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Valrie C, Crawford BS, Shipman-Lacewell J, Ajibade O, Fuh B, Smith W, Sisler I. Investigating home-based opioid use among youth with sickle cell disease using ecological momentary assessment. Pediatr Blood Cancer 2024; 71:e31116. [PMID: 38802728 PMCID: PMC11211048 DOI: 10.1002/pbc.31116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/27/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Opioids are a common and essential treatment for acute sickle cell disease (SCD) pain. However, opioids carry well-known adverse side effects, including potential development of hyperalgesia and nociplastic pain. We characterized opioid use in youth with SCD using ecological momentary assessment (EMA) data, and investigated the relationships between home-based opioid use, pain, and a range of biopsychosocial factors. METHOD Eighty-eight youth with SCD (aged 8-17 years) completed EMAs assessing home-based opioid use, pain, and related factors. Analyses consisted of descriptive and multilevel logistic regression to predict daily home opioid use. RESULTS Youth averaged 3.64 weeks of EMAs. Approximately 35% of the sample (n = 31) took an opioid during the EMA period, and used them on only 24% of reported pain days. Youth who took opioids reported a higher percentage of pain days (t = -2.67, p < .05) and mean pain severity scores (t = -2.30, p < .05) than youth who did not take opioids. Multilevel logistic regression analyses indicated that high daily pain severity (odds ratio [OR] = 1.02, p < .01), older age (OR = 1.324, p < .01), and low positive affect (OR = 0.91, p < .01) were each related to an increased likelihood of opioid use. CONCLUSION Youth with SCD take opioids appropriately in response to their pain, based on daily self-report. Beyond daily pain severity, age, and daily variation in positive affect were related to home-based opioid use. This suggests that behavioral interventions that enhance positive affect may promote reduced opioid use among youth with SCD.
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Affiliation(s)
- Cecelia Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - B. Sloan Crawford
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Opeyemi Ajibade
- Department of Pediatric Hematology Oncology, Division of Pediatric Hematology, The Children's Hospital at Montefiore, Bronx, NY, USA
| | - Beng Fuh
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, East Carolina University, Greenville, NC, USA
| | - Wally Smith
- Department of Internal Medicine, Division of General Internal Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - India Sisler
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, USA
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Beveridge JK, Walker A, Orr SL, Wilson AC, Birnie KA, Noel M. Parent Anxiety, Depression, Protective Responses, and Parenting Stress in the Context of Parent and Child Chronic Pain: A Daily Diary Study of Parent Variability. THE JOURNAL OF PAIN 2024; 25:104512. [PMID: 38492710 DOI: 10.1016/j.jpain.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/02/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
Parents with (vs without) chronic pain report poorer psychosocial functioning (eg, worse mental health, parenting difficulties), which has been linked to poorer child outcomes (eg, child pain). However, emerging research suggests that individuals vary in their functioning from day-to-day, particularly those with chronic pain. This study used daily diaries to compare parents with (versus without) chronic pain on variability in their anxiety, mood, protective responses, and parenting stress. We also examined parent chronic pain status as a moderator of the associations between parent variability and youth daily pain and interference. Participants were 76 youth with chronic pain (Mage = 14.26; 71.1% female) and one of their parents (89.5% mothers; n = 38 or 50.0% endorsing chronic pain). Parents and youth completed self-report questionnaires and 7 days of diaries. Parent variability was calculated to reflect the frequency and size of day-to-day changes. Multilevel models revealed that parents with (vs without) chronic pain were significantly more variable in their parenting stress, but not in their anxiety, mood, or protective responses. Contrary to hypotheses, parent variability was not significantly related to youth daily pain intensity or interference and parent chronic pain did not moderate any associations. Instead, mean levels of parent anxiety, protective responses, and parenting stress across the week significantly predicted youth daily pain interference. Findings suggest that while variability was observed among parents (with and without chronic pain) of youth with chronic pain, it did not significantly predict youth's daily pain-related functioning. Further research is needed to confirm these initial findings. PERSPECTIVE: Parents with chronic pain have expressed concerns that the variable nature of their pain negatively impacts their children. Our results found that parents (with and without chronic pain) were variable in their anxiety, mood, protective responses, and parenting stress, but this variability did not significantly predict youth's chronic pain-related functioning.
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Affiliation(s)
| | - Andrew Walker
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Alberta, Canada
| | - Serena L Orr
- Department of Psychology, University of Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada; Departments of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Anna C Wilson
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Oregon
| | - Kathryn A Birnie
- Department of Psychology, University of Calgary, Alberta, Canada; Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Alberta, Canada
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Doumen M, De Cock D, Van Lierde C, Betrains A, Pazmino S, Bertrand D, Westhovens R, Verschueren P. Engagement and attrition with eHealth tools for remote monitoring in chronic arthritis: a systematic review and meta-analysis. RMD Open 2022; 8:rmdopen-2022-002625. [PMID: 36302561 PMCID: PMC9621170 DOI: 10.1136/rmdopen-2022-002625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Although eHealth tools are potentially useful for remote disease monitoring, barriers include concerns of low engagement and high attrition. We aimed to summarise evidence on patients’ engagement and attrition with eHealth tools for remotely monitoring disease activity/impact in chronic arthritis. Methods A systematic literature search was conducted for original articles and abstracts published before September 2022. Eligible studies reported quantitative measures of patients’ engagement with eHealth instruments used for remote monitoring in chronic arthritis. Engagement rates were pooled using random effects meta-analysis. Results Of 8246 references, 45 studies were included: 23 using smartphone applications, 13 evaluating wearable activity trackers, 7 using personal digital assistants, 6 including web-based platforms and 2 using short message service. Wearable-based studies mostly reported engagement as the proportion of days the tracker was worn (70% pooled across 6 studies). For other eHealth tools, engagement was mostly reported as completion rates for remote patient-reported outcomes (PROs). The pooled completion rate was 80%, although between-study heterogeneity was high (I2 93%) with significant differences between eHealth tools and frequency of PRO-collection. Engagement significantly decreased with longer study duration, but attrition varied across studies (0%–89%). Several predictors of higher engagement were reported. Data on the influence of PRO-reporting frequency were conflicting. Conclusion Generally high patient engagement was reported with eHealth tools for remote monitoring in chronic arthritis. However, we found considerable between-study heterogeneity and a relative lack of real-world data. Future studies should use standardised measures of engagement, preferably assessed in a daily practice setting. Trial registeration number The protocol was registered on PROSPERO (CRD42021267936).
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Affiliation(s)
- Michaël Doumen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium,Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Diederik De Cock
- Department of Public Health, Biostatistics and Medical Informatics Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Caroline Van Lierde
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Albrecht Betrains
- General Internal Medicine, KU Leuven University Hospitals, Leuven, Belgium
| | - Sofia Pazmino
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Delphine Bertrand
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium,Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
| | - Patrick Verschueren
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, Katholieke Universiteit Leuven, Leuven, Belgium,Rheumatology, KU Leuven University Hospitals, Leuven, Belgium
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Wallrath MK, Geremek A, Rubel J, Lindner C, Hechler T. [Parental responses to child pain : The role of parental and child somatic and anxiety symptoms]. Schmerz 2021; 36:39-48. [PMID: 33929596 PMCID: PMC8821045 DOI: 10.1007/s00482-021-00551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/12/2022]
Abstract
Hintergrund Elterliche kognitiv-affektive und verhaltensbezogene Reaktionen können die Chronifizierung von kindlichen Schmerzen beeinflussen. Unklar ist, ob Mütter und Väter unterschiedlich reagieren und inwieweit Top-down- (elterliche Somatisierung, Angstsymptome) und Bottom-up-Variablen (kindliche schmerzbezogene Beeinträchtigung, Angstsymptome) die elterlichen Reaktionen modulieren. Ziele der Arbeit (1) Vergleich der Somatisierung, Angstsymptome und elterlichen Reaktionen (Katastrophisieren, Zuwendung) von Müttern und Vätern chronisch schmerzkranker Kinder und (2) Untersuchung des Einflusses von Top-down- und Bottom-up-Variablen auf die elterlichen Reaktionen. Methode Eltern-Kind-Triaden (Kind, Mutter, Vater; je N = 21, Gesamt‑N = 63; Kinder: 50 % weiblich, 11–19 Jahre, ∅15,14 Jahre) wurden während einer kinder- und jugendpsychiatrischen Behandlung ihrer chronischen Schmerzen hinsichtlich der kindlichen Schmerzen und Angstsymptome, elterlicher Somatisierung und Angstsymptome und elterlichen Reaktionen mit validierten Fragebögen erfasst. Ergebnisse Mütter und Väter unterschieden sich nicht in Somatisierung, Angstsymptomen und Reaktionen. Eltern katastrophisierten stärker, wenn ihre Kinder sowohl unter Angstsymptomen als auch unter stärkerer schmerzbezogener Beeinträchtigung litten. Elterliche Zuwendung war verstärkt, wenn Eltern selbst Angstsymptome angaben. Jüngere Kinder und Mädchen erhielten mehr Zuwendung. Diskussion Im Einklang mit vorherigen Studien zeigt sich, dass elterliche und kindliche Angstsymptome, nicht aber das elterliche Geschlecht als modulierende Faktoren der elterlichen maladaptiven Reaktionen eine Rolle spielen. Dies sollte in Prävention und Therapie von Kindern mit chronischen Schmerzen und deren Bezugspersonen berücksichtigt werden.
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Affiliation(s)
- Maren K Wallrath
- Abteilung für Klinische Psychologie und Psychotherapie des Kindes- und Jugendalters, Universität Trier, Universitätsring 15, 54286, Trier, Deutschland
| | - Adam Geremek
- Klinik für Kinder- und Jugendpsychiatrie, Helios Klinikum, Schleswig, Deutschland
| | - Julian Rubel
- Abteilung für Psychotherapieforschung, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - Clemens Lindner
- Klinik für Kinder- und Jugendpsychiatrie, Helios Klinikum, Schleswig, Deutschland
| | - Tanja Hechler
- Abteilung für Klinische Psychologie und Psychotherapie des Kindes- und Jugendalters, Universität Trier, Universitätsring 15, 54286, Trier, Deutschland.
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Rosenbloom BN, Slepian PM, Pagé MG, Isaac L, Campbell F, Stinson J, Katz J. Differential Risk Factor Profiles in the Prediction of General and Pain-Specific Functional Limitations 12 Months after Major Pediatric Surgery. CHILDREN-BASEL 2021; 8:children8050360. [PMID: 33946246 PMCID: PMC8146066 DOI: 10.3390/children8050360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/19/2022]
Abstract
Pediatric chronic post-surgical pain is a surgical complication associated with various levels of functional limitation. Two commonly used measures of functional limitations in youth are the Functional Disability Inventory (FDI) and the PROMIS Pediatric Pain Interference Scale (PPIS), where the former is general, and the latter, pain specific. The aim of the present study was to prospectively compare pre-surgical youth and parent risk factors for youth functional limitations, assessed by the FDI and PPIS, 12 months after major pediatric surgery. Risk factors for the FDI and PPIS were compared in 79 dyads consisting of youth (58% female, M = 14.56 years; SD = 2.31) undergoing major surgery and one of their parents. The FDI and PPIS were highly correlated prior to surgery (r = 0.698, p < 0.001) and even more so 12 months after surgery (r = 0.807, p < 0.001). Parent pre-surgical anxiety sensitivity and youth pre-surgical functional disability significantly predicted 12-month FDI (F(6,56) = 4.443, p = 0.001, Adjusted R2 = 0.25), whereas parent pre-surgical anxiety sensitivity, trait anxiety, pain anxiety, as well as youth pain-related anxiety and worry significantly predicted 12-month PPIS (F(6,45) = 4.104, p = 0.002, Adjusted R2 = 0.27). Risk factors for 12-month general and pain-specific functional limitations differ by dyad member and type. Functional limitations in youth after surgery are predicted by youth and parent factors, however the risk factors differ between the FDI and the PPIS.
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Affiliation(s)
- Brittany N. Rosenbloom
- Department of Psychology, York University, Toronto, ON M3J 1P3, Canada;
- Correspondence: (B.N.R.); (J.K.); Tel.: +416-636-2100 (B.N.R.); +416-636-2100 (J.K.)
| | - P. Maxwell Slepian
- Department of Psychology, York University, Toronto, ON M3J 1P3, Canada;
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
| | - M. Gabrielle Pagé
- Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 0A9, Canada;
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Lisa Isaac
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (L.I.); (F.C.)
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (L.I.); (F.C.)
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Jennifer Stinson
- Department of Anesthesia and Pain Medicine, Child Health Evaluative Sciences Research Institute, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON M3J 1P3, Canada;
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, ON M5G 2C4, Canada
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
- Department of Psychology, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Correspondence: (B.N.R.); (J.K.); Tel.: +416-636-2100 (B.N.R.); +416-636-2100 (J.K.)
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Parent Factors are Associated With Pain and Activity Limitations in Youth With Acute Musculoskeletal Pain: A Cohort Study. Clin J Pain 2020; 35:222-228. [PMID: 30362984 DOI: 10.1097/ajp.0000000000000668] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Biopsychosocial models emphasize the influence of parent/family factors on pediatric chronic pain. Little is known about how parent factors differ across the acute to chronic pain continuum, or contribute to youths' pain experience in the acute pain period. The purpose of the study was to describe parent factors in youth with acute musculoskeletal pain (n=84) compared with youth with chronic pain (n=60) and youth without pain (n=61). Further, within the acute pain sample, we tested parent factors as predictors of child pain characteristics, as well as the moderating role of child sex on associations. METHODS Participants were 205 youth (age, 10 to 17) and one biological parent per child. Children reported on their own pain and activity limitations. Parents reported on their own chronic pain, somatization, and protective pain responses. RESULTS Parents of youth with acute pain had higher prevalence of chronic pain and greater somatization than parents of youth without pain. Parents of youth with acute and chronic pain did not differ. Linear regressions within the acute pain sample revealed presence of parent chronic pain and protective behavior were associated with child pain. Moreover, parent somatization was associated with child activity limitations. Within the acute pain sample, associations between parent protectiveness and child pain were moderated by child sex, with relationships stronger for female children. DISCUSSION Findings highlight the importance of parent factors on pain experiences of youth with acute musculoskeletal pain. Future longitudinal research can elucidate temporal associations that underlie how parent factors may impact transition from acute to chronic pain.
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Parent cognitive, behavioural, and affective factors and their relation to child pain and functioning in pediatric chronic pain: a systematic review and meta-analysis. Pain 2020; 161:1401-1419. [DOI: 10.1097/j.pain.0000000000001833] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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A usability and feasibility study of a computerized version of the Bath Adolescent Pain Questionnaire: the BAPQ-C. BMC Pediatr 2020; 20:6. [PMID: 31906913 PMCID: PMC6943885 DOI: 10.1186/s12887-019-1899-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/22/2019] [Indexed: 12/25/2022] Open
Abstract
Background Pain is a common experience in adolescence, with up to 44% of adolescents reporting chronic pain. For a significant minority, severe pain becomes an ongoing disabling problem. Treatment of adolescent chronic pain aims to reduce the impact of pain on adolescents’ lives. Efficient, accurate assessment of the impact of pain is essential to treatment. The ‘Bath Adolescent Pain Questionnaire’ (BAPQ) is a psychometrically robust multidimensional self-report measure of adolescent functioning. Whilst widely used, the paper-based format of the BAPQ can present completion difficulties for adolescents experiencing chronic pain. To increase the accessibility and clinical utility of the BAPQ, an electronic version of the measure is needed. This study assesses the usability and feasibility of a computerized version of this measure (BAPQ-C) in an adolescent chronic pain population. Methods Fourteen adolescents (13 females; 13–16 years) were recruited from a hospital-based residential pain management programme. Participants completed a qualitative ‘thinking aloud task’ whilst completing the BAPQ-C. and, an acceptability questionnaire regarding the BAPQ-C. Data were analysed using thematic analysis, a widely used qualitative method of data analysis . Results Two themes labelled ‘engagement and technological appeal’ and ‘accessibility and independence’ were generated. Themes revealed numerous factors contributing to participants’ preference for the BAPQ-C compared with the paper version of the BAPQ. Participants reported that the BAPQ-C was ‘quicker’ and ‘easier’ to complete than the BAPQ. Functional aspects of the BAPQ-C which included use of a touch screen rather than a pen and paper, font colours/styles, the zoom function and the spellchecker, provided participants with improved access. This subsequently increased participants’ independence and confidence when completing the measure. Conclusion The BAPQ-C is a feasible multidimensional tool for the assessment of functioning in adolescents who experience chronic pain. It was well-received by participants who were able to complete the measure more quickly, independently and confidently than the paper-based BAPQ. Increased speed, ease and accuracy of completion make the BAPQ-C an ideal tool for use in busy clinical and research settings. Findings highlight the potential benefits of adopting the BAPQ-C when assessing the impact of chronic pain on adolescents in clinic and home-based settings.
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Wallrath MK, Rubel J, Ohls I, Demiralay C, Hechler T. Bottom‐up or top‐down?: The role of child and parent chronic pain and anxiety in the context of parental catastrophizing and solicitousness. Eur J Pain 2019; 24:604-616. [DOI: 10.1002/ejp.1512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/08/2019] [Accepted: 11/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Maren K. Wallrath
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents University of Trier Trier Germany
| | - Julian Rubel
- Department of Psychology Justus‐Liebig‐University Gießen Gießen Germany
| | - Isgard Ohls
- Department of Psychiatry and Psychotherapy University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Tanja Hechler
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents University of Trier Trier Germany
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Maternal Protective Parenting Accounts for the Relationship Between Pain Behaviors and Functional Disability in Adolescents. Clin J Pain 2019; 34:1089-1095. [PMID: 30020087 DOI: 10.1097/ajp.0000000000000638] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION A variety of factors influence parent responses to pain behaviors they observe in their adolescents with chronic pain. Certain parental responses to pain, such as attention or overprotection, can adversely impact adolescent adaptive functioning and correspond to poor clinical outcomes. OBJECTIVES It was hypothesized that the relationship between adolescent pain behaviors and functional disability was mediated by maladaptive parenting (protective, monitoring, solicitousness) responses. MATERIALS AND METHODS Participants were 303 adolescents and their mothers presenting to a pain clinic. Adolescents completed measures of functional disability and pain intensity; mothers completed measures assessing adolescent pain behaviors, their own catastrophizing about their adolescent's pain, and responses to pain. A path model tested the direct and indirect associations between pain behaviors and disability via 3 parenting responses, controlling for average pain intensity and parent pain catastrophizing. RESULTS Greater pain behavior was associated with increased protective responses (α path, P<0.001); greater protective behavior was associated with increased disability (β path, P=0.002). Including parenting responses in the model, the path between pain behaviors and disability remained significant (c' path, P<0.001). The indirect path between pain behaviors and disability via parenting responses was significant for protective responses (P<0.02), controlling for pain intensity and parent pain catastrophizing. The indirect effect of protective responses explained 18% of the variance between pain behaviors and disability. DISCUSSION Observing adolescent pain behaviors may prompt parents to engage in increased protective behavior that negatively impacts adolescents' functioning, even after controlling for the effects of parental pain catastrophizing.
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Rebane K, Orenius T, Ristolainen L, Relas H, Kautiainen H, Luosujärvi R, Säilä H, Aalto K. Pain interference and associated factors in young adults with juvenile idiopathic arthritis. Scand J Rheumatol 2019; 48:408-414. [DOI: 10.1080/03009742.2019.1596308] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- K Rebane
- Children’s Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - T Orenius
- Orton Orthopaedic Hospital, Orton, Helsinki, Finland
| | | | - H Relas
- Department of Medicine, Division of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - R Luosujärvi
- Department of Medicine, Division of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - H Säilä
- Research Institute Orton, Orton, Helsinki, Finland
| | - K Aalto
- Children’s Hospital, Pediatric Research Center, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
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Social learning pathways in the relation between parental chronic pain and daily pain severity and functional impairment in adolescents with functional abdominal pain. Pain 2019; 159:298-305. [PMID: 29016461 DOI: 10.1097/j.pain.0000000000001085] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Having a parent with chronic pain (CP) may confer greater risk of persistence of CP from childhood into young adulthood. Social learning, such as parental modeling and reinforcement, represents one plausible mechanism for the transmission of risk of CP from parents to offspring. Based on a 7-day pain diary in 154 pediatric patients with functional abdominal CP, we tested a model in which parental CP predicted adolescents' daily average CP severity and functional impairment (distal outcomes) via parental modeling of pain behaviors and parental reinforcement of adolescent's pain behaviors (mediators) and adolescents' cognitive appraisals of pain threat (proximal outcome representing adolescents' encoding of parents' behaviors). Results indicated significant indirect pathways from parental CP status to adolescent average daily pain severity (b = 0.18, SE = 0.08, 95% confidence interval: 0.04-0.31, P = 0.03) and functional impairment (b = 0.08, SE = 0.04, 95% confidence interval: 0.02-0.15, P = 0.03) over the 7-day diary period via adolescents' observations of parent pain behaviors and adolescent pain threat appraisal. The indirect pathway through parental reinforcing responses to adolescents' pain did not reach significance for either adolescent pain severity or functional impairment. Identifying mechanisms of increased risk of pain and functional impairment in children of parents with CP ultimately could lead to targeted interventions aimed at improving functioning and quality of life in families with CP. Parental modeling of pain behaviors represents a potentially promising target for family-based interventions to ameliorate pediatric CP.
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13
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Poppert Cordts KM, Stone AL, Beveridge JK, Wilson AC, Noel M. The (Parental) Whole Is Greater Than the Sum of Its Parts: A Multifactorial Model of Parent Factors in Pediatric Chronic Pain. THE JOURNAL OF PAIN 2019; 20:786-795. [PMID: 30658175 DOI: 10.1016/j.jpain.2019.01.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/19/2018] [Accepted: 01/11/2019] [Indexed: 12/13/2022]
Abstract
Parents play a critical role in children's experience of, and recovery from, chronic pain. Although several parental factors have been linked to child pain and functioning, these factors are typically examined in isolation or as moderators or mediators. Structural equation modeling affords the opportunity to examine the extent to which parental factors are interrelated, and if there are differential associations among parental factors and child outcomes. Based on extant literature, a unified model of parental factors, including chronic pain status, physical functioning, responses to child pain, and psychological factors, and their effect on child pain and functioning, was conceptualized. This model was evaluated using structural equation modeling based on data from 146 dyads recruited from a multidisciplinary pain clinic. Modifications to model iterations were made based on theoretical and statistical justification. The final model revealed associations among all parental factors, with significant loadings on child pain and functioning. Findings indicated the conceptual model was supported, with the exception of parent responses to child pain. Findings support the inclusion of parent chronic pain status and physical and psychological functioning as part of a comprehensive assessment of youth with chronic pain and may inform new parental intervention targets to improve child outcomes. PERSPECTIVE: A unified structural equation model indicated parents' own chronic pain characteristics and physical and psychological functioning represent important factors associated with child pain and functioning. Current family-based interventions that often primarily focus on parent responses to child pain may need to be adapted to more comprehensively address parental factors.
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Affiliation(s)
- Katrina M Poppert Cordts
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon; Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
| | - Amanda L Stone
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Jaimie K Beveridge
- Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Anna C Wilson
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University, Portland, Oregon
| | - Melanie Noel
- Department of Psychology, University of Calgary and Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
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Khu M, Soltani S, Neville A, Schulte F, Noel M. Posttraumatic stress and resilience in parents of youth with chronic pain. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1514606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Melanie Khu
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Sabine Soltani
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Alexandra Neville
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Fiona Schulte
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Melanie Noel
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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16
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Brock KE, Wolfe J, Ullrich C. From the Child's Word to Clinical Intervention: Novel, New, and Innovative Approaches to Symptoms in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E45. [PMID: 29597333 PMCID: PMC5920391 DOI: 10.3390/children5040045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/12/2018] [Accepted: 03/21/2018] [Indexed: 12/13/2022]
Abstract
Despite vast improvements in disease-based treatments, many children live with life-threatening disorders that cause distressing symptoms. These symptoms can be difficult to comprehensively assess and manage. Yet, frequent and accurate symptom reporting and expert treatment is critical to preserving a patient's physical, psychological, emotional, social, and existential heath. We describe emerging methods of symptom and health-related quality-of-life (HRQOL) assessment through patient-reported outcomes (PROs) tools now used in clinical practice and novel research studies. Computer-based and mobile apps can facilitate assessment of symptoms and HRQOL. These technologies can be used alone or combined with therapeutic strategies to improve symptoms and coping skills. We review technological advancements, including mobile apps and toys, that allow improved symptom reporting and management. Lastly, we explore the value of a pediatric palliative care interdisciplinary team and their role in assessing and managing distressing symptoms and minimizing suffering in both the child and family. These methods and tools highlight the way that novel, new, and innovative approaches to symptom assessment and management are changing the way that pediatrics and pediatric palliative care will be practiced in the future.
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Affiliation(s)
- Katharine E Brock
- Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.
- Pediatric Palliative Care, Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, GA 30322, USA.
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital Cancer and Blood Disorders Center, Boston, MA 02215, USA.
| | - Christina Ullrich
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA 02215, USA.
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital Cancer and Blood Disorders Center, Boston, MA 02215, USA.
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Neville A, Soltani S, Pavlova M, Noel M. Unravelling the Relationship Between Parent and Child PTSD and Pediatric Chronic Pain: the Mediating Role of Pain Catastrophizing. THE JOURNAL OF PAIN 2018; 19:196-206. [DOI: 10.1016/j.jpain.2017.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 10/07/2017] [Accepted: 10/17/2017] [Indexed: 01/31/2023]
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Disentangling the Sleep-Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms. Pain Res Manag 2017; 2017:1586921. [PMID: 29348713 PMCID: PMC5733870 DOI: 10.1155/2017/1586921] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/23/2017] [Indexed: 12/14/2022]
Abstract
Background Pediatric chronic pain often emerges in adolescence and cooccurs with internalizing mental health issues and sleep impairments. Emerging evidence suggests that sleep problems may precede the onset of chronic pain as well as anxiety and depression. Studies conducted in pediatric populations with pain-related chronic illnesses suggest that internalizing mental health symptoms may mediate the sleep-pain relationship; however, this has not been examined in youth with primary pain disorders. Objective To examine whether anxiety and depressive symptoms mediated relationships between sleep quality and pain outcomes among youth with chronic pain. Methods Participants included 147 youth (66.7% female) aged 8-18 years who were referred to a tertiary-level chronic pain program. At intake, the youth completed psychometrically sound measures of sleep quality, pain intensity, pain interference, and anxiety and depressive symptoms. Results As hypothesized, poor sleep quality was associated with increased pain intensity and pain interference, and anxiety and depressive symptoms mediated these sleep-pain relationships. Discussion For youth with chronic pain, poor sleep quality may worsen pain through alterations in mood and anxiety; however, prospective research using objective measures is needed. Future research should examine whether targeting sleep and internalizing mental health symptoms in treatments improve pain outcomes in these youth.
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