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Golden E, van der Heijden H, Ren B, Randall ET, Drubach LA, Shah N, Cay M, Ebb D, Kaban LB, Peacock ZS, Boyce AM, Mannstadt M, Upadhyay J. Phenotyping Pain in Patients With Fibrous Dysplasia/McCune-Albright Syndrome. J Clin Endocrinol Metab 2024; 109:771-782. [PMID: 37804088 DOI: 10.1210/clinem/dgad589] [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: 07/19/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
CONTEXT Pain is a poorly managed aspect in fibrous dysplasia/McCune-Albright syndrome (FD/MAS) because of uncertainties regarding the clinical, behavioral, and neurobiological underpinnings that contribute to pain in these patients. OBJECTIVE Identify neuropsychological and neurobiological factors associated with pain severity in FD/MAS. DESIGN Prospective, single-site study. PATIENTS Twenty patients with FD/MAS and 16 age-sex matched healthy controls. INTERVENTION Assessments of pain severity, neuropathic pain, pain catastrophizing (pain rumination, magnification, and helplessness), emotional health, and pain sensitivity with thermal quantitative sensory testing. Central nervous system (CNS) properties were measured with diffusion tensor imaging, structural magnetic resonance imaging, and functional magnetic resonance imaging. MAIN OUTCOME MEASURES Questionnaire responses, detection thresholds and tolerances to thermal stimuli, and structural and functional CNS properties. RESULTS Pain severity in patients with FD/MAS was associated with more neuropathic pain quality, higher levels of pain catastrophizing, and depression. Quantitative sensory testing revealed normal detection of nonnoxious stimuli in patients. Individuals with FD/MAS had higher pain tolerances relative to healthy controls. From neuroimaging studies, greater pain severity, neuropathic pain quality, and psychological status of the patient were associated with reduced structural integrity of white matter pathways (superior thalamic radiation and uncinate fasciculus), reduced gray matter thickness (pre-/paracentral gyri), and heightened responses to pain (precentral, temporal, and frontal gyri). Thus, properties of CNS circuits involved in processing sensorimotor and emotional aspects of pain were altered in FD/MAS. CONCLUSION These results offer insights into pain mechanisms in FD/MAS, while providing a basis for implementation of comprehensive pain management treatment approaches that addresses neuropsychological aspects of pain.
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Affiliation(s)
- Emma Golden
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Hanne van der Heijden
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Boyu Ren
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Edin T Randall
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Laura A Drubach
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Nehal Shah
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Mariesa Cay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - David Ebb
- Department of Pediatric Hematology Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Leonard B Kaban
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA 02114, USA
| | - Zachary S Peacock
- Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, Boston, MA 02114, USA
| | - Alison M Boyce
- Metabolic Bone Disorders Unit, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892, USA
| | - Michael Mannstadt
- Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
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Cao A, van Gool R, Golden E, Goodlett B, Camelo C, Bujoreanu S, Al-Hertani W, Upadhyay J. Case report: Chronic pain in a pediatric patient with late-onset pompe disease. FRONTIERS IN PAIN RESEARCH 2023; 4:1244609. [PMID: 37841659 PMCID: PMC10575478 DOI: 10.3389/fpain.2023.1244609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023] Open
Abstract
Pompe disease (PD) is a rare inherited metabolic disorder of deficient or absent acid alpha-glucosidase (GAA), resulting in defective lysosomal glycogen catabolism. Muscle weakness, respiratory deficiency and gastrointestinal symptoms are commonly monitored in PD. However, pain and associated psychological symptoms are less focused upon. A pediatric patient with late-onset Pompe disease (LOPD) comorbid with chronic pain is presented. Symptoms of pain in the feet were first reported between 6 and 7 years of age and were attributed to growing pains. Following progression of lower body pain, weakness, fatigue, and difficulties with ambulation, a thorough clinical assessment including genetic testing was performed, which led to a diagnosis of LOPD at 9 years of age. ERT with recombinant human alglucosidase alfa was subsequently started. The patient's clinical status is compounded by depressed mood, anxiety, and attention deficit hyperactivity disorder, which may further exacerbate pain. A multidisciplinary pain treatment approach consisting of orthopedics, physical therapy, and psychosocial therapy aimed at enhancing pain coping skills is described for this LOPD patient. This case highlights the need for a greater understanding of pain generation and identification of optimized pain treatment approaches in children with LOPD that can be implemented alongside ERT.
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Affiliation(s)
- Amanda Cao
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Raquel van Gool
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Emma Golden
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Benjamin Goodlett
- Division of Genetics and Genomics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Carlos Camelo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Simona Bujoreanu
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Walla Al-Hertani
- Division of Genetics and Genomics, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, United States
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3
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Song JZ, Luong D, Feldman ECH, Tran S, Perrier L, Eubanks K, Bayley M, Kastner M, Slepian M, Munce SEP. Psychological interventions for individuals with Ehlers-Danlos syndrome and hypermobility spectrum disorder: a scoping review. Orphanet J Rare Dis 2023; 18:254. [PMID: 37653505 PMCID: PMC10472575 DOI: 10.1186/s13023-023-02799-y] [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: 11/14/2022] [Accepted: 07/05/2023] [Indexed: 09/02/2023] Open
Abstract
PURPOSE To identify the nature and extent of the evidence on psychological interventions among individuals with Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorder (HSD). MATERIALS AND METHODS Eligible studies reported on psychological interventions for individuals of all ages with EDS and/or HSD. All studies published in English were included, with no restrictions to publication year or status. MEDLINE, CINAHL, EMBASE, and PsycINFO were searched. Two reviewers independently screened studies and abstracted data. RESULTS This scoping review included 10 studies reporting on EDS, HSD, or both. Only cohort studies and case studies were identified. Four studies investigated Cognitive Behavioural Therapy (CBT), one investigated Dialectical Behavioural Therapy (DBT), two investigated psychoeducation, two investigated Intensive Interdisciplinary Pain Treatment (IIPT), and one investigated Acceptance Commitment Therapy (ACT). Interventions targeted pain management, self-destructive behaviours, and related psychological issues (e.g., depression/anxiety). Sample sizes were small (n < 50) for most studies and interventions were generally poorly described. CONCLUSIONS There is a critical need for high-quality research surrounding psychological interventions for individuals with EDS/HSD. Psychological interventions for these individuals are understudied and existing studies lack validity. Researchers should investigate psychological interventions for individuals with all types of EDS/HSD with high-quality studies to validate findings from the existing studies.
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Affiliation(s)
- Jessica Z Song
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada.
| | - Dorothy Luong
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Estée C H Feldman
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Susan Tran
- Department of Psychology, DePaul University, Chicago, IL, USA
| | - Laure Perrier
- Dalla Lana School of Public Health, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
| | - Monika Kastner
- North York General Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maxwell Slepian
- GoodHope Ehlers-Danlos Syndrome Clinic, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah E P Munce
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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4
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Champion J, Crawford M, Jaaniste T. Predicting the Need for Transition from Pediatric to Adult Pain Services: A Retrospective, Longitudinal Study Using the Electronic Persistent Pain Outcome Collaboration (ePPOC) Databases. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020357. [PMID: 36832486 PMCID: PMC9955863 DOI: 10.3390/children10020357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
A proportion of youth with chronic pain do not respond to interdisciplinary pain management and may require transition to adult pain services. This study sought to characterize a cohort of patients referred to pediatric pain services who subsequently required referral to an adult pain service. We compared this transition group with pediatric patients eligible by age to transition but who did not transition to adult services. We sought to identify factors predicting the need to transition to adult pain services. This retrospective study utilized linkage data from the adult electronic Persistent Pain Outcomes Collaboration (ePPOC) and the pediatric (PaedePPOC) data repositories. The transition group experienced significantly higher pain intensity and disability, lower quality of life, and higher health care utilization relative to the comparison group. Parents of the transition group reported greater distress, catastrophizing, and helplessness relative to parents in the comparison group. Three factors significantly predicted transition: compensation status (OR = 4.21 (1.185-15)), daily anti-inflammatory medication use (OR = 2 (1.028-3.9)), and older age at referral (OR = 1.6 (1.3-2.17)). This study demonstrated that patients referred to pediatric pain services who subsequently need transition to adult services are a uniquely disabled and vulnerable group beyond comparative peers. Clinical applications for transition-specific care are discussed.
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Affiliation(s)
- Joel Champion
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- Correspondence: (J.C.); (T.J.); Tel.: +61-2-93825423 (J.C.); +61-2-93825422 (T.J.)
| | - Matthew Crawford
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Tiina Jaaniste
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia
- Correspondence: (J.C.); (T.J.); Tel.: +61-2-93825423 (J.C.); +61-2-93825422 (T.J.)
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5
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Hurtubise K, Brousselle A, Noel M, Caldwell K, Rayner L, Dawson M, Rasic N, Camden C. The effect domains, measures, and methods reported in pediatric-specialized multidisciplinary outpatient rehabilitation programs: An integrated review. Pain Pract 2023; 23:185-203. [PMID: 36251412 DOI: 10.1111/papr.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Specialized pain rehabilitation is recognized as the treatment of choice for youth with pain-related disability. Appropriate outcomes for program evaluation are critical. This study aimed to summarize the effect domains and methods used to evaluate pediatric-specialized outpatient pain rehabilition programs, map them to the PedIMMPACT statement, and highlight future directions. METHODS An integrated review framework, incorporating stakeholders, was used. Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar were searched for studies published in 1999-2021 featuring the treatment effects of specialized outpatient pain rehabilitation on youth with pain-related disability and their parents. Selected studies were critically appraised using the Quality Assessment Tool for Studies of Diverse Design, organized by study characteristics, and analyzed using constant comparison. RESULTS From the 1951 potentially relevant titles, 37 studies were selected. Twenty-five effects targeted youth and 24 focused on parents, with a maximum of 15 youth and 11 parent effect domains (median = 5 domains per study). Although most studies measured a combination of effect domains and were inclusive of some recommended in the PedIMMPACT statement, no effect was measured consistently across studies. Youth physical functioning and parent emotional functioning were measured most often. Eighty-five instruments were used to assess youth outcomes and 59 for parents, with self-report questionnaires dominating. DISCUSSION A lack of standardization exists associated with the domains and methods used to evaluate the effects of pediatric-specialized outpatient pain rehabilitation programs, hindering comparisons. Future program evaluations should be founded on their theory, aim, and anticipated outcomes.
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Affiliation(s)
- Karen Hurtubise
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Québec, Québec, Canada.,Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, British Columbia, Canada
| | - Melanie Noel
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Heritage Medical Research Building, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Health Research Innovation Centre, Calgary, Alberta, Canada
| | - Kathleen Caldwell
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Rayner
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Matthew Dawson
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Nivez Rasic
- Alberta Children's Hospital Research Institute, Heritage Medical Research Building, Calgary, Alberta, Canada.,Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Chantal Camden
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Québec, Québec, Canada
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6
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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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7
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Schults JA, Paterson RS, Cooke M, Richards J, Charles K, Raithatha B, Theodoros J, Alcock M. Selection and reporting of outcome measures used in long-term follow-up studies of children and adolescents with chronic pain: A scoping review. J Child Health Care 2022; 26:625-647. [PMID: 34378996 DOI: 10.1177/13674935211026124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this review was to determine the range of outcomes reported in long-term follow-up studies of children and adolescents with chronic pain. Using a scoping review methodology, a systematic search for studies reporting outcomes in children and adolescents with chronic pain over a ≥12 month period was undertaken. Studies were eligible for inclusion if they included children and adolescents (≤18 years old on study enrolment) with chronic pain, and outcomes were followed up for ≥12 months. Overall, 42 studies investigating more than 24,132 children were included in the review. Studies assessed a total of 187 unique outcome measures within the broader measures of pain (38 studies; 90%), function (33 studies; 79%) and other (21 studies; 50%). Unidimensional assessments of the severity or presence of pain and global assessments of function were the most commonly reported outcome measures. The number of study follow-up points ranged from 1 to 5, with mode duration of follow-up 12 months post intervention (25 studies; 60%; range 1-13 years). Overall, we identified a wide range of reported outcome measures in studies of children with chronic pain. Beyond assessments of pain intensity and global function, there is little consistency, and reporting of developmental outcome measures is poor. Further long-term outcome research in this population is needed.
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Affiliation(s)
- Jessica A Schults
- Department of Anaesthesia and Pain Management, 67568Queensland Children's Hospital, South Brisbane, QLD, Australia.,School of Nursing and Midwifery, Menzies Health Institute, 5723Griffith University, Nathan, QLD, Australia.,University of Queensland School of Nursing, Midwifery and Social Work, St Lucia, Australia.,Metro North Hospital and Health Service, Herston Infectious Disease Institute, Queensland, Australia
| | - Rebecca S Paterson
- School of Nursing and Midwifery, 5723Griffith University, Nathan, QLD, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Menzies Health Institute, 5723Griffith University, Nathan, QLD, Australia
| | - Julianne Richards
- Department of Anaesthesia and Pain Management, 67568Queensland Children's Hospital, South Brisbane, QLD, Australia.,Queensland Interdisciplinary Paediatric Persistent Pain Service, QLD, Australia
| | - Karina Charles
- Department of Anaesthesia and Pain Management, 67568Queensland Children's Hospital, South Brisbane, QLD, Australia.,University of Queensland School of Nursing, Midwifery and Social Work, St Lucia, Australia.,School of Nursing and Midwifery, 5723Griffith University, Nathan, QLD, Australia
| | - Bhavesh Raithatha
- Department of Anaesthesia and Pain Management, 67568Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Joanne Theodoros
- Department of Anaesthesia and Pain Management, 67568Queensland Children's Hospital, South Brisbane, QLD, Australia.,Queensland Interdisciplinary Paediatric Persistent Pain Service, QLD, Australia
| | - Mark Alcock
- Department of Anaesthesia and Pain Management, 67568Queensland Children's Hospital, South Brisbane, QLD, Australia.,Queensland Interdisciplinary Paediatric Persistent Pain Service, QLD, Australia
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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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9
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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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10
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Smith AM, Logan DE. Promoting readiness and engagement in pain rehabilitation for youth and families: Developing a pediatric telehealth motivational interviewing protocol. PAEDIATRIC & NEONATAL PAIN 2022; 4:125-135. [PMID: 36188162 PMCID: PMC9485818 DOI: 10.1002/pne2.12063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/28/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022]
Abstract
Objective Intensive interdisciplinary pain treatment (IIPT) is a promising approach for youth with complex, disabling, refractory pain conditions. However, youth and families who initiate IIPT without sufficient acceptance of its focus on functional rehabilitation or readiness to adopt a self-management approach to their pain may face challenges in IIPT and/or experience suboptimal outcomes. Motivational interviewing (MI) techniques have been shown to enhance readiness to make a number of health behavior changes for adults and youth, but it has not been systematically examined in the context of pediatric IIPT. The authors developed an MI telehealth intervention protocol explicitly designed to prepare youth and families for admission to IIPT. Method The protocol development process is detailed here, including influential models, expert consultation, and feedback from IIPT clinical experts. The intervention protocol was then piloted with a group of eligible families to elicit feedback and prompt further refining. Feasibility and acceptability were explored through measures of treatment engagement and satisfaction. Results The Promoting Readiness and Engagement in Pain Rehabilitation (PREPaRe) intervention protocol contains four modules aimed to enhance youth and parent readiness to adopt a self-management approach to persistent pain, through a motivational interviewing approach. Initial responses from the test group suggested high levels of treatment engagement and treatment satisfaction with PREPaRe. Conclusions PREPaRe appears feasible to administer and acceptable to families of youth with persistent pain seeking IIPT. Implications for implementation are discussed. Further study via randomized control trial is warranted. Trial registration ClinicalTrials.gov identifier: NCT04093921.
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Affiliation(s)
- Allison M. Smith
- Division of Pain MedicineDepartment of Anesthesiology, Perioperative & Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA
- Department of Psychiatry & Behavioral SciencesHarvard Medical SchoolBostonMassachusettsUSA
| | - Deirdre E. Logan
- Division of Pain MedicineDepartment of Anesthesiology, Perioperative & Pain MedicineBoston Children’s HospitalBostonMassachusettsUSA
- Department of Psychiatry & Behavioral SciencesHarvard Medical SchoolBostonMassachusettsUSA
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11
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Dogan M, Hartenstein-Pinter A, Lopez Lumbi S, Blankenburg M, Frühwald MC, Ahnert R, Braun S, Marschall U, Zernikow B, Wager J. Exploring the Mechanisms Underlying the Effectiveness of Psychosocial Aftercare in Pediatric Chronic Pain Treatment: A Qualitative Approach. CHILDREN 2022; 9:children9030407. [PMID: 35327779 PMCID: PMC8946967 DOI: 10.3390/children9030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022]
Abstract
A newly developed specialized psychosocial aftercare program (PAC) for pediatric patients with chronic pain following an intensive interdisciplinary pain treatment (IIPT) was found to be significantly more effective than IIPT alone. This qualitative study aimed to gain further insight into the mechanisms and prerequisites for the effectiveness of this specialized aftercare program. We conducted structured telephone interviews with patients, parents, and health care professionals conducting PAC. A total of 16 interviews were conducted—seven interviews with parents, six interviews with patients, and three interviews with health care professionals—and transcribed verbatim. Data were analyzed using reflexive thematic analysis. Four major themes consisting of 20 subcategories were identified, namely (1) frame conditions, (2) person factors, (3) stabilization and (4) catalyst. The foundations of treatment success are frame conditions, such as flexibility or constancy, and person factors, such as respect or expertise. Based on these foundations, stabilization is achieved through security, mediation, orientation and support. Altogether, these components of PAC reveal their potential as catalysts for further improvement even after discharge from IIPT. Overall, patients and their families emphasized widespread personal relevance and acceptance of the PAC program. The findings of this study may be employed in the development of other aftercare programs or interventions involving families in the context of psychotherapeutic and psychosocial health care.
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Affiliation(s)
- Meltem Dogan
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (A.H.-P.); (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58452 Witten, Germany;
- Correspondence: ; Tel.: +49-2363-975184
| | - Almut Hartenstein-Pinter
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (A.H.-P.); (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58452 Witten, Germany;
| | | | - Markus Blankenburg
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58452 Witten, Germany;
- Paediatric Pain Center Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, 70174 Stuttgart, Germany;
| | - Michael C. Frühwald
- University Children’s Hospital Augsburg, Bavarian Children’s Pain Center, 86156 Augsburg, Germany; (M.C.F.); (R.A.)
| | - Rosemarie Ahnert
- University Children’s Hospital Augsburg, Bavarian Children’s Pain Center, 86156 Augsburg, Germany; (M.C.F.); (R.A.)
| | - Sarah Braun
- Paediatric Pain Center Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, 70174 Stuttgart, Germany;
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Health Insurance, 42103 Wuppertal, Germany;
| | - Boris Zernikow
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (A.H.-P.); (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58452 Witten, Germany;
- PedScience Research Institute, 45711 Datteln, Germany;
| | - Julia Wager
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (A.H.-P.); (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58452 Witten, Germany;
- PedScience Research Institute, 45711 Datteln, Germany;
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12
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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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13
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Ocay DD, Loewen A, Premachandran S, Ingelmo PM, Saran N, Ouellet JA, Ferland CE. Psychosocial and psychophysical assessment in pediatric patients and young adults with chronic back pain: a cluster analysis. Eur J Pain 2022; 26:855-872. [PMID: 35090183 PMCID: PMC9304192 DOI: 10.1002/ejp.1912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Identifying subgroups with different clinical profiles may inform tailored management and improve outcomes. The objective of this study was to identify psychosocial and psychophysical profiles of children and adolescents with chronic back pain. Methods One hundred and ninety‐eight patients with chronic back pain were recruited for the study. Pain assessment was mainly conducted in the form of an interview and with the use of validated pain‐related questionnaires assessing their psychosocial factors and disability. All patients underwent mechanical and thermal quantitative sensory tests assessing detection and pain thresholds, and conditioned pain modulation efficacy. Results Hierarchal clustering partitioned our patients into three clusters accounting for 34.73% of the total variation of the data. The adaptive cluster represented 45.5% of the patients and was characterized to display high thermal and pressure pain thresholds. The high somatic symptoms cluster, representing 19.2% of patients, was characterized to use more sensory, affective, evaluative and temporal descriptors of pain, more likely to report their pain as neuropathic of nature, report a more functional disability, report symptoms of anxiety and depression and report poor sleep quality. The pain‐sensitive cluster, representing 35.4% of the cohort, displayed deep tissue sensitivity and thermal hyperalgesia. Conclusions This study identified clinical profiles of children and adolescents experiencing chronic back pain based on specific psychophysical and psychosocial characteristics highlighting that chronic pain treatment should address underlying nociceptive and non‐nociceptive mechanisms. Significance To our current knowledge, this study is the first to conduct cluster analysis with youth experiencing chronic back pain and displays clinical profiles based on specific physical and psychosocial characteristics. This study highlights that in a clinical context, chronic pain assessment should include multiple elements contributing to pain which can be assessed in a clinical context and addressed when pathoanatomical symptoms are unidentifiable.
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Affiliation(s)
- D D Ocay
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada
| | - A Loewen
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - S Premachandran
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada
| | - P M Ingelmo
- Chronic Pain Services, Montreal Children's Hospital, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| | - N Saran
- Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - J A Ouellet
- Department of Pediatric Orthopedics, McGill University, Montreal, Quebec, Canada
| | - C E Ferland
- Department of Experimental Surgery, McGill University, Montreal, Quebec, Canada.,Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, Quebec, Canada.,Department of Anesthesia, McGill University, Montreal, Quebec, Canada.,Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
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14
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Ruiz G, Marsac ML. Commentary: Intergenerational Associations in Pediatric Chronic Pain: Validity of an Adapted Unified Multifactorial Model of Parental Factors in Pediatric Chronic Pain. J Pediatr Psychol 2021; 47:132-134. [PMID: 34850071 DOI: 10.1093/jpepsy/jsab126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gemma Ruiz
- International Doctoral School, Faculty of Psychology, Universidad Nacional de Educación a Distancia, Spain
| | - Meghan L Marsac
- Department of Pediatrics, Kentucky Children's Hospital, USA.,College of Medicine, University of Kentucky, USA
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15
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Dogan M, Hirschfeld G, Blankenburg M, Frühwald M, Ahnert R, Braun S, Marschall U, Pfenning I, Zernikow B, Wager J. Effectiveness of a Psychosocial Aftercare Program for Youth Aged 8 to 17 Years With Severe Chronic Pain: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2127024. [PMID: 34570203 PMCID: PMC8477265 DOI: 10.1001/jamanetworkopen.2021.27024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Severe chronic pediatric pain causes individual suffering and significantly affects social functioning and psychological well-being. For children with high pain severity, intensive interdisciplinary pain treatment (IIPT) is a well-established treatment. However, across specialized centers, it is not sufficient for all patients. OBJECTIVE To evaluate the effectiveness of a psychosocial aftercare (PAC) program for pediatric patients with severe chronic pain followed up for 6 months after discharge from IIPT. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial with 4 assessment points (pre-IIPT, immediately post-IIPT, 3 months, and 6 months) was conducted at 3 pediatric specialized tertiary care pain centers in Germany between September 11, 2018, and March 31, 2020. Included patients were aged 8 to 17 with a severe chronic pain condition who had been admitted for IIPT. Data were analyzed from June 8 to September 4, 2020. INTERVENTIONS Patients and their families were randomly assigned to 1 of 2 study groups at inpatient IIPT admission. Both groups received standardized 3- to 4-week IIPT. After IIPT discharge, the intervention group received PAC and the control group received usual care. PAC involved ongoing contact with a social worker for as long as the family requested the support, up to a maximum of 6 months. MAIN OUTCOMES AND MEASURES The primary outcome measure was pain at 6 months, measured using the Chronic Pain Grading (CPG), an instrument based on an algorithm indicating severity of the chronic pain disorder. Secondary outcomes included other pain-related and emotional parameters. RESULTS A total of 419 patients were randomized (mean [SD] age, 14.3 [2.1] years; 303 [72.3%] girls; 116 [27.7%] boys), with 218 assigned to usual care and 201 assigned to PAC. At baseline in both groups, the median (IQR) CPG was 3 (2-4). Superiority of PAC compared with usual care was demonstrated at 6 months (median [IQR] CPG: usual care, 2 [2-3]; PAC, 1 [1-2]; r = 0.30; 95% CI, 0.17-0.41). Additionally, PAC significantly improved emotional parameters (eg, significant time × group interaction: b = -8.84; P < .001). CONCLUSIONS AND RELEVANCE This randomized clinical trial found that PAC improved pain-related and emotional parameters during the intervention 6 months after discharge from IIPT. Future research is needed to investigate the intervention's long-term effects. TRIAL REGISTRATION German Clinical Trials Register ID: DRKS00015230.
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Affiliation(s)
- Meltem Dogan
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, Witten/Herdecke University School of Medicine, Witten, Germany
| | - Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Markus Blankenburg
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
- Paediatric Pain Center Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, Stuttgart, Germany
| | - Michael Frühwald
- University Children’s Hospital Augsburg, Swabian Children’s Pain Center, Augsburg, Germany
| | - Rosemarie Ahnert
- University Children’s Hospital Augsburg, Swabian Children’s Pain Center, Augsburg, Germany
| | - Sarah Braun
- Paediatric Pain Center Baden-Württemberg, Department of Pediatric Neurology, Olgahospital Stuttgart, Stuttgart, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Health Insurance, Wuppertal, Germany
| | - Ingo Pfenning
- Techniker Krankenkasse, Techniker Health Insurance, Hamburg, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, Witten/Herdecke University School of Medicine, Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, Datteln, Germany
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, Witten/Herdecke University School of Medicine, Witten, Germany
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16
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Lopez Lumbi S, Ruhe AK, Pfenning I, Wager J, Zernikow B. Economic long-term effects of intensive interdisciplinary pain treatment in paediatric patients with severe chronic pain: Analysis of claims data. Eur J Pain 2021; 25:2129-2139. [PMID: 34155721 DOI: 10.1002/ejp.1825] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Chronic pain in children and adolescents gives rise to high healthcare costs. Successful treatment is supposed to reduce the economic burden. The objective of this study was to determine the changes in healthcare utilization and expenditures from 1 year before (Pre) intensive interdisciplinary pain treatment (IIPT) to the first (Post 1) and second (Post 2) years after discharge in a sample of paediatric chronic pain patients. METHODS Claims data from one statutory health insurance company were analysed for 119 children and adolescents (mean age = 15.3, 68.9% female) who sought IIPT at the German Paediatric Pain Centre. Costs incurred for inpatient treatment, outpatient treatment, medication, remedies and aids were compared before treatment and 2 years after discharge. Healthcare utilization was compared using Wilcoxon signed-rank test, and expenditures using trimmed means and the Yuen's t-test. RESULTS Overall costs were significantly lower in the 2 years after IIPT compared to before IIPT (Pre: 3,543€, Post 1:2,681€, Post 2:1937€ (trimmed means)). Healthcare utilization changed significantly; hospitalizations decreased in the years after discharge, while psychotherapies stayed stable in the year after discharge but lessened in the second year. CONCLUSION The results of this study support prior findings on the high economic burden of paediatric chronic pain. IIPT may contribute to a transition in healthcare utilization from somatic-focused treatments to more psychological treatments. Overall costs were reduced as soon as the first year after discharge and decreased even further in the second year. SIGNIFICANCE This study analyses original claims data from paediatric chronic pain patients in the year before and up to 2 years after intensive interdisciplinary pain treatment in a specialized paediatric pain centre. The analysis of long-term data reveals a continuous cost reduction after intensive interdisciplinary pain treatment and a change in the subsequent outpatient treatment.
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Affiliation(s)
| | - Ann-Kristin Ruhe
- German Pediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health - School of Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Julia Wager
- PedScience Research Institute, Datteln, Germany.,German Pediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health - School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Boris Zernikow
- PedScience Research Institute, Datteln, Germany.,German Pediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Pediatric Palliative Care, Faculty of Health - School of Medicine, Witten/Herdecke University, Witten, Germany
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17
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Randall ET, Cole-Lewis YC, Petty CR, Jervis KN. Understanding How Perfectionism Impacts Intensive Interdisciplinary Pain Treatment Outcomes: A Nonrandomized Trial. J Pediatr Psychol 2021; 46:351-362. [PMID: 33325522 DOI: 10.1093/jpepsy/jsaa111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Several factors are known to impact response to the intensive interdisciplinary pain treatment (IIPT) program described in this study, yet no research has explored the role of perfectionism. This secondary data analysis explored direct and indirect relations between perfectionism and functional disability (primary outcome) and pain severity (secondary outcome) after IIPT, with pain catastrophizing and fear of pain as mediators. METHODS Youth (N = 253) aged 8-21 with chronic pain and associated disability completed pre- and post-IIPT measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), pain catastrophizing, fear of pain, functional disability, and pain characteristics for routine clinical care and this nonrandomized trial. Eight mediated models were run for the two predictors, two mediators, and two outcomes. RESULTS Pretreatment perfectionism (SOP and SPP) led to greater reductions in pain catastrophizing over the course of IIPT, which resulted in lower pain severity (β = -.02 [CI = -0.07, -0.01] for SOP and β = -.02 [CI = -0.06, -0.003] for SPP) and less functional disability (β = -.06 [CI = -0.13, -0.01] for SOP and β = -.06 [CI = -0.14, -0.01] for SPP). Independent of pain catastrophizing, pretreatment SPP was directly associated with more posttreatment functional disability (β = .16 [CI = 0.05, 0.27]). Fear of pain was not a mediator. CONCLUSIONS Findings suggest perfectionism has the potential to negatively impact IIPT outcomes. However, when perfectionistic youth with chronic pain learn to manage pain-related distress, they benefit. Results highlight the importance of assessing for and treating perfectionism and pain-related distress in youth with chronic pain.
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Affiliation(s)
- Edin T Randall
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School
| | - Yasmin C Cole-Lewis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital
| | - Kelsey N Jervis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital
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18
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Wager J, Ruhe AK, Stahlschmidt L, Leitsch K, Claus BB, Häuser W, Brähler E, Dinkel A, Kocalevent R, Zernikow B. Long-term outcomes of children with severe chronic pain: Comparison of former patients with a community sample. Eur J Pain 2021; 25:1329-1341. [PMID: 33619774 DOI: 10.1002/ejp.1754] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Findings on the short- and long-term effectiveness of intensive interdisciplinary pain treatment (IIPT) for children with severe chronic functional pain are promising. However, a definitive appraisal of long-term effectiveness cannot be made due to a lack of comparison groups. The aim of the present study was to compare the health status of former patients with the health status of an age- and sex-matched comparison group from the community. METHODS Data from two samples, a clinical sample of former patients (n = 162; aged 14 to 26) and an age- and sex-matched community sample (n = 162), were analysed. Former patients provided data 7 years after IIPT. Pain characteristics, physical and mental health status, autonomy, coping and health care utilisation were compared between the two samples. RESULTS Seven years after treatment, the majority (58%) of the clinical sample were completely pain-free. Compared to the community sample, the clinical sample demonstrated worse physical and mental health and continued to seek more frequent health care, irrespective of whether or not they experienced ongoing chronic pain. However, the clinical sample reported better coping strategies and a comparable level of autonomy. CONCLUSION Patients experiencing severe chronic pain in childhood who engage in IIPT are likely to have recovered from their pain in early adulthood. Long-term treatment effects may manifest in better coping strategies. However, reduced mental and physical health status may indicate a negative long-term effect of early chronic pain experiences or a general vulnerability in people developing a chronic pain condition in childhood. SIGNIFICANCE The majority of severely impaired paediatric chronic pain patients no longer suffer from chronic pain seven years after intensive interdisciplinary pain treatment. However, former patients have worse physical and mental health status than a community sample, and continue to seek out more frequent health care utilisation, irrespective of whether or not they continue to experience chronic pain. Therefore, potential negative long-term effects of childhood chronic pain experiences need specific attention early on.
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Affiliation(s)
- Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.,PedScience Research Institute, Datteln, Germany
| | - Ann-Kristin Ruhe
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
| | - Kathrin Leitsch
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | | | - Winfried Häuser
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany.,Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Rüya Kocalevent
- Institute and Polyclinic of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany.,Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany.,PedScience Research Institute, Datteln, Germany
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Hurtubise K, Brousselle A, Noel M, Jordan A, White J, Rasic N, Camden C. Youth and parent perceptions on participating in specialized multidisciplinary pain rehabilitation options: A qualitative timeline effect analysis. Can J Pain 2021; 5:1-21. [PMID: 33987520 PMCID: PMC7951173 DOI: 10.1080/24740527.2020.1858709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/12/2022]
Abstract
Background: Little is known about how the specialized treatment journey is perceived by youth with pain-related disability and their parents. Aims: Describe and compare the treatment effects and outcomes as perceived by youth and their parents enrolled in intensive interdisciplinary pain treatment (IIPT) or multimodal treatment (MMT). Methods: Eleven IIPT youth and five parents and three MMT youth and five parents were recruited. All were asked to complete a treatment journey timeline, followed by separately conducted semistructured interviews. Transcribed interviews were analyzed using reflective thematic analysis. Results: The main themes spanned the treatment trajectory. All participants described similar initial struggles (Theme 1). Positive and negative treatment effects associated with acquisitions and disruptions (Theme 2), and outcomes post-discharge related to supports and realities (Theme 3) emerged. Knowledge, skills, and support acquisition during treatment and feeling empowered and confident to self-manage postdischarge were identified as IIPT benefits. However, the change effort and life disruptions required and the difficulty transitioning to real life postprogram were acknowledged as detrimental IIPT impacts. Continuing with life as usual and maintaining supports in daily contexts (e.g., school personnel, friends) were reported MMT benefits. However, the challenges of managing pain, treatment adherence within the competing demands of daily realities, and the lack of support to integrate strategies were emphasized as detrimental MMT impacts. Conclusions: Detailed impacts of two specialized multidisciplinary pain rehabilitation interventions on the lives of youth with pain-related disability and their parents are described. The treatments benefits and previously unexplored detrimental effects are unveiled.
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Affiliation(s)
- Karen Hurtubise
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Astrid Brousselle
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- School of Public Administration, University of Victoria, Victoria, British Columbia, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Health Research Innovation Centre, Calgary, Alberta, Canada
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, UK
| | - Jo White
- Department of Health and Social Sciences, University of the West of England–Bristol, Bristol, UK
| | - Nivez Rasic
- Department of Anesthesia & Pain Medicine, Foothills Hospital, Calgary, Alberta, Canada
| | - Chantal Camden
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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20
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Pain prevention and management must begin in childhood: the key role of psychological interventions. Pain 2020; 161 Suppl 1:S114-S121. [DOI: 10.1097/j.pain.0000000000001862] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Fahrenkamp A, Sim L, Roers L, Canny M, Harrison T, Harbeck-Weber C. An Innovative and Accessible Biofeedback Intervention for Improving Self-Regulatory Skills in Pediatric Chronic Pain: A Pilot Study. J Altern Complement Med 2020; 26:212-218. [DOI: 10.1089/acm.2019.0297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amy Fahrenkamp
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Sciences, Rochester, MN
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Sciences, Rochester, MN
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
| | - Lisbeth Roers
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Mark Canny
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN
| | - Tracy Harrison
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
| | - Cynthia Harbeck-Weber
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Sciences, Rochester, MN
- Pediatric Pain Rehabilitation Center, Mayo Clinic, Rochester, MN
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22
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McCarthy KF, de Leeuw TG. Trickle-down healthcare in paediatric chronic pain. Br J Anaesth 2019; 123:e188-e190. [PMID: 31128880 PMCID: PMC6676048 DOI: 10.1016/j.bja.2019.04.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 01/05/2023] Open
Affiliation(s)
| | - Tom G de Leeuw
- Department of Anesthesia and Pain Medicine, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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