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Scheurich JA, Sim LA, Gonzalez CA, Weiss KE, Dokken PJ, Willette AT, Harbeck-Weber C. Gender Diversity Among Youth Attending an Intensive Interdisciplinary Pain Treatment Program. J Clin Psychol Med Settings 2024; 31:560-570. [PMID: 38265699 DOI: 10.1007/s10880-023-09997-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/25/2024]
Abstract
Transgender and gender diverse (TGD) youth with chronic pain may be at unique risk for psychological distress and associated functional impairment, yet research on the intersection of chronic pain and gender identity is lacking. In a retrospective chart review of 491 participants admitted to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States over an approximately 4-year period, 6.11% were TGD. TGD participants who completed the IIPT program reported significant and large improvements in anxiety, depression, pain catastrophizing, and functional ability. At baseline, TGD participants presented as more emotionally distressed and functionally impaired compared to age-matched, cisgender peers. When accounting for baseline scores, TGD participants who completed the IIPT program reported similar scores to cisgender peers at discharge, yet TGD youth were significantly less likely than cisgender peers to complete the IIPT program. Future directions and implications for clinical practice are discussed.
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Affiliation(s)
- Jennifer A Scheurich
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA.
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
| | - Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Cesar A Gonzalez
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Karen E Weiss
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Peggy J Dokken
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Amber T Willette
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
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Tham SW, Li R, Edwards RR, Palermo TM. Pain Catastrophizing Moderates the Relationship Between Pain Sensitivity and Clinical Pain in Adolescents With Functional Abdominal Pain. THE JOURNAL OF PAIN 2024; 25:104549. [PMID: 38657783 DOI: 10.1016/j.jpain.2024.104549] [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: 10/12/2023] [Revised: 03/21/2024] [Accepted: 04/16/2024] [Indexed: 04/26/2024]
Abstract
Pain catastrophizing has been linked to amplified pain sensitivity assessed using quantitative sensory testing (QST) in adults; pediatric data are limited, particularly in youth with functional abdominal pain (FAP). With increasing use of QST to evaluate somatosensory function and predict pain outcomes, we examined the associations between QST and clinical pain in adolescents with FAP and tested the moderating effects of pain catastrophizing. Seventy-seven adolescents (mean age 16.6 years, 85.7% female, 72.7% White, 90.8% non-Hispanic) who fulfilled diagnostic criteria for FAP completed QST assessment (pressure pain threshold and tolerance, heat pain threshold, conditioned pain modulation) and measures of abdominal pain intensity, pain interference, and pain catastrophizing. Adjusting for age and sex, only higher heat pain threshold was associated with higher abdominal pain intensity (Beta per 1-standard deviation = .54, P = .026). Contrary to hypothesis, for youth with higher pain catastrophizing, higher pressure pain tolerance was associated with greater abdominal pain intensity, but associations were not significant for youth with lower catastrophizing (P = .049). Similarly, for those with higher pain catastrophizing (in contrast to lower pain catastrophizing), higher pressure pain thresholds and tolerance were associated with higher pain interference (P = .039, .004, respectively). Results highlight the need to investigate the influence of pain catastrophizing on QST. PERSPECTIVE: This study demonstrated unexpected findings of pain catastrophizing moderating the relationships between pressure pain threshold and tolerance, and clinical pain in adolescents with FAP. This raised questions regarding our understanding of psychological contributions to QST findings in pediatric populations with chronic pain.
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Affiliation(s)
- See Wan Tham
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Rui Li
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Massachusetts
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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Ceniza-Bordallo G, Gómez Fraile A, Martín-Casas P, Rabbitts JA, Li R, Palermo TM, López-de-Uralde-Villanueva I. Prevalence, pain trajectories, and presurgical predictors for chronic postsurgical pain in a pediatric sample in Spain with a 24-month follow-up. Pain 2024:00006396-990000000-00653. [PMID: 39047258 DOI: 10.1097/j.pain.0000000000003330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 06/01/2024] [Indexed: 07/27/2024]
Abstract
ABSTRACT Pediatric chronic pain, particularly chronic postsurgical pain (CPSP), poses a significant public health challenge, impacting 20% of pediatric populations. While several presurgical predictors have been identified, there is a scarcity of data on long-term outcomes, especially beyond 1 to 2 years postsurgery. Previous research primarily focuses on North American children, creating gaps in understanding CPSP outcomes in diverse health systems, such as in Spain. This study, registered as NCT04735211, investigates CPSP in 159 children and adolescents (mean age = 12.4 years, 37.1% girls, retention rate = 65%) undergoing various surgeries in Spain. The objectives include examining CPSP prevalence (Numerical Rating Scale ≥ 4) at 3, 6, 12, and 24 months, exploring postsurgical pain trajectories through group-based trajectory modeling, and identifying potential presurgical predictors for CPSP (pain intensity, pain catastrophizing, pain anxiety, fear of pain, kinesiophobia, health-related quality of life, pain interference, and physical activity), using multiple logistic regressions. Results show a CPSP prevalence of 41% at 3 months, decreasing to 14% at 24 months. Presurgical factors including pain intensity (adjusted odds ratio [aOR] = 1.25, 95% confidence interval [CI] = 1.02-1.53), pain catastrophizing (aOR = 1.06, 95% CI = 1.00-1.13), and pain anxiety (aOR = 1.06, 95% CI = 1.02-1.11) were associated with CPSP at 3 months. Group-based trajectory modeling revealed 3 postsurgical pain trajectories: Low Pain with Rapid Recovery Group (30.2%), Moderate Pain with Recovery Group (53.5%), and High Pain with Slow Recovery Group (16.3%), with group differences in presurgical predictors, excluding physical activity. This study contributes valuable insights into CPSP, emphasizing the need for long-term follow-up. The findings could inform the implementation of preventive programs for CPSP into diverse health systems.
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Affiliation(s)
- Guillermo Ceniza-Bordallo
- Doctoral Program in Healthcare, Faculty of Nursing, Physiotherapy and Podiatry, University Complutense of Madrid, Madrid, Spain
| | - Andrés Gómez Fraile
- Head of Service, Surgery and Urology Pediatric Unit, University Hospital 12 Octubre of Madrid, Madrid, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy, and Podiatry, University Complutense of Madrid, Madrid, Spain
- IdISSC, Madrid, Spain
| | - Jennifer A Rabbitts
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Rui Li
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy, and Podiatry, University Complutense of Madrid, Madrid, Spain
- IdISSC, Madrid, Spain
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Vroom DC, Rodgers-Melnick SN, Brown T, Owusu-Ansah A, Dusek JA. Pain screening in youth with sickle cell disease: A quality improvement study. Pediatr Blood Cancer 2024; 71:e30912. [PMID: 38348535 DOI: 10.1002/pbc.30912] [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: 10/03/2023] [Revised: 01/01/2024] [Accepted: 01/27/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Youth with sickle cell disease (SCD) face several challenges as they age, including increased pain frequency, duration, and interference. The purpose of this study was to (i) determine the feasibility of routine pain screening; (ii) identify and describe various clinical pain presentations; and (iii) understand preferences/resources related to engaging in integrative health and medicine (IHM) modalities within an outpatient pediatric SCD clinic. METHODS During routine outpatient visits, patients aged 8-18 completed measures of pain frequency, duration, and chronic pain risk (Pediatric Pain Screening Tool [PPST]). Participants screening positive for (i) persistent or chronic pain or (ii) medium or high risk for persistent symptoms and disability on the PPST were asked to complete measures of pain interference, pain catastrophizing, and interest in/resources for engaging in IHM modalities. RESULTS Between March 2022 and May 2023, 104/141 (73.8%) patients who attended at least one outpatient visit were screened. Of these 104 (mean age 12.46, 53.8% female, 63.5% HbSS), 34 (32.7%) reported persistent or chronic pain, and 48 (46.2%) reported medium or high risk for persistent symptoms and disability. Patients completing subsequent pain screening measures reported a mean pain interference T-score of 53.2 ± 8.8 and a mean pain catastrophizing total score of 24.3 ± 10.2. Patients expressed highest interest in music (55.6%) and art therapy (51.9%) and preferred in-person (81.5%) over virtual programming (22.2%). CONCLUSIONS Comprehensive pain screening is feasible within pediatric SCD care. Classifying patients by PPST risk may provide a means of triaging patients to appropriate services to address pain-related psychosocial factors.
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Affiliation(s)
- Dennis C Vroom
- University Hospitals Connor Whole Health, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Samuel N Rodgers-Melnick
- University Hospitals Connor Whole Health, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Tracie Brown
- Department of Pediatrics - Hematology and Oncology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Amma Owusu-Ansah
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Pediatrics - Hematology and Oncology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio, USA
| | - Jeffery A Dusek
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Jeong HJ, Engel JM, Muriello M, Basel D, Slavens BA. The association of pain with gait spatiotemporal parameters in children with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder. Gait Posture 2024; 109:271-276. [PMID: 38368648 DOI: 10.1016/j.gaitpost.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/22/2023] [Accepted: 02/05/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Children with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/hEDS) have a high prevalence of chronic pain, which may influence gait dynamics. However, little is known about pain outcomes and their association with gait spatiotemporal parameters in children with HSD/hEDS. RESEARCH QUESTION Does pain correlate with gait spatiotemporal parameters in children with HSD/hEDS? METHODS Eighteen children with HSD/hEDS and eighteen typically developing (TD) children participated in the study. The current level of pain (0-10 on the numeric rating scale), modified Brief Pain Inventory, and Pain Catastrophizing Scale-Child version were implemented to assess pain in children with HSD/hEDS. All children completed a gait analysis at a self-selected speed. Mean and variability (measured using the coefficient of variation) of gait spatiotemporal parameters were analyzed. Gait parameters included stride length, stride time, gait speed, percent stance time, and step width. A Mann-Whitney U-test was used to compare the gait parameters between children with HSD/hEDS and TD children. Spearman correlations were used to examine the relationships between pain and gait spatiotemporal parameters in children with HSD/hEDS. RESULTS Children with HSD/hEDS had a longer percent stance time compared to TD children (p = 0.03). Lower pain interference in relationships with other people was significantly associated with faster gait speeds (ρ = -0.55, p = 0.03). Children with HSD/hEDS also had greater pain interference during mobility (ρ = 0.5, p = 0.05) and going to school (ρ = 0.65, p = 0.01), which were significantly correlated with greater stride length variability. Greater pain interference during enjoyment of life was significantly associated with greater percent stance time variability (ρ = 0.5, p = 0.05). Greater pain catastrophizing was correlated with decreased step width variability in children with HSD/hEDS (ρ = -0.49, p = 0.05). SIGNIFICANCE Pain interference and catastrophe were significantly associated with gait spatiotemporal variability. Our findings suggest that assessing pain-associated gait alterations may help understand the clinical features and gait kinematics of children with HSD/hEDS.
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Affiliation(s)
- Hyo-Jung Jeong
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, WI, USA; Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | - Joyce M Engel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Michael Muriello
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Department of Mechanical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA; Department of Biomedical Engineering, College of Engineering and Applied Science, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Andias R, Rodrigues M, Silva AG. Predictors of improvement in community adolescents with chronic neck pain: A secondary analysis using different improvement criteria. PM R 2024. [PMID: 38415907 DOI: 10.1002/pmrj.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/13/2023] [Accepted: 11/16/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Interventions based on pain neuroscience education and exercise have emerged as effective in the management of chronic neck pain in adolescents. No studies have explored factors that might be associated with recovery in adolescents with neck pain. OBJECTIVE To explore predictors of improvement after an intervention based on exercise and pain neuroscience education. DESIGN Secondary analysis of a randomized trial. SETTING Community. PARTICIPANTS 127 community adolescents with neck pain. INTERVENTIONS Blended-learning intervention based on exercise and pain neuroscience education. MAIN OUTCOME MEASURES A set of variables including sociodemographic data, pain characteristics, physical activity, disability, sleep, catastrophizing, fear of movement, self-efficacy, symptoms of central sensitization, knowledge of pain neuroscience, pressure pain thresholds, and neck muscles endurance were used to predict a clinical response at 1 week after intervention and at 6-month follow-up. RESULTS Different predictors of improvement and non-improvement to intervention were found, but common predictors were not found for all the improvement criteria explored and time points. CONCLUSIONS These findings suggest that using different criteria to characterize adolescents with neck pain as improved and non-improved after pain neuroscience education and exercise have an effect on the variables associated with a response to the intervention.
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Affiliation(s)
- Rosa Andias
- School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Mário Rodrigues
- Higher School of Technology and Management of Águeda, Institute of Electronics and Telematics Engineering of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- CINTESIS.RISE@UA, School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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Walker SM, Peters J, Verriotis M, Farag F, Jay MA, Howard RF. Sensitivity and Specificity of a Neuropathic Screening Tool (Self-Report Leeds Assessment of Neuropathic Symptoms and Signs, S-LANSS) in Adolescents With Moderate-Severe Chronic Pain. THE JOURNAL OF PAIN 2024; 25:451-465. [PMID: 37741521 DOI: 10.1016/j.jpain.2023.09.006] [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: 04/08/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
Neuropathic screening tools improve recognition of neuropathic pain in adults. Although utilized in pediatric populations, the sensitivity, specificity and methodology of screening tool delivery have not been compared in children. We evaluated the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) in adolescents (10-18 years) referred to a tertiary pediatric pain clinic. History and examination by specialist clinicians and multidisciplinary assessment informed classification of the primary pain type. In a prospective cohort, scores were obtained at interview (S-LANSS interview; n = 161, 70% female), and following substitution of self-reported signs with examination findings in the primary pain region (Leeds Assessment of Neuropathic Symptoms and Signs, LANSS examination). Secondly, we retrospectively retrieved questionnaires self-completed by adolescents at their initial clinic appointment (S-LANSS self-completed; n = 456, 73% female). Thirdly, we explored relationships between patient-reported outcomes and S-LANSS scores. S-LANSS interview scores varied with pain classification, and S-LANSS self-completed scores were similarly highest with neuropathic pain (median [interquartile range]: 18 [11, 21]) and complex regional pain syndrome (21 [14, 24]), variable with musculoskeletal pain (13 [7, 19]) and lowest with visceral pain (6.5 [2, 11.5]) and headache (8.5 [4, 14]). As in adults, the cutpoint score of 12/24 was optimal. Sensitivity was highest with inclusion of examination findings and lowest with self-completion (LANSS examination vs S-LANSS interview vs S-LANSS self-completed: 86.3% vs 80.8% vs 74.7%), but specificity was relatively low (37.8% vs 36.7% vs 48%). High S-LANSS scores in non-neuropathic groups were associated with female sex and high pain catastrophizing. The S-LANSS is a sensitive screening tool for pain with neuropathic features in adolescents, but needs to be interpreted in the context of clinical evaluation (clinicaltrials.gov NCT03312881). PERSPECTIVE: This article reports high sensitivity of the S-LANSS screening tool for identifying pain with neuropathic features in adolescents with moderate-severe chronic pain. However, as sensitivity is lower than in adult populations, further interdisciplinary evaluation is necessary to inform diagnosis and management.
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Affiliation(s)
- Suellen M Walker
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Judy Peters
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Madeleine Verriotis
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fadila Farag
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Matthew A Jay
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Richard F Howard
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Ekberg E, Nilsson IM, Michelotti A, Al-Khotani A, Alstergren P, Rodrigues Conti PC, Durham J, Goulet JP, Hirsch C, Kalaykova S, Kapos FP, King CD, Komiyama O, Koutris M, List T, Lobbezoo F, Ohrbach R, Palermo TM, Peck CC, Penlington C, Restrepo C, Rodrigues MJ, Sharma S, Svensson P, Visscher CM, Wahlund K, Rongo R. Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents. J Oral Rehabil 2023; 50:1167-1180. [PMID: 37144484 DOI: 10.1111/joor.13488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 02/24/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed. OBJECTIVE To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings. METHODS International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents. RESULTS The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents. CONCLUSION The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.
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Affiliation(s)
- EwaCarin Ekberg
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ing-Marie Nilsson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Center for Oral Rehabilitation, Norrköping, Sweden
| | - Ambrosina Michelotti
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Amal Al-Khotani
- Dental Department, East Jeddah Hospital, Ministry of Health, Jeddah, Saudi Arabia
- Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden
| | - Per Alstergren
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden
- Department of Dental Medicine, Karolinska Institute, Huddinge, Sweden
| | - Paulo Cesar Rodrigues Conti
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry-University of São Paulo, Bauru, Sao Paulo, Brazil
- Bauru Orofacial Pain Group, University of São Paulo, Bauru, Sao Paulo, Brazil
| | - Justin Durham
- Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jean-Paul Goulet
- Faculty of Dental Medicine, Laval University, Quebec, Quebec, Canada
| | - Christian Hirsch
- Clinic of Pediatric Dentistry, University of Leipzig, Leipzig, Germany
| | - Stanimira Kalaykova
- Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Flavia P Kapos
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Osamu Komiyama
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Matsudo, Japan
| | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christopher C Peck
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chris Penlington
- Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Maria Joao Rodrigues
- Institute for Occlusion and Orofacial Pain, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sonia Sharma
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus, Denmark
| | - Corine M Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kerstin Wahlund
- Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden
| | - Roberto Rongo
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
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Ceniza-Bordallo G, Gómez Fraile A, Martín-Casas P, López-de-Uralde-Villanueva I. Validation of the Spanish version of the Pain Catastrophizing Scale for Children (PCS-C). An Pediatr (Barc) 2023; 99:295-303. [PMID: 37891137 DOI: 10.1016/j.anpede.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/04/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Pain catastrophizing is a powerful factor that can affect health care outcomes as well as emotional and physical well-being. The Pain Catastrophizing Scale for Children (PCS-C) is widely used, but it is not validated in Spanish. The aim of the study was to translate the PCS-C to Spanish and assess the validity and reliability of the translated version. PATIENTS AND METHODS This study was carried out in two phases: (a) instrument translation (via a translation-back-translation process) and (b) psychometric analysis (construct validity: exploratory and confirmatory factor analysis, internal consistency, floor and ceiling effects and convergent validity). It had a cross-sectional design and was conducted on a sample of children aged 8-18 years was selected by convenience in a paediatric hospital. The study followed the STARD checklist. RESULTS The sample included 150 children and adolescents (mean age, 12.45 years; 63.8% male) and their parents. The exploratory and the confirmatory analysis showed a good adjustment of the model to the original 3-model structure with 13 items. The internal consistency of the scale was excellent (Cronbach α, 0.904), and no floor or ceiling effects were detected. In the convergent validity analysis, the Spanish version of the PCS-C showed a moderate correlation with pain interference (r=0.400) and with health-related quality of life (r=0.217-0.303). CONCLUSIONS These results show that the Spanish version of the PCS-C is a valid and reliable scale to assess pain catastrophizing in children and adolescents.
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Affiliation(s)
- Guillermo Ceniza-Bordallo
- Programa de Doctorado de Cuidados en Salud, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Andrés Gómez Fraile
- Servicio de Cirugía y Urología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Patricia Martín-Casas
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IDISCC), Madrid, Spain.
| | - Ibai López-de-Uralde-Villanueva
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (IDISCC), Madrid, Spain
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10
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Mountain DC, Ali SM, Ghio D, McDonagh JE, Cordingley L, Lee RR. Beliefs About Pain in Pediatric Inflammatory and Noninflammatory Chronic Musculoskeletal Conditions: A Scoping Review. J Pediatr Psychol 2023; 48:825-841. [PMID: 37738667 PMCID: PMC10588974 DOI: 10.1093/jpepsy/jsad046] [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: 02/16/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The Common Sense Self-Regulatory Model posits that beliefs about pain influence coping behaviors and subsequent physical and mental health outcomes in children/young people with chronic musculoskeletal conditions. It was unclear how and what beliefs had been investigated in this population, and whether there were similarities and differences in beliefs held about pain by those experiencing inflammatory versus noninflammatory musculoskeletal conditions. This scoping review addressed this gap. METHODS A systematic search was conducted using four databases (MEDLINE, PsycINFO, Embase, and CINAHL) in November 2021. Primary studies exploring key stakeholders' (including children, parents, and/or healthcare professionals) beliefs about pain underlying pediatric chronic musculoskeletal conditions were synthesized. RESULTS Eighteen articles were identified. Cross-sectional designs were predominantly used to explore beliefs (n = 6). The majority used questionnaires to assess beliefs (n = 12). Beliefs common across musculoskeletal conditions were that children/young people felt their pain was not understood by others, and pain affected their physical functioning. Differences included children/young people and parents thinking they had some ability to control pain, and causal beliefs relating to underlying disease activity. These pain beliefs were more likely to be held in relation to inflammatory diagnoses. In contrast, children/young people and parents were more likely to view pain as uncontrollable, with more uncertainty regarding underlying causes, relating to noninflammatory diagnoses. CONCLUSIONS Methods used to explore pain beliefs were inconsistent. Studies identified similarities and differences which appear to be closely related to the underlying diagnosis. Findings justify further exploration to identify potentially modifiable targets to improve pain outcomes in this population.
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Affiliation(s)
- Danielle C Mountain
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Daniela Ghio
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
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11
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Lynch-Jordan AM, Connelly M, Guite JW, King C, Goldstein-Leever A, Logan DE, Nelson S, Stinson JN, Ting TV, Wakefield EO, Williams AE, Williams SE, Kashikar-Zuck S. Clinical Characterization of Juvenile Fibromyalgia in a Multicenter Cohort of Adolescents Enrolled in a Randomized Clinical Trial. Arthritis Care Res (Hoboken) 2023; 75:1795-1803. [PMID: 36537193 PMCID: PMC11284638 DOI: 10.1002/acr.25077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 11/01/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Juvenile fibromyalgia (JFM) is a complex chronic pain condition that remains poorly understood. The study aimed to expand the clinical characterization of JFM in a large representative sample of adolescents with JFM and identify psychological factors that predict pain interference. METHODS Participants were 203 adolescents (ages 12-17 years) who completed baseline assessments for the multisite Fibromyalgia Integrative Training for Teens (FIT Teens) randomized control trial. Participants completed the Pain and Symptom Assessment Tool, which includes a Widespread Pain Index (WPI; 0-18 pain locations) and Symptom Severity checklist of associated somatic symptoms (SS; 0-12) based on the 2010 American College of Rheumatology criteria for fibromyalgia. Participants also completed self-report measures of pain intensity, functional impairment, and psychological functioning. RESULTS Participants endorsed a median of 11 painful body sites (WPI score) and had a median SS score of 9. Fatigue and nonrestorative sleep were prominent features and rated as moderate to severe by 85% of participants. Additionally, neurologic, autonomic, gastroenterologic, and psychological symptoms were frequently endorsed. The WPI score was significantly correlated with pain intensity and catastrophizing, while SS scores were associated with pain intensity and all domains of physical and psychological functioning. Depressive symptoms, fatigue, and pain catastrophizing predicted severity of pain impairment. CONCLUSION JFM is characterized by chronic widespread pain with fatigue, nonrestorative sleep, and other somatic symptoms. However, how diffusely pain is distributed appears less important to clinical outcomes and impairment than other somatic and psychological factors, highlighting the need for a broader approach to the assessment and treatment of JFM.
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Affiliation(s)
- Anne M. Lynch-Jordan
- University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Christopher King
- University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Deirdre E. Logan
- Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts
| | - Sarah Nelson
- Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts
| | - Jennifer N. Stinson
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Tracy V. Ting
- University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Emily O. Wakefield
- University of Connecticut School of Medicine and Children’s Medical Center, Hartford
| | - Amy E. Williams
- Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana
| | - Sara E. Williams
- University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Susmita Kashikar-Zuck
- University of Cincinnati College of Medicine and Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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12
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Long RD, Walker A, Pan SC, Miller JV, Rayner L, Vallely J, Rasic N. Baseline Factors Associated with Pain Intensity, Pain Catastrophizing, and Pain Interference in Intensive Interdisciplinary Pain Treatment for Youth. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1229. [PMID: 37508726 PMCID: PMC10378082 DOI: 10.3390/children10071229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Background: More could be known about baseline factors related to desirable Intensive Interdisciplinary Pain Treatment (IIPT) outcomes. This study examined how baseline characteristics (age, gender, child pain catastrophizing (PCS-C), pain interference, pain intensity, anxiety, depression, paediatric health-related quality of life (PedsQLTM), and parent catastrophizing (PCS-P)) were associated with discharge and 3-month follow-up scores of PCS-C, pain intensity, and pain interference. Methods: PCS-C, pain intensity, and pain interference T-scores were acquired in 45 IIPT patients aged 12-18 at intake (baseline), discharge, and 3-month follow-up. Using available and imputed data, linear mixed models were developed to explore associations between PCS-C, pain intensity, and pain interference aggregated scores at discharge and follow-up with baseline demographics and a priori selected baseline measures of pain, depression, anxiety, and PCS-C/P. Results: PCS-C and pain interference scores decreased over time compared to baseline. Pain intensity did not change significantly. Baseline PCS-C, pain interference, anxiety, depression, and PedsQLTM were associated with discharge/follow-up PCS-C (available and imputed data) and pain interference scores (available data). Only baseline pain intensity was significantly associated with itself at discharge/follow-up. Conclusions: Participants who completed the IIPT program presented with reduced PCS-C and pain interference over time. Interventions that target pre-treatment anxiety and depression may optimize IIPT outcomes.
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Affiliation(s)
- Rob D. Long
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Andrew Walker
- Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Si Chen Pan
- Vi Riddell Children’s Pain & Rehabilitation Centre, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada
| | - Jillian Vinall Miller
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Vi Riddell Children’s Pain & Rehabilitation Centre, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada
- Child Brain & Mental Health Program, Alberta Children’s Hospital Research Institute, Calgary, AB T2N 4N1, Canada
- Owerko Centre, Alberta Children’s Hospital Research Institute, Calgary, AB T2N 4N1, Canada
- Brain & Behaviour Team, Hotchkiss Brain Institute, Calgary, AB T2N 4N1, Canada
- Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, AB T2N 4N1, Canada
- Department of Psychology, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB T2N 4Z6, Canada
| | - Laura Rayner
- Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Vi Riddell Children’s Pain & Rehabilitation Centre, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada
| | - Joanne Vallely
- Vi Riddell Children’s Pain & Rehabilitation Centre, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada
| | - Nivez Rasic
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Vi Riddell Children’s Pain & Rehabilitation Centre, Alberta Children’s Hospital, Calgary, AB T3B 6A8, Canada
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13
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Shih S, Donati MR, Cohen LL, Shneider C, Sil S. A dyadic analysis of parent and child pain catastrophizing and health-related quality of life in pediatric sickle cell disease. Pain 2023; 164:1537-1544. [PMID: 36645172 DOI: 10.1097/j.pain.0000000000002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/05/2022] [Indexed: 01/17/2023]
Abstract
ABSTRACT The purpose of this study was to examine the dyadic and individual level effects of parent and child pain catastrophizing on child health-related quality of life (HRQOL) in pediatric sickle cell disease. Questionnaires assessing child pain frequency, child and parent pain catastrophizing, and child HRQOL were completed by youth and their primary caregiver. A Common Fate Model was estimated to test the dyadic level relationship between parent and child pain catastrophizing and child HRQOL. An Actor-Partner-Common Fate Model hybrid was estimated to test the relationship between child HRQOL and individual-level child pain catastrophizing and parent pain catastrophizing, respectively. In each model, child HRQOL was modelled as a dyadic variable by factoring parent and child ratings. Patients (N = 100, M age = 13.5 years, 61% female) and their caregivers (M age = 41.8 years, 86% mothers) participated. Dyad-level pain catastrophizing was negatively associated with child HRQOL, demonstrating a large effect (β = -0.809). Individual-level parent and child pain catastrophizing were each uniquely negatively associated with child HRQOL, demonstrating small to medium effects (β = -0.309, β = -0.270). Individual level effects were net of same-rater bias, which was significant for both parents and children. Both the unique and the overlapping aspects of parent and child pain catastrophizing are significant contributors to associations with child HRQOL, such that higher levels of pain catastrophizing are associated with worse child HRQOL. Findings suggest the need for multipronged intervention targeting factors common to parent-child dyads and factors unique to parents and children, respectively.
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Affiliation(s)
- Sharon Shih
- Georgia State University, Atlanta, GA, United States
| | | | - Lindsey L Cohen
- Georgia State University, Atlanta, GA, United States
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | - Soumitri Sil
- Children's Healthcare of Atlanta, Atlanta, GA, United States
- Emory University School of Medicine, Atlanta, GA, United States
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14
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Holley AL, Battison EA, Heierle J, Clohessy D, Wesemann D, Hall T, Orwoll B, Wilson AC, Williams C. Long-term Pain Symptomatology in PICU Survivors Aged 8-18 Years. Hosp Pediatr 2023; 13:641-655. [PMID: 37357737 PMCID: PMC10312233 DOI: 10.1542/hpeds.2022-007027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Children discharged from the PICU often experience long-term physical, psychological, social and cognitive challenges, described as postintensive care syndrome. This study fills a critical gap by describing the long-term pain symptoms many children experience using child self-report. METHODS Participants in this cross-sectional study were children aged 8 to 18 years (and 1 parent, n = 64 dyads) who were 8 to 24 months post-PICU discharge. Participants completed measures assessing pain, psychosocial function, and treatment utilization. Health information relevant to the PICU admission was obtained from the electronic medical record. RESULTS Children were an average age of 14.3 years and 50% female. Average pain intensity in the past month was 3.65 (0-10 numeric rating scale), with 36% of children reporting pain ≥2 to 3 days a week. Youth with higher intensity (≥4) and more frequent pain (≥2-3 days a week) had greater pain catastrophizing, pain-related fear, anxiety, and sleep disturbance than those with less frequent and intense pain. Higher pain frequency was also associated with greater pain-related disability and depressive symptoms. Pain was not associated with any PICU-related variables abstracted from the electronic medical record. Parents reported children frequently accessed pain treatment services postdischarge; however, 37.5% reported the coronavirus disease 2019 pandemic impacted access to recommended services. CONCLUSIONS A significant portion of children experience pain post-PICU discharge. For many of these children, pain is frequent and is associated with impairments in psychosocial function. Future prospective research studies can be used to identify risk factors of poor pain outcomes so children can receive targeted interventions.
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Affiliation(s)
- Amy L. Holley
- Division of Pediatric Psychology, Department of Pediatrics
| | | | | | - Denae Clohessy
- Division of Pediatric Psychology, Department of Pediatrics
| | | | - Trevor Hall
- Division of Pediatric Psychology, Department of Pediatrics
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
| | - Ben Orwoll
- Division of Pediatric Critical Care, Departments of Pediatrics
- Medical Informatics and Clinical Epidemiology
| | - Anna C. Wilson
- Division of Pediatric Psychology, Department of Pediatrics
| | - Cydni Williams
- Division of Pediatric Critical Care, Departments of Pediatrics
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon
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15
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Rangu S, Collins J, García-Romero MT, Augsburger BD, Bruckner AL, Diaz LZ, Eichenfield LF, Faig W, Gorell ES, Lefferdink R, Lucky AW, Morel KD, Paller AS, Park H, Pastrana-Arellano E, Peoples K, Wiss K, Perman MJ, Castelo-Soccio L. Assessing pain catastrophizing and functional disability in pediatric epidermolysis bullosa patients. Pediatr Dermatol 2023; 40:422-427. [PMID: 36579717 PMCID: PMC11089464 DOI: 10.1111/pde.15220] [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: 08/02/2022] [Accepted: 11/24/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES The primary objective was to assess pain catastrophizing and functional disability in pediatric patients with epidermolysis bullosa (EB) and their parents/guardians. Secondary objectives included examining relationships between pain catastrophizing, functional disability, and correlations with other factors (e.g., age, disease severity, and percent of body surface area (BSA) involved). METHODS Patients with EB ages 8-16 and their parents/guardians who were English or Spanish speaking completed a one-time online survey. Parent measures included: demographics questionnaire, Pain Catastrophizing Scale-Parent (PCS), and Parent Functional Disability Inventory (FDI). Child measures included: PCS child and child FDI. Higher scores on both scales indicate higher levels of catastrophizing and functional disability. RESULTS Of 31 children, the mean age was 11.47 years and the majority (70.97%) had dystrophic EB. Mean scores were: 35.84 = PCS parent; 34.58 = PCS child; 30.87 = parent FDI; 29.77 = child FDI. Total scores for PCS parent, parent FDI, and child FDI increased significantly with disease severity and percentage of involved BSA (p < .01 for all). Total scores for PCS child increased significantly with percent of EB skin involvement (p = .04) but not disease severity. Older children reported more functional disability than their parents and younger children (p = .02). CONCLUSIONS Our results demonstrate significant positive correlations between negative thoughts related to pain and the experience of functional difficulties in patients with EB and their caregivers. Psychological, psychiatric, and/or behavioral interventions to help managing chronic pain may be effective for patients with EB.
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Affiliation(s)
- Sneha Rangu
- Section of Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jessica Collins
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Bret D. Augsburger
- Department of Dermatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Anna L. Bruckner
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Lucia Z. Diaz
- Division of Dermatology and Dermatologic Surgery, Department of Internal Medicine, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
| | - Lawrence F. Eichenfield
- Department of Dermatology, University of California San Diego, San Diego, California, USA
- Department Pediatrics, University of California San Diego, San Diego, California, USA
- Pediatric and Adolescent Dermatology, Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Walter Faig
- Children’s Hospital of Philadelphia, Research Institute, Philadelphia, Pennsylvania, USA
| | - Emily S. Gorell
- Department of Dermatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
| | - Rachel Lefferdink
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anne W. Lucky
- Department of Dermatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kimberly D. Morel
- Department of Dermatology, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York, USA
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York, USA
| | - Amy S. Paller
- Children’s Hospital of Philadelphia, Research Institute, Philadelphia, Pennsylvania, USA
| | - Helen Park
- Department Pediatrics, University of California San Diego, San Diego, California, USA
| | | | - Kathleen Peoples
- Department of Dermatology, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Karen Wiss
- Department of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Marissa J. Perman
- Section of Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leslie Castelo-Soccio
- Section of Dermatology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- National Institutes of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
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de Koning LE, Warnink-Kavelaars J, van Rossum MA, Bosman D, Menke LA, Malfait F, de Boer R, Oosterlaan J, Engelbert RHH, Rombaut L. Somatic symptoms, pain, catastrophizing and the association with disability among children with heritable connective tissue disorders. Am J Med Genet A 2023. [PMID: 37186039 DOI: 10.1002/ajmg.a.63204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 05/17/2023]
Abstract
The aim of the present study was to investigate the nature and prevalence of nonspecific somatic symptoms, pain and catastrophizing in children with Heritable Connective Tissue Disorders (HCTD), and to determine their association with disability. This observational, multicenter study included 127 children, aged 4-18 years, with Marfan syndrome (MFS) (59%), Loeys-Dietz syndrome (LDS) (8%), Ehlers-Danlos syndromes (EDS) (12%) and hypermobile Ehlers-Danlos syndrome (hEDS) (23%). The assessments included the Children's Somatization Inventory or parent proxy (CSI, PCSI), pain visual-analogue scale (VAS), SUPERKIDZ body diagram, Pain Catastrophizing Scale Child or parent proxy (PCS-C, PCS-P) and Childhood Health Assessment Questionnaire (CHAQ-30). Data from children aged ≥8 years were compared to normative data. In children ≥ 8 years (n = 90), pain was present in 59%, with a median of 4 (IQR = 3-9) pain areas. Compared to normative data, the HCTD group reported significantly higher on the CSI (p ≤ 0.001, d = 0.85), VAS pain intensity (p ≤ 0.001, d = 1.22) and CHAQ-30 (p ≤ 0.001, d = 1.16) and lower on the PCS-C (p = 0.017, d = -0.82) and PCS-P (p ≤ 0.001, d = -0.49). The intensity of nonspecific somatic symptoms and pain explained 45% of the variance in disability (r2 = 0.45 F(2,48) = 19.70, p ≤ 0.001). In children ≤ 7 years (n = 37), pain was present in 35% with a median of 5(IQR = 1-13) pain areas. The mean(SD) VAS scores for pain intensity was 1.5(2.9). Functional disability was moderately correlated to the number of pain areas (r = 0.56, p ≤ 0.001), intensity of nonspecific somatic symptoms (r = 0.63, p ≤ 0.001) and pain (r = 0.83, p ≤ 0.001). In conclusion, this study supports the need for comprehensive assessment of nonspecific somatic symptoms, pain, and disability in children with HCTD to allow tailored treatment.
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Affiliation(s)
- Lisanne E de Koning
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
| | - Jessica Warnink-Kavelaars
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
| | - Marion A van Rossum
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
- Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
| | - Diederik Bosman
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Leonie A Menke
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
| | - Rosa de Boer
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital Amsterdam UMC Follow-Me Program & Emma Neuroscience Group, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Raoul H H Engelbert
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation and Development, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Lies Rombaut
- Center for Medical Genetics, Ghent University Hospital/Ghent University, Ghent, Belgium
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Sciruicchio V, D'Agnano D, Clemente L, Rutigliano A, Laporta A, de Tommaso M. Clinical Correlates of Osmophobia in Primary Headaches: An Observational Study in Child Cohorts. J Clin Med 2023; 12:jcm12082939. [PMID: 37109275 PMCID: PMC10144088 DOI: 10.3390/jcm12082939] [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: 02/16/2023] [Revised: 03/31/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
Primary headaches, especially migraines, have a significant impact on physical and mental health, as well as on the scholarly performance and quality of life of children and adolescents. Osmophobia could be a potential diagnostic marker of migraine diagnosis and disability. This multicenter observational cross-sectional study included 645 children, aged 8-15, with a diagnosis of primary headaches. We took into consideration the duration, intensity and frequency of headaches, pericranial tenderness, allodynia and osmophobia. In a subgroup of migraine children, we evaluated the migraine-related disability, Psychiatric Self-Administration Scales for Youths and Adolescents, and the Child Version of the Pain Catastrophizing Scale. Osmophobia was found to be present in 28.8% of individuals with primary headaches, with children suffering from migraines having the highest prevalence (35%). Migraine patients with osmophobia also showed a more severe clinical picture, with enhanced disability, anxiety, depression, pain catastrophizing, and allodynia symptoms (F Roy square 10.47 p < 0.001). The presence of osmophobia could help in identifying a clinical migraine phenotype coherent with an abnormal bio-behavioral allostatic model that is worthy of prospective observations and careful therapeutic management.
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Affiliation(s)
| | - Daniela D'Agnano
- Children Epilepsy and EEG Center, San Paolo Hospital, 70132 Bari, Italy
| | - Livio Clemente
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
| | | | - Anna Laporta
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
| | - Marina de Tommaso
- Neurophysiopathology Unit, DiBrain Department, Bari Aldo Moro University, 70121 Bari, Italy
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18
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Sieberg CB, Lunde CE, Wong C, Manganella J, Starkweather AR, Sethna N, Perry-Eaddy MA. Pilot Investigation of Somatosensory Functioning and Pain Catastrophizing in Pediatric Spinal Fusion Surgery. Pain Manag Nurs 2023; 24:27-34. [PMID: 36564325 PMCID: PMC9925410 DOI: 10.1016/j.pmn.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Chronic post-surgical pain (CPSP) is a significant concern and contributes to the opioid epidemic; however, little is known about CPSP in young people. DESIGN This prospective study aimed to identify sensory, psychological, and demographic factors that may increase the risk of CPSP after spinal fusion surgery for children and adolescents with idiopathic scoliosis. METHODS 32 children and adolescents from two children's hospitals completed quantitative sensory testing (QST) and the Pain Catastrophizing Scale Child (PCS-C) pre-and 4-6 months post spinal fusion surgery. Between-group differences were assessed using an independent samples t-test. Pearson's correlations and stepwise linear regression were used to assess the relationship between variables at both time points. RESULTS 56% of patients endorsed pain post-surgery. They were more sensitive tomechanical detection on both a control non-pain site (r = -2.87, p = .004) and the back (r = -1.83, p = .04), as well as pressure pain (r=-2.37, p = .01) on the back. This group also reported worse pain scores pre-surgery. Pre-surgery helplessness positively correlated with preoperative pain (r = .67 p < .001), and age was negatively correlated with the post-surgical catastrophizing total score (r =-.39, p = .05), suggesting that younger patients endorsed more pain-related worry after surgery. CONCLUSIONS Patients who present with pain during their preoperative appointment may need to be monitored with increased vigilance throughout the perioperative period, possibly with bedside QST and psychological questionnaires, which nurses could administer. Biobehavioral interventions targeting pain intensity and feelings of helplessness and anxiety during the preoperative period may alleviate the transition to CPSP.
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Affiliation(s)
- Christine B Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts; Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.
| | - Claire E Lunde
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts; Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, England
| | - Cindy Wong
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts
| | - Juliana Manganella
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts
| | | | - Navil Sethna
- Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts; Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Mayo Family Pediatric Pain Rehabilitation Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts
| | - Mallory A Perry-Eaddy
- University of Connecticut, School of Nursing, Storrs, Connecticut; University of Connecticut, School of Medicine, Department of Pediatrics, Storrs, Connecticut; University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), Storrs, Connecticut; Pediatric Intensive Care Unit, Connecticut Children's, Hartford, CT
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19
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Pate JW, Harrison LE, Hess CW, Moseley GL, Rush G, Heathcote LC, Simons LE. Targeting Pain Science Education in Youth With Chronic Pain: What Are the Sticking Points for Youth and Their Parents? Clin J Pain 2023; 39:60-67. [PMID: 36453624 DOI: 10.1097/ajp.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES An important part of providing pain science education is to first assess baseline knowledge and beliefs about pain, thereby identifying misconceptions and establishing individually-tailored learning objectives. The Concept of Pain Inventory (COPI) was developed to support this need. This study aimed to characterize the concept of pain in care-seeking youth and their parents, to examine its clinical and demographic correlates, and to identify conceptual gaps. MATERIALS AND METHODS Following an initial interdisciplinary evaluation, a cohort of 127 youth aged 8 to 18 years, and their parents, completed a series of questionnaires. RESULTS Parents had slightly higher COPI scores than youth did, reflecting parents' greater alignment with contemporary pain science. The moderate positive association with older age among youth ( r =.32) suggests that COPI is sensitive to cognitive development and life experiences. Youth and parent COPI responses were weakly associated ( r =0.24), highlighting the importance of targeting the concept of pain in both groups. For both parents and youth, 'Learning about pain can help you feel less pain' was the least endorsed concept. This conceptual 'gap' is a key point of intervention that could potentially lead to greater engagement with multidisciplinary pain treatment. DISCUSSION The COPI appears useful for identifying conceptual gaps or 'sticking points'; this may be an important step to pre-emptively address misconceptions about pain through pain science education. Future research should determine the utility of COPI in assessing and treating youth seeking care for pain. The COPI may be a useful tool for tailoring pain science education to youth and their parents.
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Affiliation(s)
- Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, NSW
| | - Lauren E Harrison
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Courtney W Hess
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - G Lorimer Moseley
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Gillian Rush
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
| | - Lauren C Heathcote
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Laura E Simons
- IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, SA
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20
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Jeong HJ, Engel JM, Wilwert O, Muriello M, Basel D, Slavens BA. Pain Characteristics and Symptom Management in Children with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder. Phys Occup Ther Pediatr 2023; 43:630-643. [PMID: 36647261 DOI: 10.1080/01942638.2022.2163601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 12/04/2022] [Accepted: 12/25/2022] [Indexed: 01/18/2023]
Abstract
AIMS This study aims to investigate pediatric hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) pain features and management strategies. METHODS This is a mixed-methods, cross-sectional study design using patient-reported outcomes in 21 children diagnosed with hEDS/HSD. Children who reported bothersome pain were interviewed for pain features. The Child Activity Limitation Interview-21, the Brief Pain Inventory pain interference items, and the Functional Disability Inventory were used to investigate pain interference. To evaluate psychological symptoms regarding pain, the pediatric version of the Survey of Pain Attitude and the child version of the Pain Catastrophizing Scale were used. RESULTS Nineteen children had bothersome pain and of them, eight children reported constant pain. The most frequently reported regions of pain were at the ankle (mild pain) and the back (moderate-to-severe pain). Children reported mild-to-moderate pain interference and believed medications were beneficial for their pain management. Nineteen children sought treatment and of those 16 children used to exercise and acetaminophen and 13 visited physicians as a means of treatment. Parents were overall satisfied with their child's treatment (13 out of 19). CONCLUSIONS Sufficient awareness of pain-related symptoms and understanding of the treatment strategies in early childhood is needed to prevent deleterious consequences in adulthood.
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Affiliation(s)
- Hyo-Jung Jeong
- Orthopaedic and Rehabilitation Engineering Center, Marquette University, Milwaukee, Wisconsin, USA
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Joyce M Engel
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Olivia Wilwert
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Michael Muriello
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Donald Basel
- Division of Genetics, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brooke A Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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21
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Shulman J, Cybulski A, Randall E, Greco KF, Bryant G, Jervis K, Weller E, Sethna NF. Clinical Assessment of Mechanical Allodynia in Youth With Complex Regional Pain Syndrome: Development and Preliminary Validation of the Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense). THE JOURNAL OF PAIN 2022; 24:706-715. [PMID: 36592646 DOI: 10.1016/j.jpain.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022]
Abstract
Youth with complex regional pain syndrome (CRPS) commonly experience mechanical allodynia and disability. Assessment of mechanical allodynia is typically binary (present or absent), making it difficult to assess the quality and degree of mechanical allodynia before and after treatment. This study developed and validated the Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense) to provide an easy way for rehabilitation clinicians to evaluate mechanical allodynia before and after intensive interdisciplinary pain treatment. The 6 Pedi-Sense items demonstrated adequate internal consistency reliability (CR) at admission (CR = .956) and discharge (CR = .973), reasonably fit the hypothesized linear model of stimulus intensity (P < .0001), and significantly loaded onto a single latent factor, mechanical allodynia (P < .0001), at admission and discharge. Pedi-Sense scores significantly correlated with disability (rs = .40; P = .004) and pain catastrophizing (rs = .33; P = .017) at admission. The Pedi-Sense appeared responsive to intervention as participants' total scores improved by 1.44 points (95% CI: .72, 2.15) after IIPT interventions that included daily tactile desensitization. However, test-retest and interrater reliability and the specific contribution of desensitization treatment to the overall success of multi-modal pain rehabilitation still needs to be evaluated. PERSPECTIVE: This article presents the development and preliminary validation of a novel clinical assessment of static and dynamic mechanical allodynia. The Pediatric Tactile Sensitivity Test of Allodynia (Pedi-Sense) allows rehabilitation clinicians to easily evaluate mechanical allodynia at the bedside with minimal training and simple equipment to guide desensitization treatment in clinical settings.
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Affiliation(s)
- Julie Shulman
- Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, Massachusetts; Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts.
| | - Anna Cybulski
- Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, Massachusetts; Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts
| | - Edin Randall
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts; Department of Psychiatry & Behavioral Sciences, Harvard Medical School, Boston, Massachusetts
| | - Kimberly F Greco
- Boston Children's Hospital, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts
| | - Gabrielle Bryant
- Department of Physical and Occupational Therapy, Boston Children's Hospital, Boston, Massachusetts; Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts
| | - Kelsey Jervis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Edie Weller
- Boston Children's Hospital, Institutional Centers for Clinical and Translational Research, Boston, Massachusetts
| | - Navil F Sethna
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Waltham, Massachusetts; Department of Anesthesiology, Harvard Medical School, Boston, Massachusetts; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
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22
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Electroencephalographic characteristics of children and adolescents with chronic musculoskeletal pain. Pain Rep 2022; 7:e1054. [PMID: 36601627 PMCID: PMC9788982 DOI: 10.1097/pr9.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/11/2022] [Accepted: 10/25/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction The pathophysiology of pediatric musculoskeletal (MSK) pain is unclear, contributing to persistent challenges to its management. Objectives This study hypothesizes that children and adolescents with chronic MSK pain (CPs) will show differences in electroencephalography (EEG) features at rest and during thermal pain modalities when compared with age-matched controls. Methods One hundred forty-two CP patients and 45 age-matched healthy controls (HCs) underwent a standardized thermal tonic heat and cold stimulations, while a 21-electrode headset collected EEG data. Cohorts were compared with respect to their EEG features of spectral power, peak frequency, permutation entropy, weight phase-lag index, directed phase-lag index, and node degree at 4 frequency bands, namely, delta (1-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), and beta (13-30 Hz), at rest and during the thermal conditions. Results At rest, CPs showed increased global delta (P = 0.0493) and beta (P = 0.0002) power in comparison with HCs. These findings provide further impetus for the investigation and prevention of long-lasting developmental sequalae of early life chronic pain processes. Although no cohort differences in pain intensity scores were found during the thermal pain modalities, CPs and HCs showed significant difference in changes in EEG spectral power, peak frequency, permutation entropy, and network functional connectivity at specific frequency bands (P < 0.05) during the tonic heat and cold stimulations. Conclusion This suggests that EEG can characterize subtle differences in heat and cold pain sensitivity in CPs. The complementation of EEG and evoked pain in the clinical assessment of pediatric chronic MSK pain can better detect underlying pain mechanisms and changes in pain sensitivity.
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23
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Claus BB, Stahlschmidt L, Dunford E, Major J, Harbeck-Weber C, Bhandari RP, Baerveldt A, Neß V, Grochowska K, Hübner-Möhler B, Zernikow B, Wager J. Intensive interdisciplinary pain treatment for children and adolescents with chronic noncancer pain: a preregistered systematic review and individual patient data meta-analysis. Pain 2022; 163:2281-2301. [PMID: 35297804 DOI: 10.1097/j.pain.0000000000002636] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic noncancer pain in children and adolescents can be impairing and results in substantial health care costs. Intensive interdisciplinary pain treatment (IIPT), an inpatient or day hospital treatment delivered by a team of 3 or more health professionals, may be an effective intervention for these children and adolescents. Based on previous reviews and meta-analyses, we updated findings regarding the description of available treatments and estimated the effectiveness of IIPT, overcoming methodological shortcomings of previous work by requesting and analyzing individual participant data. On June 26, 2021, we searched 5 literature databases (PubMed, PsycINFO, Web of Science, Cochrane Library, and PubPsych) for studies examining the effectiveness of IIPT. Included studies used a pre-post design, assessed patients younger than 22 years, and presented their results in English, German, French, or Spanish. We used standard methodological procedures expected by Cochrane to pool treatment effects and assess risk of bias. We identified 13 different treatment sites with similar treatment inclusion criteria and treatment components, but the descriptions of those treatments varied widely. Regarding treatment effectiveness, IIPT may result in large improvements in the mean pain intensity ( g = -1.28), disability ( g = -1.91), and number of missed school days at the 12-month follow-up ( g = -0.99), as well as moderate improvements in anxiety ( g = -0.77) and depression ( g = -0.76). The certainty of the evidence, however, was graded from very low to low. We recommend that future researchers use more scientific rigor to increase the certainty of the evidence for IIPT and standardize treatment outcomes for children and adolescents with chronic pain.
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Affiliation(s)
- Benedikt B Claus
- PedScience Research Institute, Datteln, Germany
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Emma Dunford
- Oxford Centre for Children and Young People in Pain (OXCCYPP), Oxford University Hospitals, Oxford, United Kingdom
| | - János Major
- Paediatric Pain Centre, HRC Bethesda Children's Hospital, Budapest, Hungary
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | | | - Rashmi Parekh Bhandari
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Palo Alto, CA, United States
| | - Ardith Baerveldt
- Get Up and Go Persistent Pediatric Pain Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Bloorview Research Institute, Toronto, ON, Canada
| | - Verena Neß
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Kamila Grochowska
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Bettina Hübner-Möhler
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Boris Zernikow
- PedScience Research Institute, Datteln, Germany
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Julia Wager
- PedScience Research Institute, Datteln, Germany
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
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24
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Ramo BA, Collins-Jones TL, Thornberg D, Klinkerman L, Rathjen K, Jo CH. Pain Catastrophizing Influences Preoperative and Postoperative Patient-Reported Outcomes in Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am 2022; 104:1859-1868. [PMID: 35984014 DOI: 10.2106/jbjs.22.00258] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients with adolescent idiopathic scoliosis (AIS) often report chronic back pain; however, there is inadequate research on psychological factors associated with pain in this patient population. Pain catastrophizing, a psychological factor that describes a pattern of negative thoughts and feelings about pain, has been associated with poorer responses to medical treatment for pain. The purpose of this study was to report the prevalence of pain catastrophizing in the AIS population and assess its relationship with preoperative and postoperative self-reported outcomes. METHODS In this prospective cohort study of consecutive patients undergoing posterior spinal fusion (PSF) for AIS, patients experiencing clinically relevant pain catastrophizing, defined as a Pain Catastrophizing Scale for Children (PCS) score in the 75th percentile or higher, were compared with patients with normal PCS scores. Preoperative and 2-year postoperative Scoliosis Research Society Society Questionnaire-30 (SRS-30) scores were correlated with the preoperative PCS score. RESULTS One hundred and eighty-nine patients underwent PSF for AIS, and 20 (10.6%) were considered to be experiencing pain catastrophizing. Despite comparable demographic and radiographic variables, pain catastrophizing was associated with significantly lower preoperative scores than were found in the normal-PCS group in all SRS-30 domains, including pain (2.98 versus 3.95; p < 0.001), appearance (2.98 versus 3.48; p < 0.001), activity (3.51 versus 4.06; p < 0.001), mental health (3.12 versus 4.01; p < 0.001), and total score (3.18 versus 3.84; p < 0.001), except satisfaction (3.72 versus 3.69; p > 0.999). At 2 years, the pain catastrophizing group experienced significant improvement from their preoperative scores in most SRS-30 domains, including a large clinically relevant improvement in pain (from 2.98 preoperatively to 3.84 postoperatively; p < 0.001) and the total score (from 3.18 to 3.85; p < 0.001), but continued to have lower scores than the normal-PCS group for pain (3.84 versus 4.22; p = 0.028) and the total score (3.85 versus 4.15; p = 0.038). Receiver operating characteristic (ROC) curve analysis indicated that an SRS-30 pain score of <3.5 has good sensitivity for predicting pain catastrophizing (PCS ≥75th percentile). CONCLUSIONS In this cohort, patients with AIS who exhibited pain catastrophizing experienced significant improvement in self-reported health 2 years after PSF. However, they did not have the same levels of self-reported health as the normal-PCS group. Pain catastrophizing may be identifiable by lower preoperative SRS-30 pain scores. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Brandon A Ramo
- Scottish Rite for Children, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Karl Rathjen
- Scottish Rite for Children, Dallas, Texas.,University of Texas Southwestern Medical Center, Dallas, Texas
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25
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Nelson S, Smith AM, Jervis K, Silvia MN, Randall E. Will This Treatment Help My Child?: How Parent/Caregiver Treatment Expectations Relate to Intensive Pain Rehabilitation Outcomes for Youth With Chronic Pain. Clin J Pain 2022; 38:651-658. [PMID: 36075895 PMCID: PMC9720665 DOI: 10.1097/ajp.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE An extensive body of research has highlighted the impact that parent/caregiver factors have on functioning and treatment outcomes among youth with chronic pain. However, parent/caregiver expectations in pain treatment have been largely understudied, despite strong evidence that treatment expectations are associated with treatment engagement and overall outcomes in nonpain populations. Accordingly, the primary aim of this investigation was to preliminarily examine the manifestation and measurement of parent/caregiver treatment expectations in an intensive interdisciplinary pediatric pain treatment (IIPT) setting. METHODS Participants in this study (N=328) included children and adolescents who attended an IIPT program for chronic pain between August 2013 and March 2020 and their parent/caregiver(s). Outcomes examined include parent/caregiver self-report of treatment expectations for their child upon admission to the IIPT in addition to pain-related and psychosocial factors at admission and discharge. RESULTS Findings revealed a high level of expectations (ie, belief that the treatment will be helpful) on average, with higher parent/caregiver expectations associated with poorer functioning at admission to and discharge from the IIPT program. CONCLUSION Extremely high treatment expectations among parents of more disabled youth may be indicative of unrealistic hopes or the "need" for IIPT to help their child; tempering parental expectations with psychoeducation about IIPT goals and realistic outcomes may indirectly improve treatment outcomes for their children. Future research should examine the potentially unique and important role that treatment expectations, of both parent/caregivers and their children, may have in overall IIPT outcomes.
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Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Allison M. Smith
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelsey Jervis
- Division of Pain Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Boston Children’s Hospital, Boston, MA, USA
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Waltham, MA
| | - Megan N. Silvia
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA
| | - Edin Randall
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Waltham, MA
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26
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Sil S, Manikowski A, Schneider M, Cohen LL, Dampier C. Identifying Chronic Pain Subgroups in Pediatric Sickle Cell Disease: A Cluster-Analytic Approach. Clin J Pain 2022; 38:601-611. [PMID: 35997659 PMCID: PMC9481686 DOI: 10.1097/ajp.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 08/11/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Youth with sickle cell disease (SCD) and chronic pain, defined in this study as pain on most days for 3 months, experience variability in daily pain and physical and psychosocial functioning. This study aimed to (1) empirically derive chronic pain subgroups based on pain characteristics among youth with chronic SCD pain; and (2) investigate derived subgroups for differences in sociodemographics, clinical characteristics, and psychosocial and functional outcomes. MATERIALS AND METHODS Youth with chronic SCD pain (n=62, Mage =13.9, SD=2.5, 10 to 18 y; 58% female, 60% HbSS) completed a battery of questionnaires. Clinical characteristics (eg, medications, treatments) and health care utilization were abstracted from electronic medical records. Hierarchical cluster analysis informed the number of clusters at the patient level. k-means cluster analysis used multidimensional pain assessment to identify and assign patients to clusters. RESULTS Cluster 1 (n=35; Moderate Frequency, Moderate Pain) demonstrated significantly lower worst pain intensity, number of pain days per month, number of body sites affected by pain, and pain quality ratings. Cluster 2 (n=27; Almost Daily, High Pain) reported high ratings of worst pain intensity, almost daily to daily pain, greater number of body sites affected by pain, and higher ratings of pain quality (all P 's <0.05). There were no differences between subgroups by sociodemographics, clinical characteristics, or health care utilization. The Almost Daily, High Pain subgroup reported significantly higher pain interference, depressive symptoms, and pain catastrophizing than the Moderate Frequency, Moderate Pain subgroup. DISCUSSION Identifying chronic SCD pain subgroups may inform tailored assessment and intervention to mitigate poor pain and functional outcomes.
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Affiliation(s)
- Soumitri Sil
- Emory University School of Medicine, Department of Pediatrics
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
| | - Alison Manikowski
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Mallory Schneider
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences
| | - Lindsey L. Cohen
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
- Georgia State University, Department of Psychology
| | - Carlton Dampier
- Emory University School of Medicine, Department of Pediatrics
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
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27
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Brosbe MS, Thompson CC, Flanders XC, Day A, Ward C, Slifer KJ. Pain Catastrophizing and Functional Disability in Youth with Chronic Pain: An Examination of Indirect Effects. J Clin Psychol Med Settings 2022; 29:546-556. [PMID: 35545726 DOI: 10.1007/s10880-022-09877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/26/2022]
Abstract
Pediatric pain conditions are not uncommon and may lead to functional disability. The purpose of this study is to examine indirect effects of pain catastrophizing on functional disability through anxiety, depression, and pain in youth with chronic pain. Participants included 197 youth (144 females, Mage = 14.67 years) with chronic pain conditions. Youth completed self-report measures of pain catastrophizing, depression, anxiety, pain intensity, and functional disability. Caregivers also completed a measure of youth functional disability. Using a cross-sectional design, a multiple mediator model was estimated with pain catastrophizing as the predictor, functional disability as the outcome, and depression, anxiety, and pain intensity as mediators. Results supported a mediation model in which depression (B = 0.1145, SE = 0.0528, Z = 2.1686; B = 0.1512, SE = 0.0585, Z = 2.5846) and pain intensity (B = 0.1015, SE = 0.0422, Z = 2.4052; B = 0.0634, SE = 0.0343, Z = 1.8484) significantly mediated the effects of catastrophizing on child self-report and parent-report functional disability, respectively, while anxiety (B = - 0.0260, SE = 0.0439501, Z = - 0.5923; B = - 0.0637, SE = 0.0552, Z = - 1.1540) did not. Theoretical and clinical applications are discussed.
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Affiliation(s)
- Micah S Brosbe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 1800 Orleans Street, Bloomberg 12, Baltimore, MD, 21287, USA.
| | - Caitlin C Thompson
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ximena C Flanders
- South Florida Pediatric Psychology, Parkland, FL, USA
- JDCH Pediatric Psychology, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Alyssa Day
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Cynthia Ward
- North Atlanta Pediatric Psychology, Roswell, GA, USA
| | - Keith J Slifer
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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28
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Holley AL, Gaultney W, Wilson AC. Using the Parent Risk Screening Measure (PRISM) to Assess Pain-Related Risk Factors in Parents of Youth Seeking Treatment for Acute Musculoskeletal Pain. Clin J Pain 2022; 38:520-527. [PMID: 35696711 PMCID: PMC9283372 DOI: 10.1097/ajp.0000000000001053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/26/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The Parent Risk Screening Measure (PRISM) rapidly assesses parent distress, psychosocial function, and behaviors associated with child pain-related dysfunction in parents of youth with chronic pain. Recognizing the importance of parent pain-related cognitions and responses to pain during the acute pain period, the current study examined the utility of the PRISM in screening parents of youth with acute pain. METHODS Participants were 175 parent-youth dyads taking part in a larger study examining risk and resilience in youth with acute musculoskeletal pain. Parents completed the PRISM and a battery of measures reporting on their child's pain-related disability and cognitions and behaviors in response to their child's pain. Youth reported on their pain, pain-related disability, pain-related fear, catastrophizing, and pain self-efficacy. RESULTS PRISM total scores ( M =2.55, SD=2.77) were correlated with many parent and child report measures (eg, protectiveness, catastrophizing, and pain-related fear), with higher scores associated with greater symptoms. Using published PRISM cutoffs, 86.9% of parents were classified as low and 13.13% as elevated risk. t tests revealed significant differences between elevated and low-risk groups on several measures. Moreover, youth of parents in the elevated risk group were more likely to meet clinical cutoffs on pain catastrophizing and fear avoidance measures. DISCUSSION Findings suggest the PRISM is useful in screening for parent distress and behaviors associated with elevated pain symptomatology in a pediatric acute musculoskeletal pain sample. The important next steps are to identify the ideal time for administering the PRISM and to examine the associations among PRISM scores and pain outcomes over time.
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Affiliation(s)
- Amy L Holley
- Division of Psychology, Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, OR
| | | | - Anna C Wilson
- Division of Psychology, Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, OR
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29
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Schneider MB, Manikowski A, Cohen L, Dampier C, Sil S. The distinct longitudinal impact of pain catastrophizing on pain interference among youth living with sickle cell disease and chronic pain. J Behav Med 2022; 45:622-631. [PMID: 35171440 PMCID: PMC9308676 DOI: 10.1007/s10865-021-00280-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/28/2021] [Indexed: 01/11/2023]
Abstract
Youth living with chronic sickle cell disease (SCD) pain are at risk for psychosocial distress and high levels of pain catastrophizing that contribute to functional impairment. This study aimed to identify the unique long-term impact of pain catastrophizing on pain impairment among youth with SCD. Youth with chronic SCD pain (N = 63, 10-18 years old, 58.3% female, 95.1% Black or African American) were recruited within comprehensive SCD clinics and completed a battery of measures at baseline and 4-months follow-up. A linear hierarchical regression examined baseline demographic and clinical characteristics (child SCD genotype, age, and average pain intensity), psychosocial functioning (anxiety, depression), and pain catastrophizing as predictors of pain interference at 4-months follow-up. Pain catastrophizing was the only unique predictor of pain interference at 4-months follow-up. Among youth with chronic SCD pain, pain catastrophizing warrants greater consideration as an important predictor that influences pain management and overall functioning.
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Affiliation(s)
- Mallory B Schneider
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 515 N Crossville Rd, Roswell, GA, 30075, USA.
- Emory University School of Medicine, Atlanta, USA.
| | - Alison Manikowski
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 515 N Crossville Rd, Roswell, GA, 30075, USA
- Emory University School of Medicine, Atlanta, USA
| | - Lindsey Cohen
- Emory University School of Medicine, Atlanta, USA
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Carlton Dampier
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 515 N Crossville Rd, Roswell, GA, 30075, USA
- Emory University School of Medicine, Atlanta, USA
| | - Soumitri Sil
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 515 N Crossville Rd, Roswell, GA, 30075, USA
- Emory University School of Medicine, Atlanta, USA
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30
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Comparison of pain and psychosocial correlates among Hispanic and Non-Hispanic White youth with chronic pain. Pain Rep 2022; 7:e1020. [PMID: 35924081 PMCID: PMC9296181 DOI: 10.1097/pr9.0000000000001020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction: Despite well-documented pain disparities among adults from non-White and Hispanic groups, less is known about pain disparities in non-White and Hispanic pediatric populations. Objectives: We compare pain and related psychosocial factors at the individual (pain intensity, pain interference, pain catastrophizing, co-occurring symptoms), social (peer relations), and systemic (health insurance) levels among Hispanic and Non-Hispanic White (NHW) youth with chronic pain. Methods: Eight hundred thirty-seven (71.4% female) Hispanic (n = 268, 32%) and NHW (n = 569, 68%) youth ages 8 to 17 years (M = 14.00; SD = 2.54) completed a survey at their initial visit to a pain clinic. Independent sample t tests investigated mean differences in psychosocial factors at the individual and social levels. Chi-squared tests investigated differences at the systemic level. Bivariate correlations for each group were compared using Fisher r-to-z transformations. Results:. Hispanic youth reported higher levels of pain intensity (t[811] = −2.75, P = 0.006). Groups did not differ in reports of other individual or social factors. Non-Hispanic White youth were more likely to have private insurance (OR, 5.66). All examined variables were significantly correlated among NHW youth. Correlations were weaker or nonsignificant among Hispanic youth. Fisher r-to-z transformations revealed these group differences to be significant. Conclusion: Hispanic youth report higher pain levels than NHW counterparts and lower likelihood of having private insurance. Pain and psychosocial factors correlate differently among the 2 groups highlighting a need to better understand the chronic pain experiences of diverse youth because models derived primarily from NHW populations may not generalize across ethnic and racial groups.
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31
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Andias R, Sa-Couto P, Silva AG. Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial. Phys Ther 2022; 102:6575293. [PMID: 35485186 DOI: 10.1093/ptj/pzac048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP). METHODS A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up. RESULTS There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found. CONCLUSION Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups.
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Affiliation(s)
- Rosa Andias
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS), Piso 2, Edifício nascente, Porto, Portugal
| | - Pedro Sa-Couto
- CINTESIS@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, Aveiro, Portugal
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32
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Tutelman PR, Chambers CT, Cornelissen L, Fernandez CV, Flanders A, MacLeod J, Sherry SB, Stewart SH, Urquhart R, de Gagne S, Guilcher GM, Hashmi J, Heathcote LC, Noel M, Schulte FS, Stinson JN, Stern M. Long-term alterations in somatosensory functioning in survivors of childhood cancer. Pain 2022; 163:1193-1205. [PMID: 34855647 PMCID: PMC9100454 DOI: 10.1097/j.pain.0000000000002486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/06/2021] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Cancer and its treatment can have lasting consequences on somatosensation, including pain, which is often underrecognized and undertreated. Research characterizing the impact of cancer on pain and sensory processing in survivors of childhood cancer is scarce. This study aimed to quantify generalized differences in pain and sensory processing in survivors of childhood cancer compared with reference data using a standardized thermal and mechanical quantitative sensory testing (QST) protocol. The association between demographic, clinical (eg, leukemia vs other cancers and treatment exposures), and psychosocial (eg, anxiety and pain catastrophizing) variables and sensitivity to pain and sensory stimuli were also evaluated. Participants were 56 survivors of various types of childhood cancer (52% male, Mage = 13.5 years, SD = 3.2, range = 8-17 years). On average, children were 7 years (SD = 4.1, range = 1.2-16.5) post treatment. Almost all participants (86%) had at least 1 abnormal QST parameter compared with age- and sex-matched reference data; however, few participants self-reported the presence of sensory abnormalities. Generally, participants exhibited reduced sensitivity across the QST parameters examined (Ps < 0.05, ds = 0.40-3.45). A significant minority (45%) also exhibited pain sensitization (P <0.001, d = 0.42). Several risk factors for changes in sensory processing were identified, including current age, history of leukemia, certain treatment exposures (eg, vincristine cumulative dose, major surgery, and bone marrow or stem cell transplant), time off treatment, and higher anxiety and pain catastrophizing scores. Overall, this study demonstrated that somatosensory changes are prevalent in survivors of childhood cancer years after the completion of treatment. Future research is needed to understand long-term implications of altered somatosensation in this complex population.
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Affiliation(s)
- Perri R. Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Christine T. Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Laura Cornelissen
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anaesthesia, Harvard Medical School, Boston, MA, United States
| | - Conrad V. Fernandez
- Division of Pediatric Hematology‐Oncology, IWK Health Centre, Halifax, NS, Canada
- Departments of Pediatrics and Bioethics, Dalhousie University, Halifax, NS, Canada
| | - Annette Flanders
- Division of Pediatric Hematology‐Oncology, IWK Health Centre, Halifax, NS, Canada
| | | | - Simon B. Sherry
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Gregory M.T. Guilcher
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Haematology, Oncology & Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Javeria Hashmi
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, CA, United States
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Fiona S.M. Schulte
- Haematology, Oncology & Transplant Program, Alberta Children's Hospital, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Verriotis M, Sorger C, Peters J, Ayoub LJ, Seunarine KK, Clark CA, Walker SM, Moayedi M. Amygdalar Functional Connectivity Differences Associated With Reduced Pain Intensity in Pediatric Peripheral Neuropathic Pain. FRONTIERS IN PAIN RESEARCH 2022; 3:918766. [PMID: 35692562 PMCID: PMC9184677 DOI: 10.3389/fpain.2022.918766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background There is evidence of altered corticolimbic circuitry in adults with chronic pain, but relatively little is known of functional brain mechanisms in adolescents with neuropathic pain (NeuP). Pediatric NeuP is etiologically and phenotypically different from NeuP in adults, highlighting the need for pediatric-focused research. The amygdala is a key limbic region with important roles in the emotional-affective dimension of pain and in pain modulation. Objective To investigate amygdalar resting state functional connectivity (rsFC) in adolescents with NeuP. Methods This cross-sectional observational cohort study compared resting state functional MRI scans in adolescents aged 11–18 years with clinical features of chronic peripheral NeuP (n = 17), recruited from a tertiary clinic, relative to healthy adolescents (n = 17). We performed seed-to-voxel whole-brain rsFC analysis of the bilateral amygdalae. Next, we performed post hoc exploratory correlations with clinical variables to further explain rsFC differences. Results Adolescents with NeuP had stronger negative rsFC between right amygdala and right dorsolateral prefrontal cortex (dlPFC) and stronger positive rsFC between right amygdala and left angular gyrus (AG), compared to controls (PFDR<0.025). Furthermore, lower pain intensity correlated with stronger negative amygdala-dlPFC rsFC in males (r = 0.67, P = 0.034, n = 10), and with stronger positive amygdala-AG rsFC in females (r = −0.90, P = 0.006, n = 7). These amygdalar rsFC differences may thus be pain inhibitory. Conclusions Consistent with the considerable affective and cognitive factors reported in a larger cohort, there are rsFC differences in limbic pain modulatory circuits in adolescents with NeuP. Findings also highlight the need for assessing sex-dependent brain mechanisms in future studies, where possible.
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Affiliation(s)
- Madeleine Verriotis
- Paediatric Pain Research Group, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- *Correspondence: Madeleine Verriotis
| | - Clarissa Sorger
- Paediatric Pain Research Group, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Judy Peters
- Paediatric Pain Research Group, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Lizbeth J. Ayoub
- Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for the Study of Pain, Toronto, ON, Canada
- Division of Clinical and Computational Neuroscience, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Kiran K. Seunarine
- Developmental Imaging and Biophysics Section, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Chris A. Clark
- Developmental Imaging and Biophysics Section, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Suellen M. Walker
- Paediatric Pain Research Group, Developmental Neurosciences Department, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, University of Toronto, Toronto, ON, Canada
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- University of Toronto Centre for the Study of Pain, Toronto, ON, Canada
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34
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Andias R, Silva AG. Impact of sex, sleep, symptoms of central sensitization and psychosocial factors in adolescents with chronic musculoskeletal pain-an exploratory study. PAIN MEDICINE 2022; 23:1777-1792. [PMID: 35389479 DOI: 10.1093/pm/pnac053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE This study aimed to explore and compare the association between psychosocial factors, sleep, central sensitization, and chronic neck, back, limbs, and multiregional pain and disability. METHODS 1730 adolescents responded to an online questionnaire containing: sociodemographic data, Nordic Musculoskeletal Questionnaire, International Physical Activity Questionnaire, Functional Disability Inventory, Depression, Anxiety and Stress Scale, Basic Scale on Insomnia Complaints and Quality of Sleep, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia, Child Self-Efficacy Scale and Central Sensitization Inventory. Univariable and multivariable regression analysis was used to assess the associations between these variables and pain and disability. RESULTS Groups were categorized into neck (n = 54), back (n = 80), upper limb (n = 52), lower limb (n = 109) and multiregional (n = 1140) pain. Multivariable analysis showed that symptoms of central sensitization increased odds of neck, back, and multiregional pain; depression, anxiety and stress, and physical activity increased odds of multiregional pain; and fear of movement increased odds of lower limb pain. Female gender increased the odds of pain in all groups, except in the lower limb group. Depression, anxiety, and stress also remained associated with disability in neck, back, upper limb, and multiregional pain; poorer sleep remained associated with disability in neck, upper limb, and multiregional pain; catastrophizing remained associated with back, and multiregional pain; and fear of movement and symptoms of central sensitization were only associated with disability in multiregional pain. CONCLUSIONS There are similar but also different variables associated with the presence of pain and disability in the neck, back, limbs, and multiregional pain.
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Affiliation(s)
- Rosa Andias
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, 3800-193, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS), Piso 2, Edifício nascente, Rua Dr. Plácido da Costa, s/n, 4200-450, Porto, Portugal
| | - Anabela G Silva
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, 3800-193, Aveiro, Portugal.,CINTESIS.RISE@UA, School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, 3800-193, Aveiro, Portugal
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35
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Timmers I, López-Solà M, Heathcote LC, Heirich M, Rush GQ, Shear D, Borsook D, Simons LE. Amygdala functional connectivity mediates the association between catastrophizing and threat-safety learning in youth with chronic pain. Pain 2022; 163:719-728. [PMID: 35302974 PMCID: PMC8933619 DOI: 10.1097/j.pain.0000000000002410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/25/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is a need to identify brain connectivity alterations predictive of transdiagnostic processes that may confer vulnerability for affective symptomology. Here, we tested whether amygdala resting-state functional connectivity (rsFC) mediated the relationship between catastrophizing (negative threat appraisals and predicting poorer functioning) and altered threat-safety discrimination learning (critical to flexibly adapt to new and changing environments) in adolescents with persistent pain. We examined amygdala rsFC in 46 youth with chronic pain and 29 healthy peers (age M = 15.8, SD = 2.9; 64 females) and its relationship with catastrophizing and threat-safety learning. We used a developmentally appropriate threat-safety learning paradigm and performed amygdala seed-based rsFC and whole-brain mediation analyses. Patients exhibited enhanced connectivity between the left amygdala and right supramarginal gyrus (SMG) (cluster-level P-FDR < 0.05), whereas right amygdala rsFC showed no group differences. Only in patients, elevated catastrophizing was associated with facilitated threat-safety learning (CS+>CS-; rp = 0.49, P = 0.001). Furthermore, in patients, elevated catastrophizing was associated with reduced left amygdala connectivity with SMG / parietal operculum, and increased left amygdala connectivity with hippocampus, dorsal striatum, paracingulate, and motor regions (P < 0.001). In addition, blunted left amygdala rsFC with right SMG/parietal operculum mediated the association between catastrophizing and threat-safety learning (P < 0.001). To conclude, rsFC between the left amygdala (a core emotion hub) and inferior parietal lobe (involved in appraisal and integration of bodily signals and attentional reorienting) explains associations between daily-life relevant catastrophizing and threat-safety learning. Findings provide a putative model for understanding pathophysiology involved in core psychological processes that cut across diagnoses, including disabling pain, and are relevant for their etiology.
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Affiliation(s)
- Inge Timmers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Marina López-Solà
- Serra Hunter Program, Unit of Psychological Medicine, Department of Medicine, School of Medicine and Health Sciences, University of Barcelona, 08007 Barcelona, Spain
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Marissa Heirich
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Gillian Q Rush
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - Deborah Shear
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
| | - David Borsook
- Center for Pain and the Brain, Boston Children’s Hospital, Center for Pain and the Brain, Boston, MA 02115, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, United States
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36
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Ocay DD, Larche CL, Betinjane N, Jolicoeur A, Beaulieu MJ, Saran N, Ouellet JA, Ingelmo PM, Ferland CE. Phenotyping Chronic Musculoskeletal Pain in Male and Female Adolescents: Psychosocial Profiles, Somatosensory Profiles and Pain Modulatory Profiles. J Pain Res 2022; 15:591-612. [PMID: 35250304 PMCID: PMC8892739 DOI: 10.2147/jpr.s352607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
Purpose A major limitation in treatment outcomes for chronic pain is the heterogeneity of the population. Therefore, a personalized approach to the assessment and treatment of children and adolescents with chronic pain conditions is needed. The objective of the study was to subgroup pediatric patients with chronic MSK pain that will be phenotypically different from each other based on their psychosocial profile, somatosensory function, and pain modulation. Patients and Methods This observational cohort study recruited 302 adolescents (10–18 years) with chronic musculoskeletal pain and 80 age-matched controls. After validated self-report questionnaires on psychosocial factors were completed, quantitative sensory tests (QST) and conditioned pain modulation (CPM) were performed. Results Three psychosocial subgroups were identified: adaptive pain (n=125), high pain dysfunctional (n=115), high somatic symptoms (n=62). Based on QST, four somatosensory profiles were observed: normal QST (n=155), thermal hyperalgesia (n=98), mechanical hyperalgesia (n=34) and sensory loss (n=15). Based on CPM and temporal summation of pain (TSP), four distinct groups were formed, dysfunctional central processing group (n=27) had suboptimal CPM and present TSP, dysfunctional inhibition group (n=136) had suboptimal CPM and absent TSP, facilitation group (n=18) had optimal CPM and present TSP, and functional central processing (n=112) had optimal CPM and absent TSP. A significant association between the psychosocial and somatosensory profiles. However, no association was observed between the psychosocial or somatosensory profiles and pain modulatory profiles. Conclusion Our results provide evidence that adolescents with chronic musculoskeletal pain are a heterogenous population comprising subgroups that may reflect distinct mechanisms and may benefit from different treatment approaches. The combination of screening self-reported questionnaires, QST, and CPM facilitate subgrouping of adolescents with chronic MSK pain in the clinical context and may ultimately contribute to personalized therapy.
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Affiliation(s)
- Don Daniel Ocay
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Cynthia L Larche
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Natalie Betinjane
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Alexandre Jolicoeur
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Marie Josee Beaulieu
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
| | - Neil Saran
- Department of Pediatric Orthopedics, McGill University, Montreal, QC, Canada
| | - Jean A Ouellet
- Department of Pediatric Orthopedics, McGill University, Montreal, QC, Canada
| | - Pablo M Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Research Institute-McGill University Health Centre, Montreal, QC, Canada
- Alan Edwards Research Center for Pain, McGill University, Montreal, QC, Canada
| | - Catherine E Ferland
- Department of Experimental Surgery, McGill University, Montreal, QC, Canada
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Research Institute-McGill University Health Centre, Montreal, QC, Canada
- Alan Edwards Research Center for Pain, McGill University, Montreal, QC, Canada
- Correspondence: Catherine E Ferland, Shriners Hospitals for Children-Canada, 1003, Decarie Blvd, Montreal, H4A 0A9, Canada, Tel +1 514 842-4464, extension 7177,Fax +1 514 842-8664, Email
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Luo H, Cai Z, Huang Y, Song J, Ma Q, Yang X, Song Y. Study on Pain Catastrophizing From 2010 to 2020: A Bibliometric Analysis via CiteSpace. Front Psychol 2022; 12:759347. [PMID: 34975649 PMCID: PMC8718514 DOI: 10.3389/fpsyg.2021.759347] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/29/2021] [Indexed: 12/14/2022] Open
Abstract
Purpose: This study aimed to evaluate the global scientific output of research on pain catastrophizing and explore the hotspots and frontiers from 2010 to 2020 using bibliometric methods. Methods: Publications regarding pain catastrophizing published from 2010 to 2020 were extracted from the Web of Science Core Collection. CiteSpace was used to analyze the number of publications, countries, institutions, journals, authors, cited references, and keywords using standard bibliometric indicators. Results: A total of 1,576 publications on pain catastrophizing were retrieved from 2010 to December 31, 2020. The number and rate of the annual publications gradually increased totally. Pain (130) was the most productive journal. Meanwhile, Pain ranked first in the frequency (1,432) and centrality (0.31) of the cited journals. The most productive country and institution in this frequency field were the United States (642) and the University of Washington (73), respectively. Jensen MP (34) was the most prolific author, and Sullivan MJL (1,196) ranked first among the cited authors. In the ranking of frequency in the cited references, the first article was a critical review about pain catastrophizing published by Quartana (100). The keyword “Low back pain” had the highest frequency (556). “Total hip” was identified as a frontier research item for 2016–2020. Conclusion: The findings of this bibliometric study provide the current status and trends in the clinical research of pain catastrophizing and may help researchers to identify hot topics and explore new research directions in this field.
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Affiliation(s)
- Huifang Luo
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zongliao Cai
- Physical and Mental Medicine, Guangzhou Brain Hospital, Guangzhou, China
| | - Yanyi Huang
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiating Song
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qing Ma
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiangwei Yang
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yang Song
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
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Holley AL, Gaultney W, Turner H, Wilson AC. The Pediatric Pain Screening Tool (PPST) can Rapidly Identify Elevated Pain and Psychosocial Symptomatology in Treatment-Seeking Youth with Acute Musculoskeletal Pain. THE JOURNAL OF PAIN 2022; 23:65-73. [PMID: 34256088 PMCID: PMC8724415 DOI: 10.1016/j.jpain.2021.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/04/2021] [Accepted: 06/20/2021] [Indexed: 02/09/2023]
Abstract
This cross-sectional study examines the utility of the Pediatric Pain Screening Tool (PPST) for rapidly assessing pain and psychosocial symptomatology in treatment-seeking youth with acute musculoskeletal pain. Participants were 166 youth (10-18 years, 53.6% female) participating in one of two larger cohort studies of youth with acute musculoskeletal pain. Youth completed the PPST and measures of pain, pain-related fear, pain catastrophizing, pain-related disability, and sleep quality. Participants were categorized into PPST risk groups using published cut-offs. ANOVA and chi-square examined associations between PPST risk groups and self-report measures; receiver operating characteristic (ROC) analyses examined associations among PPST scores and clinical reference cut-offs. The PPST classified 28.3% of youth as high, 23.5% as moderate, and 48.2% as low-risk. Females were more likely to be high-risk. ANOVAs revealed differences in clinical factors by PPST risk group particularly differences among youth labeled high versus low-risk. ROC analyses showed the PPST is effective in discriminating "cases" versus "non-cases" on pain-related disability, pain-fear and catastrophizing. Results reveal the PPST is effective for rapidly screening youth with acute pain for pain and psychosocial symptomatology. An important next step will be to examine the validity of the PPST in predicting recovery outcomes of acute pain samples. PERSPECTIVE: This article presents the Pediatric Pain Screening Tool (PPST) as a measure for rapidly screening youth with acute pain for pain and psychosocial symptomatology. The tool categorizes youth into low, moderate or high-risk groups and discriminates among those with versus without clinically significant levels of disability, pain-related fear and catastrophizing.
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Affiliation(s)
- Amy L. Holley
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University (OHSU)
| | - Wendy Gaultney
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University (OHSU)
| | - Hayley Turner
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University (OHSU)
| | - Anna C. Wilson
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University (OHSU)
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Gamwell KL, Mara CA, Hommel KA, Kashikar-Zuck S, Cunningham NR. Establishing Clinical Cut-points on the Pediatric PROMIS-Pain Interference Scale in Youth With Abdominal Pain. Clin J Pain 2021; 38:173-181. [PMID: 34928870 PMCID: PMC8958958 DOI: 10.1097/ajp.0000000000001012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Abdominal pain is a common presenting complaint in youth seeking medical care and can be debilitating. Therefore, it is important to understand the impact of pain on functioning using a clinically sensitive approach. The National Institutes of Health has established a common core of psychometrically precise measures through the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative. The Pediatric PROMIS-Pain Interference (PPPI) scale was developed to measure pain-related interference, drawing from existing legacy measures. However, its clinical validity has not been thoroughly established in clinical populations. The current study sought to develop clinical cut-points and investigate the validity of the PPPI in a large sample (N=5281) of youth presenting to gastroenterological care with abdominal pain symptoms. MATERIALS AND METHODS Convergent validity of the PPPI was investigated. Quartile and tertile groupings of the PPPI were calculated and compared with cut-points derived from healthy populations and mixed convenience samples on clinical outcomes via multivariate analyses of variance. RESULTS There was good evidence of convergent validity. The tertile solution was superior in classifying different levels of pain-related outcomes as compared with other cut-points. The tertile solution suggested the following PPPI groupings: minimal (≤51), moderate (52 to 59), and severe (≥60). DISCUSSION Results suggest the PPPI is a valid measure with clinically meaningful cut-points to assess pain-related interference in youth with abdominal pain.
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Affiliation(s)
- Kaitlyn L. Gamwell
- University of South Carolina School of Medicine, Department of Pediatrics, Greenville, SC
- Prisma Health Children’s Hospital, Department of Pediatric Pain Medicine, Greenville, SC
| | - Constance A. Mara
- University of Cincinnati, College of Medicine, Department of Pediatrics, Cincinnati, OH
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH
| | - Kevin A. Hommel
- University of Cincinnati, College of Medicine, Department of Pediatrics, Cincinnati, OH
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH
| | - Susmita Kashikar-Zuck
- University of Cincinnati, College of Medicine, Department of Pediatrics, Cincinnati, OH
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, OH
| | - Natoshia R. Cunningham
- Michigan State University, Department of Family Medicine, College of Human Medicine, Grand Rapids, MI
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Matthews E, Murray G, McCarthy K. ICD-11 Classification of Pediatric Chronic Pain Referrals in Ireland, with Secondary Analysis of Primary vs Secondary Pain Conditions. PAIN MEDICINE 2021; 22:2533-2541. [PMID: 33769541 PMCID: PMC8633725 DOI: 10.1093/pm/pnab116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective To classify pediatric chronic pain referrals in Ireland according to the classification system of the 11th version of the International Classification of Diseases (ICD-11). In addition, differences between primary and secondary pain groups were assessed. Methods Retrospective review of complex pain assessment forms completed at the time of initial attendance at pediatric chronic pain clinics in Dublin, Ireland. Patients were classified as having a chronic primary (CPP) or chronic secondary (CSP) pain condition as per ICD-11 classification. Secondary analysis of between-group and within-group differences between primary and secondary pain conditions was undertaken. Results Of 285 patients coded, 123 patients were designated as having a CPP condition (77% of whom were assigned an adjunct parent code) and 162 patients as having a CSP condition (61% of whom were assigned an adjunct parent code). Between-group comparisons found that the lowest reported pain scores were higher in CPP than in CSP conditions. There were stronger correlations between parental pain catastrophizing and pain intensity, school attendance, and pain interference with social activities in the CSP group than in the CPP group. Conclusions The majority of children with both CPP and CSP were assigned multiple parent codes. There appears to be a gradient in the differences in biopsychosocial profile between CPP and CSP conditions. Additional field testing of the ICD-11 classification in pediatric chronic pain will be required.
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Affiliation(s)
| | | | - Kevin McCarthy
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple Street, Dublin, Ireland.,Department of Paediatrics, Trinity College Dublin, Dublin, Ireland
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41
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Wainwright E, Jordan A, Fisher E, Wilson C, Mullen D, Madhavakkannan H. Beliefs About Worry and Pain Amongst Adolescents With and Without Chronic Pain. J Pediatr Psychol 2021; 47:432-445. [PMID: 34725707 DOI: 10.1093/jpepsy/jsab109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore beliefs about worries, beliefs about pain, and worries about pain held by adolescents with and without chronic pain. METHODS Adolescents with and without chronic pain aged 14-19 completed an online survey with free text questions about pain and worry. We collected demographics and used the Penn State Worry Questionnaire and Pain Catastrophizing Scale for Children to contextualize the qualitative data, which was analyzed with reflexive thematic analysis. RESULTS Eighty-one participants completed the survey, 36 with chronic pain and 45 without (mean age: 16.73). Compared to adolescents without chronic pain, adolescents living with chronic pain reported significantly higher general worry and pain catastrophizing. Thematic analysis generated two themes, "Worry changes perceptions of selfhood" and "Pain changes perceptions of selfhood." Each theme comprised two sub-themes showing how current and future identity trajectories were distorted by worry and pain. The theme "Pain changes perceptions of selfhood" also included a third sub-theme: "Pain impedes future working choices." Worry content as well as process was problematic in all adolescents. Adolescents experiencing chronic pain had specific, additional worries that pain reduces future career progression. These worries appeared highly salient and challenging. CONCLUSIONS Adolescents may need greater support in recognizing worry as part of normative development. Adolescents in pain may benefit from specific support identifying and reducing how pain-related worries interact with their futures and careers, and from school-based and vocational interventions to reduce the realistic risks they face negotiating modern labor markets.
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Affiliation(s)
- Elaine Wainwright
- Psychology Department, Bath Spa University, Bath, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, UK.,Versus Arthritis MRC Centre for Musculoskeletal Health and Work, UK.,Centre for Pain Research, University of Bath, Bath, UK
| | - Abbie Jordan
- Centre for Pain Research, University of Bath, Bath, UK.,Department of Psychology, University of Bath, Bath, UK
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK.,Cochrane Pain, Palliative, and Supportive Care, Oxford University Hospitals, Oxford, UK
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Chabot B, Sweatman H, Ocay DD, Premachandran S, Roy M, Ferland CE. Pain Catastrophizing Throughout the Perioperative Period in Adolescents With Idiopathic Scoliosis. Clin J Pain 2021; 37:688-697. [PMID: 34265790 PMCID: PMC8360666 DOI: 10.1097/ajp.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pain catastrophizing in children and adolescents has been associated to unfavorable postsurgical outcomes. However, pain catastrophizing is rarely measured throughout the perioperative period. Using a prospective longitudinal approach, the present study aimed to identify how pain catastrophizing changes over the perioperative period in pediatric surgical patients with adolescent idiopathic scoliosis. MATERIALS AND METHODS Adolescent patients undergoing spinal fusion surgery completed the Pain Catastrophizing Scale for Children and additional questionnaires to assess pain intensity, state and trait anxiety, and kinesiophobia before surgery, and 1, 2, 5 days, 6 weeks, and 6 months after surgery. RESULTS Patients who had higher levels of pain catastrophizing before surgery were more likely to be anxious, avoid activity that may cause pain, report higher pain intensity before surgery and anticipate more pain after surgery. Low pain catastrophizers increased into a moderate level of pain catastrophizing before decreasing after discharge from the hospital. Meanwhile, moderate and high pain catastrophizers both decreased into lower and moderate levels of catastrophizing, respectively, after discharge from the hospital. DISCUSSION These findings demonstrate that pain catastrophizing in adolescents changes over the perioperative period. Observing changes in pain catastrophizing throughout the perioperative period may help in recognizing when patients are most vulnerable during this time. Decreasing pain catastrophizing before surgery or in the acute postoperative period through therapies that target pain catastrophizing may help reduce the patient's likelihood of experiencing unfavorable postoperative outcomes.
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Affiliation(s)
| | | | - Don D. Ocay
- Experimental Surgery
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
| | | | | | - Catherine E. Ferland
- Anesthesia
- Integrated Program in Neuroscience, McGill University
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
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Battle of the Appraisals: Pain-Related Injustice Versus Catastrophizing as Mediators in the Relationship Between Pain Intensity and 3-Month Outcomes in Adolescents with Chronic Pain. THE JOURNAL OF PAIN 2021; 23:223-235. [PMID: 34403788 DOI: 10.1016/j.jpain.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Abstract
Pain appraisals are closely tied to pain and functional outcomes. Pain-related injustice and pain catastrophizing appraisals have both been identified as important cognitive-emotional factors in the pain experience of youth. Although pain-related injustice and catastrophizing have been linked to worse pain outcomes - as primary predictors and intermediary variables - little is known about whether they operate as independent or parallel mediators of the relationship between pain and functioning in youth. We tested pain-related injustice and catastrophizing appraisals as candidate mediators of the relationship between baseline pain intensity and 3-month functional outcomes in adolescents. Youth with chronic pain (N = 89, 76% female, 89% White, average age = 15 years) completed measures assessing pain intensity, pain-related injustice, and catastrophizing at baseline, as well as measures assessing functional disability and overall quality of life 3 months later. Multiple mediation analyses indicated that injustice mediated the relationship between pain intensity and 3 month quality of life. Exploratory analyses of specific quality of life domains indicated that injustice mediated the relationship between pain intensity and 3 month emotional functioning, whereas catastrophizing mediated the relationship between pain intensity and 3 month social functioning. The findings suggest these pain-related appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes. PERSPECTIVE: Pain-related injustice and catastrophizing appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes in youth with chronic pain. Treatments targeting pain-related injustice appraisals in pediatric populations are needed to complement existing treatments for catastrophizing.
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Battison EAJ, Wilson AC, Holley AL. Perceived Injustice Is Associated With Pain-related Function and Mood in Youth With Acute Musculoskeletal Pain. Clin J Pain 2021; 37:575-582. [PMID: 34008507 PMCID: PMC8273116 DOI: 10.1097/ajp.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 04/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Perceived injustice (PI), which is one's appraisal of justice or fairness regarding the pain experience, is an emerging area of interest in pediatric pain research. No previous studies have investigated PI in youth with acute pain. To fill this gap, this study examined (1) associations among PI, pain-related function, and psychological function in treatment-seeking youth with acute musculoskeletal (MSK) pain, and (2) the impact of parent-child PI discordance on children's pain and psychosocial function. MATERIALS AND METHODS Participants were youth (aged 11 to 17, 55% male) with acute pain (onset <1 mo) recruited from emergency departments or outpatient clinics and participating parents (102 parent-child dyads). Dyads completed study questionnaires within 1 month of the child's pain onset. RESULTS Youth-reported PI was significantly correlated with poorer physical and psychosocial quality of life, higher pain catastrophizing, higher fear of pain, increased pain-related disability, and greater depression and anxiety. Furthermore, PI was significantly associated with the physical quality of life, psychosocial quality of life, and pain-related disability. Moreover, discordance in youth and parent ratings of PI was associated with children's psychological and pain-related function. Specifically, compared with Concordant dyads, youth in the Discordant dyads (youth high PI/parent low PI) reported significantly poorer physical quality of life, psychosocial quality of life, higher pain-related disability, depression, anxiety, and pain catastrophizing. DISCUSSION These findings reveal that PI in youth with acute MSK pain is associated with quality of life and pain-related disability. Furthermore, results highlight the importance of discordance between youth and parent reports of PI on pain-related functioning.
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Affiliation(s)
- Eleanor A J Battison
- Department of Pediatrics, Division of Psychology, Oregon Health & Science University, Portland, OR
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45
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Chronic musculoskeletal pain, catastrophizing, and physical function in adult women were improved after 3-month aerobic-resistance circuit training. Sci Rep 2021; 11:14939. [PMID: 34294740 PMCID: PMC8298582 DOI: 10.1038/s41598-021-91731-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Although exercise is beneficial for chronic musculoskeletal pain (CMP), the optimal type and amount of exercise are unclear. This study aimed to determine the impact of circuit training that combines aerobic and resistance exercises on adult women with CMP. A total of 139 women with CMP underwent circuit training for 3 months and were asked to complete the following questionnaires at baseline and 3 months later: Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), Roland-Morris Disability Questionnaire (RDQ), Shoulder36, and Knee injury and Osteoarthritis Outcome Score (KOOS). Significant improvements were observed in NRS, PCS, RDQ, and KOOS activities of daily living (ADL) scores after the intervention relative to baseline (p < 0.0001, p = 0.0013, 0.0004, and 0.0295, respectively), whereas shoulder function did not improve. When considering the impact of exercise frequency, NRS scores improved regardless of exercise frequency. Furthermore, PCS, RDQ, and KOOS scores improved in participants who exercised at least twice a week (24 sessions over the course of 3 months). In conclusion, CMP, pain catastrophizing, and physical function in adult female fitness club participants with CMP of NRS 4 or higher improved after 3 months of aerobic-resistance circuit training.
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Olbrecht VA, O'Conor KT, Williams SE, Boehmer CO, Marchant GW, Glynn SM, Geisler KJ, Ding L, Yang G, King CD. Guided Relaxation-Based Virtual Reality for Acute Postoperative Pain and Anxiety in a Pediatric Population: Pilot Observational Study. J Med Internet Res 2021; 23:e26328. [PMID: 34048358 PMCID: PMC8314162 DOI: 10.2196/26328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Distraction-based therapies, such as virtual reality (VR), have been used to reduce pain during acutely painful procedures. However, distraction alone cannot produce prolonged pain reduction to manage sustained postoperative pain. Therefore, the integration of VR with other pain-reducing therapies, like guided relaxation, may enhance its clinical impact. OBJECTIVE The goal of this pilot study was to assess the impact of a single guided relaxation-based VR (VR-GR) session on postoperative pain and anxiety reduction in children. We also explored the influence of pain catastrophizing and anxiety sensitivity on this association. METHODS A total of 51 children and adolescents (7-21 years) with postoperative pain and followed by the Acute Pain Service at Cincinnati Children's Hospital were recruited over an 8-month period to undergo a single VR-GR session. Prior to VR, the patients completed 2 questionnaires: Pain Catastrophizing Scale for Children (PCS-C) and the Child Anxiety Sensitivity Index (CASI). The primary outcome was a change in pain intensity following the VR-GR session (immediately, 15 minutes, and 30 minutes). The secondary outcomes included changes in pain unpleasantness and anxiety. RESULTS The VR-GR decreased pain intensity immediately (P<.001) and at 30 minutes (P=.04) after the VR session, but not at 15 minutes (P=.16) postsession. Reductions in pain unpleasantness were observed at all time intervals (P<.001 at all intervals). Anxiety was reduced immediately (P=.02) but not at 15 minutes (P=.08) or 30 minutes (P=.30) following VR-GR. Patients with higher CASI scores reported greater reductions in pain intensity (P=.04) and unpleasantness (P=.01) following VR-GR. Pain catastrophizing was not associated with changes in pain and anxiety. CONCLUSIONS A single, short VR-GR session showed transient reductions in pain intensity, pain unpleasantness, and anxiety in children and adolescents with acute postoperative pain. The results call for a future randomized controlled trial to assess the efficacy of VR-GR. TRIAL REGISTRATION ClinicalTrials.gov NCT04556747; https://clinicaltrials.gov/ct2/show/NCT04556747.
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Affiliation(s)
- Vanessa A Olbrecht
- Center for Understanding Pediatric Pain, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Keith T O'Conor
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Sara E Williams
- Center for Understanding Pediatric Pain, Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Chloe O Boehmer
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Gilbert W Marchant
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Susan M Glynn
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kristie J Geisler
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Gang Yang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Christopher D King
- Center for Understanding Pediatric Pain, Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Olbrecht VA, O'Conor KT, Williams SE, Boehmer CO, Marchant GW, Glynn SM, Geisler KJ, Pickerill HM, Ding L, Yang G, King CD. Transient Reductions in Postoperative Pain and Anxiety using Virtual Reality in Children. PAIN MEDICINE 2021; 22:2426-2435. [PMID: 34175959 DOI: 10.1093/pm/pnab209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Virtual reality (VR) is a promising method to manage pain. Distraction-based VR (VR-D) is thought to reduce pain by redirecting attention. While VR-D can reduce pain associated with acutely painful procedures, it is unclear if VR-D can reduce pain after surgery. We assessed the ability of a single VR-D session to decrease postoperative pain and anxiety and explored if pain catastrophizing and anxiety sensitivity influenced these outcomes in children following surgery. DESIGN Single-center, prospective, pilot study. SETTING Cincinnati Children's Hospital Medical Center (CCHMC). SUBJECTS 50 children (7-21 years) with postoperative pain followed by the Acute Pain Service. METHODS Patients received one VR-D session following surgery. Prior to the session, patients completed pain catastrophizing (PCS-C) and anxiety sensitivity (CASI) questionnaires. Primary outcome consisted of changes in pain intensity following VR-D (immediately, 15, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety. RESULTS VR-D use was associated with a decrease in pain intensity immediately and 15-minutes after VR-D. Reductions in pain unpleasantness were observed up to 30 minutes following VR-D. VR-D was also associated with a reduction in anxiety immediately and at 15-minutes. While patients with higher pain catastrophizing had higher baseline pain intensity and unpleasantness, they did not show larger pain reductions following VR-D compared to those with lower pain catastrophizing. CONCLUSIONS VR-D may be beneficial in transiently reducing pain intensity, unpleasantness, and anxiety in children with postoperative pain. This study informs design of larger, randomized, controlled study assessing VR-D for acute postoperative pain and anxiety management.
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Affiliation(s)
- Vanessa A Olbrecht
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Keith T O'Conor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sara E Williams
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chloe O Boehmer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gilbert W Marchant
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Susan M Glynn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Lili Ding
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Gang Yang
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Matthews E, Muldoon M, O'Keeffe N, McCarthy KF. Social deprivation and paediatric chronic pain referrals in Ireland: a cross-sectional study. Scand J Pain 2021; 21:597-605. [PMID: 34080402 DOI: 10.1515/sjpain-2021-0031] [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: 02/11/2021] [Accepted: 04/29/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Social deprivation is associated with a higher prevalence of chronic pain in children and an under-representation in specialist paediatric chronic pain programs. Our primary objective was to determine if there was a relationship between social deprivation and paediatric chronic pain referrals in Ireland. Secondary objectives included analysing for differences between deprivation groups in pain characteristics and function that are recorded at first clinic visit. METHODS Families attending the national paediatric complex pain service in Dublin, Ireland, complete questionnaires on pain characteristics, parental pain catastrophizing, and pain-related disability including sleep quality and school attendance. We retrospectively reviewed records from between February 2016 and November 2019 on 288 patients. Social deprivation was assessed using the Pobal HP Deprivation Index, which is based on data from the Irish national census. RESULTS Referrals followed a normal distribution across deprivation grades. Children in the disadvantaged group had a longer duration of pain, greater use of screens at bedtime, and longer sleep onset latency. Parents in the disadvantaged group had significantly higher levels of parental pain catastrophizing. CONCLUSIONS In Ireland, while paediatric chronic pain referrals were normally distributed across deprivation group, the disadvantaged group was different in several ways that may be clinically significant. Further work will be needed to determine the longitudinal relationship between these factors before and after the referral and initial review. Screening for, and targeting, potential risk factors for pain chronicity may be needed to harmonize treatment outcomes in children from socially disadvantaged families.
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Affiliation(s)
| | - Maeve Muldoon
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Norma O'Keeffe
- Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Kevin F McCarthy
- Children's Health Ireland at Crumlin, Dublin, Ireland.,Children's Health Ireland at Temple Street, Dublin, Ireland.,Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Sil S, Woodward KE, Johnson YL, Dampier C, Cohen LL. Parental Psychosocial Distress in Pediatric Sickle Cell Disease and Chronic Pain. J Pediatr Psychol 2021; 46:557-569. [PMID: 33484135 PMCID: PMC8502425 DOI: 10.1093/jpepsy/jsaa130] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/20/2020] [Accepted: 12/19/2020] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Pediatric sickle cell disease (SCD) management can result in considerable caregiver distress. Parents of youth with chronic SCD pain may face the additional challenge of managing children's chronic pain and chronic illness. This study examined associations between parent psychological distress and child functioning and the moderating role of chronic pain among youth with SCD. METHODS Youth presenting to pediatric outpatient comprehensive SCD clinics and their primary caregivers completed a battery of questionnaires. Parents reported on parenting stress, parent mental and physical health, and family functioning. Children completed measures of pain characteristics, depressive symptoms, catastrophic thinking, functional disability, and quality of life. RESULTS Patients (N = 73, Mage = 14.2 years, 57% female) and their caregivers (Mage = 41.1 years, 88% mothers, 88% Black) participated. Worse parent functioning was associated with worse child pain, functioning, quality of life, and depressive symptoms. Beyond the effects of SCD, chronic SCD pain magnified the negative associations between parenting stress frequency and child quality of life, parent physical health and child quality of life, and parent depressive symptoms and child depressive symptoms. CONCLUSIONS Chronic pain may exacerbate the relations between parent and child functioning beyond the effects of SCD alone. The management of both SCD and chronic pain may present additional challenges for parents that limit their psychosocial functioning. Family-focused interventions to support parents and youth with chronic SCD pain are warranted to optimize health outcomes.
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Affiliation(s)
- Soumitri Sil
- Department of Pediatrics
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - Kerri E Woodward
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine
| | - Yelena L Johnson
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine
| | - Carlton Dampier
- Department of Pediatrics
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
| | - Lindsey L Cohen
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta
- Department of Psychology, Georgia State University
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Heffernan M, Wilson C, Keating K, McCarthy K. "Why Isn't It Going Away?": A Qualitative Exploration of Worry and Pain Experiences in Adolescents with Chronic Pain. PAIN MEDICINE 2021; 22:459-469. [PMID: 33001170 DOI: 10.1093/pm/pnaa245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION The role of cognition is central to the fear avoidance (FA) model of chronic pain (CP), which emphasizes the importance of catastrophic pain interpretations and has been shown to be applicable to pediatric CP populations. However, while we know that pain catastrophizing plays a distinct role in influencing outcomes for children with CP, we know little about the specifics of how young people with CP experience catastrophizing and worry, as well as their general pain beliefs. OBJECTIVE To qualitatively explore beliefs about and experiences of worry and pain among a purposeful sample of adolescents with CP. METHODS Individual semistructured interviews with 12 adolescents (aged 12-17) with varying forms of CP attending an outpatient pain clinic in a general children's hospital. Relevant psychometric measures were administered orally to further inform the data. Data were analyzed using critical realist thematic analysis. RESULTS Three themes and one subtheme were identified. Themes were 1) the worry ripple: mind, body, and behavior (subtheme: worry content: personal competence and health); 2) the pain mystery: living in a "scribble of black"; and 3) the resist or avoid conundrum. CONCLUSIONS The findings highlight the need for psychological interventions targeting acceptance of uncertainty and also informing education on mind/body connections in adolescents with CP.
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Affiliation(s)
| | | | - Kim Keating
- Temple Street Children's University Hospital, Dublin, Ireland
| | - Kevin McCarthy
- Temple Street Children's University Hospital, Dublin, Ireland
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