study highlights the relationship between perfectionism and sleep quality in adolescents with chronic pain and suggests that perfectionistic youth with less disability are at the greatest risk for sleep problems. Longitudinal research is needed to understand how perfectionism, sleep, and disability interact over time in youth with chronic pain.
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Affiliation(s)
- Michelle A Clementi
- Departments of Psychiatry & Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado
| | - Laura S Gray
- Pediatric Pain Medicine Clinic, Children's National Hospital.,Department of Psychiatry, The George Washington University School of Medicine
| | - Samantha P Bento
- Department of Psychology, University of Maryland- Baltimore County
| | - Kelsey Jervis
- Pediatric Pain Rehabilitation Program, Boston Children's Hospital
| | - Angela A Fletcher
- Pediatric Pain Medicine Clinic, Children's National Hospital.,Department of Psychiatry, The George Washington University School of Medicine
| | - Kelsey Borner
- Pediatric Pain Medicine Clinic, Children's National Hospital.,Department of Psychiatry, The George Washington University School of Medicine
| | - Edin T Randall
- Pediatric Pain Rehabilitation Program, Boston Children's Hospital.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School
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7
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Randall ET, Cole-Lewis YC, Petty CR, Jervis KN. Understanding How Perfectionism Impacts Intensive Interdisciplinary Pain Treatment Outcomes: A Nonrandomized Trial. J Pediatr Psychol 2021; 46:351-362. [PMID: 33325522 DOI: 10.1093/jpepsy/jsaa111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Several factors are known to impact response to the intensive interdisciplinary pain treatment (IIPT) program described in this study, yet no research has explored the role of perfectionism. This secondary data analysis explored direct and indirect relations between perfectionism and functional disability (primary outcome) and pain severity (secondary outcome) after IIPT, with pain catastrophizing and fear of pain as mediators. METHODS Youth (N = 253) aged 8-21 with chronic pain and associated disability completed pre- and post-IIPT measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), pain catastrophizing, fear of pain, functional disability, and pain characteristics for routine clinical care and this nonrandomized trial. Eight mediated models were run for the two predictors, two mediators, and two outcomes. RESULTS Pretreatment perfectionism (SOP and SPP) led to greater reductions in pain catastrophizing over the course of IIPT, which resulted in lower pain severity (β = -.02 [CI = -0.07, -0.01] for SOP and β = -.02 [CI = -0.06, -0.003] for SPP) and less functional disability (β = -.06 [CI = -0.13, -0.01] for SOP and β = -.06 [CI = -0.14, -0.01] for SPP). Independent of pain catastrophizing, pretreatment SPP was directly associated with more posttreatment functional disability (β = .16 [CI = 0.05, 0.27]). Fear of pain was not a mediator. CONCLUSIONS Findings suggest perfectionism has the potential to negatively impact IIPT outcomes. However, when perfectionistic youth with chronic pain learn to manage pain-related distress, they benefit. Results highlight the importance of assessing for and treating perfectionism and pain-related distress in youth with chronic pain.
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Affiliation(s)
- Edin T Randall
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School
| | - Yasmin C Cole-Lewis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital
| | - Kelsey N Jervis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital
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8
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Hsu C, Loecher N, Park AL, Simons LE. Chronic Pain in Young Athletes: The Impact of Athletic Identity on Pain-related Distress and Functioning. Clin J Pain 2021; 37:219-225. [PMID: 33543871 DOI: 10.1097/ajp.0000000000000917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 12/28/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND It is common for youth to engage in sport and unfortunately also common for chronic pain to emerge in childhood. The convergence of chronic pain and sports participation in youth has not been extensively studied. OBJECTIVE The goal of this study was to examine the association between athletic identity (AI) and pain-related distress and functioning in youth with chronic pain. PARTICIPANTS Our cohort consisted of 305 youth ages 8 to 21, 83.6% of whom reported being currently engaged or previously involved in sport. Correlation and regression analyses were completed to evaluate the relationship between AI and pain-related distress and functioning in our cohort of chronic pain patients. RESULTS Children currently involved in sport had higher total AI and social AI, lower fear of pain, and lower functional disability. Greater negative affectivity-AI had the strongest relationship with pain-related distress, including pain catastrophizing, fear and avoidance of pain, and anxiety. Stronger social AI was associated with lower levels of depression and pain-related avoidance of activities. Functional disability was not significantly associated with AI, but was lowest in individuals currently involved in sport. CONCLUSION Our study provides evidence that focusing on continued sports engagement in the context of chronic pain is associated with less pain-related distress and functional limitations when compared with those who discontinue sports involvement, thus may serve as a buffer in the context of chronic pain. The association of AI with pain-related distress suggests that there is emotional significance in the degree to which youth identify as an athlete. This may be beneficial to clinically assess in youth with chronic pain.
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Affiliation(s)
- Connie Hsu
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Laura E Simons
- Stanford University
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Palo Alto, CA
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9
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Sánchez-Rodríguez E, Ferreira-Valente A, Pathak A, Solé E, Sharma S, Jensen MP, Miró J. The Role of Perfectionistic Self-Presentation in Pediatric Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020591. [PMID: 33445761 PMCID: PMC7828281 DOI: 10.3390/ijerph18020591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 11/18/2022]
Abstract
This study sought to better understand the associations between perfectionistic self-presentation and measures of pain intensity, pain catastrophizing, pain interference, and fatigue in children and adolescents with pain. In the study, 218 adolescents responded to measures of perfectionistic self-presentation (i.e., perfectionistic self-promotion, nondisplay of imperfection and nondisclosure of imperfection), pain intensity, pain catastrophizing, pain interference, and fatigue. Four hierarchical regression analyses and three mediation analyses were conducted. Our results showed that perfectionistic self-promotion was significantly and independently associated with pain intensity and that nondisplay of imperfection was significantly and independently associated with pain catastrophizing, pain interference, and fatigue. Nondisclosure of imperfection was not significantly associated with any criterion variable. Pain catastrophizing mediated the association between both perfectionistic self-presentation and nondisplay imperfection and pain interference but not between nondisclosure of imperfection and pain interference. The findings provide new information about the role of perfectionistic self-presentation in children and adolescents’ experience of pain. These findings, if replicated, support perfectionism as a potential target of pain treatment in young people.
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Affiliation(s)
- 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, 43007 Tarragona, Spain; (E.S.-R.); (E.S.)
- Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
| | - Alexandra Ferreira-Valente
- William James Center for Research, ISPA-Instituto Universitário, Rua Jardim do Tabaco No 34, 1149-041 Lisbon, Portugal;
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, USA;
| | - Anupa Pathak
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, Dunedin 9054, New Zealand; (A.P.); (S.S.)
| | - Ester Solé
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain–ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Spain; (E.S.-R.); (E.S.)
- Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
| | - Saurab Sharma
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, Dunedin 9054, New Zealand; (A.P.); (S.S.)
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel 45209, Nepal
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, USA;
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain–ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Spain; (E.S.-R.); (E.S.)
- Institut d’Investigació Sanitària Pere Virgili, 43007 Tarragona, Spain
- Correspondence:
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10
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Jacobs K, Smith A, Heathcote LC, Caes L. Which passengers are on your bus? A taxonomy of the barriers adolescents with chronic pain face in achieving functional recovery. Eur J Pain 2020; 25:348-358. [PMID: 33063388 DOI: 10.1002/ejp.1673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite evidence that intensive interdisciplinary pain treatment (IIPT) is effective in facilitating functional recovery in adolescents with chronic pain, engagement with IIPT is suboptimal among adolescents. A key aspect of IIPT is to support functional recovery via (re)engagement with age-appropriate daily activities. The aim of this study was to gain a comprehensive insight into adolescents' perceptions of the barriers they need to overcome to engage with age-appropriate activities in order to achieve functional recovery. METHODS Forty-one adolescents who were starting an IIPT programme completed the 'passenger-on-the-bus metaphor', an exercise in which they identify and describe their perceived barriers (i.e. 'passengers' on their bus) that prevent them from engaging with age-appropriate activities. The responses were analysed using inductive thematic analyses to generate a taxonomy of perceived barriers to functional recovery. RESULTS We generated a taxonomy of seven different barriers that participants described facing on their road to functional recovery: physical constraints, being 'fed up', low self-confidence and self-esteem, perfectionism, avoidance of engagement with pain, feelings (such as sadness, anger, guilt, anxiety) and social barriers (received from a range of sources such as parents, friends, school and wider society). CONCLUSION The findings reveal a variety of barriers that were perceived to hinder functional recovery through reduced engagement with age-appropriate activities and thereby hamper progress within IIPT. The Passenger on the bus metaphor can be used to identify similar barriers faced by adolescents in an individualized treatment approach, thereby making it possible for clinicians to target their IIPT more precisely.
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Affiliation(s)
- Konrad Jacobs
- Oxford Centre for Children and Young People in Pain, Oxford University Hospitals, Oxford, UK.,Department of Children's Psychological Medicine, Children's Hospital, Oxford, UK
| | - Alisha Smith
- Oxford Centre for Children and Young People in Pain, Oxford University Hospitals, Oxford, UK
| | - Lauren C Heathcote
- Department of Anaesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
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11
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Lilley C, Sirois F, Rowse G. A meta-analysis of parental multidimensional perfectionism and child psychological outcomes. PERSONALITY AND INDIVIDUAL DIFFERENCES 2020. [DOI: 10.1016/j.paid.2020.110015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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12
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Mascaro Walter S. Taking on enduring distress: Building a concept to lead a program of research. Nurs Forum 2020; 55:678-686. [PMID: 32643164 DOI: 10.1111/nuf.12484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022]
Abstract
Concept building consists of a 10-phase approach using a practice story as the first step in developing a defined concept supported by both scientific and experiential evidence. The purpose of concept building is to guide development of a program of research that informs nursing knowledge and evidence-based practice. Thus, concept building can serve as a teaching strategy for early-stage doctoral students to initiate scholarly inquiry. In this example, the process of concept building occurred as a nurse practitioner in a doctor of philosophy program began to transition ideas that stemmed from practice into phenomenon for scholarly research. The practice story for the concept taking on enduring distress stems from a patient encounter in the nurse practitioner's adolescent headache clinic. Information gained from concept building laid the foundation for an adolescent headache program of research. The purpose of this paper is to demonstrate a step-by-step approach using Liehr and Smith's 10-phase process for concept building and to describe the program of research that followed.
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Affiliation(s)
- Suzy Mascaro Walter
- Department of Family and Community Health, West Virginia University School of Nursing, Morgantown, West Virginia, 26506
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13
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Abstract
PURPOSE OF REVIEW The purpose of this review is to examine the multitude of factors which may impact learning and academic performance in patients with pediatric migraine. RECENT FINDINGS A range of associations of varying degree were noted between pediatric migraine and conditions such as ADHD, learning disabilities, sleep disorders, and psychiatric comorbidities with regard to headache pain and school functioning. Recent literature highlights the importance of sleep in relation to headache, mood disorders, and learning in youth and the emerging role of perfectionism. Children with migraine remain at risk for school related and learning difficulties which may be primarily due to pain, due to other medical and psychiatric comorbidities commonly found in this population, or a combination. The relationships are complex and further studies are needed to clearly elucidate the shared biological and environmental pathophysiologic mechanisms.
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Affiliation(s)
- Raquel Langdon
- The George Washington University School of Medicine & Health Sciences, Children's National Hospital, 111 Michigan Ave, NW, Washington, DC, 20010, USA.
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14
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Nelson S, Burns M, McEwen B, Borsook D. Stressful experiences in youth: "Set-up" for diminished resilience to chronic pain. Brain Behav Immun Health 2020; 5:100095. [PMID: 34589863 PMCID: PMC8474662 DOI: 10.1016/j.bbih.2020.100095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023] Open
Abstract
Chronic pain in youth is common, with prevalence rates in some reports exceeding 50%. Given the plasticity of brain systems in youth and their general level of activity, the underlying processes relating to the evolution of chronic pain may be different from that observed in adults. One aspect that affects brain development is childhood stress. Preliminary research indicates that maladaptive responses to stressful events that induce biological and psychological inability to adapt may be related to pain chronicity in youth. This relationship is particularly notable given the high rates of exposure to stressful events in pediatric pain populations. A review of the literature was performed in the areas of biological, cognitive, psychological and social processes associated with chronic pain and psychological stress and trauma in youth and adult populations. The current review presents a theoretical framework, adapted from McEwen's model (1998) on stress and allostatic load, which aims to outline the potential connection between exposure to stressful events and pediatric chronic pain. Avenues for future investigation are also identified.
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Affiliation(s)
- Sarah Nelson
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Maureen Burns
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
| | | | - David Borsook
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
- Department of Anesthesia, Harvard Medical School, USA
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15
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Parental Proxy PROMIS Pain Interference Scores are Only Modestly Concordant With Their Child's Scores: An Effect of Child Catastrophizing. Clin J Pain 2019; 36:1-7. [PMID: 31599745 DOI: 10.1097/ajp.0000000000000772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Pediatric patients with chronic musculoskeletal conditions such as idiopathic scoliosis awaiting surgical correction can experience pain that interferes with their daily functioning. Reports of this interference are commonly gathered from patients through the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference Scale and through parent-proxy scores. However, the child and parent/caregiver reports vary. To provide appropriate treatment for young patients with pain, the nature of the discrepancies and under which circumstances the reports differ needs to be understood. This report offers new information on the level of concordance among parent and child report of pain interference within this patient population, and which parent and child characteristics may influence concordance rates. METHODS Youth (age=10 to 17 y) with a history of musculoskeletal disorders, including idiopathic scoliosis, under consideration for surgical correction of that scoliosis and parent/caregiver dyads (n=103) completed the PROMIS Pain Interference Scale during an orthopedic presurgical visit. The current data was taken from a larger study examining postsurgical pain among patients undergoing orthopedic surgical procedures to correct scoliosis. The purpose of the current study was to measure the degree of agreement between parent and child reports of pain interference and discovery of relationships among predictors of pain interference score correspondence among dyads. RESULTS Correspondence between parent/caregiver and child reports of pain interference was modest (intraclass correlation coefficient=0.530). In total, 46% of dyads had similar pain interference scores, whereas 24% of parents reported higher pain interference in comparison to their child, the remaining 30% reported lower pain interference in relation to their child's report. Among children where discrepancies appeared, using logistic regression models, only child catastrophizing scores were associated with differences in parent and child estimation of child's pain interference scores. No parental characteristics predicted discrepancies between dyad pain interference reports. DISCUSSION Parent-proxy and child reports generally correspond, but when discrepant, 24% of parents reported higher pain interference in relationship to the child report of pain interference and 31% noted less intense pain interference than their child's pain interference. Given these results, care should be taken when interpreting parent reports of child pain interference, especially when a child reports higher degrees of pain interference.
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16
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Holley AL, Palermo TM. Introduction to the Special Issue: Advances in Behavioral and Psychological Pain Research in Children: From Prevention Through Chronic Pain Management. J Pediatr Psychol 2019; 43:219-223. [PMID: 29579295 DOI: 10.1093/jpepsy/jsx156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 12/28/2017] [Indexed: 01/16/2023] Open
Affiliation(s)
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington
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Stone AL, Walker LS, Heathcote LC, Hernandez JM, Basch MC, Wilson AC, Simons LE. Somatic Symptoms in Pediatric Patients With Chronic Pain: Proposed Clinical Reference Points for the Children's Somatic Symptoms Inventory (Formerly the Children's Somatization Inventory). THE JOURNAL OF PAIN 2019; 20:932-940. [PMID: 30771592 DOI: 10.1016/j.jpain.2019.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/09/2019] [Accepted: 02/08/2019] [Indexed: 01/30/2023]
Abstract
Among youth with chronic pain, elevated somatic symptoms across multiple body systems have been associated with greater emotional distress and functional disability and could represent poor adaptation to pain. The Children's Somatic Symptoms Inventory (formerly the Children's Somatization Inventory) is commonly used to assess somatic symptoms in children. However, no studies have evaluated the clinical usefulness of the measure in the assessment of pediatric patients with chronic pain. This study evaluated the factor structure and clinical relevance of the 24-item Children's Somatic Symptoms Inventory (CSSI-24) in youth (n = 1,150) with mixed chronic pain complaints presenting to a tertiary pain clinic. The CSSI-24 total scores were equal or superior to factor scores as indicators of patients' clinical characteristics (functional disability, pain catastrophizing, fear of pain, and anxiety and depressive symptoms) and parental catastrophizing and protective responses. Tertile-derived clinical reference points for the CSSI-24 total score (<18, low; 19-31, moderate; ≥ 32, high) significantly differed on measures of clinical characteristics and parent factors. Controlling for age, sex, pain intensity, and primary pain complaint, the high somatic symptoms group exhibited significantly greater health care use compared with the moderate and low groups. The assessment of somatic symptoms in pediatric patients with chronic pain may provide useful information regarding patients' psychosocial risk and tendency to access health services. Perspective: Clinical reference points based on the CSSI-24 total scores meaningfully differentiated youth with chronic pain on measures of emotional distress, functioning, parent catastrophizing and protective responses, and health care use. Assessing somatic symptoms could provide useful information regarding a pediatric patient's psychosocial risk, tendency to access health services, and need for enhanced care coordination.
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Affiliation(s)
- Amanda L Stone
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - J Maya Hernandez
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Molly C Basch
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Anna C Wilson
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Laura E Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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