Review of childhood pain highlights the role of negative stress

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for adolescents

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for use in adults is in use worldwide. Until now, no version of this instrument for use in adolescents has been proposed.

OBJECTIVE

To present comprehensive and short-form adaptations of the adult version of DC/TMD that are appropriate for use with adolescents in clinical and research settings.

METHODS

International experts in TMDs and experts in pain psychology participated in a Delphi process to identify ways of adapting the DC/TMD protocol for physical and psychosocial assessment of adolescents.

RESULTS

The proposed adaptation defines adolescence as ages 10-19 years. Changes in the physical diagnosis (Axis I) include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for adolescents, (ii) adding two general health questionnaires, one for the adolescent patient and one for their caregivers and (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire. Changes in the psychosocial assessment (Axis II) include (i) adapting the language of the Graded Chronic Pain Scale to be developmentally appropriate for adolescents, (ii) adding anxiety and depression assessment that have been validated for adolescents and (iii) adding three constructs (stress, catastrophizing and sleep disorders) to assess psychosocial functioning in adolescents.

CONCLUSION

The recommended DC/TMD, including Axis I and Axis II for adolescents, is appropriate to use in clinical and research settings. This adapted first version for adolescents includes changes in Axis I and Axis II requiring reliability and validity testing in international settings. Official translations of the comprehensive and short-form to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Stress and recurrent abdominal pain

We discuss the aetiology of recurrent abdominal pain of non-organic origin, according to the Rome Criteria for Functional Gastrointestinal Disorders and a psychogenic hypothesis. Stress activates the brain-gut axis, which is important for local gut symptoms, such as abdominal pain, but it also causes pain in other areas, including the head, back and chest. Our research has indicated that the startle reflex plays a dominant role in this stress-induced pain pattern, which is manifested in the whole body. Localised abdominal pain can be part of a general negative stress reaction that causes multiple pains in other areas of the body.

Changes in physical and mental health in Swedish schoolchildren in the digital age

AIM

Poor physical and mental health are common and increasing in Swedish children. The aim was to investigate significant changes in health and digital habits in fourth grade and ninth grade pupils in 2020 compared to 2011.

METHODS

A validated questionnaire was conducted in 2011 and 2020 among schoolchildren in fourth (10 years) and ninth grade (15 years) in Sweden. The study population consisted of 196 students in 2020 and 254 students in 2011.

RESULTS

A significant increase was seen in self-reported sleeping difficulties, tiredness, life dissatisfaction and dissatisfaction with academic abilities among fourth grade children and a sixfold increase in their refusal to go to school. Students in fourth grade also reported that they spent more time on social media and had a reduced interest in sports. Both students in fourth and ninth grade described an increase in attacks of anger and unhappiness, as well as decreased time with family.

CONCLUSION

We conclude that fourth grade children have more physical and mental health symptoms in 2020 compared to 2011. The ninth grade students showed a high frequency of physical and mental symptoms in 2011, which remained high in 2020. One possible explanation may be that digital habits have increased.

Nation-wide decrease in the prevalence of pediatric chronic pain during the COVID-19 pandemic

OBJECTIVES

The COVID-19 pandemic was expected to increase prevalence and severity of chronic pain. We compared pandemic-era and pre-pandemic prevalence of chronic pain among children in the US.

METHODS

Data were obtained from the 2019 and 2020 National Survey of Children's Health, a web-or mail-based survey representative of children living in the US (n=20,359 in 2019; 29,159 in 2020). Caregiver-reported prevalence of chronic pain was compared between survey years using bivariate and multivariable methods.

RESULTS

The prevalence of chronic pain among US children decreased from 11 to 8% in the first year of the pandemic. Multivariable analysis adjusting for children's and caregivers' demographics and socioeconomic characteristics confirmed that in 2020, odds of caregiver-reported chronic pain declined by 33% (95% confidence interval: 23%, 42%; p<0.001).

CONCLUSIONS

The encouraging finding of a nationwide decrease in the prevalence of chronic pain calls into question initial predictions anticipating the pandemic to contribute to onset or persistence of chronic pain among children.

Expectations and Experiences of Internet-Based Therapy for Adolescents with TMD Pain

AIMS

To investigate expectations and experiences of internet-based therapy (IBT) in adolescents with temporomandibular disorder (TMD) pain.

METHODS

Seven adolescents were strategically selected for this study. All patients had received IBT for their TMD pain in a previous randomized controlled trial. One-on-one interviews were conducted in a nonclinical setting. The interviews were semi-structured, following an interview guide with six domains. The recorded interviews were transcribed, and a qualitative inductive content analysis was then performed.

RESULTS

Content analysis indicated that the expectations of the adolescents and their experiences of IBT as a treatment for TMD pain can be understood in light of three main categories: (1) To become better; (2) An ambivalent experience; and (3) A personal challenge. The adolescents expressed expectations of less TMD pain after treatment, but also of improvement in general well-being and everyday life. Although their experiences of IBT varied, adolescents described having mixed feelings about treatment and feeling that it was personally challenging.

CONCLUSION

Gained understanding of expectations and experiences is a necessary basis for revising the IBT program to meet the demands of adolescents and to improve treatment adherence. Furthermore, the content of the three categories clarifies the values of adolescents, and this understanding can in turn contribute to the development of new patient-centered treatment programs.

Interlinking alcohol intake, mental stress, psychotic experiences and job performance of higher institutions' graduates: A structural equation modelling

BACKGROUND

Graduates' job performance has become a matter that needs urgent attention. This is because many stakeholders are increasingly becoming interested in understanding the extent schools are able to produce output that meets the yearnings of society. Along these lines, we examined the contributions of alcohol intake to the job performance of higher education graduates while treating mental stress and psychotic experiences as mediators in the nexus.

MATERIALS AND METHODS

The study's population comprised all the graduates of higher education institutions in Nigeria between 2015 and 2020. Data were collected from a virtual cross-section of 3,862 graduates who self-reported to have taken alcohol in the past. These participants responded to an electronic questionnaire that was mailed to them. The scale content validity for clarity and relevance were 0.90 and 0.88, respectively, while the Cronbach alpha reliability estimate of the instrument is 0.86.

RESULTS

Amongst many others, key findings indicate that alcohol intake, mental stress and psychotic experiences jointly made a significant negative contribution to the overall job performance of graduates (R ² = 0.256, 95% confidence interval (CI) [0.23, 0.28], P = 0.00). Mental stress (B = -0.09, β = -0.14, z = -4.45, 95%CI [-0.24, -0.05], P = 0.00) and psychotic experiences (B = -0.26, β = -0.43, z = -8.07, 95%CI [-0.68, -0.16], P = 0.01) have significant negative contributions to graduates' job performance, respectively. Alcohol intake and mental stress jointly predict the psychotic experiences of graduates (B = -0.26, β = -0.43, z = -8.07, 95%CI [-0.68, -0.16], P = 0.01). Alcohol intake has a positive contribution to the mental stress of graduates (R ² = 0.797, 95%CI [0.77, 0.825], P = 0.01). Mental stress and psychotic experiences jointly mediated the relationship between alcohol intake and graduates' job performance.

CONCLUSION

It was concluded that high intake of alcohol and high levels of mental stress and psychotic experiences significantly reduce graduates' job performance generally and in specific aspects. Alcohol intake can increase graduates' job performance to a small extent depending on the amount consumed.

Chronic Pain in Schoolchildren and its Association With Psychological Wellbeing Before and During the COVID-19 Pandemic

PURPOSE

The current longitudinal observational study aimed to explore how chronic pain among schoolchildren changed before and during the COVID-19 pandemic, and how changes in chronic pain were related to changes in psychological wellbeing and COVID-19-related experiences.

METHODS

Data were collected from N = 777 German schoolchildren (aged 9-17 years) at two assessments before and one assessment during the COVID-19 pandemic lockdown. Participants self-reported chronic pain experience, anxiety, depression, and quality of life across all assessments; and COVID-19-related experiences at the last assessment. Trajectories of anxiety, depression, and quality of life as well as COVID-19-related experiences were analyzed separately for groups of stable chronic pain trajectories compared to chronic pain trajectories that changed during the pandemic.

RESULTS

Chronic pain prevalence was lowest at the assessment during the COVID-19 pandemic (22.8% vs. 29.2% and 29.9% before the pandemic). However, 4.6% experienced new chronic pain onset during the COVID-19 pandemic. This was preceded by heightened depression and anxiety, as well as lowered quality of life scores. These students were also more likely to describe time with their family during the COVID-19 pandemic as tense compared to students who did not develop chronic pain. During the COVID-19 pandemic boys were more likely to recover from ongoing chronic pain than girls.

CONCLUSIONS

Overall, during the COVID-19 pandemic the prevalence of chronic pain decreased. However, stressful situations and pre-existing vulnerabilities in psychological wellbeing can facilitate the development of chronic pain during the pandemic.

Schoolchildren's experience of pain-A focus group interview study

AIM

To explore the experience of pain in 10- to 12-year-old children.

METHODS

This interview study included students (n = 42) in grade 4-6 in focus groups (n = 10) in southern Sweden (52% girls); mean age, 11.3 years (range 10-12 years). The interviews were audio-recorded and transcribed verbatim and analysed with qualitative content analysis.

RESULTS

The analysis resulted in one theme: Pain as a unique experience for each individual, which was divided into five categories: (a) Feeling bodily pain; (b) Pain related to the school environment and schoolwork; (c) Internal pain related to sorrow and grief; (d) Pain related to conflicts and remorse; and (e) Pain can be good.

CONCLUSION

The children made distinctions between physical pain and emotional pain. Bullying, noisy school environments, grief and remorse were reported to be linked with headaches, stomachache and heartache.

The effects of a dance intervention on somatic symptoms and emotional distress in adolescent girls: A randomized controlled trial

Objective

To investigate whether a dance intervention for adolescent girls reduces stress-related symptoms.

Methods

This was a randomized controlled trial of an after-school intervention. Participants were 112 girls aged 13 to 18 years with stress-related somatic symptoms and emotional distress. The intervention comprised twice-weekly dance sessions for 8 months with a focus on enjoyment and socialization. A questionnaire was administered at baseline and after 8, 12 and 20 months. Participants rated the frequency with which they had experienced somatic symptoms and emotional distress during the previous 3 months.

Results

After the intervention, there was a significantly greater reduction in somatic symptoms and emotional distress in the dance intervention group than in the control group. The difference in the mean score change on a 5-point scale was 0.26 (95% confidence interval [CI]: 0.04 to 0.47) for somatic symptoms and 0.30 (95% CI: 0.04 to 0.58) for emotional distress.

Conclusion

Dance interventions may reduce somatic symptoms and emotional distress in adolescent girls, and may constitute a nonpharmacological complement to school health services. However, continued participation is needed for long-term sustainable results. Additional randomized studies are required to further evaluate the effect of this type of intervention in different settings.

 This study was registered with ClinicalTrials.gov. Study name: ‘Influencing Adolescent Girls With Creative Dance Twice Weekly’.

 URL: http: //clinicaltrials.gov/ct2/show/study/NCT01523561.

 Trial registration number: NCT01523561.

A Scoping Review of Nursing Research Priorities in Pediatric Care

PROBLEM

Priority setting for pediatric nursing is important to plan, coordinate and direct future research. The aim of this scoping review was to systematically identify and synthesise the nature, range and extent of published pediatric nursing research priorities.

ELIGIBILITY CRITERIA

English language full text publications focusing generic nursing research priorities for the child or adolescent, indexed in CINAHL, EMBASE, The Cochrane Database of Systematic Reviews, AMED, MEDLINE and PsycINFO and published from 2008 to 2019.

SAMPLE

A total of 789 citations were identified, 44 full text articles were retrieved and assessed for eligibility and eight studies were finally reviewed, quality assessed (CREDES) and synthesised.

RESULTS

All eight studies used a consensus building method to identify research priorities reported by nurses. Six used Delphi technique, one Nominal Group Technique (NGT) and one consensus workshop. CREDES score range was 10-14 of a possible 16. Synthesis of the 234 nursing research priorities generated four themes; evidenced-based practice, pediatric context, child and family-centered care; pediatric nursing, with 14 subthemes.

CONCLUSION

The nursing research priorities reported appear to be still current and important to nurses. There was a focus on acute care, with fewer priorities reflecting areas of child-, school-, or mental- health. Consumer and community priorities have not been reported.

IMPLICATIONS

These nursing research priorities can be used to inform the national or local research agenda, although there is a need to establish priorities from the perspective of all stakeholders and in particular, identify what is important to consumers.

Development of the Help Overcoming Pain Early (HOPE) Programme Built on a Person-Centred Approach to Support School Nurses in the Care of Adolescents with Chronic Pain-A Feasibility Study

Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care.