Sex differences in adolescent chronic pain and pain-related coping

Characterization of chronic pain, pain interference, and daily pain experiences in adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study

ABSTRACT

Although survivors of childhood cancer are at an increased risk, little is known about the prevalence of chronic pain, associated interference, and daily pain experiences. Survivors (N = 233; mean age = 40.8 years, range 22-64 years; mean time since diagnosis = 32.7 years) from the Childhood Cancer Survivor Study completed pain and psychosocial measures. Survivors with chronic pain completed 2-week, daily measures assessing pain and psychological symptoms using mHealth-based ecological momentary assessment. Multivariable-modified Poisson and linear regression models estimated prevalence ratio estimates (PR) and mean effects with 95% confidence intervals (CI) for associations of key risk factors with chronic pain and pain interference, respectively. Multilevel mixed models examined outcomes of daily pain and pain interference with prior day symptoms. Ninety-six survivors (41%) reported chronic pain, of whom 23 (24%) had severe interference. Chronic pain was associated with previous intravenous methotrexate treatment (PR = 1.6, 95% CI 1.1-2.3), respiratory (PR = 1.8, 95% CI 1.2-2.5), gastrointestinal (PR = 1.6, 95% CI 11.0-2.3), and neurological (PR = 1.5, 95% CI 1.0-2.1) chronic health conditions, unemployment (PR = 1.4, 95% CI 1.0-1.9) and clinically significant depression and anxiety (PR = 2.9, 95% CI 2.0-4.2), as well as a diagnosis of childhood Ewing sarcoma or osteosarcoma (PR = 1.9, 95% CI 1.0-3.5). Higher pain interference was associated with cardiovascular and neurological conditions, unemployment and clinical levels of depression and/or anxiety, and fear of cancer recurrence. For male, but not female survivors, low sleep quality, elevated anxiety, and elevated depression predicted high pain intensity and interference the next day. A substantial proportion of childhood cancer survivors experience chronic pain and significant associated interference. Chronic pain should be routinely evaluated, and interventions are needed.

Sex differences in pain catastrophizing and its relation to the transition from acute pain to chronic pain

BACKGROUND AND IMPORTANCE

Differences exist between sexes in pain and pain-related outcomes, such as development of chronic pain. Previous studies suggested a higher risk for pain chronification in female patients. Furthermore, pain catastrophizing is an important risk factor for chronification of pain. However, it is unclear whether sex differences in catastrophic thinking could explain the sex differences in pain chronification.

OBJECTIVES

The aim of this study was to examine sex differences in pain catastrophizing. Additionally, we investigated pain catastrophizing as a potential mediator of sex differences in the transition of acute to chronic pain.

DESIGN, SETTINGS AND PARTICIPANTS

Adults visiting one of the 15 participating emergency departments in the Netherlands with acute pain-related complaints. Subjects had to meet inclusion criteria and complete questionnaires about their health and pain.

OUTCOMES MEASURE AND ANALYSIS

The outcomes in this prospective cohort study were pain catastrophizing (short form pain catastrophizing) and pain chronification at 90 days (Numeric Rating Scale ≥ 1). Data was analysed using univariate and multivariable logistic regression models. Finally, stratified regression analyses were conducted to assess whether differences in pain catastrophizing accounted for observed differences in pain chronification between sexes.

MAIN RESULTS

In total 1,906 patients were included. Females catastrophized pain significantly more than males (p < 0.001). Multiple regression analyses suggested that pain catastrophizing is associated with pain chronification in both sexes.

CONCLUSIONS

This study reported differences between sexes in catastrophic cognitions in the development of chronic pain. This is possibly of clinical importance to identify high-risk patients and ensure an early intervention to prevent the transition from acute to chronic pain.

A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar

Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.

Perioperative Management and Outcomes in Patients With Autism Spectrum Disorder: A Retrospective Cohort Study

BACKGROUND

Autism spectrum disorder (ASD) is a neurocognitive disorder characterized by impairments in communication and socialization. There are little data comparing the differences in perioperative outcomes in children with and without ASD. We hypothesized that children with ASD would have higher postoperative pain scores than those without ASD.

METHODS

Pediatric patients undergoing ambulatory tonsillectomy/adenoidectomy, ophthalmological surgery, general surgery, and urologic procedures between 2016 and 2021 were included in this retrospective cohort study. ASD patients, defined by International Classification of Diseases-9/10 codes, were compared to controls utilizing inverse probability of treatment weighting based on surgical category/duration, age, sex, race and ethnicity, anesthetizing location, American Society of Anesthesiology physical status, intraoperative opioid dose, and intraoperative dexmedetomidine dose. The primary outcome was the maximum postanesthesia care unit (PACU) pain score, and secondary outcomes included premedication administration, behavior at induction, PACU opioid administration, postoperative vomiting, emergence delirium, and PACU length of stay.

RESULTS

Three hundred thirty-five children with ASD and 11,551 non-ASD controls were included. Maximum PACU pain scores in the ASD group were not significantly higher than controls (median, 5; interquartile range [IQR], 0-8; ASD versus median, 5; IQR, 0-8 controls; median difference [95% confidence interval {CI}] of 0 [-1.1 to 1.1]; P = .66). There was no significant difference in the use of premedication (96% ASD versus 95% controls; odds ratio [OR], 1.5; [95% CI, 0.9-2.7]; P = .12), but the ASD cohort had significantly higher odds of receiving an intranasal premedication (4.2% ASD versus 1.2% controls; OR, 3.5 [95% CI, 1.8-6.8]; P < .001) and received ketamine significantly more frequently (0.3% ASD versus <0.1% controls; P < .001). Children with ASD were more likely to have parental (4.9% ASD versus 1.0% controls; OR, 5 [95% CI, 2.1-12]; P < .001) and child life specialist (1.3% ASD versus 0.1% controls; OR, 9.9 [95% CI, 2.3-43]; P < .001) presence at induction, but were more likely to have a difficult induction (11% ASD versus 3.4% controls; OR, 3.42 [95% CI, 1.7-6.7]; P < .001). There were no significant differences in postoperative opioid administration, emergence delirium, vomiting, or PACU length of stay between cohorts.

CONCLUSIONS

We found no difference in maximum PACU pain scores in children with ASD compared to a similarly weighted cohort without ASD. Children with ASD had higher odds of a difficult induction despite similar rates of premedication administration, and significantly higher parental and child life specialist presence at induction. These findings highlight the need for future research to develop evidence-based interventions to optimize the perioperative care of this population.

Lower back pain in young climbers: a retrospective cross-sectional study

Objective

The popularity of sport climbing has been growing since its inclusion in the Olympic Games program, which led to more people practicing it on recreational, amateur, and professional levels. Strenuous climbing training sessions and competitions might lead to frequent and serious musculoskeletal injuries and complaints among competitive climbers. This study aimed to investigate the prevalence of low back pain (LBP) and to explore the influence of various risk factors on LBP in adolescent climbers.

Methods

The sample included 180 competitive climbers (46.6% males) aged 13-19 years competing in under-16 (48.3%) or under-20 categories. Data collection was carried out using the Nordic Musculoskeletal Questionnaire (NMQ) and the Graded Chronic Pain Scale (GCPS).

Results

A total of 74.4% of the entire sample of participants (male = 75%; female = 74%) reported lower back complaints throughout the past twelve months, and only 15.5% during the last seven days. A major part of complaints was classified as low intensity-low disability (Grade I, 62.8%; male = 72.6%; female = 54.2%). Under-20 competitors reported a small but significantly higher percentage of almost all NMQ measures compared to under-16 athletes.

Conclusions

This study found a relatively high prevalence of LBP, although complaints were of limited severity and did not affect climbers' regular training practice. Moreover, climbers did not differ in LBP prevalence according to sex, while climbers from the older age group reported higher complaints and seeking medical attention than younger climbers. Future studies should prospectively monitor the influence of climbing on LBP in youth climbers.

The role of functional disability and social support in psychological outcomes for individuals with pediatric hypermobile ehlers-danlos syndrome

Hypermobile Ehlers-Danlos syndrome (hEDS) includes physical symptoms of chronic pain, fatigue, gastrointestinal dysfunction, and joint subluxations/dislocations. This study aims to fill a research gap regarding the psychosocial well-being in pediatric hEDS by assessing relationships between functional disability, social support, and mental health. Increased functional disability is hypothesized to be associated with increased mental health challenges, specifically anxiety and depression, and general social support is hypothesized to moderate this relationship, such that higher perceived social support will mitigate the negative psychological impacts of functional disability. Gender's influence on mental health in pediatric hEDS is also explored. Thirty-four youth with pediatric hEDS recruited from a United States Midwest multidisciplinary genetics clinic completed self-report questionnaires. Results demonstrate associations between functional disability and mental health, and social support and mental health independently; however, moderation was not found. Functional disability and social support each have a unique influence on the mental health of children with pediatric hEDS and should each receive clinical attention. Exploratory analyses into the influence of gender provide a groundwork for future studies.

Exploring the difference between men and women in physical functioning: How do sociodemographic, lifestyle- and health-related determinants contribute?

Background

To explore whether differences between men and women in the sensitivity to (strength of the association) and/or in the exposure to determinants (prevalence) contribute to the difference in physical functioning, with women reporting more limitations.

Methods

Data of the Doetinchem Cohort Study was used (n = 5856, initial ages 26–70 years), with follow-up measurements every 5 years (up to 20). Physical functioning (subscale SF-36, range:0–100), sex (men or women) and a number of socio-demographic, lifestyle- and health-related determinants were assessed. Mixed-model multivariable analysis was used to investigate differences between men and women in sensitivity (interaction term with sex) and in exposure (change of the sex difference when adjusting) to determinants of physical functioning.

Results

The physical functioning score among women was 6.55 (95%CI:5.48,7.61) points lower than among men. In general, men and women had similar determinants, but pain was more strongly associated with physical functioning (higher sensitivity), and also more prevalent among women (higher exposure). The higher exposure to low educational level and not having a paid job also contributed to the lower physical functioning score among women. In contrast, current smoking, mental health problems and a low educational level were more strongly associated with a lower physical functioning score among men and lower physical activity and higher BMI were more prevalent among men.

Conclusions

Although important for physical functioning among both men and women, our findings provide no indications for reducing the difference in physical functioning by promoting a healthy lifestyle but stress the importance of differences in pain, work and education.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03216-y.

Testing a Combined Cognitive Bias Hypothesis of Pain and Pain-related Worry in Young People

Cognitive factors are thought to contribute and maintain pain experiences in young people. However, most of these factors have been assessed in isolation. Considering more than 1 cognitive factor could increase explanatory power and identify multiple targets for intervention. Here, we tested a Combined Cognitive Bias Hypothesis (CCBH) that suggests information-processing factors associate with each other and exert either additive and/or interactive influences on pain outcomes. We conducted secondary analysis of data from 243 adolescents aged 16 to 19 years, who had completed a task measuring pain-related attention control impairments (emotion-priming visual search task) and a task measuring biased interpretations towards threatening cues (Adolescent Interpretation of Bodily Threat task). These young people also completed measures of recent pain experiences and pain catastrophizing, which served as primary and secondary outcomes, respectively. Regression analyses revealed that difficulties with attention control (following presentation of pain-related stimuli) and tendencies to endorse threatening interpretations of ambiguous situations had significant additive effects on both pain outcomes. However, correlations between these factors were non-significant. They also did not interact to influence pain outcomes. These findings require replication in broader age ranges and clinical samples but potentially suggest that, measuring multiple cognitive factors increases explanatory power of youth pain outcomes. PERSPECTIVE: Weak attention control following exposure to pain cues and tendencies to endorse threat interpretations, uniquely and additively associate with self-reported pain experiences and pain catastrophizing in community youth. Measuring several cognitive factors simultaneously could improve our ability to explain pain outcomes in adolescent populations.

No Gender Differences in Pain Perception and Medication after Lumbar Spine Sequestrectomy—A Reanalysis of a Randomized Controlled Clinical Trial

Background: Gender issues have received increasing attention in clinical research of the past years, and biological sex has been introduced as a moderating variable in experimental pain perception. However, in clinical studies of acute pain and gender, there are conflicting results. In particular, there are limited data on the impact of gender differences after spinal sequestrectomy. The aim of this work is to examine gender differences in postoperative pain and pain medication consumption in an inpatient clinical setting. Methods: Data of a completed double-blind RCT was subdivided by gender and reanalyzed by means of an analysis of variance in repeated measures. Outcomes included pain severity measured on a VAS, affective (SES-A) and sensory pain perception (SES-S) and morphine equivalent doses (MED) of analgesics after spinal sequestrectomy. Results: In total, 42 female (47.73%) and 46 male (52.27%) patients were analyzed. No differences in pain severity (VAS: Gender × Time F = 0.35; (df = 2, 86); p = 0.708), affective and sensory pain perception (SES-A: Gender × Time F = 0.08; (df = 2, 86); p = 0.919; SES-S: Gender × Time F = 0.06; (df = 2, 86); p = 0.939) or post-operative opioid use between men and women (MEDs: Gender × Time F = 1.44; (df = 2, 86); p = 0.227) could be observed. Conclusions: This reanalysis of an RCT with respect to gender differences is to our knowledge the first attempt to investigate the role of gender in pain perception and medication after lumbar spine sequestrectomy. In contrast to other studies, we were not able to show significant differences between male and female patients in all pain-related outcomes. Apart from well-established pain management, psychological reasons such as gender-specific response biases or the observer effect might explain our results. Trial registration: The study was registered as a regulatory phase IV study at the German Clinical Trials Register (DRKS), an open-access online register for clinical trials conducted in Germany (Reg-No: DRKS00007913).

Prevalence and Impact of Dysmenorrhea Among University Students in Ireland

OBJECTIVE

Primary dysmenorrhea (PD), or painful menstruation, is a common gynecological condition that can cause intense pain and functional disability in women of reproductive age. As a nonmalignant condition, PD is relatively understudied and poorly managed. The purpose of this study was to estimate the prevalence and impact of PD among third-level students in Ireland.

DESIGN

A cross-sectional observational design was used.

METHODS

Students (n = 892; age range = 18-45 years) completed an online survey on menstrual pain characteristics, pain management strategies, pain interference, and pain catastrophizing.

RESULTS

The prevalence of PD was 91.5% (95% confidence interval = 89.67-93.33). Nonpharmacological management strategies were most popular (95.1%); of these, heat application (79%), rest (60.4%), hot shower/bath (40.9%), and exercise (25.7%) were most common. Perceived effectiveness of these methods varied between participants. Analgesic use was also common (79.5%); of these, paracetamol was most used (60.5%) despite limited perceived effectiveness. Pain catastrophizing was a significant predictor of variance in both pain intensity and pain interference scores such that those with higher pain catastrophizing scores reported more intense pain and greater interference with daily activities and academic demands.

CONCLUSIONS

This article presents the first investigation into PD among third-level students in Ireland. Poorly managed menstrual pain may impact functional ability across several domains. Future research should focus on improving menstrual pain management education and support and promoting menstrual health literacy for women affected by PD.

Lifetime Prevalence of Nonspecific Low Back Pain in Adolescents: A Cross-sectional Epidemiologic Survey

BACKGROUND

Many nonconclusive studies have been conducted on low back pain (LBP) in adolescents and associated factors.

OBJECTIVE

The aim was to assess the lifetime prevalence and associated factors of LBP in adolescents.

MATERIALS AND METHODS

A questionnaire was administered in high school students (14-19-yr-old participants) in Veneto region (Italy). The self-administered, structured questionnaire included anthropometric data; psychologic factors and lifestyle; presence, intensity, and family history of LBP; referral to professional health care for LBP; and a short version of the International Physical Activity Questionnaire.

RESULTS

A total of 6281 adolescents were recruited; 5204 questionnaires were included in the final analysis. A total of 2549 (48.98%) students reported one or more LBP episodes and 723 (13.89%) reported nonspecific disabling lumbar pain (i.e., no underlying pathology); 1040 (41.11%) subjects with LBP consulted a healthcare professional. A significant association emerged for LBP with sex (female), positive family history, time spent sitting or using electronic devices, sleep deprivation (<5 hrs/night), and low level of physical activity.

CONCLUSION

In a large sample of adolescents, LBP lifetime prevalence is high and often associated with disabling pain and sedentary lifestyle, requiring professional care. These findings may support the development of prevention and treatment strategies of LBP in adolescents, reducing the risk of developing chronic pain.

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

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

The predictors, barriers and facilitators to effective management of acute pain in children by emergency medical services: A systematic mixed studies review

We aimed to identify predictors, barriers and facilitators to effective pre-hospital pain management in children. A segregated systematic mixed studies review was performed. We searched from inception to 30-June-2020: MEDLINE, CINAHL Complete, PsycINFO, EMBASE, Web of Science Core Collection and Scopus. Empirical quantitative, qualitative and multi-method studies of children under 18 years, their relatives or emergency medical service staff were eligible. Two authors independently performed screening and selection, quality assessment, data extraction and quantitative synthesis. Three authors performed thematic synthesis. Grading of Recommendations Assessment, Development and Evaluation and Confidence in the Evidence from Reviews of Qualitative Research were used to determine the confidence in cumulative evidence. From 4030 articles screened, 78 were selected for full text review, with eight quantitative and five qualitative studies included. Substantial heterogeneity precluded meta-analysis. Predictors of effective pain management included: 'child sex (male)', 'child age (younger)', 'type of pain (traumatic)' and 'analgesic administration'. Barriers and facilitators included internal (fear, clinical experience, education and training) and external (relatives and colleagues) influences on the clinician along with child factors (child's experience of event, pain assessment and management). Confidence in the cumulative evidence was deemed low. Efforts to facilitate analgesic administration should take priority, perhaps utilising the intranasal route. Further research is recommended to explore the experience of the child. Registration: PROSPERO CRD42017058960.

Neck and shoulder pain in adolescents seldom occur alone: Results from the Norwegian Ungdata Survey

BACKGROUND

No previous studies have investigated the prevalence of co-occurring neck/shoulder pain, other musculoskeletal pain, headache and depressive symptoms in adolescents. This study aimed to describe the prevalence of isolated neck/shoulder pain and the co-occurrence of neck/shoulder pain with other musculoskeletal pain, headache and depressive symptoms in Norwegian adolescents.

METHODS

This is a cross-sectional study using data from the Norwegian Ungdata survey (2017-2019). Adolescents from almost all municipalities in Norway answered a comprehensive questionnaire, including physical complaints. We investigated the prevalence of self-reported neck/shoulder pain in isolation and neck/shoulder pain in combination with other musculoskeletal pain, headache and depressive symptoms. The results were presented with per cent and stratified by school level and sex.

RESULTS

In total, 253,968 adolescents (50% girls) participated in the study, of which 56.5% were from lower secondary school. The total prevalence of neck/shoulder pain was 24%, but only 5% reported isolated neck/shoulder pain. Among students reporting neck/shoulder pain, half of them also reported other musculoskeletal pain, and 50% of the boys and 70% of the girls reported co-occurring headache. Depressive symptoms were reported in 28% of the boys and 45% of the girls with neck/shoulder pain.

CONCLUSION

Neck/shoulder pain in adolescents is seldom isolated, but seems to co-occur with headache, other musculoskeletal pain and depressive symptoms. Researchers and clinicians should keep a broader health perspective in mind when approaching adolescents with neck/shoulder pain.

SIGNIFICANCE

One in five adolescents reported neck/shoulder pain in this large population-based study of Norwegian adolescents. A majority of adolescents reported neck/shoulder pain in co-occurrence with other musculoskeletal pain, headache and depression. Researchers and clinicians should assess these comorbidities when assessing adolescents with neck/shoulder pain.

Chronic Pain after Open Appendectomy and Its Effects on Quality of Life in Children Aged 8-18 Years

Background

Chronic postsurgical pain is an important problem for both children and adults. This study aims to investigate the prevalence of chronic postappendectomy pain (CPAP) in children and its social and physical effects.

Methods

This prospective observational study was conducted on children aged 8-18 years who had undergone open appendectomies. In the sixth month after the surgical procedure, the presence of chronic pain was examined in the lower right abdominal area. CPAP and its effects on children's daily life activities were assessed using the numeric rating scale (NRS) and the Pediatric Quality of Life Scale (PedsQL).

Results

Analysis was performed on 158 children, 97 of whom were boys (61.4%) and 61 were girls (38.6%). The average age was 12.8 ± 3 years, the average NRS was 4.48 ± 1.1, and the average scar length was 6.09 ± 1.6 cm. Twenty-nine children described CPAP, and its prevalence at six months after the surgery was 18.4%. Of these, 16 (55.2%) complained of pain only during exercise and 13 (44.8%) experienced pain while resting. The rate of CPAP was significantly higher in girls. Female gender and longer scar length were associated with the development of chronic pain. The PedsQL scores from the children's self-reports and their parents' reports were significantly lower for children who described CPAP as compared to those without CPAP.

Conclusion

CPAP occurs quite frequently in children, especially in girls, and negatively affects children's quality of life.

Under Pressure to Perform: Impact of Academic Goal Orientation, School Motivational Climate, and School Engagement on Pain and Somatic Symptoms in Adolescents

OBJECTIVES

Various academic factors are known to influence pain and somatic symptoms in adolescents, but the roles of academic goal orientation, school motivational climate, and school engagement are unknown. This study examined how these understudied academic factors are associated with adolescent pain and somatic symptoms and whether sex moderates the relations.

MATERIALS AND METHODS

High school students (n=90) from a high-achieving community completed questionnaires assessing academic variables, various pain characteristics, and somatic symptoms.

RESULTS

The majority of adolescents (67%) experienced pain and somatic symptoms in the past month, with 56% reporting multisite pain and 58% reporting at least 1 severe somatic symptom. Headache and abdominal pain were the most frequently reported "most bothersome" pains, and pain was rated, on average, as moderately severe, typically occurring several times per month, and was primarily chronic in nature (duration, ≥3 mo). Higher levels of ego goal orientation and perceived performance motivational climate were associated with more somatic symptoms, and ego goal orientation was also associated with more intense and frequent pain. Alternatively, greater school engagement was associated with fewer somatic symptoms. Task goal orientation and mastery motivational climate were unassociated with all pain and somatic symptom outcomes.

DISCUSSION

This study demonstrates that adolescents from a high-achieving community report more somatic symptoms and pain when they are less engaged in school and when their academic focus is on grades and outperforming peers. Results suggest that de-emphasizing competition and performance outcomes may support physical well-being in adolescents.

A Phenomenological Exploration of the Personal Implications of Female Adolescents Living With Chronic Pain

INTRODUCTION

Chronic pain (CP) negatively impacts everyday previously taken-for-granted activities resulting in considerable psychosocial stress for the individual. Qualitative research in pediatric CP is limited despite the considerable influence CP has on the process of establishing one's personal identity during these formative years and invites the opportunity to understand how CP affects these young individuals from their perspective. The objective of the study was to inquire into the experiences of female adolescents living with CP in order to enhance our understanding of how CP affects their personal lives.

METHOD

We used an interpretive phenomenological approach; two researchers interviewed eight female patients of the Montreal Children's Hospital Chronic Pain Management Clinic (aged 14-17 years) for one session each.

RESULTS

Self-reported factors that improved these female adolescents' personal life included having engaging hobbies, accepting the incurability of CP, and envisioning a fulfilling future.

DISCUSSION

The findings from this study suggest a need to orient CP-related services around goals and interests that female adolescents living with CP set for themselves in order to improve their perceived quality of life.

Distraction from pain: The role of selective attention and pain catastrophizing

Background

Previous research has demonstrated the efficacy of cognitive engagement in reducing concurrent pain. However, little is known about the role of individual differences in inhibitory control abilities and negative pain‐related cognitions in modulating the magnitude of this type of distraction from pain.

Methods

In a pain distraction paradigm, 41 participants completed a working memory task with both a demanding high load condition (2‐back) and an easy low load condition (0‐back), while receiving warm or painful thermal stimuli to their left forearm. To control for individual differences in sensitivity to pain and perceived task difficulty, nociceptive stimulus intensity and task speed were individually calibrated. Additionally, participants completed a set of cognitive inhibition tasks (flanker, go/nogo, Stroop) and questionnaires about negative pain‐related cognitions (fear of pain, pain catastrophizing) prior to the distraction paradigm.

Results

As expected, engaging in the high load condition significantly reduced perceived intensity and unpleasantness of nociceptive stimuli, compared to the low load condition. The size of the distraction effect correlated significantly with better cognitive inhibition and selective attention abilities, as measured by the flanker task. A moderation analysis revealed a significant interaction between pain catastrophizing and performance in the flanker task in predicting the distraction effect size: Participants who performed well on the flanker task showed more pain reduction, but only when they were average to high pain catastrophizers.

Conclusions

Selective attention abilities and pain catastrophizing seem to be important factors in explaining individual differences in the size of the analgesic response to a distractive task.

Significance

Understanding which factors influence the effectiveness of cognitive engagement in distracting from pain could help to optimize its therapeutic application in patient care. This study shows that a complex interplay of cognitive inhibition abilities, specifically selective attention, and negative pain‐related cognitions, such as pain catastrophizing, modulate the magnitude of the distraction effect.

Mediators of Pain and Physical Function in Female and Male Patients with Chronic Pain

Purpose

Chronic pain is often multifactorial and accompanied by psychological distress, catastrophizing thoughts, reduced physical function, and socio-economic worries. In this explorative study, we investigated potential mediators in the relationships of psychological and demographic variables with chronic pain and physical function in women and men.

Patients and Methods

The study included 301 patients admitted to a multidisciplinary pain clinic. Prior to their first consultation, patients completed a questionnaire including items on demographics (age, education, occupational and financial situation), catastrophizing thoughts, psychological distress, pain intensity, and physical function. Hierarchical multiple regression analyses examined demographic and psychological factors associated with pain intensity and physical function. Mediation and reversed mediation models were tested and developed based on calculated relations in the regression analyses between demographic, psychological, pain intensity and physical function variables.

Results

Fifty-eight percent were females and mean age 43.8 and 46.0 years for women and men, respectively. In the regression analyses, psychological factors accounted better for pain intensity than demographic variables, while physical function was best accounted for by demographic variables. Among women, catastrophizing thoughts mediated significantly the relationships between education and pain intensity, and between education and physical function. Psychological distress mediated significantly the relationships between financial situation and pain intensity, and between financial situation and physical function in women. In men, the only significant mediation model was psychological distress mediating the relationship between financial situation and pain intensity. Some of the reversed models revealed indirect effects, indicating bidirectionality.

Conclusion

The results indicate that there might be gender-specific mediators in how demographic variables are associated with pain intensity and physical function. This suggests an awareness among clinicians of potential gender-specific factors mediating pain problems, and the need for a gender-specific, multidisciplinary approach in the treatment of chronic pain.

The relationship between pain and associated characteristics of chronic ankle instability: A retrospective study

BACKGROUND

Up to 74% of people with a history of ankle sprain develop chronic ankle instability (CAI). One commonly reported residual impairment is ankle pain; however, it has not been included in models or inclusion criteria for CAI. We investigated the prevalence of pain in people with CAI and the association between presence of pain and other CAI characteristics.

METHODS

Retrospective data from 1147 participants with CAI (age 26.6 ± 10.7 years, 59% female) were collated from previous studies that used the Cumberland Ankle Instability Tool as an assessment tool. Pain was assessed from Item 1 of the Cumberland Ankle Instability Tool, which asks participants about ankle pain. Responses were divided into 3 categories: pain during daily activities, pain during moderate/vigorous physical activities, and no pain. The presence of pain was analyzed with descriptive statistics, the correlation between pain category and CAI characteristics was analyzed by χ² tests and factors associated with each pain category were analyzed by logistic regression.

RESULTS

Among the participants, 60.1% (n = 689) reported ankle pain. Of all participants, 12.4% (n = 142) reported pain during daily activities, 47.7% (n = 547) reported pain during moderate/vigorous physical activities, and 39.9% (n = 458) reported no pain. There was a strong association between ankle instability and ankle pain (χ² = 122.2, p < 0.001, OR = 5.38, 95% confidence interval (CI): 3.84-7.53). Perceived ankle instability, age and unilateral ankle sprains were independently associated with pain (ankle instability: χ² = 43.29, p < 0.001; age: χ² = 30.37, p < 0.001; unilateral ankle sprains: χ² = 6.25, p < 0.05). There was no significant difference in the presence of pain between genders.

CONCLUSION

The prevalence of pain in people with CAI was high and was related to perceived ankle instability. Number of sprains, age, gender and unilateral or bilateral sprain did not modify this result except for the first pain category (pain during daily activities). There is large gap in current knowledge about the impact of pain in people with CAI, and this topic needs further investigation.

Truncal blocks and teenager postoperative pain perception after laparoscopic surgical procedures

Introduction:

The prevalence of moderate to severe pain is high in hospitalized teenage patients admitted to surgical services.

Objectives:

The aims of this study were to determine (1) the preoperative and postoperative factors influencing teenager postoperative pain perception; and (2) suffering, defined as the patient's anxiety, pain catastrophizing thoughts, and mood.

Methods:

Data were collected from medical records and from 2 medical interviews at the time of enrollment and postoperative day 1. Stepwise linear regression was conducted to assess variables that predicted teenagers' pain scores and suffering.

Results:

Two hundred two patients (mean age = 13.8 years, SD = 1.9), 56.4% females, scheduled for laparoscopic surgical procedures completed the study. The variables found to be significant predictors of pain response in teenagers were pain on the day of surgery (6.81, 95% confidence interval [CI] = 0.08–13.55, P = 0.05) and use of regional anesthesia (single-injection rectus sheath, transversus abdominis plane, and paravertebral nerve blocks) (−6.58, 95% CI = −12.87 to −0.30, P = 0.04). The use of regional anesthesia was found to predict mood responses (all patients: 2.60, 95% CI = 0.68–4.52, P = 0.01; girls: 3.45, 95% CI = 0.96–5.93, P = 0.01; 14–17-year-old teens: 2.77, 95% CI = 0.44–5.10, P = 0.02) and to negatively predict catastrophic thoughts among all patients as a group (−4.35, 95% CI = −7.51 to −1.19, P = 0.01) and among 14- to 17-year-old teens (−5.17, 95% CI = −9.44 to −0.90, P = 0.02).

Conclusion:

A comprehensive pain approach that includes truncal blocks may improve teenagers' postoperative pain control after laparoscopic surgeries.

Catastrophizing, pain, and functional outcomes for children with chronic pain: a meta-analytic review

Pediatric chronic pain is associated with numerous negative outcomes including increased physical disability, increased rates of depression and anxiety, and decreased quality of life (QOL). Pain catastrophizing-broadly conceptualized as including rumination, magnification, and helplessness cognitions surrounding one's pain-has been linked with poor functional outcomes in children with chronic pain. Pain catastrophizing in pediatric chronic pain is often considered a key factor on which to focus treatment efforts. However, absent a systematic review that integrates the relevant literature, this call for routine assessment and targeted treatment may be premature. This study aimed to: (1) meta-analytically quantify the relationship between catastrophizing and pain and functional/psychosocial outcomes (functional disability/physical functioning, anxiety, depression, and QOL) in children with chronic pain, and (2) examine potential moderators of these relationships. Using a random-effects model, a total of 111 effect sizes from 38 studies were analyzed. Effect sizes ranged from medium to large, with anxiety, depression, and QOL demonstrating a strong association with catastrophizing. Pain intensity and physical disability had a moderate association with catastrophizing. These relationships were robust, minimizing potential publication bias. None of the examined moderators were significant. The strong relationships found between catastrophizing and anxiety, depression, and QOL suggest that successfully intervening on catastrophizing could have far reaching implications in improving pain outcomes in pediatric chronic pain.

Gender, genetics, and analgesia: understanding the differences in response to pain relief

Genetic variations and gender contribute significantly to the large interpatient variations in opioid-related serious adverse effects and differences in pain relief with other analgesics. Opioids are the most commonly used analgesics to relieve moderate-to-severe postoperative pain. Narrow therapeutic index and unexplained large interpatient variations in opioid-related serious adverse effects and analgesia negatively affect optimal perioperative outcomes. In surgical, experimental, chronic, and neuropathic pain models, females have been reported to have more pain than males. This review focuses on literature evidence of differences in pain relief due to multiple genetic variations and gender of the patient.

Sex, Gender, and Orofacial Pain

This review examines gender prevalence in orofacial pain to elucidate underlying factors that can explain such differences. This review highlights how gender affects (1) the association of hormonal factors and pain modulation; (2) the genetic aspects influencing pain sensitivity and pain perception; (3) the role of resting blood pressure and pain threshold; and (4) the impact of sociocultural, environmental, and psychological factors on pain.

Cuff Pressure Pain Detection Is Associated with Both Sex and Physical Activity Level in Nonathletic Healthy Subjects

Purpose

The aim of this study was to evaluate pressure pain sensitivity on leg and arm in 98 healthy persons (50 women) using cuff algometry. Furthermore, associations with sex and physical activity level were investigated.

Method

Normal physical activity level was defined as Godin Leisure-Time Exercise Questionnaire (GLTEQ) score ≤ 45 and high activity level as GLTEQ > 45. A pneumatic double-chamber cuff was placed around the arm or leg where a single chamber was inflated. The cuff inflation rate (1 kPa/s) was constant, and pain intensity was registered continuously on a 10 cm electronic visual analogue scale (VAS). The pain detection threshold (PDT) was defined as when the pressure was perceived as painful, and pain tolerance (PTT) was when the subject terminated the cuff inflation. For PTT, the corresponding VAS score was recorded (VAS-PTT). The protocol was repeated with two chambers inflated.

Result

Only single cuff results are given. For women compared with men, the PDT was lower when assessed in the arm ( P = 0.002), PTTs were lower in the arm and leg ( P < 0.001), and the VAS-PTT was higher in the arm and leg ( P < 0.033). Highly active participants compared with less active had higher PDT ( P = 0.027) in the leg. Women showed facilitated spatial summation ( P < 0.014) in the arm and leg and a steeper VAS slope (i.e., the slope of the VAS pressure curve between PDT and PPT) in the arm and leg ( P < 0.003).

Conclusion

This study indicates that reduced pressure pain sensitivity is associated both with male sex and physical activity level.

Analysis of factors affecting baseline SF-36 Mental Component Summary in Adult Spinal Deformity and its impact on surgical outcomes

OBJECTIVES

To identify the factors that affect SF-36 mental component summary (MCS) in patients with adult spinal deformity (ASD) at the time of presentation, and to analyse the effect of SF-36 MCS on clinical outcomes in surgically treated patients.

METHODS

Prospectively collected data from a multicentric ASD database was analysed for baseline parameters. Then, the same database for surgically treated patients with a minimum of 1-year follow-up was analysed to see the effect of baseline SF-36 MCS on treatment results. A clinically useful SF-36 MCS was determined by ROC Curve analysis.

RESULTS

A total of 229 patients with the baseline parameters were analysed. A strong correlation between SF-36 MCS and SRS-22, ODI, gender, and diagnosis were found (p < 0.05). For the second part of the study, a total of 186 surgically treated patients were analysed. Only for SF-36 PCS, the un-improved cohort based on minimum clinically important differences had significantly lower mean baseline SF-36 MCS (p < 0.001). SF-36 MCS was found to have an odds ratio of 0.914 in improving SF-36 PCS score (unit by unit) (p < 0.001). A cut-off point of 43.97 for SF-36 MCS was found to be predictive of SF-36 PCS (AUC = 0.631; p < 0.001).

CONCLUSIONS

The factors effective on the baseline SF-36 MCS in an ASD population are other HRQOL parameters such as SRS-22 and ODI as well as the baseline thoracic kyphosis and gender. This study has also demonstrated that baseline SF-36 MCS does not necessarily have any effect on the treatment results by surgery as assessed by SRS-22 or ODI.

LEVEL OF EVIDENCE

Level III, prognostic study.

Pain and its Impact on the Functional Ability in Children Treated at the Children's Cancer Center of Lebanon

PURPOSE

The purpose of this study was to describe the characteristics of pain in children under treatment at the Children Cancer Centre of Lebanon at the American University of Beirut Medical Centre. Design and Methods A cross-sectional correlational survey was used. The Adolescent Pediatric Pain Tool and the Functional Disability Inventory were used to examine the characteristics of pain experienced in a consecutive sample of children treated at the CCCL and its impact on their functional abilities.

RESULTS

The mean age of the 62 participants was 12.3 (SD 2.9). The overall mean pain intensity rating for the sample was 5.06 (SD 1.87) on a 10 cm Word Graphic Rating Scale. More than one-half of the children in the sample (57.4%) reported having pain "sometimes" with a median duration of two hours per pain episode. The most frequently reported locations of pain were the forehead, the abdomen, and the lower back. For the most part, the children used sensory words to describe their pain experience. The children reported moderate levels of functional disability (mean FDI score 25.04, SD 13.81). Multivariable linear regression analysis identified frequency, duration, location, use of affective descriptors, and treatments as statistically significant predictors of pain intensity.

CONCLUSION

Regrettably, the findings reported attest once again to unrelieved pain in a pediatric oncology population.

PRACTICE IMPLICATIONS

Policy makers can contribute to pain control by introducing legislation and national policies to ensure adequate pain management for children with cancer in Lebanon.

Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review

In this meta-analytic and narrative review, we examine several overarching issues related to the study of coping, emotion regulation, and internalizing and externalizing symptoms of psychopathology in childhood and adolescence, including the conceptualization and measurement of these constructs. We report a quantitative meta-analysis of 212 studies (N = 80,850 participants) that measured the associations between coping and emotion regulation with symptoms of internalizing and externalizing psychopathology. Within the meta-analysis we address the association of broad domains of coping and emotion regulation (e.g., total coping, emotion regulation), intermediate factors of coping and emotion regulation (e.g., primary control coping, secondary control coping), and specific coping and emotion regulation strategies (e.g., emotional expression, cognitive reappraisal) with internalizing and externalizing symptoms. For cross-sectional studies, which made up the majority of studies included, we examine 3 potential moderators: age, measure quality, and single versus multiple informants. Finally, we separately consider findings from longitudinal studies as these provide stronger tests of the effects. After accounting for publication bias, findings indicate that the broad domain of emotion regulation and adaptive coping and the factors of primary control coping and secondary control coping are related to lower levels of symptoms of psychopathology. Further, the domain of maladaptive coping, the factor of disengagement coping, and the strategies of emotional suppression, avoidance, and denial are related to higher levels of symptoms of psychopathology. Finally, we offer a critique of the current state of the field and outline an agenda for future research. (PsycINFO Database Record

Physical activity level at work and risk of chronic low back pain: A follow-up in the Nord-Trøndelag Health Study

Background

Physical activity in leisure time seems to reduce the risk of low back pain, but it is not known whether occupational activity, as recorded in a representative working population, produces a higher or lower risk.

Objective

To study associations between physical activity level at work and risk of chronic low back pain.

Methods

Associations were examined in a Norwegian prospective study using data from the HUNT2 and HUNT3 surveys carried out in the whole county of Nord-Trøndelag. Participants were 7580 women and 7335 men who supplied information about physical activity level at work. Levels considered were sedentary work, work involving walking but no heavy lifting, work involving walking and heavy lifting, and particularly strenuous physical work. Nobody in the cohort was affected by chronic low back pain at baseline. After 11 years, participants reported whether they suffered from chronic low back pain. Generalized linear modelling with adjustment for potential confounders was applied to assess associations with risk factors.

Results

In age-adjusted analyses both women and men showed statistically significant associations between physical activity at work and risk of chronic low back pain, suggesting positive relationships. For particularly strenuous physical work the relative risk of chronic low back pain was 1.30 (95% CI: 1.00–1.71) in women and 1.36 (95% CI 1.17–1.59) in men, compared to sedentary work. Women still showed a general association with activity level after adjustment for education, leisure time physical activity, BMI, smoking and occupational category. In men, the higher risk was only maintained for particularly strenuous work.

Conclusion

In this cohort, women had a higher risk of chronic low back pain with work involving walking and heavy lifting or particularly strenuous work, compared to sedentary work. Men participating in particularly strenuous work also experienced a higher risk of chronic low back pain.

The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain

Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed.

PERSPECTIVE

This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.

Variations in Pain, Sleep, and Activity During Hospitalization in Children With Cancer

This study examines the pain experiences of children with cancer during hospitalization. A descriptive design with repeated measures was used to describe the location, intensity, and quality of pain, pain medications, amount of pain relief, and perceptions of sleep and activity during hospitalization. Data were collected once daily from the day of admission for up to a maximum of 5 consecutive days during hospitalization. Results show that more than half of the patients (27 of 49 patients) indicated they were having pain. Eleven patients (22.4%) had mild pain (mean = 2.3 ± 0.9 SD; range, 0.3-3.6), 10 (20.4%) had moderate pain (mean = 5.3 ± 0.2 SD; range, 5.0-5.5), and 6 (12.2%) had severe pain (mean = 7.6 ± 1.3 SD; range, 6.5-10.0). The highest pain intensity ratings occurred on day 1. Overall, most patients reported good relief after pain medications during hospitalization. Consistent assessment and implementation of pain interventions within the 24 hours of admission is recommended, with particular attention to persistent pain after painful procedures.

Sex and Gender Differences in Central Nervous System-Related Disorders

There are important sex differences in the brain that seem to arise from biology as well as psychosocial influences. Sex differences in several aspects of human behavior and cognition have been reported. Gonadal sex steroids or genes found on sex chromosomes influence sex differences in neuroanatomy, neurochemistry and neuronal structure, and connectivity. There has been some resistance to accept that sex differences in the human brain exist and have biological relevance; however, a few years ago, it has been recommended by the USA National Institute of Mental Health to incorporate sex as a variable in experimental and clinical neurological and psychiatric studies. We here review the clinical literature on sex differences in pain and neurological and psychiatric diseases, with the aim to further stimulate interest in sexual dimorphisms in the brain and brain diseases, possibly encouraging more research in the field of the implications of sex differences for treating these conditions.

Chronic multisite pain in adolescent girls and boys with emotional and behavioral problems: the Young-HUNT study

The aim of this study was to assess the prevalence of chronic multisite pain with high disability in relation to emotional or behavioral problems and resilience factors in adolescence. A second aim was to investigate if resilience factors could attenuate the associations between psychiatric symptoms and chronic multisite pain. The study was based on a large cross-sectional study carried out in Norway between 2006 and 2008 and included 7,070 adolescents aged 13-19 years. Chronic multisite pain was defined as pain at least once a week during the last 3 months, scoring high on a disability index, and occurring in three or more locations. Chronic multisite pain was prevalent among adolescents with high scores (>85%) for anxiety/depression, social anxiety, conduct or attention problems (22.8-31.0 for girls, 8.8-19.0% for boys). Several coexistent psychiatric symptoms increased the prevalence of chronic multisite pain for both girls and boys. Resilience factors, including high self-esteem, seldom feeling lonely, and high scores for family cohesion or social competence, were associated with a lower prevalence and markedly attenuated the association between psychiatric symptoms and chronic multisite pain. Psychiatrists should be careful to assess and treat comorbid chronic pain in adolescents with emotional or behavioral problems.

Factors Associated with Sexual Orientation and Gender Disparities in Chronic Pain Among U.S. Adolescents and Young Adults

OBJECTIVE

This research investigated factors associated with sexual orientation disparities in chronic pain frequency among youth.

METHOD

Data were analyzed from 4534 female and 3785 male youth from Waves I-IV (1995-2009) of the U.S. National Longitudinal Study of Adolescent to Adult Health. Gender-stratified weighted logistic regression models controlled for sociodemographic characteristics and included sexual orientation (primary predictor) and frequency of three types of chronic pain (outcomes). Models with sexual orientation only were compared to models with factors hypothesized to increase or decrease risk of pain. Significant odds ratios (OR) for chronic pain frequency (daily/weekly vs. rarely) with confidence intervals (CI) and associated factors are reported.

RESULTS

Compared to same-gender heterosexual females, mostly heterosexuals were more likely to report headaches (OR=1.40, CI=1.09, 1.79) and mostly heterosexuals and bisexuals were more likely to report muscle/joint pain (mostly heterosexual OR=1.69, CI=1.29, 2.20; bisexual OR=1.87, CI=1.03, 3.38). Compared to same-gender heterosexual males, gay males were more likely to report headaches (OR=2.00, CI=1.06, 3.82), but less likely to report muscle/joint pain (OR=0.28, CI=0.11, 0.74). Significant disparities were attenuated by up to 16% when associated factors were added to the model.

CONCLUSION

Sexual orientation disparities in chronic pain were partially explained by associated factors, but more research is needed to develop intervention and prevention strategies.

Chronic pain in children after cardiac surgery via sternotomy

INTRODUCTION

Chronic pain is common after sternotomy in adults with reported prevalence rates of 20-50%. So far, no studies have examined whether children develop chronic pain after sternotomy.

MATERIAL AND METHODS

Postal questionnaires were sent to 171 children 10-60 months after undergoing cardiac surgery via sternotomy at the age of 0-12 years. The children were asked to recall the intensity and duration of their post-operative pain, if necessary with the help from their parents, and to describe the intensity and character of any present pain. Another group of 13 children underwent quantitative sensory testing of the scar area 3 months after sternotomy.

RESULTS

A total of 121 children, median (range) age 7.7 (4.2-16.9) years, answered the questionnaire. Their age at the time of surgery was median (range) 3.8 (0-12.9) years, and the follow-up period was median (range) 4 (0.8-5.1) years. In all, 26 children (21%) reported present pain and/or pain within the last week located in the scar area; in 12 (46%) out of the 26 children, the intensity was ≥4 on a numeric rating scale (0-10). Quantitative sensory testing of the scar area revealed sensory abnormalities--pinprick hyperalgesia and brush and cold allodynia--in 10 out of 13 children.

CONCLUSION

Chronic pain after cardiac surgery via sternotomy in children is a problem that should not be neglected. The pain is likely to have a neuropathic component as suggested by the sensory abnormalities demonstrated by quantitative sensory testing.

Neuroanatomical differences between men and women in help-seeking coping strategy

Help seeking (HS) is a core coping strategy that is directed towards obtaining support, advice, or assistance as means of managing stress. Women have been found to use more HS than men. Neural correlates of sex differences have also been reported in prefrontal-limbic system (PLS) regions that are linked to stress and coping, yet structural differences between men and women relating to HS in the PLS are still unknown. Thus, the association between gray matter volume (GMV) and HS was investigated using voxel-based morphometry (VBM) in a large healthy sample (126 men and 156 women). Results indicated women reported more HS than men did. VBM results showed that the relation between HS scores and GMV differed between men and women in regions of the bilateral orbitofrontal cortex extending to the subgenual anterior cingulate cortex(OFC/sgACC). Among women, higher HS scores were associated with smaller GMV in these areas while a positive correlation between GMV and HS scores was observed among men. These results remained significant after controlling for general intelligence, stress, anxiety and depression. Thus, this study suggested that structural differences between men and women are correlated to characteristic brain regions known to be involved in the PLS which is considered critical in stress regulation.