1
|
Mesaroli G, Davidge KM, Davis AM, Perruccio AV, Choy S, Walker SM, Stinson JN. Age and Sex Differences in Pediatric Neuropathic Pain and Complex Regional Pain Syndrome: A Scoping Review. Clin J Pain 2024; 40:428-439. [PMID: 38616343 DOI: 10.1097/ajp.0000000000001217] [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: 07/26/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Age and sex differences may exist in the frequency (incidence, prevalence) or symptoms of neuropathic pain (NP) and complex regional pain syndrome (CRPS) due to biopsychosocial factors (eg, neurodevelopment, physiological and hormonal changes, psychosocial differences) that evolve through childhood and adolescence. Age and sex differences may have implications for evaluating screening and diagnostic tools and treatment interventions. OBJECTIVE To map the existing literature on pediatric NP and CRPS with respect to age and sex distributions, and age and sex differences in symptomology and frequency. METHODS A scoping literature review was conducted. Databases were searched from inception to January 2023. Data were collected on study design, setting, demographics, and age and sex differences in frequency and symptoms. RESULTS Eighty-seven studies were included. Distribution of participants with CRPS (n=37 studies) was predominantly early adolescence (10 to 14 y) and female sex, while NP (n=42 studies) was most commonly reported throughout adolescence (10 to 19 y) in both sexes. Forty-one studies examined age and sex differences in frequency; 6 studies reported higher frequency in adolescence. Very few studies (n=11) examined differences in symptomology. DISCUSSION Large epidemiological studies are required to further understand age and sex differences in frequency of pediatric NP and CRPS. Age and sex differences must be considered when evaluating screening and diagnostic tools and treatment interventions to ensure relevance and validity to both sexes and across ages. Validated tools will improve understanding of age-dependent and sex-dependent differences in symptoms, pathophysiology, and psychosocial impact of pediatric NP and CRPS.
Collapse
Affiliation(s)
- Giulia Mesaroli
- Department of Physical Therapy, University of Toronto
- Department of Rehabilitation, The Hospital for Sick Children and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | - Kristen M Davidge
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children and Department of Surgery, University of Toronto
| | - Aileen M Davis
- Department of Physical Therapy, University of Toronto
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto
| | - Samantha Choy
- Department of Physical Therapy, University of Toronto
| | - Suellen M Walker
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, London, UK
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
2
|
Einhorn LM, Krishnan P, Poirier C, Ingelmo P. Chronic Postsurgical Pain in Children and Adolescents: A Call for Action. J Pain Res 2024; 17:1967-1978. [PMID: 38828088 PMCID: PMC11144433 DOI: 10.2147/jpr.s464009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024] Open
Abstract
Chronic postsurgical pain (CPSP) affects a significant proportion of children and adolescents after major surgery and is a detriment to both short- and long-term recovery outcomes. While clinical characteristics and psychosocial risk factors for developing CPSP in children and adults are well established in the literature, there has been little progress on the prevention and management of CPSP after pediatric surgery. Limited evidence to support current pharmacologic approaches suggests a fundamentally new paradigm must be considered by clinicians to both conceptualize and address this adverse complication. This narrative review provides a comprehensive evaluation of both the known and emerging mechanisms that support our current understanding of CPSP. Additionally, we discuss the importance of optimizing perioperative analgesic strategies to mitigate CPSP based on individual patient risks. We highlight the importance of postoperative pain trajectories to identify those most at risk for developing CPSP, the early referral to multi-disciplinary pain clinics for comprehensive evaluation and treatment of CPSP, and additional work needed to differentiate CPSP characteristics from other chronic pain syndromes in children. Finally, we recognize ongoing challenges associated with the universal implementation of available knowledge about pediatric CPSP into practically useful care plans for clinicians.
Collapse
Affiliation(s)
- Lisa M Einhorn
- Department of Anesthesiology, Division of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Padmaja Krishnan
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA
| | - Cassandra Poirier
- Department of Anesthesiology, University of British Columbia, Kelowna, BC, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC, Canada
- Research Institute, McGill University Health Center, Montreal, QC, Canada
- Department of Anesthesia, McGill University, Montreal, QC, Canada
- Alan Edwards Center for Research in Pain, Montreal, QC, Canada
| |
Collapse
|
3
|
Palermo TM, Li R, Birnie KA, Crombez G, Eccleston C, Kashikar-Zuck S, Stone AL, Walco GA. Updated recommendations on measures for clinical trials in pediatric chronic pain: a multiphase approach from the Core Outcomes in Pediatric Persistent Pain (Core-OPPP) Workgroup. Pain 2024; 165:1086-1100. [PMID: 38112633 PMCID: PMC11017748 DOI: 10.1097/j.pain.0000000000003105] [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: 06/07/2023] [Revised: 08/09/2023] [Accepted: 08/31/2023] [Indexed: 12/21/2023]
Abstract
ABSTRACT Many gaps remain in finding effective, safe, and equitable treatments for children and adolescents with chronic pain and in accessing treatments in different settings. A major goal of the field is to improve assessment of pain and related experience. Valid and reliable patient-reported outcome measures are critical for advancing knowledge of clinical interventions for pediatric chronic pain. Building on the work of the Ped-IMMPACT group, we previously updated a core outcome set (COS) for pediatric chronic pain clinical trials using stakeholder feedback from providers, youth, and parents. The new COS includes 3 mandatory domains: pain severity, pain-related interference with daily living, and adverse events and 4 optional domains: overall well-being, emotional functioning, physical functioning, and sleep quality. The aim of this study was to use a multiphased approach to recommend specific measures for each of the 7 domains identified in our new COS for pediatric chronic pain. We synthesized evidence through conducting the following: (1) a Delphi study of experts to identify candidate measures for the new COS domains, (2) a review phase to gather evidence for measurement properties for candidate measures, and (3) an expert consensus conference to reach agreement on measurement recommendations. Final recommendations included 9 patient-reported measures. Important contextual considerations are discussed, and guidance is provided regarding strengths and limitations of the recommendations. Implementation of these recommendations may be enhanced by widespread dissemination and ease of access to measurement tools.
Collapse
Affiliation(s)
- Tonya M. Palermo
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine Seattle, WA, United States
| | - Rui Li
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kathryn A. Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary Calgary, AB, Canada
| | - Geert Crombez
- Department of Experimental Clinical Psychology and Health Psychology, Ghent University, Ghent, Belgium
| | | | - Susmita Kashikar-Zuck
- University of Cincinnati, Department of Pediatrics, Cincinnati, OH, United States
- Cincinnati Children's Hospital Medical Center Cincinnati, OH, United States
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Gary A. Walco
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine Seattle, WA, United States
| |
Collapse
|
4
|
Santos VS, Fandim JV, Silva FG, Hatakeyama BA, Fioratti I, Costa LOP, Saragiotto BT, Yamato TP. Evaluation of methodological and reporting quality of systematic reviews on conservative non-pharmacological musculoskeletal pain management in children and adolescents: A methodological analysis. Musculoskelet Sci Pract 2024; 69:102902. [PMID: 38211435 DOI: 10.1016/j.msksp.2023.102902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND There are no studies investigating the methodological and report quality of systematic reviews of non-pharmacological interventions for musculoskeletal pain management among children and adolescents. OBJECTIVE To evaluate the methodological and reporting quality of systematic reviews on conservative non-pharmacological pain management in children and adolescents with musculoskeletal pain. METHODS Searches were conducted on the Cochrane Database of Systematic Reviews, Medline, Embase, and three other databases. Two pairs of reviewers independently assessed each article according to the predetermined selection criteria. We assessed the methodological quality of systematic reviews, using the AMSTAR 2 checklist and the quality of reporting, using PRISMA checklist. Descriptive analysis was used to summarise the characteristics of all included systematic reviews. The percentage of systematic reviews achieving each item from the AMSTAR 2, PRISMA checklist and the overall confidence in the results were described. RESULTS We included 17 systematic reviews of conservative non-pharmacological pain management for musculoskeletal pain in children and adolescents. Of the 17 systematic reviews included, nine (53%) were rated as "critically low", seven (41%) were rated as "low", and one (6%) was rated as "high" methodological quality by AMSTAR-2. The reporting quality by items from PRISMA range from 17.6% (95% CI 6.2 to 41) to 100% (95% CI 81.6 to 100). CONCLUSION This systematic review of physical interventions in children and adolescents showed overall 'very low' to 'high' methodological quality and usually poor reporting quality.
Collapse
Affiliation(s)
- Veronica Souza Santos
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Junior V Fandim
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Fernanda Gonçalves Silva
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Bruna Alves Hatakeyama
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Iuri Fioratti
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Leonardo Oliveira Pena Costa
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil
| | - Bruno T Saragiotto
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Tiê P Yamato
- Masters and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, SP, Brazil; Faculty of Medicine and Health, University of Sydney, Australia; Nepean Blue Mountains Local Health District, NSW, Australia.
| |
Collapse
|
5
|
Walker SM, Peters J, Verriotis M, Farag F, Jay MA, Howard RF. Sensitivity and Specificity of a Neuropathic Screening Tool (Self-Report Leeds Assessment of Neuropathic Symptoms and Signs, S-LANSS) in Adolescents With Moderate-Severe Chronic Pain. THE JOURNAL OF PAIN 2024; 25:451-465. [PMID: 37741521 DOI: 10.1016/j.jpain.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
Neuropathic screening tools improve recognition of neuropathic pain in adults. Although utilized in pediatric populations, the sensitivity, specificity and methodology of screening tool delivery have not been compared in children. We evaluated the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) in adolescents (10-18 years) referred to a tertiary pediatric pain clinic. History and examination by specialist clinicians and multidisciplinary assessment informed classification of the primary pain type. In a prospective cohort, scores were obtained at interview (S-LANSS interview; n = 161, 70% female), and following substitution of self-reported signs with examination findings in the primary pain region (Leeds Assessment of Neuropathic Symptoms and Signs, LANSS examination). Secondly, we retrospectively retrieved questionnaires self-completed by adolescents at their initial clinic appointment (S-LANSS self-completed; n = 456, 73% female). Thirdly, we explored relationships between patient-reported outcomes and S-LANSS scores. S-LANSS interview scores varied with pain classification, and S-LANSS self-completed scores were similarly highest with neuropathic pain (median [interquartile range]: 18 [11, 21]) and complex regional pain syndrome (21 [14, 24]), variable with musculoskeletal pain (13 [7, 19]) and lowest with visceral pain (6.5 [2, 11.5]) and headache (8.5 [4, 14]). As in adults, the cutpoint score of 12/24 was optimal. Sensitivity was highest with inclusion of examination findings and lowest with self-completion (LANSS examination vs S-LANSS interview vs S-LANSS self-completed: 86.3% vs 80.8% vs 74.7%), but specificity was relatively low (37.8% vs 36.7% vs 48%). High S-LANSS scores in non-neuropathic groups were associated with female sex and high pain catastrophizing. The S-LANSS is a sensitive screening tool for pain with neuropathic features in adolescents, but needs to be interpreted in the context of clinical evaluation (clinicaltrials.gov NCT03312881). PERSPECTIVE: This article reports high sensitivity of the S-LANSS screening tool for identifying pain with neuropathic features in adolescents with moderate-severe chronic pain. However, as sensitivity is lower than in adult populations, further interdisciplinary evaluation is necessary to inform diagnosis and management.
Collapse
Affiliation(s)
- Suellen M Walker
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Judy Peters
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Madeleine Verriotis
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fadila Farag
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Matthew A Jay
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Richard F Howard
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
6
|
Harrop E, Liossi C, Jamieson L, Gastine S, Oulton K, Skene SS, Howard RF, Johnson M, Boyce K, Mitchell L, Jassal S, Anderson AK, Hain RDW, Hills M, Bayliss J, Soman A, Laddie J, Vickers D, Mellor C, Warlow T, Wong IC. Oral morphine versus transmucosal diamorphine for breakthrough pain in children: methods and outcomes: UK (DIPPER study) consensus. BMJ Support Palliat Care 2024; 13:e1019-e1028. [PMID: 34903585 PMCID: PMC10850727 DOI: 10.1136/bmjspcare-2021-003278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/04/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES No randomised controlled trials have been conducted for breakthrough pain in paediatric palliative care and there are currently no standardised outcome measures. The DIPPER study aims to establish the feasibility of conducting a prospective randomised controlled trial comparing oral and transmucosal administration of opioids for breakthrough pain. The aim of the current study was to achieve consensus on design aspects for a small-scale prospective study to inform a future randomised controlled trial of oral morphine, the current first-line treatment, versus transmucosal diamorphine. METHODS The nominal group technique was used to achieve consensus on best practice for mode of administration, dose regimen and a range of suitable pain intensity outcome measures for transmucosal diamorphine in children and young people with breakthrough pain. An expert panel of ten clinicians in paediatric palliative care and three parent representatives participated. Consensus was achieved when agreement was reached and no further comments from participants were forthcoming. RESULTS The panel favoured the buccal route of administration, with dosing according to the recommendations in the Association for Paediatric Palliative Medicine formulary (fifth Edition, 2020). The verbal Numerical Rating Scale was selected to measure pain in children 8 years old and older, the Faces Pain Scale-Revised for children between 4 and 8 years old, and Face, Legs, Activity, Cry and Consolability (FLACC)/FLACC-Revised as the observational tools. CONCLUSIONS The nominal group technique allowed consensus to be reached for a small-scale, prospective, cohort study and provided information to inform the design of a randomised controlled trial.
Collapse
Affiliation(s)
- Emily Harrop
- Helen and Douglas House Hospice, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Christina Liossi
- School of Psychology, University of Southampton, Southampton, UK
- Department of Psychology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Liz Jamieson
- Research Dept of Practice & Policy, University College London School of Pharmacy, London, UK
- UCLH-UCL Centre for Medicines Optimisation Research and Education, London, UK
| | - Silke Gastine
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon S Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
- School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Margaret Johnson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Katherine Boyce
- Helen and Douglas House Hospice, Oxford, UK
- Flexicare Oxford & Abingdon, Oxford, UK
| | | | - Satbir Jassal
- Rainbows Hospice for Children and Young People, Loughborough, UK
| | - Anna-Karenia Anderson
- Paediatrics, Royal Marsden Hospital, Sutton, UK
- Shooting Star Children's Hospice, Guildford, UK
| | - Richard D W Hain
- All-Wales Managed Clinical Network in Paediatric Palliative Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Michelle Hills
- Martin House Hospice for Children and Young People, Boston Spa, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Julie Bayliss
- The Louis Dundas Centre, Oncology Outreach and Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Archana Soman
- Sheffield Children's Hospital, Sheffield, UK
- Bluebell Wood Children's Hospice, North Anston, UK
| | | | - David Vickers
- Medical Director, Cambridgeshire Community Services NHS Trust, St Ives, UK
- East Anglia's Children's Hospices, Cambridgeshire, UK
| | | | - Tim Warlow
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Naomi House and Jacksplace, Winchester, UK
| | - Ian Ck Wong
- Research Dept of Practice & Policy, University College London School of Pharmacy, London, UK
- UCLH-UCL Centre for Medicines Optimisation Research and Education, London, UK
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Pok Fu Lam, Hong Kong
| |
Collapse
|
7
|
Einhorn LM, Hudon J, Ingelmo P. The Pharmacological Treatment of Neuropathic Pain in Children. Curr Neuropharmacol 2024; 22:38-52. [PMID: 37539933 DOI: 10.2174/1570159x21666230804110858] [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: 11/29/2022] [Revised: 02/22/2023] [Accepted: 03/12/2023] [Indexed: 08/05/2023] Open
Abstract
The International Association for the Study of Pain (IASP) defines neuropathic pain as pain caused by a lesion or disease of the somatosensory nervous system. It is characterized as a clinical condition in which diagnostic studies reveal an underlying cause of an abnormality in the peripheral or central nervous system. Many common causes of neuropathic pain in adults are rare in children. The purpose of this focused narrative review is, to 1) provide an overview of neuropathic pain in children, 2) highlight unique considerations related to the diagnosis and mechanisms of neuropathic pain in children, and 3) perform a comprehensive analysis of the pharmacological treatments available. We emphasize that data for routine use of pharmacological agents in children with neuropathic pain are largely inferred from adult literature with little research performed on pediatric populations, yet have clear evidence of harms to pediatric patients. Based on these findings, we propose risk mitigation strategies such as utilizing topical treatments whenever possible, assessing pain phenotyping to guide drug class choice, and considering pharmaceuticals in the broader context of the multidisciplinary treatment of pediatric pain. Furthermore, we highlight important directions for future research on pediatric neuropathic pain treatment.
Collapse
Affiliation(s)
- Lisa M Einhorn
- Department of Anesthesiology, Pediatric Division, Duke University School of Medicine, Durham, North Carolina, United States
| | - Jonathan Hudon
- Division of Secondary Care, Department of Family Medicine, McGill University Health Centre, Montreal, Qc, Canada
- Palliative Care Division, Jewish General Hospital, Montreal, Qc, Canada
- Alan Edwards Pain Management Unit, Montreal General Hospital, McGill University Health Center, Montreal, Qc, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, Canada
- Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Pablo Ingelmo
- Alan Edwards Centre for Pain Research, McGill University, Montreal, Canada
- Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
- Research Institute of the McGill University Health Center, Montreal, Canada
- Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montréal, QC, Canada
| |
Collapse
|
8
|
Vittori A. Pediatric Pain Management: The Time for Action Is Now. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1894. [PMID: 38136096 PMCID: PMC10742136 DOI: 10.3390/children10121894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023]
Abstract
Pediatric anesthesia is a field of research and assistance in which more specialization needs are emerging [...].
Collapse
Affiliation(s)
- Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy
| |
Collapse
|
9
|
Plummer K, McCarthy M, Newall F, Manias E. The management of pain during pediatric hematopoietic stem cell transplantation: A qualitative study of contextual factors that influenced pain management practices. Pediatr Blood Cancer 2023; 70:e30614. [PMID: 37548486 DOI: 10.1002/pbc.30614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Children hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment. OBJECTIVES To describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices. METHODS A qualitative case study was conducted and involved semi-structured interviews at two time points following transplantation (30 and 90 days) with parents (n = 10) and naturalistic observations of pain-related care provided to children (n = 29) during HSCT therapy by their healthcare providers (n = 10). Semi-structured interviews were also conducted with healthcare providers (n = 14). RESULTS The effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence-based guidelines for the sustained, and often long-term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain. CONCLUSIONS There is a pressing need to create evidence-based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.
Collapse
Affiliation(s)
- Karin Plummer
- Department of Nursing, University of Melbourne, Carlton, Melbourne, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, Australia
| | - Maria McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Newall
- Department of Nursing, University of Melbourne, Carlton, Melbourne, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Nursing Research, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Kaseweter K, Nazemi M, Gregoire N, Louw WF, Walsh Z, Holtzman S. Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era. BMC Health Serv Res 2023; 23:1131. [PMID: 37864210 PMCID: PMC10588239 DOI: 10.1186/s12913-023-10157-8] [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: 08/16/2022] [Accepted: 10/16/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Chronic pain is a highly prevalent and disabling condition which is often undertreated and poorly managed in the community. The emergence of COVID-19 has further complicated pain care, with an increased prevalence of chronic pain and mental health comorbidities, and burnout among physicians. While the pandemic has led to a dramatic increase in virtual health care visits, the uptake of a broader range of eHealth technologies remains unclear. The present study sought to better understand physicians' current needs and barriers in providing effective pain care within the context of COVID-19, as well as gauge current use, interest, and ongoing barriers to eHealth implementation. METHODS A total of 100 practicing physicians in British Columbia, Canada, completed a brief online survey. RESULTS The sample was comprised of physicians practicing in rural and urban areas (rural = 48%, urban = 42%; both = 10%), with the majority (72%) working in family practice. The most prominent perceived barriers to providing chronic pain care were a lack of interdisciplinary treatment and allied health care for patients, challenges related to opioid prescribing and management, and a lack of time to manage the complexities of chronic pain. Moreover, despite expressing considerable interest in eHealth for chronic pain management (82%), low adoption rates were observed for several technologies. Specifically, only a small percentage of the sample reported using eHealth for the collection of intake data (21%), patient-reported outcomes (14%), and remote patient monitoring (26%). The most common perceived barriers to implementation were cost, complexity, and unfamiliarity with available options. CONCLUSIONS Findings provide insight into physicians' ongoing needs and barriers in providing effective pain management during the COVID-19 pandemic. Despite the potential for eHealth technologies to help address barriers in pain care, and strong interest from physicians, enhanced useability, education and training, and funding are likely required to achieve successful implementation of a broader range of eHealth technologies in the future.
Collapse
Affiliation(s)
- Kimberley Kaseweter
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
| | - Mark Nazemi
- Clinical and Wellbeing Solutions, Thrive Health Inc, 200 - 116 West Hastings Street, Vancouver, BC, V6B 1G8, Canada
| | - Nina Gregoire
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - W Francois Louw
- Department of Family Practice, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Bill Nelems Pain and Research Centre, 309-2755 Tutt St, Kelowna, BC, V1Y 0G1, Canada
| | - Zach Walsh
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| | - Susan Holtzman
- Department of Psychology, University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada
| |
Collapse
|
11
|
Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP, Miró J. Psychological factors and pain medication use in adolescents with chronic pain. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1183-1188. [PMID: 37341626 DOI: 10.1093/pm/pnad075] [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: 01/03/2023] [Revised: 05/20/2023] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVE The purpose of this study was to examine (1) the associations of anxiety, depressive symptoms, and pain catastrophizing with pain medication use in adolescents with chronic pain and (2) the extent to which these associations differed as a function of adolescents' sex. METHODS Cross-sectional data from 320 adolescents 12-18 years of age with chronic pain were drawn from an epidemiological study on pediatric chronic pain conducted in Reus (Catalonia, Spain). Participants were asked to provide sociodemographic information and respond to measures assessing pain (location, frequency, intensity, and interference), pain medication use, anxiety, depressive symptoms, and pain catastrophizing. Point biserial correlations were conducted to examine univariate associations between the psychological variables and pain medication use. Hierarchical logistic regression analysis was used to examine these associations while controlling for demographic characteristics, pain intensity, and pain interference. RESULTS Anxiety, depressive symptoms, and pain catastrophizing were significantly associated with pain medication use in univariate analyses. Regression analysis identified pain catastrophizing as a unique independent predictor of pain medication use after controlling for the effect of demographic variables (sex and age), pain intensity, and pain interference (odds ratio = 1.1, P < .05). No moderating effect of adolescents' sex on the associations between psychological factors and pain medication use was found. CONCLUSIONS Adolescents with chronic pain with higher levels of pain catastrophizing use pain medications more often. Research to examine the impact of interventions targeting pain catastrophizing on pain medication use among adolescents with chronic pain would be an important next step.
Collapse
Affiliation(s)
- Josep Roman-Juan
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Ester Solé
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98104, United States
| | - Jordi Miró
- Universitat Rovira i Virgili, Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment (CRAMC), Department of Psychology, Tarragona, 43007 Catalonia, Spain
- Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Catalonia, Spain
| |
Collapse
|
12
|
Locher C, Petignat M, Wagner C, Hediger K, Roth B, Gaab J, Koechlin H. Animal-Assisted Psychotherapy for Pediatric Chronic Pain: Case Series of an Open Pilot Study to Test Initial Feasibility and Potential Efficacy. J Pain Res 2023; 16:1799-1811. [PMID: 37273273 PMCID: PMC10237188 DOI: 10.2147/jpr.s394270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/23/2023] [Indexed: 06/06/2023] Open
Abstract
Objective Chronic pain is a common complaint in children and adolescents, placing an enormous burden on individuals, their families, and the healthcare system. New innovative approaches for the treatment of pediatric chronic pain (PCP) are clearly warranted, as drop-out rates in intervention studies are high and it can be difficult to engage patients with PCP in therapy. Here, animal-assisted interventions (AAIs) might be promising, since there is preliminary evidence for the approach in adults with chronic pain, and AAIs are generally known to foster the therapeutic motivation of patients. To date, however, AAIs have not been examined in pediatric chronic pain. Methods The aim of this open pilot study was to examine the initial feasibility of recruitment and potential efficacy of an animal-assisted group psychotherapy (including horses, rabbits, chickens, goats, and a dog), providing case reports of three children with chronic pain. We applied a mixed-methods approach, including the conductance of semi-structured interviews and assessment of quantitative pre-post data with a focus on pain severity, avoidance behavior, pain acceptance, and ability to defocus from the pain. Results The three participating girls (age: 9-12 years) reported chronic pain in the head and abdomen. The process of recruitment turned out to be challenging. All three children reported reduced pain-related disability and pain-related distress, as well as an increased ability to accept pain and to defocus from the pain. The qualitative data revealed that patients and their parents had a positive attitude towards AAIs. Conclusion Our initial open pilot study is the first to investigate AAIs in the context of pediatric chronic pain. Notably, we had difficulties in the recruitment procedure, mostly due to the Covid-19 situation. Based on three case reports, we found some first indication that AAI approaches might be associated with symptom changes. Future randomized-control studies with larger sample sizes are clearly warranted. Clinicaltrialsgov Identifier NCT04171336.
Collapse
Affiliation(s)
- Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Milena Petignat
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cora Wagner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin Hediger
- Division of Clinical Psychology and Animal-Assisted Interventions, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Psychology, Open University, Heerlen, the Netherlands
| | - Binia Roth
- Interdisciplinary Pain Consultation, Child and Adolescent Psychiatry of Basel-Landschaft, Binningen, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Helen Koechlin
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
13
|
Marchetti G, Vittori A, Cascella M, Mascilini I, Piga S, Petrucci E, Castellano A, Caruso R, Francia E, Stocchi F, Marinangeli F, Inserra A, Picardo SG. Pain prevalence and pain management in children and adolescents in an italian third level pediatric hospital: a cross-sectional study. Ital J Pediatr 2023; 49:41. [PMID: 36978099 PMCID: PMC10053721 DOI: 10.1186/s13052-023-01439-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In 2016, we performed a one-day investigation to analyze the prevalence of pain, pain intensity, and pain therapy in the Departments of Surgery and Onco-Hematology of the Ospedale Pediatrico Bambino Gesù. To improve the knowledge gap highlighted in the previous study, refresher courses and even personalized audits have been carried out during these years. The purpose of this study is to evaluate if, after 5 years, there have been improvements in the management of pain. METHODS The study was conducted on 25 January 2020. Pain assessment, pain therapies, pain prevalence and intensity in the preceding 24 h and during the recovery period were recorded. Pain outcomes were compared with previous audit results. RESULTS Out of the 63 children with at least one documented pain assessment (starting from 100 eligible), 35 (55.4%) experienced pain: 32 children (50.7%) experienced moderate /severe pain while 3 patients (4%) felt mild pain. In the preceding 24 h, 20 patients (31.7%) reported moderate/severe pain while 10 (16%) reported moderate or severe pain during the interview. The average value of the Pain Management Index (PMI) was - 1.3 ± 0.9 with a minimum of -3 and a maximum of 0. 28 patients (87%) undergoing analgesic therapy for moderate/severe pain had a PMI of less than 0 (undertreated pain), while 3 patients (13%) scored value of 0 or higher (adequate pain therapy), 4 patients (12.5%) received multimodal analgesia with opioids and 2 patients (6%) opioids alone. Time-based therapy was prescribed to 20 patients (62.5%), intermittent therapy was prescribed to 7 patients (22%) and 5 patients (15.5%) did not receive any therapy. The prevalence of pain was higher during hospitalization and 24 h before the interview, while at the time of the interview, the proportion was the same. In this audit, the daily prescription modality of the therapy had some improvements (time-based: 62.5% vs. 44%; intermittent: 22%vs 25%; no therapy: 15.5% vs. 31%). CONCLUSION Pain management in hospitalized children constantly requires special daily attention from health professionals aimed at mitigating the components of intractable pain and resolving those of treatable pain. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov, number (NCT04209764), registered 24 December 2019, https://clinicaltrials.gov/ct2/show/NCT04209764?term=NCT04209764&draw=2&rank=1 .
Collapse
Affiliation(s)
- Giuliano Marchetti
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Aurora Castellano
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Roberta Caruso
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Francesca Stocchi
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Inserra
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| |
Collapse
|
14
|
Boisvert-Plante V, Poulin-Harnois C, Ingelmo P, Einhorn LM. What we know and what we don't know about the perioperative use of methadone in children and adolescents. Paediatr Anaesth 2023; 33:185-192. [PMID: 36281540 PMCID: PMC10416808 DOI: 10.1111/pan.14584] [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: 02/25/2022] [Revised: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 02/05/2023]
Abstract
Postoperative pain control is essential to optimizing patient outcomes, improving satisfaction, and allowing patients to resume their baseline functional activities. Methadone, a synthetic mu-opioid agonist, has multiple pharmacologic properties that may be optimal for perioperative use. Compared to other opioids, methadone has a longer duration of action, rapid onset, extended dosing intervals, high oral bioavailability, low cost, lack of active metabolites, and action on multiple receptors. The current literature examining the use of methadone in the perioperative care of children and adolescents is limited and most often reported within the context of spine or cardiothoracic surgery. Overall, these studies support the hypothesis that perioperative methadone in pediatric patients may decrease postoperative pain, opioid consumption, length-of-stay, and the incidence of some opioid-related side effects, like constipation and urinary retention. A variety of protocols for the perioperative use of methadone have been described, including a single intraoperative dose as well as multiple small doses within multimodal pain protocols. The superiority of these protocols has not been established. Like all opioids, methadone has a side effect profile which includes nausea, vomiting, reduced GI motility, sedation, and respiratory depression at high doses. There is also a concern that it can cause QTc prolongation in patients. The primary aim of this educational review is to examine the pharmacologic data, published perioperative protocols, dosing considerations, and risks and benefits associated with inclusion of methadone in analgesic regimens for surgical patients. A secondary aim is to introduce opportunities for research around the perioperative use of methadone in children and adolescents. Based on our review, we would prioritize establishing optimal procedure-specific methadone protocols, determining generalizability for use in routine pediatric surgeries, and investigating methadone safety and efficacy prospectively as the primary opioid for pain management in the postanesthesia care unit or postsurgical floors.
Collapse
Affiliation(s)
| | - Christelle Poulin-Harnois
- Department of Pediatric Anesthesia, Montreal Children’s Hospital, McGill University Health Center, Montréal, Quebec, Canada
| | - Pablo Ingelmo
- Department of Pediatric Anesthesia, Montreal Children’s Hospital, McGill University Health Center, Montréal, Quebec, Canada
- Alan Edwards Centre for Pain Research, McGill University, Montreal, Quebec, Canada
- Edwards Family Interdisciplinary Complex Pain Centre, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada
| | - Lisa M. Einhorn
- Department of Anesthesiology, Pediatric Division, Duke University School of Medicine, Durham, North Carolina, United States
| |
Collapse
|
15
|
Ocay DD, Ross BD, Moscaritolo L, Ahmed N, Ouellet JA, Ferland CE, Ingelmo PM. The Psychosocial Characteristics and Somatosensory Function of Children and Adolescents Who Meet the Criteria for Chronic Nociplastic Pain. J Pain Res 2023; 16:487-500. [PMID: 36815125 PMCID: PMC9939946 DOI: 10.2147/jpr.s397829] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Purpose Nociplastic pain distinguishes individuals with pain and hypersensitivity in body regions with apparently normal tissues, without any signs of neuropathy, but with contribution of central and/or peripheral sensitization. There is a lack of literature describing nociplastic pain in the pediatric population. The objective of this study was to investigate the differences between pediatric patients with nociplastic pain compared with patients with non-nociplastic pain. Patients and Methods This study included 414 pediatric patients followed at an interdisciplinary centre for complex pain. All patients underwent an exhaustive pain assessment consisting of face-to-face interviews, validated self-report questionnaires and quantitative sensory testing. Recently established criteria for chronic nociplastic pain, and quantitative sensory testing was used to describe and stratify our cohort. Results One hundred and sixty-five patients (40%) were stratified as having possible nociplastic pain and two hundred and forty-nine (60%) patients, as non-nociplastic pain. Patients with nociplastic pain displayed pain hypersensitivity in the region of pain, more symptoms of panic and social phobia, and worse sleep quality than patients with non-nociplastic pain. The proportion of patients achieving a meaningful clinical outcome after completion of their treatment (medications, physiotherapy, psychology, nursing, social worker, and/or interventional procedures) was lower in patients with nociplastic pain (62%) than those without nociplastic pain (86%). Conclusion Our results suggest that patients who meet the criteria for nociplastic pain can be identified in a population of children and adolescents being treated in a center for complex pain. Combining screening with validated questionnaires and quantitative sensory testing facilitates the phenotyping and graded severity of patients with nociplastic pain in daily clinical practice.
Collapse
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,Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Brendan D Ross
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Lorenzo Moscaritolo
- Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
| | - Nabeel Ahmed
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jean A Ouellet
- Department of Clinical Research, Shriners Hospitals for Children Canada, Montreal, QC, Canada,Department of Pediatric Surgery, McGill University, Montreal, QC, Canada,Department of Anesthesia, McGill University, Montreal, QC, Canada,Research Institute-McGill University Health Centre, 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,Edwards Family Interdisciplinary Centre 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
| | - Pablo M Ingelmo
- Edwards Family Interdisciplinary Centre 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,Correspondence: Pablo M Ingelmo, Edwards Family Interdisciplinary Centre for Complex Pain, Montreal Children’s Hospital, B02-3525-1001 Boulevard Décarie, Montreal, H4A 13J, Canada, Tel +1 514 412-4448, Fax +1 514 412-4341, Email
| |
Collapse
|
16
|
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.
Collapse
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.)
| |
Collapse
|
17
|
Chronic pain concepts of pediatricians: a qualitative survey. Pain Rep 2023; 8:e1060. [PMID: 36699994 PMCID: PMC9845015 DOI: 10.1097/pr9.0000000000001060] [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: 06/10/2022] [Revised: 10/27/2022] [Accepted: 11/24/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Chronic pain is a prevalent, yet underrecognized, condition in children and adolescents. A biopsychosocial framework has been widely adopted over the past decades and resulted in a new pain classification in the International Classification of Diseases, 11th revision (ICD-11). Nevertheless, little is known about pediatricians' pain concepts. Objectives We explored pain concepts of Swiss pediatricians by means of a qualitative analysis. Method A cross-sectional online survey was sent to clinically active Swiss pediatricians registered with the Swiss Society for Pediatrics. A case vignette of a girl with chronic musculoskeletal pain was presented and pediatricians were asked (1) what they think caused the pain, and (2) how they would explain the pain to the patient and their family. Structuring content analysis was applied to describe major themes within the answers. Results The following main categories emerged: psychological factors, biological factors, unclear etiology, social context, disorder specific, and multifactorial. Most pediatricians reported the belief that psychological factors explained the pain. However, when explaining the pain to the patient, biological factors were reported most often. Conclusion There is a discrepancy between pediatricians' conviction that chronic pain is mostly explained by psychological factors and their exploratory model towards patients that focuses on biological factors. Promoting the biopsychosocial framework of chronic pain is key to ensure timely and effective treatment. The new pain classification in the ICD-11 has the potential to increase the use of the biopsychosocial model.
Collapse
|
18
|
Högström S, Eriksson M, Mörelius E, Duberg A. "A source of empowerment and well-being": Experiences of a dance and yoga intervention for young girls with functional abdominal pain disorders. Front Pediatr 2023; 11:1040713. [PMID: 37152307 PMCID: PMC10160435 DOI: 10.3389/fped.2023.1040713] [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] [Received: 09/09/2022] [Accepted: 03/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background Functional abdominal pain disorders are common among children and adolescents worldwide and effective treatments are needed to alleviate suffering for these children and their families. This study aimed to explore the experience of participating in a combined dance and yoga intervention from the perspectives of girls aged 9-13 years with functional abdominal pain disorders. Materials and Methods A randomized controlled trial called Just in TIME (Try, Identify, Move and Enjoy) recruited 121 girls aged 9-13 years with functional abdominal pain disorders. The eight-month intervention combined dance and yoga twice a week, focusing on enjoyment, socialization and playful creativity in an undemanding and non-judgemental environment. The intervention group comprised 64 girls, of whom 25 were purposefully selected for this qualitative interview study. Semi-structured interviews were conducted and analysed using qualitative content analysis with an inductive approach. Results The girls' experiences of the Just in TIME intervention can be described as "A source of empowerment and well-being which facilitated personal growth and new ways of engaging in life". The main category was derived from six generic categories: "A sense of belonging", "Joy and emotional expression through movement", "Relief from pain", "More self-confident", "More active in daily life" and "A sense of calm." Conclusions Regular participation in an eight-month intervention with combined dance and yoga in a supportive and non-judgemental atmosphere can ease pain and strengthen inner resources, resulting in empowerment, well-being and a more active life for girls with functional abdominal pain disorders. Trial registration The Just in TIME study is available online at clinicaltrials.gov, ID: NCT02920268.
Collapse
Affiliation(s)
- Sofie Högström
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Correspondence: Sofie Högström
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Evalotte Mörelius
- Edith Cowan University, School of Nursing and Midwifery, Joondalup, WA, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Duberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
19
|
Trottier ED, Ali S, Doré-Bergeron MJ, Chauvin-Kimoff L. Les pratiques exemplaires pour l’évaluation et le traitement de la douleur chez les enfants. Paediatr Child Health 2022; 27:429-448. [PMCID: PMC9732860 DOI: 10.1093/pch/pxac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Résumé
L’évaluation et le traitement de la douleur sont des aspects essentiels des soins pédiatriques. L’évaluation de la douleur adaptée au développement représente une première étape importante pour en optimiser la prise en charge. L’autoévaluation de la douleur est à prioriser. Si c’est impossible, des outils appropriés d’évaluation du comportement, adaptés au développement, doivent être utilisés. Des directives et stratégies de prise en charge et de prévention de la douleur aiguë, qui combinent des approches physiques, psychologiques et pharmacologiques, doivent être accessibles dans tous les milieux de soins. Le meilleur traitement de la douleur chronique fait appel à une combinaison de modalités thérapeutiques et de counseling, dans l’objectif premier d’obtenir une amélioration fonctionnelle. La planification et la mise en œuvre de stratégies de prise en charge de la douleur chez les enfants doivent toujours être personnalisées et axées sur la famille.
Collapse
Affiliation(s)
- Evelyne D Trottier
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Samina Ali
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Marie-Joëlle Doré-Bergeron
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Laurel Chauvin-Kimoff
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| |
Collapse
|
20
|
Trottier ED, Ali S, Doré-Bergeron MJ, Chauvin-Kimoff L. Best practices in pain assessment and management for children. Paediatr Child Health 2022; 27:429-448. [PMID: 36524020 PMCID: PMC9732859 DOI: 10.1093/pch/pxac048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/14/2022] [Indexed: 09/04/2023] Open
Abstract
Pain assessment and management are essential components of paediatric care. Developmentally appropriate pain assessment is an important first step in optimizing pain management. Self-reported pain should be prioritized. Alternatively, developmentally appropriate behavioural tools should be used. Acute pain management and prevention guidelines and strategies that combine physical, psychological, and pharmacological approaches should be accessible in all health care settings. Chronic pain is best managed using combined treatment modalities and counselling, with the primary goal of attaining functional improvement. The planning and implementation of pain management strategies for children should always be personalized and family-centred.
Collapse
Affiliation(s)
- Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Samina Ali
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Marie-Joëlle Doré-Bergeron
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Laurel Chauvin-Kimoff
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| |
Collapse
|
21
|
Bruneau A, Carrié S, Moscaritolo L, Ingelmo P. Mechanism-Based Pharmacological Treatment for Chronic Non-cancer Pain in Adolescents: Current Approaches and Future Directions. Paediatr Drugs 2022; 24:573-583. [PMID: 36053398 DOI: 10.1007/s40272-022-00534-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/26/2022]
Abstract
Chronic non-cancer pain in pediatrics is a widespread phenomenon that affects about 20% of adolescents (10-19 years old). Although interdisciplinary pain treatment programs, which often include pharmacological treatment, have emerged as the standard of care in management of this patient population, evidence regarding an optimal treatment is lacking. The efficacy and safety profiles of pharmacological treatments used to help adolescents suffering from chronic non-cancer pain remain understudied. This lack of evidence may increase polypharmacy and the risk of drug interactions and adverse events. This review examines evidence for the use of pharmacological treatments prescribed to treat chronic pain in adolescents (10-19 years old), with a focus on mechanism-based pharmacology. The objectives of this review are to: (a) review the evidence for mechanism-based pharmacological treatments for chronic non-cancer pain in adolescents and (b) describe the pharmacological agents that are commonly prescribed to manage chronic pain in adolescents, including dosage information, mechanism, and potential adverse effects. Pharmacological treatments should be used carefully with adolescents, ideally within an interdisciplinary treatment program that will incorporate physical rehabilitation, integrative medicine/active mind-body techniques, psychology, and global efforts to normalize daily activities.
Collapse
Affiliation(s)
- Alice Bruneau
- Faculty of Medicine, McGill University, Montreal, QC, H3A 0C7, Canada.
| | - Sabrina Carrié
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Anaesthesia, McGill University, Montreal, QC, Canada
| | - Lorenzo Moscaritolo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Anaesthesia, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children's Hospital, Montreal, QC, Canada
- Department of Anaesthesia, McGill University, Montreal, QC, Canada
- Alan Edward Centre for Research on Pain, Montreal, QC, Canada
- Research Institute, McGill University Health Center, Montreal, QC, Canada
| |
Collapse
|
22
|
Sun N, Cunha N, Amar S, Brown S. Synthetic Cannabinoid for the Treatment of Severe Chronic Noncancer Pain in Children and Adolescents. Can J Pain 2022; 6:225-231. [DOI: 10.1080/24740527.2022.2132138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Naiyi Sun
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave. Toronto, ON, M2G 1X8, USA
- Department of Anesthesiology and Pain Medicine, University of Toronto, 555 University Ave, Toronto, ON, M2G 1X8, USA
| | - Natasha Cunha
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave. Toronto, ON, M2G 1X8, USA
| | - Shawnee Amar
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave. Toronto, ON, M2G 1X8, USA
| | - Stephen Brown
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave. Toronto, ON, M2G 1X8, USA
| |
Collapse
|
23
|
Association between the Use of Quantitative Sensory Testing and Conditioned Pain Modulation and the Prescription of Medication and Interventional Procedures in Children with Chronic Pain Conditions. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081157. [PMID: 36010048 PMCID: PMC9406785 DOI: 10.3390/children9081157] [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: 06/20/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 11/17/2022]
Abstract
The evidence supporting the use of pharmacological treatments in pediatric chronic pain is limited. Quantitative sensory testing (QST) and conditioned pain modulation evaluation (CPM) provide information on pain phenotype, which may help clinicians to tailor the treatment. This retrospective study aimed to evaluate the association between the use of QST/CPM phenotyping on the selection of the treatment for children with chronic pain conditions. We retrospectively analyzed the medical records of 208 female patients (mean age 15 ± 2 years) enrolled in an outpatient interdisciplinary pediatric complex pain center. Pain phenotype information (QST/CPM) of 106 patients was available to the prescribing physician. The records of 102 age- and sex-matched patients without QST/CPM were used as controls. The primary endpoint was the proportion of medications and interventions prescribed. The secondary endpoint was the duration of treatment. The QST/CPM group received less opioids (7% vs. 28%, respectively, p < 0.001), less anticonvulsants (6% vs. 25%, p < 0.001), and less interventional treatments (29% vs. 44%, p = 0.03) than controls. Patients with an optimal CPM result tended to be prescribed fewer antidepressants (2% vs. 18%, p = 0.01), and patients with signs of allodynia and/or temporal summation tended to be prescribed fewer NSAIDs (57% vs. 78%, p = 0.04). There was no difference in the duration of the treatments between the groups. QST/CPM testing appears to provide more targeted therapeutic options resulting in the overall drop in polypharmacy and reduced use of interventional treatments while remaining at least as effective as the standard of care.
Collapse
|
24
|
Comparison of Side Effects of Nalbuphine and Morphine in the Treatment of Pain in children with Cancer: A Prospective Study. Cancers (Basel) 2022; 14:cancers14153617. [PMID: 35892877 PMCID: PMC9330467 DOI: 10.3390/cancers14153617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/01/2023] Open
Abstract
Contemporary pain management regimens in children do not include the use of the middle step of the analgesic ladder, i.e., weak opioids. The aim of this study was to analyse the comparison of side effects and the therapeutic efficacy of morphine and nalbuphine in pain management in children with cancer. We conducted an observational, prospective study and analysed medical records of patients treated at the Clinic of Paediatric Haematology and Oncology of the University Hospital in Wroclaw (Poland), who developed mucositis during treatment. The efficacy and safety of both drugs were analysed, and the efficacy of pain relief and the incidence of adverse effects characteristic of opioid drugs were compared. The cases of 96 of children treated with opioid drugs nalbuphine or morphine were analysed. Nalbuphine therapy was accompanied by a statistically significantly lower incidence of side effects such as skin pruritus, constipation, and micturition disorders compared to morphine (p < 0.05). After the discontinuation of nalbuphine, signs of withdrawal syndrome were much less frequent than after morphine (p < 0.05). In Conclusion, nalbuphine used as a pain killer in children with oncological disorder is a safe drug. It provides stable analgesia in most children. Compared to morphine, the side effects typical of opioid use are less common, and the incidence decreases over time.
Collapse
|
25
|
What Works When Treating Children and Adolescents With Low Back Pain? J Orthop Sports Phys Ther 2022; 52:419-424. [PMID: 35584032 DOI: 10.2519/jospt.2022.10768] [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: 02/07/2023]
Abstract
BACKGROUND Low back pain is a common health condition for all ages. One quarter to a third of children report persistent pain, including low back pain. CLINICAL QUESTION The aim of this Clinical Commentary is to provide an overview of evidence-based treatment approaches for children and adolescents with low back pain. KEY RESULTS Physical, psychological, and pharmacological interventions are effective in reducing pain intensity and disability. Interdisciplinary and patient- and family-centered treatment approaches are the gold standard for persistent pain in children and adolescents. Communication between health professionals, children, and parents is a key part of a therapeutic alliance. The use of holistic and complementary therapies is not supported by compelling evidence. CLINICAL APPLICATION Physical interventions can be delivered alone or as a component of other interventions. The interventions are delivered over 8 to 12 weeks. Psychological therapies are mostly delivered as a component of a multidisciplinary treatment program: cognitive behavioral therapy is most often used, and interventions usually run from 4 to 10 weeks. Pharmacological interventions should be delivered in combination with physical and psychological interventions. Tailor family-centered interventions to personal aspects, such as age, gender, and family structure. When communicating with children and adolescents, use simple language that is clear and direct. Aim to support trust between health professionals and parents to facilitate family decision making. J Orthop Sports Phys Ther 2022;52(7):419-424. Epub: 18 May 2022. doi:10.2519/jospt.2022.10768.
Collapse
|
26
|
Fuller C, Huang H, Thienprayoon R. Managing Pain and Discomfort in Children with Cancer. Curr Oncol Rep 2022; 24:961-973. [PMID: 35353347 DOI: 10.1007/s11912-022-01277-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Approximately 15,600 children are diagnosed with cancer annually. Many of these children have cancer-related pain that improves with cancer treatment, but some develop intractable pain from cancer progression or sequelae from treatment modalities. The purpose of this paper is to provide a critical evaluation of the literature relevant to pain management in children with cancer. We intend to emphasize important and up-to-date findings in pharmacology, interventional pain management, and complementary and alternative medicine. RECENT FINDINGS Alternative medications and routes of administration, complementary and alternative medicine techniques, and interventional pain procedures offer possible routes for a multi-pronged pediatric cancer pain management plan, although high-level data is often lacking. To improve pediatric cancer pain management, a multifaceted approach embracing the biopsychosocial model of pain is recommended, incorporating evidence-based pharmacology, complementary and alternative medicine techniques, and if needed, interventional pain procedures.
Collapse
Affiliation(s)
- Clinton Fuller
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Ste A3300, Houston, TX, USA.
| | - Henry Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Ste A3300, Houston, TX, USA
| | - Rachel Thienprayoon
- Departments of Pediatrics and Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
27
|
Treatment of Unspecific Back Pain in Children and Adolescents: Results of an Evidence-Based Interdisciplinary Guideline. CHILDREN 2022; 9:children9030417. [PMID: 35327789 PMCID: PMC8947172 DOI: 10.3390/children9030417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/17/2022] [Accepted: 03/12/2022] [Indexed: 01/08/2023]
Abstract
Using a structured approach and expert consensus, we developed an evidence-based guideline on the treatment and prevention of non-specific back pain in children and adolescents. A comprehensive and systematic literature search identified relevant guidelines and studies. Based on the findings of this literature search, recommendations on treatment and prevention were formulated and voted on by experts in a structured consensus-building process. Physical therapy (particularly physical activity) and psychotherapy (particularly cognitive behavioral therapy) are recommended for treating pediatric non-specific back pain. Intensive interdisciplinary treatment programs should be provided for chronic and severe pain. Drug therapy should not be applied in children and adolescents. Further research on non-specific back pain in childhood and adolescence is strongly needed to reduce the imbalance between the high burden of non-specific back pain in childhood and adolescence and the low research activity in this field.
Collapse
|
28
|
Ahmed N, Vigouroux M, Ingelmo P. Implications of Nerve Fiber Density on the Diagnosis and Treatment of Juvenile Fibromyalgia. J Pain Res 2022; 15:513-520. [PMID: 35210850 PMCID: PMC8860391 DOI: 10.2147/jpr.s340038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/28/2022] [Indexed: 11/23/2022] Open
Abstract
Juvenile fibromyalgia (JFM) is a condition that presents as chronic widespread musculoskeletal pain and affects children and adolescents. JFM remains a challenging diagnosis, as it is both based on subjective criteria and the pathogenesis is poorly understood. Small fiber neuropathy (SFN) is a distinct condition, which is characterized by pathology of small A-delta and C fibers, and can present similarly to JFM. Small fiber pathology is characterized by reduced intraepidermal nerve fiber density (IENFD) on skin biopsy. Recent studies have found that as many as half of patients with JFM can demonstrate decreased IENFD, in pattern similar to SFN. This phenomenon has been referred to as small fiber pathology. The meaning of these findings was disputed; however, the current consensus remains that fibromyalgia and SFN are distinct conditions. Additionally, among patients with fibromyalgia, there are two phenotypes: those with small fiber pathology and those without. The purpose of this review was to characterize the role assessment of IENFD plays in the clinical context. We conducted a narrative review of pertinent articles pertaining to JFM, SFN and small fiber pathology in fibromyalgia. We concluded that assessment of IENFD should be completed if SFN is suspected either when a patient first presents or in patients who were previously diagnosed with fibromyalgia and SFN is later suspected. Distinguishing between JFM and SFN is important because recommended therapies differ between the two conditions. However, there is no evidence to support the use of skin biopsy to distinguish between the two discussed fibromyalgia phenotypes. More studies are needed to elucidate whether IENFD varies with morbidity and if both fibromyalgia phenotypes vary in their response to different therapeutic regimens.
Collapse
Affiliation(s)
- Nabeel Ahmed
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marie Vigouroux
- Faculty of Dentistry, McGill University, Montreal, QC, Canada
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Correspondence: Marie Vigouroux, Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, 1001 boul. Décarie A02.3523, Montreal, QC, H4A 3J1, Canada, Tel +1 514 412 4448, Fax +1 514 412 4341, Email
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, Montreal, QC, Canada
- Research Institute, McGill University Health Centre, Montreal, QC, Canada
- Alan Edwards Research Center for Pain, McGill University, Montreal, QC, Canada
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Fisher E, Villanueva G, Henschke N, Nevitt SJ, Zempsky W, Probyn K, Buckley B, Cooper TE, Sethna N, Eccleston C. Efficacy and safety of pharmacological, physical, and psychological interventions for the management of chronic pain in children: a WHO systematic review and meta-analysis. Pain 2022; 163:e1-e19. [PMID: 33883536 DOI: 10.1097/j.pain.0000000000002297] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
ABSTRACT Chronic pain in childhood is an international public health problem. We conducted a systematic review and meta-analysis to provide a summary of the published evidence of pharmacological, physical, and psychological therapies for children with chronic pain conditions. We searched CENTRAL, MEDLINE, EMBASE, and PsycINFO from inception to April 2020; clinical trial registries; and other sources for randomised controlled trials or comparative observational trials. We extracted critical outcomes of pain intensity, quality of life, physical functioning, role functioning, emotional functioning, sleep, and adverse events. We assessed studies for risk of bias and certainty of the evidence using GRADE. We included 34 pharmacological (4091 participants), 25 physical therapy (1470 participants), and 63 psychological trials (5025 participants). Participants reported a range of chronic pain conditions. Most studies were assessed to have unclear or high risk of bias across multiple domains. Pharmacological, physical, and psychological therapies showed some benefit for reducing pain, posttreatment, but only physical and psychological therapies improved physical functioning. We found no benefit of any treatment modality for health-related quality of life, role functioning, emotional functioning, or sleep. Adverse events were poorly reported, particularly for psychological and physical interventions. The largest evidence base for the management of chronic pain in children supports the use of psychological therapies, followed by pharmacological and physical therapies. However, we rated most outcomes as low or very low certainty, meaning further evidence is likely to change our confidence in the estimates of effects. This protocol was registered on PROSPERO (CRD42020172451).
Collapse
Affiliation(s)
- Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative and Supportive Care Review Group, Oxford, United Kingdom
| | | | | | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Liverpool United Kingdom
| | - William Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, United States
| | | | | | - Tess E Cooper
- Cochrane Kidney and Transplant, Centre for Kidney Research, Children's Hospital at Westmead, Australia
- Sydney School of Public Health, The University of Sydney, Australia
| | - Navil Sethna
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesiology, Harvard Medical School, Boston, MA, United States
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative and Supportive Care Review Group, Oxford, United Kingdom
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| |
Collapse
|
31
|
Al-Janabi N, Olesen AE, Straszek CL, Guldhammer C, Rathleff MS, Andreucci A. Pain medication use for musculoskeletal pain among children and adolescents: a systematic review. Scand J Pain 2021; 21:653-670. [PMID: 34506696 DOI: 10.1515/sjpain-2021-0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 08/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Musculoskeletal pain is common among children and adolescents. Despite the lack of evidence regarding harms and benefits, musculoskeletal pain is often managed with pain medication. The aim of this systematic review is to assess the prevalence of pain medication use for musculoskeletal pain among children and adolescents and the factors and side effects associated with use. CONTENT Three databases (EMBASE, CINAHL and PsychINFO) were systematically searched to identify studies designed to examine the prevalence, frequency or factors associated with the use of pain medication for musculoskeletal pain in children and adolescents (aged 6-19 years). The included studies were assessed for study quality and data were extracted. SUMMARY The search initially provided 20,135 studies. After screening titles, abstracts and full-texts, 20 studies were included. In school settings, 8-42% of children used pain medication for musculoskeletal pain, and 67-75% of children in sports clubs and from pain clinics used pain medication. The most consistent factors associated with the use of pain medications were pain characteristics and psychological factors (e.g. being bullied, low-self-esteem), while mixed evidence was found for increasing age and female gender. Only two studies reported on the duration of use and only one study on adverse effects related to the use of pain medication. OUTLOOK We found that 8-42% of adolescents from school-based samples use pain medication for MSK pain, while the prevalence among adolescents from sports clubs and pain clinics is higher (67-75%). Pain characteristics (pain duration, severity, intensity, disability levels and the presence of ≥2 pain conditions or multisite pain) and psychological factors were associated with a higher use of pain medication, while for higher age and female gender the evidence of association was mixed. Future studies should systematically collect information on the type, duration of use of pain medication and side effects to confirm the findings of this review.
Collapse
Affiliation(s)
- Nabil Al-Janabi
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Anne Estrup Olesen
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Christian Lund Straszek
- Center for General Practice, Aalborg University, Aalborg, Denmark.,Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Clara Guldhammer
- Center for General Practice, Aalborg University, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice, Aalborg University, Aalborg, Denmark.,Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | |
Collapse
|
32
|
Högström S, Philipson A, Ekstav L, Eriksson M, Fagerberg UL, Falk E, Möller M, Sandberg E, Särnblad S, Duberg A. Dance and yoga reduced functional abdominal pain in young girls: A randomized controlled trial. Eur J Pain 2021; 26:336-348. [PMID: 34529293 DOI: 10.1002/ejp.1862] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/25/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Functional abdominal pain disorders (FAPDs) affect children, especially girls, all over the world. The evidence for existing treatments is mixed, and effective accessible treatments are needed. Dance, a rhythmic cardio-respiratory activity, combined with yoga, which enhances relaxation and focus, may provide physiological and psychological benefits that could help to ease pain. OBJECTIVES The aim of this study was to evaluate the effect of a dance and yoga intervention on maximum abdominal pain in 9- to 13-year- old girls with FAPDs. METHODS This study was a prospective randomized controlled trial with 121 participants recruited from outpatient clinics as well as the general public. The intervention group participated in dance and yoga twice weekly for 8 months; controls received standard care. Abdominal pain, as scored on the Faces Pain Scale-Revised, was recorded in a pain diary. A linear mixed model was used to estimate the outcomes and effect sizes. RESULTS Dance and yoga were superior to standard health care alone, with a medium to high between-group effect size and significantly greater pain reduction (b = -1.29, p = 0.002) at the end of the intervention. CONCLUSIONS An intervention using dance and yoga is likely a feasible and beneficial complementary treatment to standard health care for 9- to 13-year-old girls with FAPDs. SIGNIFICANCE FAPDs affect children, especially girls, all over the world. The negative consequences such as absence from school, high consumption of medical care and depression pose a considerable burden on children and their families and effective treatments are needed. This is the first study examining a combined dance/yoga intervention for young girls with FAPDs and the result showed a reduction of abdominal pain. These findings contribute with new evidence in the field of managing FAPDs in a vulnerable target group.
Collapse
Affiliation(s)
- Sofie Högström
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Philipson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lars Ekstav
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Ulrika L Fagerberg
- Department of Pediatrics, Center for Clinical Research, Västmanland Hospital, Västerås, Uppsala University Uppsala, Västerås, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Elin Falk
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Child and Adolescent Psychiatry, Uppsala University hospital, Uppsala, Sweden
| | - Margareta Möller
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Elin Sandberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Sciences, Center for primary Health Care Research, Lund University, Malmö, Sweden
| | - Stefan Särnblad
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Anna Duberg
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
33
|
Barney CC, Andersen RD, Defrin R, Genik LM, McGuire BE, Symons FJ. [Challenges in pain assessment and management among individuals with intellectual and developmental disabilities : German version]. Schmerz 2021; 36:49-58. [PMID: 34515871 DOI: 10.1007/s00482-021-00589-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. OBJECTIVES This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD. METHODS This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice. RESULTS The past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report. CONCLUSION Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.
Collapse
Affiliation(s)
- Chantel C Barney
- Gillette Children's Specialty Healthcare, 200 University Ave E., 55101, Saint Paul, MN, USA. .,Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA.
| | - Randi D Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norwegen
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine & Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel
| | - Lara M Genik
- Department of Psychology, University of Guelph, Guelph, ON, Kanada
| | - Brian E McGuire
- School of Psychology and Centre for Pain Research, National University of Ireland, Galway, Irland
| | - Frank J Symons
- Department of Educational Psychology, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
34
|
Marchetti G, Vittori A, Ferrari F, Francia E, Mascilini I, Petrucci E, Piga S, Pardi V, Cascella M, Contini G, Marinangeli F, Inserra A, Picardo SG. Incidence of Acute and Chronic Post-Thoracotomy Pain in Pediatric Patients. CHILDREN-BASEL 2021; 8:children8080642. [PMID: 34438533 PMCID: PMC8392193 DOI: 10.3390/children8080642] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/20/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022]
Abstract
We studied acute and chronic pain in pediatric patients who underwent thoracotomy for benign disease with a follow-up of at least three months. A telephone interview investigated about the presence of pain and the analgesic therapy in progress. The results were compared with the anesthetic technique, postoperative pain and the adequacy of pain therapy, both during the first week after surgery and at the time of interview. Fifty-six families consented to the study. The mean age of the children at surgery was 2.9 ± 4.5 years, while at the time of the interview was 6.5 ± 4.4 years. We performed different anesthetic strategies: Group A: general anesthesia (36 pts); Group B: general anesthesia and thoracic epidural (10 pts); Group C: general anesthesia and intercostal nerve block (10 pts). During the immediate postoperative period, 21 patients (37.5%) had at least one painful episode. At the time of interview, 3 children (5.3%) had moderate chronic neuropathic (burning) pain on surgical scar. There was no statistically significant difference between the type of anesthesia and the incidence and severity of acute post-operative pain. Despite its limitations, this study confirms the low incidence of chronic post-thoracotomy pain syndrome in children.
Collapse
Affiliation(s)
- Giuliano Marchetti
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
- Correspondence: ; Tel.: +39-06-68592397
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| | - Fabio Ferrari
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| | - Elisa Francia
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| | - Ilaria Mascilini
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L’Aquila, Via Vetoio, 48, 67100 L’Aquila, Italy;
| | - Simone Piga
- Unit of Clinical Epidemiology, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy;
| | - Valerio Pardi
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (V.P.); (G.C.); (A.I.)
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Via Mariano Semmola, 53, 80131 Naples, Italy;
| | - Giorgia Contini
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (V.P.); (G.C.); (A.I.)
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L’Aquila, Piazzale Salvatore Tommasi, 1, 67100 Coppito, Italy;
| | - Alessandro Inserra
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (V.P.); (G.C.); (A.I.)
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical Care, ARCO Roma, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165 Rome, Italy; (A.V.); (F.F.); (E.F.); (I.M.); (S.G.P.)
| |
Collapse
|
35
|
Kouri M, Somaini M, Cárdenas VHG, Niburski K, Vigouroux M, Ingelmo P. Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents. CHILDREN (BASEL, SWITZERLAND) 2021; 8:606. [PMID: 34356585 PMCID: PMC8306937 DOI: 10.3390/children8070606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Abstract
Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient's Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children's Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.
Collapse
Affiliation(s)
- Megan Kouri
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada; (M.K.); (K.N.)
| | - Marta Somaini
- Department of Anaesthesia, Grande Ospedale Metropolitano Niguarda, 201262 Milano, Italy;
| | - Victor Hugo González Cárdenas
- Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), 111221 Bogotá, Colombia;
- Department of Anesthesia, Los Cobos Medical Center, 110121 Bogotá, Colombia
- Department of Anesthesia, Pain and Palliative Care, Hospital Universitario de la Samaritana, 110411 Bogotá, Colombia
| | - Kacper Niburski
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada; (M.K.); (K.N.)
| | - Marie Vigouroux
- Faculty of Dentistry, McGill University, Montreal, QC H3A 1G1, Canada;
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- The Alan Edwards Centre Research on Pain, McGill University, Montreal, QC H3A 0G1, Canada
| |
Collapse
|
36
|
Fisher E, Moore RA, Fogarty AE, Finn DP, Finnerup NB, Gilron I, Haroutounian S, Krane E, Rice ASC, Rowbotham M, Wallace M, Eccleston C. Cannabinoids, cannabis, and cannabis-based medicine for pain management: a systematic review of randomised controlled trials. Pain 2021; 162:S45-S66. [PMID: 32804836 DOI: 10.1097/j.pain.0000000000001929] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/28/2020] [Indexed: 02/07/2023]
Abstract
ABSTRACT Cannabinoids, cannabis, and cannabis-based medicines (CBMs) are increasingly used to manage pain, with limited understanding of their efficacy and safety. We summarised efficacy and adverse events (AEs) of these types of drugs for treating pain using randomised controlled trials: in people of any age, with any type of pain, and for any treatment duration. Primary outcomes were 30% and 50% reduction in pain intensity, and AEs. We assessed risk of bias of included studies, and the overall quality of evidence using GRADE. Studies of <7 and >7 days treatment duration were analysed separately. We included 36 studies (7217 participants) delivering cannabinoids (8 studies), cannabis (6 studies), and CBM (22 studies); all had high and/or uncertain risk of bias. Evidence of benefit was found for cannabis <7 days (risk difference 0.33, 95% confidence interval 0.20-0.46; 2 trials, 231 patients, very low-quality evidence) and nabiximols >7 days (risk difference 0.06, 95% confidence interval 0.01-0.12; 6 trials, 1484 patients, very low-quality evidence). No other beneficial effects were found for other types of cannabinoids, cannabis, or CBM in our primary analyses; 81% of subgroup analyses were negative. Cannabis, nabiximols, and delta-9-tetrahydrocannabinol had more AEs than control. Studies in this field have unclear or high risk of bias, and outcomes had GRADE rating of low- or very low-quality evidence. We have little confidence in the estimates of effect. The evidence neither supports nor refutes claims of efficacy and safety for cannabinoids, cannabis, or CBM in the management of pain.
Collapse
Affiliation(s)
- Emma Fisher
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
| | - R Andrew Moore
- Appledore, Court Road, Newton Ferrers, Plymouth, United Kingdom
| | - Alexandra E Fogarty
- Department of Neurology, Division of Physical Medicine and Rehabilitation, Washington University in St. Louis School of Medicine, St Louis, MO, United States
| | - David P Finn
- Pharmacology and Therapeutics, School of Medicine, Galway Neuroscience Centre and Centre for Pain Research, Human Biology Building, National University of Ireland Galway, University Road, Galway, Ireland
| | - Nanna B Finnerup
- Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Ian Gilron
- Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- School of Policy Studies, Queen's University, Kingston, ON, Canada
| | - Simon Haroutounian
- Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, Washington University Pain Center, St Louis, MO, United States
| | - Elliot Krane
- Department of Anesthesiology, Perioperative, and Pain Medicine, and Pediatrics, Stanford University School of Medicine, Stanford, CA, United States
- Palo Alto, Santa Clara, CA, United States
| | - Andrew S C Rice
- Pain Research, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Michael Rowbotham
- Department of Anesthesia, University of California, San Francisco, CA, United States
- Sutter Health, CPMC Research Institute, California Pacific Medical Center Research Institute, San Francisco, CA, United States
| | - Mark Wallace
- Division of Pain Medicine, Department of Anesthesiology, University of California, San Francisco, CA, United States
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Cochrane Pain, Palliative, and Supportive Care Review Groups, Oxford University Hospitals, Oxford, United Kingdom
- Department of Clinical and Health Psychology, Ghent University, Ghent, Belgium
| |
Collapse
|
37
|
[Chronic pain in pediatric primary care : What do adolescents and parents expect and how do they perceive treatment?]. Schmerz 2021; 36:89-98. [PMID: 34170398 DOI: 10.1007/s00482-021-00564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Recurrent pain in childhood and adolescence is a common health problem. Pediatricians are usually the patients' first contact person. The current study investigated patients' and parents' expectations when consulting a pediatrician and their rating of the treatment. MATERIALS AND METHODS In 36 pediatric practices, 224 patients with recurrent pain and 273 parents participated in this cross-sectional tablet survey. The collected data included the motivation for arranging a physician consultation, pain concept, treatment expectations, and assessment of treatment. Additionally, the patients' age was investigated as an influencing factor. RESULTS The patients' and parents' predominant motivation for arranging a consultation was the clarification of the cause of pain. Older patients were additionally motivated by frequent but ineffective drug use. Predominantly in older patients, a biopsychosocial pain explanation was identified. Approximately half of all patients and parents indicated biological and psychological influencing factors. The most frequent expectation of the consultation was obtaining information on pain management. Overall, consultations were rated very positively, especially when patients and parents felt understood and taken seriously. CONCLUSIONS Information about the cause of pain and pain management are essential for patients and parents. Besides good communication, sufficient time resources of the practitioner are required.
Collapse
|
38
|
Scheufler A, Wallace DP, Fox E. Comparing Three Music Therapy Interventions for Anxiety and Relaxation in Youth With Amplified Pain. J Music Ther 2021; 58:177-200. [PMID: 33251538 DOI: 10.1093/jmt/thaa021] [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] [Indexed: 11/14/2022]
Abstract
Research in pediatric hospitals has shown that active music engagement, preferred music listening, and music-assisted relaxation can decrease anxiety and increase relaxation responses. However, there is little research on the use of music therapy with pediatric chronic pain conditions such as amplified pain syndromes. The purpose of the current study was to examine the effects of 3 specific music therapy interventions (active music engagement, live patient-selected music, and music-assisted relaxation) on anxiety and relaxation levels in youth (ages 10-18) participating in a 40 hr per week hospital-based intensive interdisciplinary pain treatment program. A sample of 48 patients participated in this study which utilized a 3-period, 3-treatment cross-over design with 3 interventions delivered in a quasi-randomized order determined by when the patients started the treatment program. State anxiety was measured via the state form of the State-Trait Inventory for Cognitive and Somatic Anxiety for Children and relaxation scores were assessed with a Visual Analog Scale. Statistically significant changes were found in anxiety and relaxation outcomes across all interventions provided. Results suggest that music therapy services (using active music engagement, live patient-selected music, and music-assisted relaxation) may be an effective modality to decrease anxiety and increase relaxation levels in pediatric patients with amplified pain syndromes.
Collapse
Affiliation(s)
| | | | - Emily Fox
- Children's Mercy Hospital, Kansas City, MO, USA
| |
Collapse
|
39
|
Jamieson L, Harrop E, Johnson M, Liossi C, Mott C, Oulton K, Skene SS, Wong ICK, Howard RF. Healthcare professionals' views of the use of oral morphine and transmucosal diamorphine in the management of paediatric breakthrough pain and the feasibility of a randomised controlled trial: A focus group study (DIPPER). Palliat Med 2021; 35:1118-1125. [PMID: 33845654 PMCID: PMC8188993 DOI: 10.1177/02692163211008737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Oral morphine is frequently used for breakthrough pain but the oral route is not always available and absorption is slow. Transmucosal diamorphine is administered by buccal, sublingual or intranasal routes, and rapidly absorbed. AIM To explore the perspectives of healthcare professionals in the UK caring for children with life-limiting conditions concerning the assessment and management of breakthrough pain; prescribing and administration of transmucosal diamorphine compared with oral morphine; and the feasibility of a comparative clinical trial. DESIGN/ PARTICIPANTS Three focus groups, analysed using a Framework approach. Doctors, nurses and pharmacists (n = 28), caring for children with life-limiting illnesses receiving palliative care, participated. RESULTS Oral morphine is frequently used for breakthrough pain across all settings; with transmucosal diamorphine largely limited to use in hospices or given by community nurses, predominantly buccally. Perceived advantages of oral morphine included confidence in its use with no requirement for specific training; disadvantages included tolerability issues, slow onset, unpredictable response and unsuitability for patients with gastrointestinal failure. Perceived advantages of transmucosal diamorphine were quick onset and easy administration; barriers included lack of licensed preparations and prescribing guidance with fears over accountability of prescribers, and potential issues with availability, preparation and palatability. Factors potentially affecting recruitment to a trial were patient suitability and onerousness for families, trial design and logistics, staff time and clinician engagement. CONCLUSIONS There were perceived advantages to transmucosal diamorphine, but there is a need for access to a safe preparation. A clinical trial would be feasible provided barriers were overcome.
Collapse
Affiliation(s)
- Liz Jamieson
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
- UCLH-UCL Centre for Medicines Optimisation Research and Education, London, UK
| | - Emily Harrop
- Helen & Douglas House Hospice, Oxford, UK
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - Margaret Johnson
- Patient & Public Representative c/o Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Christina Liossi
- School of Psychology, University of Southampton, Southampton, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christine Mott
- Hummingbird House Hospice, Brisbane, Queensland, Australia
- Children’s Health Queensland Hospital and Health Service, Paediatric Palliative Care Service
| | - Kate Oulton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Simon S. Skene
- Surrey Clinical Trials Unit, University of Surrey, Surrey, UK
| | - Ian CK Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
- UCLH-UCL Centre for Medicines Optimisation Research and Education, London, UK
- Department of Pharmacology and Pharmacy, University of Hong Kong, Hong Kong
| | - Richard F Howard
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
40
|
Phenotyping peripheral neuropathic pain in male and female adolescents: pain descriptors, somatosensory profiles, conditioned pain modulation, and child-parent reported disability. Pain 2021; 162:1732-1748. [PMID: 33394878 DOI: 10.1097/j.pain.0000000000002172] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
ABSTRACT Neuropathic pain (NeuP) can be difficult to diagnose and manage in children. Data regarding prevalence and sex-dependent differences are limited, and more detailed phenotyping is needed. This observational cohort study recruited adolescents (10-17 years) with NeuP or complex regional pain syndrome (CRPS). After pain history and NeuP questionnaires, quantitative sensory testing was performed. Individual z-score plots were calculated with body-region control measures and matched to mechanism-related sensory profiles (sensory loss, thermal hyperalgesia, and mechanical hyperalgesia). Conditioned pain modulation was assessed with pressure pain threshold and a contralateral cold conditioning stimulus, and meaningful conditioned pain modulation defined as twice the standard error of measurement. Patients and parents completed validated questionnaires for child quality of life (QoL), pain catastrophizing, and self-reported anxiety/depression. Males (n = 23) and females (n = 43) with NeuP (n = 52) or CRPS (n = 14) reported moderate-severe pain with neuropathic sensory descriptors. Mixed patterns of sensory gain/loss at pain sites were not sex-dependent. Thermal hyperalgesia was common in both NeuP and CRPS, whereas sensory loss occurred only with NeuP and in a smaller proportion than adult cohorts. Conditioned pain modulation was inhibitory in 54%, facilitatory in 14%, and nonresponders had variable cold conditioning sensitivity. Males and females reported marked impairment of QoL, increased emotional distress, and pain catastrophising. Child-parent QoL scores correlated, but catastrophizing scores were discordant when parents or adolescents reported higher anxiety/depression. NeuP in adolescents is associated with significant pain, physical impairment, and psychosocial impairment. Quantifying alterations in somatosensory profiles, descending modulation, child and parent psychological function will inform individualized therapy and stratification for future clinical trials.
Collapse
|
41
|
Koechlin H, Kossowsky J, Lam TL, Barthel J, Gaab J, Berde CB, Schwarzer G, Linde K, Meissner K, Locher C. Nonpharmacological Interventions for Pediatric Migraine: A Network Meta-analysis. Pediatrics 2021; 147:peds.2019-4107. [PMID: 33688031 DOI: 10.1542/peds.2019-4107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Migraine is a common neurologic disorder in children and adolescents. However, a comparison of multiple nonpharmacological treatments is lacking. OBJECTIVE To examine whether nonpharmacological treatments are more effective than waiting list and whether there are differences between interventions regarding efficacy. DATA SOURCES Systematic review and network meta-analysis of studies in Medline, Cochrane, Embase, and PsycINFO published through August 5, 2019. STUDY SELECTION Randomized controlled trials of nonpharmacological treatments in children and adolescents diagnosed with episodic migraine. DATA EXTRACTION Effect sizes, calculated as standardized mean differences (SMDs) for the primary outcome efficacy, were assessed in a random-effects model. RESULTS Twelve studies (N = 576) were included. When interventions were classified into groups on the basis of similarity of treatment components, self-administered treatments, biofeedback, relaxation, psychological treatments, and psychological placebos were significantly more effective than waiting list with effect sizes ranging between SMD = 1.14 (95% confidence interval, 0.09 to 2.19) for long-term psychological placebos to SMD = 1.44 (95% confidence interval, 0.26 to 2.62) for short-term self-administered treatments. However, when all interventions were examined individually (ie, 1 node per intervention), none were significantly more effective compared with waiting list, mainly because of lack of statistical power. LIMITATIONS Because of our focus on pediatric migraine, only a small number of studies could be included. CONCLUSIONS Our findings reveal that components of nonpharmacological interventions are effective in treating pediatric migraine. Some effects have to be interpreted carefully because they are based on small studies. Future researchers should identify factors associated with individual responses in large, multicentered studies.
Collapse
Affiliation(s)
- Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Contributed equally as co-first authors
| | - Joe Kossowsky
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Contributed equally as co-first authors
| | - Thanh Lan Lam
- Institute of Medical Psychology, LMU Munich, Munich, Germany
| | | | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, University of Freiburg, Breisgau, Germany
| | - Klaus Linde
- Institute of General Practice and Health Services Research, School of Medicine, Technical University Munich, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, LMU Munich, Munich, Germany.,Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland; .,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Faculty of Health, University of Plymouth, Plymouth, United Kingdom; and.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
42
|
Leake HB, Moseley GL, Stanton TR, Heathcote LC, Pate JW, Wewege MA, Lee H. Using Mediation Analysis to Understand How Treatments for Paediatric Pain Work: A Systematic Review and Recommendations for Future Research. CHILDREN-BASEL 2021; 8:children8020147. [PMID: 33669210 PMCID: PMC7919827 DOI: 10.3390/children8020147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/02/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022]
Abstract
Clinicians have an increasing number of evidence-based interventions to treat pain in youth. Mediation analysis offers a way of investigating how interventions work, by examining the extent to which an intermediate variable, or mediator, explains the effect of an intervention. This systematic review examined studies that used mediation analysis to investigate mechanisms of interventions on pain-relevant outcomes for youth (3–18 years) with acute or chronic pain, and provides recommendations for future mediation research in this field. We searched five electronic databases for clinical trials or observational longitudinal studies that included a comparison group and conducted mediation analyses of interventions on youth and assessed pain outcomes. We found six studies (N = 635), which included a total of 53 mediation models examining how interventions affect pain-relevant outcomes for youth. Five studies were secondary analyses of randomized controlled trials of psychological interventions for chronic pain; one was a longitudinal observational study of morphine for acute pain. The pain conditions studied were irritable bowel syndrome, functional abdominal pain, juvenile fibromyalgia, mixed chronic pain, and post-operative pain. Fourteen putative mediators were tested, of which three partially mediated treatment effect; seven did not significantly mediate treatment effect and four had mixed results. Methodological and reporting limitations were common. There are substantial gaps in the field with respect to investigating, and therefore understanding, how paediatric interventions work.
Collapse
Affiliation(s)
- Hayley B. Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia; (G.L.M.); (T.R.S.)
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia;
- Correspondence:
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia; (G.L.M.); (T.R.S.)
| | - Tasha R. Stanton
- IIMPACT in Health, University of South Australia, Adelaide, SA 5000, Australia; (G.L.M.); (T.R.S.)
| | - Lauren C. Heathcote
- Department of Anaesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA 94304, USA;
| | - Joshua W. Pate
- Department of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW 2008, Australia;
| | - Michael A. Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia;
- Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Hopin Lee
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK;
- School of Medicine and Public Health, University of Newcastle, NSW 2308, Australia
| |
Collapse
|
43
|
Eccleston C, Fisher E, Howard RF, Slater R, Forgeron P, Palermo TM, Birnie KA, Anderson BJ, Chambers CT, Crombez G, Ljungman G, Jordan I, Jordan Z, Roberts C, Schechter N, Sieberg CB, Tibboel D, Walker SM, Wilkinson D, Wood C. Delivering transformative action in paediatric pain: a Lancet Child & Adolescent Health Commission. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:47-87. [PMID: 33064998 DOI: 10.1016/s2352-4642(20)30277-7] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/30/2020] [Accepted: 08/06/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK; Cochrane Pain, Palliative, and Supportive Care Review Groups, Churchill Hospital, Oxford, UK; Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium.
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK; Cochrane Pain, Palliative, and Supportive Care Review Groups, Churchill Hospital, Oxford, UK
| | - Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, UK; Wellcome Centre for Integrative Neuroimaging, Oxford Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paula Forgeron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, ON, Canada
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, USA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, AB, Canada
| | - Brian J Anderson
- Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Christine T Chambers
- Department of Psychology and Neuroscience, and Department of Pediatrics, Dalhousie University, Halifax, NS, Canada; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Geert Crombez
- Department of Clinical-Experimental and Health Psychology, Ghent University, Ghent, Belgium
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | | | - Neil Schechter
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Christine B Sieberg
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dick Tibboel
- Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Suellen M Walker
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dominic Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; John Radcliffe Hospital, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Chantal Wood
- Department of Spine Surgery and Neuromodulation, Poitiers University Hospital, Poitiers, France
| |
Collapse
|
44
|
Howard RF, Radic T, Sohns M, Eerdekens M, Waßmuth A. Tapentadol Prolonged Release for Long-Term Treatment of Pain in Children. J Pain Res 2020; 13:3157-3170. [PMID: 33311995 PMCID: PMC7725093 DOI: 10.2147/jpr.s272751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/27/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose Investigation of the efficacy and safety of tapentadol prolonged release (PR) compared with morphine PR for long-term treatment of pain in children. Patients and Methods Children aged 6 to <18 years requiring long-term treatment with opioids were studied in a 12-month, 2-part, multi-center trial: Part 1, 14-day open-label, randomized, active-controlled, parallel group non-inferiority trial comparing twice daily tapentadol PR with morphine PR; Part 2, open-label treatment with tapentadol PR for up to 12 months or no treatment “safety observation period”. Pain intensity was rated with visual analogue scale or Faces Pain Scale-Revised, and non-inferiority was assessed by comparison of “treatment responders” (those completing the 14-day treatment period and showing pre-defined changes in pain rating) in each group. Results Twenty-three of 48 centers enrolled 73 patients. In Part 1, 45 and 24 patients received tapentadol or morphine, respectively, of which 40 and 22 completed 14-day treatment. In Part 2, thirty-six and 58 patients entered the tapentadol PR or observation periods, respectively, with 20/36 completing at least 12 weeks of treatment; 10 of the 36 had received morphine in Part 1. Forty-four of the 58 patients in the safety observation period had received tapentadol. Tapentadol PR was non-inferior to morphine PR (lower limit of confidence interval above negative non-inferiority margin of −0.2) in Part 1. Rates of adverse events were as expected with nausea (22.2%) and constipation (15.6%) in the tapentadol PR group, and with vomiting (33.3%), nausea and constipation (each 16.7%) in the morphine PR group. No new safety issues were identified; the safety profile of tapentadol over the 12 months treatment and observation periods was comparable to that established in subjects >18 years old. Conclusion Tapentadol PR was well tolerated and equivalent to morphine PR for both efficacy and safety in children (6 to <18 years old) requiring long-term treatment with opioids.
Collapse
Affiliation(s)
- Richard F Howard
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital and the GOS-UCL Institute of Child Health, London, UK
| | | | | | | | | |
Collapse
|
45
|
Neuropathic pain in children: Steps towards improved recognition and management. EBioMedicine 2020; 62:103124. [PMID: 33248373 PMCID: PMC7704400 DOI: 10.1016/j.ebiom.2020.103124] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/21/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022] Open
Abstract
Neuropathic pain in children can be severe and persistent, difficult to recognise and manage, and associated with significant pain-related disability. Recognition based on clinical history and sensory descriptors is challenging in young children, and screening tools require further validation at older ages. Confirmatory tests can identify the disease or lesion of the somatosensory nervous system resulting in neuropathic pain, but feasibility and interpretation may be influenced by age- and sex-dependent changes throughout development. Quantitative sensory testing identifies specific mechanism-related sensory profiles; brain imaging is a potential biomarker of alterations in central processing and modulation of both sensory and affective components of pain; and genetic analysis can reveal known and new causes of neuropathic pain. Alongside existing patient- and parent-reported outcome measures, somatosensory system research methodologies and validation of mechanism-based standardised end-points may inform individualised therapy and stratification for clinical trials that will improve evidence-based management of neuropathic pain in children.
Collapse
|
46
|
de Leeuw TG, van der Zanden T, Ravera S, Felisi M, Bonifazi D, Tibboel D, Ceci A, Kaguelidou F, de Wildt SN. Diagnosis and Treatment of Chronic Neuropathic and Mixed Pain in Children and Adolescents: Results of a Survey Study amongst Practitioners. CHILDREN-BASEL 2020; 7:children7110208. [PMID: 33147808 PMCID: PMC7694093 DOI: 10.3390/children7110208] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/30/2020] [Indexed: 12/16/2022]
Abstract
Validated diagnostic tools to diagnose chronic neuropathic and mixed pain in children are missing. Therapeutic options are often derived from therapeutics for adults. To investigate the international practice amongst practitioners for the diagnosis and treatment of chronic, neuropathic pain in children and adolescents, we performed a survey study among members of learned societies or groups whose members are known to treat pediatric pain. The survey included questions concerning practitioners and practice characteristics, assessment and diagnosis, treatment and medication. We analyzed 117 returned questionnaires, of which 41 (35%) were fully completed and 76 (65%) were partially completed. Most respondents based the diagnosis of neuropathic pain on physical examination (68 (58.1%)), patient history (67 (57.3%)), and underlying disease (59 (50.4%)) combined. Gabapentin, amitriptyline, and pregabalin were the first-choice treatments for moderate neuropathic pain. Tramadol, ibuprofen, amitriptyline, and paracetamol were the first-choice treatments for moderate mixed pain. Consensus on the diagnostic process of neuropathic pain in children and adolescents is lacking. Drug treatment varies widely for moderate, severe neuropathic, and mixed pain. Hence, diagnostic tools and therapy need to be harmonized and validated for use in children.
Collapse
Affiliation(s)
- Thomas G. de Leeuw
- Department of Pediatric Anesthesia and Pain Medicine, Erasmus MC-Sophia Children’s Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
- Correspondence:
| | - Tjitske van der Zanden
- Intensive Care and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (T.v.d.Z.); (D.T.); (S.N.d.W.)
| | - Simona Ravera
- Pharmaceutical Research Management Srl, Via Luigi Porta 14, 27100 Pavia, Italy; (S.R.); (M.F.)
| | - Mariagrazia Felisi
- Pharmaceutical Research Management Srl, Via Luigi Porta 14, 27100 Pavia, Italy; (S.R.); (M.F.)
| | - Donato Bonifazi
- Consorzio per Valutazioni Biologiche e Farmacologiche, Via Putignani 178, 70122 Bari, Italy;
| | - Dick Tibboel
- Intensive Care and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (T.v.d.Z.); (D.T.); (S.N.d.W.)
| | - Adriana Ceci
- Fondazione per la Ricerca Farmacologica Gianni Benzi onlus, Via Abate Eustasio 30, 70010 Valenzano, Italy;
| | - Florentia Kaguelidou
- Centre d’Investigations Cliniques, INSERM CIC1426, Hôpital Robert Debré, APHP, Université de Paris, UMR-1123 ECEVE, 75019 Paris, France;
| | - Saskia N. de Wildt
- Intensive Care and Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (T.v.d.Z.); (D.T.); (S.N.d.W.)
- Department of Pharmacology and Toxicology, Radboud Institute Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | | |
Collapse
|
47
|
Quinn PD, Fine KL, Rickert ME, Sujan AC, Boersma K, Chang Z, Franck J, Lichtenstein P, Larsson H, D’Onofrio BM. Association of Opioid Prescription Initiation During Adolescence and Young Adulthood With Subsequent Substance-Related Morbidity. JAMA Pediatr 2020; 174:1048-1055. [PMID: 32797146 PMCID: PMC7418042 DOI: 10.1001/jamapediatrics.2020.2539] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
IMPORTANCE Concerns about adverse outcomes associated with opioid analgesic prescription have led to major guideline and policy changes. Substantial uncertainty remains, however, regarding the association between opioid prescription initiation and increased risk of subsequent substance-related morbidity. OBJECTIVE To examine the association of opioid initiation among adolescents and young adults with subsequent broadly defined substance-related morbidity. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed population-register data from January 1, 2007, to December 31, 2013, on Swedish individuals aged 13 to 29 years by January 1, 2013, who were naive to opioid prescription. To account for confounding, the analysis compared opioid prescription recipients with recipients of nonsteroidal anti-inflammatory drugs as an active comparator, compared opioid-recipient twins and other multiple birth individuals with their nonrecipient co-multiple birth offspring (co-twin control), examined dental prescription as a specific indication, and included individual, parental, and socioeconomic covariates. Data were analyzed from March 30, 2019, to January 22, 2020. EXPOSURES Opioid prescription initiation, defined as first dispensed opioid analgesic prescription. MAIN OUTCOMES AND MEASURES Substance-related morbidity, assessed as clinically diagnosed substance use disorder or overdose identified from inpatient or outpatient specialist records, substance use disorder or overdose cause of death, dispensed pharmacotherapy for alcohol use disorder, or conviction for substance-related crime. RESULTS Among the included cohort (n = 1 541 862; 793 933 male [51.5%]), 193 922 individuals initiated opioid therapy by December 31, 2013 (median age at initiation, 20.9 years [interquartile range, 18.2-23.6 years]). The active comparator design included 77 143 opioid recipients without preexisting substance-related morbidity and 229 461 nonsteroidal anti-inflammatory drug recipients. The adjusted cumulative incidence of substance-related morbidity within 5 years was 6.2% (95% CI, 5.9%-6.5%) for opioid recipients and 4.9% (95% CI, 4.8%-5.1%) for nonsteroidal anti-inflammatory drug recipients (hazard ratio, 1.29; 95% CI, 1.23-1.35). The co-twin control design produced comparable results (3013 opioid recipients and 3107 nonrecipients; adjusted hazard ratio, 1.43; 95% CI, 1.02-2.01), as did restriction to analgesics prescribed for dental indications and additional sensitivity analyses. CONCLUSIONS AND RELEVANCE Among adolescents and young adults analyzed in this study, initial opioid prescription receipt was associated with an approximately 30% to 40% relative increase in risk of subsequent substance-related morbidity in multiple designs that adjusted for confounding. These findings suggest that this increase may be smaller than previously estimated in some other studies.
Collapse
Affiliation(s)
- Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington
| | - Kimberly L. Fine
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington
| | - Martin E. Rickert
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Ayesha C. Sujan
- Department of Psychological and Brain Sciences, Indiana University, Bloomington
| | - Katja Boersma
- Center for Health and Medical Psychology, School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Zheng Chang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Brian M. D’Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
48
|
Hurley-Wallace A, Schoth DE, Lilley S, Williams G, Liossi C. Online paediatric chronic pain management: assessing the needs of UK adolescents and parents, using a cross-sectional survey. Br J Pain 2020; 15:312-325. [PMID: 34377458 PMCID: PMC8339947 DOI: 10.1177/2049463720940341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Adolescent chronic pain is prevalent, and interdisciplinary treatment is
recommended. Although it is well known that technology is a key part of
adolescents’ daily lives, there have not been any online, interdisciplinary
interventions developed for adolescents with chronic pain in a UK healthcare
context. Little is known about how adolescents currently use online
resources to manage chronic pain, or what guidance they seek. Methods: Ninety-five participants from the community answered this mixed-methods,
online survey (adolescent n = 54, parent n = 41), which assessed the needs
of UK-based adolescents for a new online chronic pain management
resource. Results: Findings indicated that, at the time of the survey, adolescents frequently
used social media platforms, such as Instagram, for chronic pain management.
Desired techniques for a new interdisciplinary resource for adolescents
included ‘advice on explaining chronic pain to others’ (86.7% of
adolescents) and sleep hygiene (82.2% of adolescents), though access to a
range of pain management techniques was desired. Qualitative results
indicated endorsement of a new programme by adolescents and parents. Conclusions: Adolescents and parents had a positive outlook towards the development of a
UK-specific online resource to help manage chronic pain. Such an
intervention should aim to be made accessible via the National Health
Service. Adolescent use of social media platforms to seek support for
chronic pain requires further exploration in future research.
Collapse
Affiliation(s)
- Anna Hurley-Wallace
- Pain Research Laboratory, School of Psychology, University of Southampton, Southampton, UK
| | - Daniel E Schoth
- Pain Research Laboratory, School of Psychology, University of Southampton, Southampton, UK
| | - Suzanne Lilley
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Glyn Williams
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Christina Liossi
- Pain Research Laboratory, School of Psychology, University of Southampton, Southampton, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
49
|
Birnie KA, Ouellette C, Do Amaral T, Stinson JN. Mapping the evidence and gaps of interventions for pediatric chronic pain to inform policy, research, and practice: A systematic review and quality assessment of systematic reviews. Can J Pain 2020; 4:129-148. [PMID: 33987493 PMCID: PMC7951164 DOI: 10.1080/24740527.2020.1757384] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/09/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
Background: Reviews in pediatric chronic pain often focus on only one intervention or population, making it difficult for policymakers and decision makers to quickly synthesize knowledge to inform larger-scale policy and funding priorities. Aims: The aims of this study were to (1) create an evidence and gap map of interventions for pediatric chronic pain and (2) identify gaps between existing evidence and recently identified patient-oriented research priorities. Methods: We performed a systematic review of English-language peer-reviewed systematic reviews or clinical practice guidelines of pediatric chronic pain intervention published in the past 20 years. Database searches of Medline, Embase, PsycINFO, Web of Science, CINAHL, and SCOPUS were conducted inclusive to June 3, 2019. Review quality was assessed using the AMSTAR-2. Results: Of 4168 unique abstracts, 50 systematic reviews (including 2 clinical practice guidelines) crossing diverse pediatric chronic pain populations and intervention settings were included. One third were rated high quality, with half rated low to critically low quality. The largest proportion of reviews addressed psychological and pharmacological interventions, followed by interdisciplinary, other (e.g., dietary), and physical interventions. Most common outcomes included pain, physical, emotional, and role functioning and quality of life. Treatment satisfaction and adverse events were less common, with minimal report of sleep or economic factors. Most patient-oriented research priorities had not been investigated. Conclusions: Sufficient quality evidence is available to guide evidence-informed policies in pediatric chronic pain, most notably regarding psychological and pharmacological interventions. Numerous evidence gaps in patient-oriented research priorities and treatment outcomes should guide prioritization of research funds, as well as study aims and design.
Collapse
Affiliation(s)
- Kathryn A. Birnie
- Department of Anesthesiology, Perioperative and Pain Medicine, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Carley Ouellette
- Faculty of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Tamara Do Amaral
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
50
|
Challenges in pain assessment and management among individuals with intellectual and developmental disabilities. Pain Rep 2020; 5:e821. [PMID: 32656458 PMCID: PMC7302581 DOI: 10.1097/pr9.0000000000000822] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/22/2020] [Indexed: 12/16/2022] Open
Abstract
Pain is common for individuals with intellectual and developmental disabilities, and we need to accelerate the use of evidence-based approaches to assess and manage pain. Introduction: Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. Objectives: This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD. Methods: This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice. Results: The past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report. Conclusion: Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.
Collapse
|