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Epp S, Walker A, Boudes E, Bray S, Noel M, Rayner L, Rasic N, Miller JV. Brain Function and Pain Interference After Pediatric Intensive Interdisciplinary Pain Treatment. Clin J Pain 2024; 40:393-399. [PMID: 38606879 DOI: 10.1097/ajp.0000000000001216] [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: 10/27/2023] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Intensive interdisciplinary pain treatments (IIPTs) are programs that aim to improve functioning in youth with severe chronic pain. Little is known about how the brain changes after IIPT; however, decreased brain responses to emotional stimuli have been identified previously in pediatric chronic pain relative to healthy controls. We examined whether IIPT increased brain responses to emotional stimuli, and whether this change was associated with a reduction in pain interference. PATIENTS AND METHODS Twenty youths with chronic pain aged 14 to 18 years were scanned using functional magnetic resonance imaging, pre and post-IIPT. During the functional magnetic resonance imaging, patients were presented with emotional stimuli (ie, faces expressing happiness/fear), neutral expressions, and control (ie, scrambled) images. Patients completed a measure of pain interference pre and post-IIPT. Paired t tests were used to examine differences in brain activation in response to emotional versus neutral stimuli, pre to post-IIPT. Data from significant brain clusters were entered into linear mixed models to examine the relationships between brain activation and impairment pre and post-IIPT. RESULTS Patients demonstrated a decrease in middle frontal gyrus (MFG) activation in response to emotional stimuli (happy + fear) relative to scrambled images, between pre and post-IIPT ( P < 0.05). Lower MFG activation was associated with lower pain interference, pre and post-IIPT ( P < 0.05). CONCLUSION Contrary to our hypothesis, IIPT was associated with a reduction in MFG activation to emotional stimuli, and this change was associated with reduced pain interference. The MFG is a highly interconnected brain area involved in both pain chronification and antinociception. With further validation of these results, the MFG may represent an important biomarker for evaluating patient treatment response and target for future pain interventions.
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Affiliation(s)
- Spencer Epp
- Department of Anesthesiology, Perioperative and Pain Medicine
| | - Andrew Walker
- Department of Anesthesiology, Perioperative and Pain Medicine
| | | | - Signe Bray
- Department of Radiology, Cumming School of Medicine
- Hotchkiss Brain Institute
- Owerko Centre, Alberta Children's Hospital Research Institute
- Alberta Children's Hospital Research Institute
| | - Melanie Noel
- Department of Radiology, Psychology
- Hotchkiss Brain Institute
- Owerko Centre, Alberta Children's Hospital Research Institute
- Alberta Children's Hospital Research Institute
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, AB, Canada
| | - Laura Rayner
- Department of Anesthesiology, Perioperative and Pain Medicine
| | - Nivez Rasic
- Department of Anesthesiology, Perioperative and Pain Medicine
- Alberta Children's Hospital Research Institute
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, AB, Canada
| | - Jillian Vinall Miller
- Department of Anesthesiology, Perioperative and Pain Medicine
- Department of Radiology, Psychology
- O'Brien Institute for Public Health, University of Calgary
- Hotchkiss Brain Institute
- Owerko Centre, Alberta Children's Hospital Research Institute
- Alberta Children's Hospital Research Institute
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, AB, Canada
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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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Pigott T, McPeak A, de Chastelain A, DeMayo MM, Rasic N, Rayner L, Noel M, Miller JV, Harris AD. Changes in Brain GABA and Glutamate and Improvements in Physical Functioning Following Intensive Pain Rehabilitation in Youth With Chronic Pain. THE JOURNAL OF PAIN 2023; 24:1288-1297. [PMID: 36966034 DOI: 10.1016/j.jpain.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/27/2023]
Abstract
Intensive interdisciplinary pain treatments (IIPT) have been developed to treat youth with unmanaged chronic pain and functional disability. Dysregulation of metabolites gamma-aminobutyric acid (GABA) and glutamate are thought to play a role in the chronification of pain due to imbalances in inhibition and excitation in adults. Using magnetic resonance spectroscopy (MRS), we investigated the effect of IIPT on GABA and Glx (glutamate + glutamine) in 2 pain-related brain regions: the left posterior insula (LPI) and the anterior cingulate cortex (ACC). Data were collected in 23 youth (mean age = 16.09 ± 1.40, 19 female) at entry and discharge from a hospital-based outpatient IIPT. GABA and Glx were measured using GABA-edited MEGA-PRESS and analyzed using Gannet. Physical measures including a 6-minute walk test were recorded, and patients completed the PLAYSelf Physical Literacy Questionnaire, PROMIS Pain Interference Questionnaire, and Functional Disability Inventory. LPI GABA (P < .05) significantly decreased, but not ACC GABA (P > .05), following IIPT. There were no significant Glx changes (P > .05). The decrease in LPI GABA was associated with increased distance in the 6-minute walk test (P < .001). IIPT may decrease GABAergic inhibitory tone within the LPI, thereby promoting plasticity and contributing to improvements in physical outcomes with IIPT. PERSPECTIVE: Regional GABA changes are associated with a reduction in pain interference and improvement in physical function in youth following intensive pain rehabilitation. GABA may serve as a possible biomarker for IIPT; and may also further aid in the development of IIPT, and other treatments for chronic pain in youth.
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Affiliation(s)
- Taylor Pigott
- Biological Sciences, University of Calgary, Calgary, Alberta, Canada; Psychology, University of Calgary, Calgary, Alberta, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Allison McPeak
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amanda de Chastelain
- Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marilena M DeMayo
- Radiology, University of Calgary, Calgary, Alberta, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Brain and Mental Health, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Nivez Rasic
- Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Laura Rayner
- Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Melanie Noel
- Psychology, University of Calgary, Calgary, Alberta, Canada; Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Brain and Mental Health, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Jillian Vinall Miller
- Psychology, University of Calgary, Calgary, Alberta, Canada; Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, Alberta, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada; The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Brain and Mental Health, Hotchkiss Brain Institute, Calgary, Alberta, Canada.
| | - Ashley D Harris
- Radiology, University of Calgary, Calgary, Alberta, Canada; Child Brain & Mental Health Program, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Brain and Mental Health, Hotchkiss Brain Institute, Calgary, Alberta, Canada
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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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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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Dogan M, Zernikow B, Wager J. Short-Term and Long-Term Effectiveness of Intensive Interdisciplinary Pain Treatment for Children and Adolescents with Chronic Headache: A Longitudinal Observation Study. CHILDREN-BASEL 2021; 8:children8030220. [PMID: 33809278 PMCID: PMC8000365 DOI: 10.3390/children8030220] [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] [Received: 02/04/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/24/2022]
Abstract
Pediatric chronic headache causes significant impairment to those affected and bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) was found to positively affect pain-related and emotional outcomes in pediatric patients with chronic pain up to 4 years after treatment. This study was aimed at investigating the effect of IIPT on solely pediatric chronic headache patients. As part of a longitudinal observation study, n = 70 children and adolescents with chronic headache receiving IIPT were included, of which n = 47 completed the assessment at four assessment time points: before treatment (PRE) and at three follow-ups (6-MONTH FOLLOW-UP, 1-YEAR FOLLOW-UP, and 4-YEAR FOLLOW-UP). Pain-related (pain intensity, pain-related disability, school absence), as well as psychological outcome domains (anxiety, depression), were investigated. The results support the short-term and long-term efficacy of IIPT for pediatric chronic headache patients regarding the pain-related outcome measures by significant reductions from PRE to all follow-up measure points. For anxiety and depression, only short-term improvements were found. Future studies should specifically focus on the identification of methods to consolidate the beneficial short-term effects of IIPT on psychological outcome domains in the long term.
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Affiliation(s)
- Meltem Dogan
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
- Correspondence: ; Tel.: +49-2363-975-8062
| | - Boris Zernikow
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital, 45711 Datteln, Germany; (B.Z.); (J.W.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58448 Witten, 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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