How children and adolescents in primary care cope with pain and the biopsychosocial factors that correlate with pain-related disability

The Pain Coping Questionnaire short-form: preliminary reliability and validity

Supplemental Digital Content is Available in the Text. A brief 16-item format of the Pain Coping Questionnaire was developed and found to have acceptable preliminary reliability and validity.

Introduction:

The Pain Coping Questionnaire (PCQ) has support for its validity and reliability as a tool to understand how a child copes with pain of an extended duration. However, measure length may limit feasibility in clinical settings.

Objectives:

The primary goal of this study was to develop a short-form (PCQ-SF) that could be used for screening how children cope with chronic or recurrent pain and examine its reliability and validity.

Methods:

The PCQ-SF was developed in a stepwise manner. First, a confirmatory factor analysis was computed using an amalgamated data set from the validation studies of the PCQ (N = 1225). Next, ratings from researchers and clinicians were obtained on PCQ item content and clarity (n = 12). Finally, the resulting 16-item short-form was tested in a pediatric sample living with chronic and recurrent pain (65 parent–child dyads; n = 128).

Results:

The PCQ-SF has acceptable preliminary reliability and validity. Both statistical and expert analyses support the collective use of the 16 items as an alternative to the full measure.

Conclusions:

The compact format of the PCQ-SF will allow practitioners in high-volume clinical environments to quickly determine a child's areas of strengths and weaknesses when coping with pain. Future research using larger more diverse samples to confirm clinical validity is warranted.

Secular trends in childhood pain and comorbid psychiatric symptoms: a population-based study

PURPOSE

Pain symptoms are common in childhood. They often lead to functional impairment and co-occur with psychiatric difficulties. Although children's lives have undergone enormous changes in recent decades, long-term data on changes in pain symptoms, and in comorbid psychiatric difficulties, is lacking. This knowledge is crucial, as co-occurring psychiatric symptoms are significant predictors of long-term outcome for children who suffer from pain. The main purpose of the present study was to explore secular changes in comorbid pain and psychiatric symptoms.

METHODS

Four population-based, cross-sectional surveys of 8-9-year-old children were conducted in Southwest Finland in 1989, 1999, 2005, and 2013. Identical methodologies and questionnaire-based measures were used each study year. Participation ranged from 891 to 986 over the study period. The children were asked about the frequency of headache, abdominal pain, and other pains. Children, their parents, and teachers provided information on the child's psychiatric difficulties, including internalizing and externalizing symptoms.

RESULTS

The cumulative odds ratios and 95% confidence intervals for the overall prevalence of pain symptoms increased among both genders from 1989 to 2013 and ranged from 1.4 (1.03-1.8) for other pains to 2.4 (1.7-3.3) for abdominal pain. Comorbid internalizing symptoms increased among girls with odd ratios and 95% CIs of 1.8 (1.03-3.1) for children with any kind of pain, and 3.0 (1.4-6.2) for children with headache. No changes were found among boys.

CONCLUSION

Overall pain symptoms doubled in both genders, but the most novel finding was that comorbid emotional difficulties tripled among girls who reported headaches. Further research is needed to confirm, and explain, these findings.

Development, preliminary validation and reliability testing of SEDA - Self-Efficacy in Daily Activities for children with pain

BACKGROUND

Self-efficacy can affect a child's ability to perform important activities, infuse him/her with a sense of control and is likely an integral target for successful treatment in pediatric pain rehabilitation. Modern physical therapy treatment includes behavioral aspects and valid measures of self-efficacy are important for both research and clinical practice. In this study, the aim was to develop and perform preliminary testing of a self-efficacy scale for children and adolescents with pain.

METHODS

Children and adolescents participated, along with researchers and healthcare staff, in developing the Self-Efficacy in Daily Activities (SEDA) measure. A total of 109 children and adolescents seeking physical therapy treatment for pain lasting longer than 3 months responded to the SEDA. Pain and pain-related disability were assessed using the Functional Disability Inventory (FDI). Exploratory analyzes for testing validity and reliability - principal component analyses (PCA), intraclass correlation coefficients (ICCs) and bivariate correlations - were performed.

RESULTS

The PCA revealed a 16-item SEDA and a three-component scale. The components represented self-efficacy for physical activities, self-efficacy for personal care and self-efficacy for daily exertion. Validity correlation analyses showed moderate association between SEDA and FDI, -0.72 (p < .01), and low correlation with pain intensity, -0.29 (p = .03).

CONCLUSIONS

The 16-item SEDA has satisfactory psychometric properties in children moderately affected by long-term pain. Further validation of the SEDA in other populations and confirmatory analyses are warranted.

Dealing with adolescents' recurrent pain problems in school health care-Swedish school nurses' view

Aim

To explore school nurses' strategies for supporting adolescents with recurrent pain.

Design

An explorative inductive qualitative design.

Method

Twenty-one Swedish school nurses were interviewed, and the interviews were subjected to content analysis.

Results

The findings show that the nurses are aware that recurrent pain problems are common among the adolescents. In their attempt to support these adolescents, the nurses describe how they are striving in attempts to acquire an understanding of the adolescents' situation, to understand the cause of the pain problem and to devise strategies that can be used to help the adolescents handle the situation.

A Person-Centred Approach When Encountering Students With Recurrent Pain: School Nurses' Experiences

Stress has a negative impact on students' daily lives and can be associated with recurrent pain. School nurses play a key role in supporting young people with stress-related pain. The purpose of this qualitative interview study was to elucidate school nurses' experiences of encountering students with recurrent pain when practicing person-centred care. The school nurses were based at public and private schools and worked with students aged 12-19. Data were collected through interviews with 18 school nurses and analyzed with deductive content analysis. The school nurses felt that actively listening to the students' narratives about daily life with recurrent pain, and co-creation of a health plan, encouraged the students to participate as partners in their own care and strengthened their relation with the students. The application of a person-centred approach in school health care meant that traditional knowledge transfer was replaced with a dialogue that reflects both the student's and school nurse's perspective.

Physical therapists' experiences of learning and delivering a complex behavioral medicine intervention to adolescents with pain

The objective was to study physical therapists' (PTs') experiences of learning and delivering a complex intervention, a tailored behavioral medicine treatment (BMT) targeting adolescents with pain in primary care.Method: An explorative study with qualitative approach, using content analysis. Three primary care PTs delivering the treatments in a randomized controlled study were interviewed regarding their views on the BMT.Results: The participating PTs considered learning about and delivering the BMT as challenging but rewarding. The biopsychosocial approach, tailoring of the treatment and dialogues with parents were identified as key aspects of the BMT program. The process of formulating a functional behavioral analysis was perceived as strenuous. The supervision of the PTs throughout the study was regarded as crucial and necessary for learning about and providing tailored BMT.Conclusion: Learning about and delivering BMT targeting adolescents with persistent pain is fruitful but laborious and demanding according to three PTs experienced with treatment of pediatric pain in primary care. Extensive education and long periods of supervision seem to be crucial for success and safe delivery according to protocol.

Child and adolescent musculoskeletal pain (CAM-Pain) feasibility study: testing a method of identifying, recruiting and collecting data from children and adolescents who consult about a musculoskeletal condition in UK general practice

OBJECTIVES

Test a method of identifying, recruiting and collecting data from children and adolescents who consult their general practitioner about a musculoskeletal condition.

DESIGN

Prospective cohort feasibility study.

SETTING

13 general practices in West Midlands of England.

PARTICIPANTS

Patients aged 8-19 years who consult their general practice about a musculoskeletal condition. Patients were identified via a relevant musculoskeletal Read code entered at the point of consultation.

OUTCOME MEASURES

Feasibility was assessed in terms of study processes (recruitment rates), data collection procedures (duration, response variability), resource utilisation (mail-outs) and ethical considerations (acceptability).

RESULTS

From October 2016 to February 2017, an eligible musculoskeletal Read code was entered on 343 occasions, 202 patients were excluded (declined, n=153; screened not suitable, n=49) at the point of consultation. The remaining 141 patients were mailed an invitation to participate (41.1%); 46 patients responded to the invitation (response rate: 32.6%), of which 27 patients consented (consent rate: 19.1%). Participants mean age was 13.7 years (SD 2.7) and current pain intensity was 2.8 (SD 2.7). All participants completed the 6-week follow-up questionnaire. All participants found the interview questions to be acceptable and would consider participating in a similar study in the future. The majority of general practitioners/nurse practitioners, and all of the research nurses reported to be adequately informed about the study and found the study processes acceptable.

CONCLUSION

The expected number of participants were identified and invited, but consent rate was low (<20%) indicating that this method is not feasible (eg, for use in a large prospective study). Recruiting children and adolescents with musculoskeletal conditions in a primary care setting currently presents a challenge for researchers. Further work is needed to identify alternative ways to conduct studies in this population in order to address the current knowledge gap in this field.

Disability, Quality of Life, and Pain Coping in Pediatric Migraine: An Observational Study

OBJECTIVES

The objective was to examine the relationship between disability, health-related quality of life (HrQoL), and pain coping in pediatric migraineurs.

METHOD

Eighty-five patients with migraine were recruited from Pediatric Neurology clinics. Participants completed the Pediatric Migraine Disability Assessment Scale, the Pediatric Quality of Life Inventory, the Pain Coping Questionnaire, and the Pain Catastrophizing Scale. Means were compared to published norms using t-tests. Spearman correlations and logistic regression were used to explore the relationships between the variables.

RESULTS

Mean HrQoL scores were lower than norms for controls and chronically ill pediatric patients ( P < .0001). Patients reported lower mean pain coping scores and higher mean pain catastrophizing scores than norms ( P < .0001). After controlling for age and sex, only the relationship between disability and HrQoL remained significant (OR = 0.91, 95% CI: 0.86-0.95).

CONCLUSION

Pediatric patients with migraine report lower HrQoL, fewer pain coping strategies and more catastrophizing than controls, while disability is inversely associated with HrQoL.

How adolescents experience and cope with pain in daily life: a qualitative study on ways to cope and the use of over-the-counter analgesics

OBJECTIVE

The aim of this study was to describe how different adolescents experience and manage pain in their daily life, with a focus on their use of over-the-counter analgesics. More specifically, the aim was to explore different patterns among the adolescents in pain descriptions, in the management of pain, in relationships with others, and in their daily life.

DESIGN

Qualitative semistructured interviews on experiences with pain, pain management and involvement of family and friends during pain. Pain and stress management strategies and attachment theory will be in focus for interpretations.

PARTICIPANTS AND SETTING

25 participants aged 15-16-years from six different junior high schools, both genders, with and without immigrant background were interviewed at their local schools in Norway.

RESULTS

We identified 4 groups of adolescents with similarities in attitudes and management strategies to pain: 'pain is manageable', 'pain is communicable', 'pain is inevitable' and 'pain is all over'. The participants within each group differed in how they engaged their parents in pain; how they perceived, communicated and managed pain; and how they involved emotions and used over-the-counter analgesics.

CONCLUSIONS

The adolescents' different involvement with the family during pain related to their pain perception and management. Knowledge of the different ways of approaching pain is important when supporting adolescents and may be a subject for further research on the use of over-the-counter analgesics in the family.