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Djurtoft C, Bruun MK, Riel H, Hoegh MS, Darlow B, Rathleff MS. How do we explain painful non-traumatic knee conditions to adolescents? A multiple-method study to develop credible explanations. Eur J Pain 2024; 28:659-672. [PMID: 37987218 DOI: 10.1002/ejp.2210] [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: 06/14/2023] [Revised: 09/19/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Perceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand "what's wrong with me". Our aim is to develop credible explanations about the condition for adolescents suffering from non-traumatic knee pain. METHODS This multiple-method study integrated findings from two systematic literature searches of qualitative and quantitative studies, an Argumentative Delphi with international experts (n = 16) and think-aloud interviews with adolescents (n = 16). Experts provided feedback with arguments on how to communicate credible explanations to meet adolescents' needs; we analysed feedback using thematic analysis. The explanations were tailored based on the adolescent end-users' input. RESULTS We screened 3239 titles/abstracts and included 16 papers exploring diagnostic uncertainty from adolescents' and parents' perspectives. Five themes were generated: (1) understanding causes and contributors to the pain experience, (2) feeling stigmatized for having an invisible condition, (3) having a name for pain, (4) controllability of pain, and (5) worried about something being missed. The Argumentative Delphi identified the following themes: (1) multidimensional perspective, (2) tailored to adolescents, (3) validation and reassurance, and (4) careful wording. Merging findings from the systematic search and the Delphi developed three essential domains to address in credible explanations: "What is non-traumatic knee pain and what does it mean?", "What is causing my knee pain?" and "How do I manage my knee pain?" CONCLUSIONS Six credible explanations for the six most common diagnoses of non-traumatic knee pain were developed. We identified three domains to consider when tailoring credible explanations to adolescents experiencing non-traumatic knee pain. SIGNIFICANCE This study provides credible explanations for the six most common diagnoses of non-traumatic knee pain. Additionally, we identified three key domains that may need to be addressed to reduce diagnostic uncertainty in adolescents suffering from pain complaints. Based on our findings, we believe that clinicians will benefit from exploring adolescents' own perceptions of why they experience pain and perceived management strategies, as this information might capture important clinical information when managing these young individuals.
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Affiliation(s)
- C Djurtoft
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - M K Bruun
- Center for General Practice at Aalborg University, Aalborg, Denmark
| | - H Riel
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Department of Physiotherapy, University College of Northern Denmark, Aalborg, Denmark
| | - M S Hoegh
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - B Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - M S Rathleff
- Center for General Practice at Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Nestor BA, Chimoff J, Koike C, Weitzman ER, Riley BL, Uhl K, Kossowsky J. Adolescent and Parent Perspectives on Digital Phenotyping in Youths With Chronic Pain: Cross-Sectional Mixed Methods Survey Study. J Med Internet Res 2024; 26:e47781. [PMID: 38206665 PMCID: PMC10811597 DOI: 10.2196/47781] [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: 04/05/2023] [Revised: 09/28/2023] [Accepted: 11/29/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Digital phenotyping is a promising methodology for capturing moment-to-moment data that can inform individually adapted and timely interventions for youths with chronic pain. OBJECTIVE This study aimed to investigate adolescent and parent endorsement, perceived utility, and concerns related to passive data stream collection through smartphones for digital phenotyping for clinical and research purposes in youths with chronic pain. METHODS Through multiple-choice and open-response survey questions, we assessed the perspectives of patient-parent dyads (103 adolescents receiving treatment for chronic pain at a pediatric hospital with an average age of 15.6, SD 1.6 years, and 99 parents with an average age of 47.8, SD 6.3 years) on passive data collection from the following 9 smartphone-embedded passive data streams: accelerometer, apps, Bluetooth, SMS text message and call logs, keyboard, microphone, light, screen, and GPS. RESULTS Quantitative and qualitative analyses indicated that adolescents and parent endorsement and perceived utility of digital phenotyping varied by stream, though participants generally endorsed the use of data collected by passive stream (35%-75.7% adolescent endorsement for clinical use and 37.9%-74.8% for research purposes; 53.5%-81.8% parent endorsement for clinical and 52.5%-82.8% for research purposes) if a certain level of utility could be provided. For adolescents and parents, adjusted logistic regression results indicated that the perceived utility of each stream significantly predicted the likelihood of endorsement of its use in both clinical practice and research (Ps<.05). Adolescents and parents alike identified accelerometer, light, screen, and GPS as the passive data streams with the highest utility (36.9%-47.5% identifying streams as useful). Similarly, adolescents and parents alike identified apps, Bluetooth, SMS text message and call logs, keyboard, and microphone as the passive data streams with the least utility (18.5%-34.3% identifying streams as useful). All participants reported primary concerns related to privacy, accuracy, and validity of the collected data. Passive data streams with the greatest number of total concerns were apps, Bluetooth, call and SMS text message logs, keyboard, and microphone. CONCLUSIONS Findings support the tailored use of digital phenotyping for this population and can help refine this methodology toward an acceptable, feasible, and ethical implementation of real-time symptom monitoring for assessment and intervention in youths with chronic pain.
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Affiliation(s)
- Bridget A Nestor
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesia, Harvard Medical School, Boston, MA, United States
| | - Justin Chimoff
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Camila Koike
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Elissa R Weitzman
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
- Division of Addiction Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Bobbie L Riley
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesia, Harvard Medical School, Boston, MA, United States
| | - Kristen Uhl
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States
| | - Joe Kossowsky
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Anesthesia, Harvard Medical School, Boston, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
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Themelis K, Tang NKY. The Management of Chronic Pain: Re-Centring Person-Centred Care. J Clin Med 2023; 12:6957. [PMID: 38002572 PMCID: PMC10672376 DOI: 10.3390/jcm12226957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/26/2023] Open
Abstract
The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.
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Affiliation(s)
- Kristy Themelis
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
| | - Nicole K. Y. Tang
- Department of Psychology, University of Warwick, Coventry CV4 7AL, UK
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Mountain DC, Ali SM, Ghio D, McDonagh JE, Cordingley L, Lee RR. Beliefs About Pain in Pediatric Inflammatory and Noninflammatory Chronic Musculoskeletal Conditions: A Scoping Review. J Pediatr Psychol 2023; 48:825-841. [PMID: 37738667 PMCID: PMC10588974 DOI: 10.1093/jpepsy/jsad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The Common Sense Self-Regulatory Model posits that beliefs about pain influence coping behaviors and subsequent physical and mental health outcomes in children/young people with chronic musculoskeletal conditions. It was unclear how and what beliefs had been investigated in this population, and whether there were similarities and differences in beliefs held about pain by those experiencing inflammatory versus noninflammatory musculoskeletal conditions. This scoping review addressed this gap. METHODS A systematic search was conducted using four databases (MEDLINE, PsycINFO, Embase, and CINAHL) in November 2021. Primary studies exploring key stakeholders' (including children, parents, and/or healthcare professionals) beliefs about pain underlying pediatric chronic musculoskeletal conditions were synthesized. RESULTS Eighteen articles were identified. Cross-sectional designs were predominantly used to explore beliefs (n = 6). The majority used questionnaires to assess beliefs (n = 12). Beliefs common across musculoskeletal conditions were that children/young people felt their pain was not understood by others, and pain affected their physical functioning. Differences included children/young people and parents thinking they had some ability to control pain, and causal beliefs relating to underlying disease activity. These pain beliefs were more likely to be held in relation to inflammatory diagnoses. In contrast, children/young people and parents were more likely to view pain as uncontrollable, with more uncertainty regarding underlying causes, relating to noninflammatory diagnoses. CONCLUSIONS Methods used to explore pain beliefs were inconsistent. Studies identified similarities and differences which appear to be closely related to the underlying diagnosis. Findings justify further exploration to identify potentially modifiable targets to improve pain outcomes in this population.
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Affiliation(s)
- Danielle C Mountain
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Syed Mustafa Ali
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- Division of Informatics, Imaging and Data Sciences, Centre for Health Informatics, Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Daniela Ghio
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
| | - Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester Academic Health Science Centre, UK
- Division of Psychology and Mental Health, Manchester Centre for Health Psychology, University of Manchester, UK
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France E, Uny I, Turley R, Thomson K, Noyes J, Jordan A, Forbat L, Caes L, Silveira Bianchim M. A meta-ethnography of how children and young people with chronic non-cancer pain and their families experience and understand their condition, pain services, and treatments. Cochrane Database Syst Rev 2023; 10:CD014873. [PMID: 37795766 PMCID: PMC10552070 DOI: 10.1002/14651858.cd014873.pub2] [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] [Indexed: 10/06/2023]
Abstract
BACKGROUND Chronic non-cancer pain in childhood is widespread, affecting 20% to 35% of children and young people worldwide. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on their lives and quality of life, and leads to increased use of healthcare services and medication. In many countries, there are few services for managing children's chronic non-cancer pain, with many services being inadequate. Fourteen Cochrane Reviews assessing the effects of pharmacological, psychological, psychosocial, dietary or physical activity interventions for managing children's chronic non-cancer pain identified a lack of high-quality evidence to inform pain management. To design and deliver services and interventions that meet the needs of patients and their families, we need to understand how children with chronic non-cancer pain and their families experience pain, their views of services and treatments for chronic pain, and which outcomes are important to them. OBJECTIVES 1. To synthesise qualitative studies that examine the experiences and perceptions of children with chronic non-cancer pain and their families regarding chronic non-cancer pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. 2. To explore whether our review findings help to explain the results of Cochrane Reviews of intervention effects of treatments for children's chronic non-cancer pain. 3. To determine if programme theories and outcomes of interventions match children and their families' views of desired treatments and outcomes. 4. To use our findings to inform the selection and design of patient-reported outcome measures for use in chronic non-cancer pain studies and interventions and care provision to children and their families. The review questions are: 1. How do children with chronic non-cancer pain and their families conceptualise chronic pain? 2. How do children with chronic non-cancer pain and their families live with chronic pain? 3. What do children with chronic non-cancer pain and their families think of how health and social care services respond to and manage their child's chronic pain? 4. What do children with chronic non-cancer pain and their families conceptualise as 'good' chronic pain management and what do they want to achieve from chronic pain management interventions and services? SEARCH METHODS Review strategy: we comprehensively searched 12 bibliographic databases including MEDLINE, CINAHL, PsycInfo and grey literature sources, and conducted supplementary searches in 2020. We updated the database searches in September 2022. SELECTION CRITERIA To identify published and unpublished qualitative research with children aged 3 months to 18 years with chronic non-cancer pain and their families focusing on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with a patient and public involvement group of children and young people with chronic non-cancer pain and their families. DATA COLLECTION AND ANALYSIS We conducted a qualitative evidence synthesis using meta-ethnography, a seven-phase, systematic, interpretive, inductive methodology that takes into account the contexts and meanings of the original studies. We assessed the richness of eligible studies and purposively sampled rich studies ensuring they addressed the review questions. Cochrane Qualitative Methods Implementation Group guidance guided sampling. We assessed the methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus, characteristics and conceptual findings from study reports using NVivo software. We compared these study data to determine how the studies related to one another and grouped studies by pain conditions for synthesis. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Sampling, organising studies for synthesis, and analysis and interpretation involved our patient and public involvement group who contributed throughout the conduct of the review. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each review finding. We used a matrix approach to integrate our findings with existing Cochrane Reviews on treatment effectiveness for children's chronic non-cancer pain. MAIN RESULTS We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Included studies involved 633 participants. GRADE-CERQual assessments of findings were mostly high (n = 21, 58%) or moderate (n = 12, 33%) confidence with three (8%) low or very low confidence. Poorly managed, moderate or severe chronic non-cancer pain had profound adverse impacts on family dynamics and relationships; family members' emotions, well-being, autonomy and sense of self-identity; parenting strategies; friendships and socialising; children's education and future employment prospects; and parental employment. Most children and parents understood chronic non-cancer pain as having an underlying biological cause and wanted curative treatment. However, families had difficulties seeking and obtaining support from health services to manage their child's pain and its impacts. Children and parents felt that healthcare professionals did not always listen to their experiences and expertise, or believe the child's pain. Some families repeatedly visited health services seeking a diagnosis and cure. Over time, some children and families gave up hope of effective treatment. Outcomes measured within trials and Cochrane Reviews of intervention effects did not include some outcomes of importance to children and families, including impacts of pain on the whole family and absence of pain. Cochrane Reviews have mainly neglected a holistic biopsychosocial approach, which specifies the interrelatedness of biological, psychological and social aspects of illness, when selecting outcome measures and considering how chronic pain management interventions work. AUTHORS' CONCLUSIONS We had high or moderate confidence in the evidence contributing to most review findings. Further research, especially into families' experiences of treatments and services, could strengthen the evidence for low or very low confidence findings. Future research should also explore families' experiences in low- to middle-income contexts; of pain treatments including opioid use in children, which remains controversial; and of social care services. We need development and testing of family-centred interventions and services acceptable to families. Future trials of children's chronic non-cancer pain interventions should include family-centred outcomes.
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Affiliation(s)
- Emma France
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Isabelle Uny
- Institute of Social Marketing, University of Stirling, Stirling, UK
| | - Ruth Turley
- Development Directorate, Cochrane Central Executive, Cochrane, London, UK
| | - Katie Thomson
- Occupational Therapy, Human Nutrition & Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Jane Noyes
- Centre for Health-Related Research, Fron Heulog, Bangor University, Bangor, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Bath Centre for Pain Research, University of Bath, Bath, UK
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Line Caes
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | - Mayara Silveira Bianchim
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Centre for Population Health and Wellbeing Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
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You DS, Hettie G, Darnall BD, Ziadni MS. Spontaneous self-affirmation: an adaptive coping strategy for people with chronic pain. Scand J Pain 2023; 23:531-538. [PMID: 36935574 DOI: 10.1515/sjpain-2022-0099] [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: 07/18/2022] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVES Self-affirmation may be a promising treatment strategy for improving clinical outcomes. This study examined the association between self-affirmation and self-reported health status among people with chronic pain. METHODS In this cross-sectional study, 768 treatment seeking people (female 67.2%, mean age=50.4 years with SD of 17.1, White/Caucasian 59.9%) completed surveys using a learning healthcare system. Measures included spontaneous self-affirmation (SSA) items, PROMIS® outcome measures, and Pain Catastrophizing Scale (PCS). Multiple regressions were conducted to examine if strength-based SSA, value-based SSA, and their interaction would predict perceived health status and pain coping strategy. Sensitivity analysis was done by performing additional regressions with covariates (age, sex, race/ethnicity, and education). Lastly, exploratory analysis examined if average SSA scores would have a linear relationship with perceived health status. RESULTS The strength x value-based SSA interaction significantly predicted the PROMIS-depression, anxiety, and social isolation T-scores (ps≤0.007), but not anger T-scores (p=0.067). Specifically, greater tendency to use both SSA styles predicted less symptoms of depression, anxiety and social isolation. This interaction remained significant when controlling for the covariates. The two SSA styles and their interaction did not significantly predict pain interference, sleep disturbance, fatigue, average pain rating and PCS scores (ps≥0.054). Exploratory analysis revealed SSA average scores did not have a significant linear relationship with perceived health status. CONCLUSIONS The current study showed self-affirmation as being associated with better psychosocial health, but not associated with physical health and pain catastrophizing among patients with chronic pain. Our findings suggested the potential benefit of incorporating strength- and value-based affirmations in pain intervention approaches.
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Affiliation(s)
- Dokyoung S You
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA
| | - Gabrielle Hettie
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA
| | - Beth D Darnall
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA
| | - Maisa S Ziadni
- Department Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, USA
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Kallesøe KH, Wellnitz KB, Ørnbøl E, Rask CU. Clinical Impact of Systematic Assessment and Psychoeducation in Specialized Treatment of Adolescents with Severe Functional Somatic Disorders: Results from the AHEAD Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1101. [PMID: 37508598 PMCID: PMC10378561 DOI: 10.3390/children10071101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
Functional somatic disorders (FSD), characterized by persistent and disabling physical symptoms, are common in adolescents. Diagnostic uncertainty and insufficient illness explanations are proposed perpetuating factors that may constitute barriers for treatment engagement. This study describes the impact of manualized assessment and psychoeducation on diagnostic certainty and various clinical outcomes in adolescents with multi-system FSD. Ninety-one adolescents (15-19 years) received systematic assessment (4 h) and a subsequent psychiatric consultation (1.5 h). Clinical characteristics included self-reported physical health, symptom severity, illness perception, illness-related behavior, and psychological flexibility assessed before and approximately two months after assessment, prior to specialized treatment. Data were analyzed using t-tests. Immediately following assessment, 71 (80.7%) adolescents out of 88 reported a higher diagnostic certainty and 74 (84.1%) reported that attending assessment gave them positive expectations for future treatment. A clinically relevant improvement of physical health was not observed at two months but considerable reductions were seen in symptom severity, illness worry, negative illness perceptions, illness-related limiting behavior, and psychological inflexibility. The results emphasize that systematic assessment and psychoeducation are important in their own right in the specialized treatment of adolescents with severe FSD.
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Affiliation(s)
- Karen Hansen Kallesøe
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
| | - Kaare Bro Wellnitz
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul Jensens Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba/Skejby Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul Jensens Boulevard 11, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba/Skejby Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba/Skejby Building 2, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
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8
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Joslin R, Donovan‐Hall M, Roberts L. "You just want someone to help": Outcomes that matter to parents when their child is treated for chronic pain. PAEDIATRIC & NEONATAL PAIN 2023; 5:38-48. [PMID: 37283953 PMCID: PMC10240402 DOI: 10.1002/pne2.12098] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/05/2022] [Accepted: 02/09/2023] [Indexed: 06/08/2023]
Abstract
In children's chronic pain services, healthcare decisions involve a three-way interaction between the child, their parent or guardian, and the health professional. Parents have unique needs, and it is unknown how they visualize their child's recovery and which outcomes they perceive to be an indication of their child's progress. This qualitative study explored the outcomes parents considered important, when their child was undergoing treatment for chronic pain. A purposive sample of twenty-one parents of children receiving treatment for chronic musculoskeletal pain, completed a one-off semi-structured interview that involved drawing a timeline of their child's treatment. The interview and timeline content were analyzed using thematic analysis. Four themes are evident at different points of the child's treatment course. The "perfect storm" that described their child's pain starting, "fighting in the dark" was a stage when parents focused on finding a service or health professional that could solve their child's pain. The third stage, "drawing a line under it," changed the outcomes parents considered important, parents changed how they approached their child's pain and worked alongside professionals, focusing on their child's happiness and engagement with life. They watched their child make positive change and moved toward the final theme "free." The outcomes parents considered important changed over their child's treatment course. The shift described by parents during treatment appeared pivotal to the recovery of young people, demonstrating the importance of the role of parents within chronic pain treatment.
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Affiliation(s)
- Rhiannon Joslin
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
- Women's and Children's DepartmentUniversity Hospitals Sussex, St. Richards HospitalChichesterUK
| | | | - Lisa Roberts
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
- Therapy Services DepartmentUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
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Johansen SK, Kanstrup AM, Haseli K, Stenmo VH, Thomsen JL, Rathleff MS. Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study. JMIR Hum Factors 2023; 10:e44462. [PMID: 37115609 PMCID: PMC10182461 DOI: 10.2196/44462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents' knee pain in a general practice setting. OBJECTIVE The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. METHODS Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. RESULTS Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. CONCLUSIONS An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance.
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Affiliation(s)
- Simon Kristoffer Johansen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | | | - Kian Haseli
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Visti Hildebrandt Stenmo
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Janus Laust Thomsen
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Hess CW, Rosen MA, Simons LE. Looking inward to improve pediatric chronic pain outcomes: a call for team science research. Pain 2023; 164:690-697. [PMID: 36637136 PMCID: PMC10879964 DOI: 10.1097/j.pain.0000000000002836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/22/2022] [Indexed: 01/14/2023]
Affiliation(s)
- Courtney W. Hess
- Stanford University School of Medicine; Department of Anesthesiology, Perioperative, & Pain Medicine
| | - Michael A. Rosen
- Johns Hopkins University School of Medicine; Department of Anesthesiology and Critical Care Medicine
| | - Laura E. Simons
- Stanford University School of Medicine; Department of Anesthesiology, Perioperative, & Pain Medicine
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11
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Yessick LR, Tanguay J, Gandhi W, Harrison R, Dinu R, Chakrabarti B, Borg E, Salomons TV. Investigating the relationship between pain indicators and observers' judgements of pain. Eur J Pain 2023; 27:223-233. [PMID: 36377314 DOI: 10.1002/ejp.2053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 11/01/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to the inherent subjectivity of pain, it is difficult to make accurate judgements of pain in others. Research has found discrepancies between the ways in which perceived "objective" (e.g., medical evidence of injury) and "subjective" information (e.g., self-report) influence judgements of pain. This study aims to explore which potential cues (depictions of sensory input, brain activation, self-reported pain and facial expressions) participants are most influenced by when evaluating pain in others. METHODS First, 60 participants (23 women, 36 ± 10 years old) judged who was in more pain between two different pain indicators representing two different patients. These trials revealed which congruent indicator (i.e., two high pain indicators) would most influence participant decisions. Second, participants prescribed quantities of analgesia for one patient's pain based on two different pain indicators. These trials revealed which incongruent indicators (i.e., one high and one low indicator) would most influence participant decisions. RESULTS As predicted, facial expressions were perceived as subjective and were the least likely, among all pain indicators, to influence observer's judgements of pain. Participants relied upon indicators they perceived as objective. Self-report pain ratings had the greatest influence on participants judgements about how much analgesic cream to prescribe and was perceived as objective by half of the participants. CONCLUSIONS We found that in situations where incongruent information was presented about an individual's pain, participants relied on pain indicators that they perceived to be objective. The current study provides important insights about biases that people hold when making judgements of pain in others. SIGNIFICANCE Interpretation and assessment of pain remains one of the largest barriers to pain management and involves complex, idiosyncratic processing. This study provides insights into what information participants view as critical in making attributions of pain when presented with multiple, seemingly incongruent sources of information.
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Affiliation(s)
- Lindsey R Yessick
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
| | - Justine Tanguay
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, Ontario, Canada
| | - Wiebke Gandhi
- Department of Psychological and Applied Language Sciences, University of Reading, Reading, UK
| | - Richard Harrison
- Department of Psychological and Applied Language Sciences, University of Reading, Reading, UK
| | - Ruxandra Dinu
- Department of Psychological and Applied Language Sciences, University of Reading, Reading, UK
| | - Bhismadev Chakrabarti
- Department of Psychological and Applied Language Sciences, University of Reading, Reading, UK
| | - Emma Borg
- Department of Philosophy, University of Reading, Reading, UK
| | - Tim V Salomons
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
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12
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Hill JC, Stokes LE, Higgins KK. Career Transitions Caused by Chronic Illness: A Career Construction Perspective. REHABILITATION RESEARCH, POLICY, AND EDUCATION 2022. [DOI: 10.1891/re-21-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose:People living with chronic illness face significant challenges with employment. This study explores the impact of participating in the Career Construction Interview (CCI) on the career exploration of individuals facing a forced career transition due to the onset or exacerbation of a chronic illness.Method:An instrumental multiple case study design was used in this qualitative study. A purposeful, homogeneous sample of three female adults was used to gain multiple perspective of forced career transitions. The participants were within 2 years of their diagnosis or exacerbation of one or more chronic health conditions and had to change their career because of the impact of their condition(s).Results:Eight open codes and five axial codes were discovered through the process of constant comparative analysis. For this study one open code (CCI experience) and five axial codes will be discussed.Conclusions:This study found patterns related to chronic illness and career and that the Career Construction Interview was helpful to the participants in assisting them with making decisions about potential careers and options for employment. Implications for rehabilitation counseling practice and suggestions for future research.
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13
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Wakefield EO, Kissi A, Mulchan SS, Nelson S, Martin SR. Pain-related stigma as a social determinant of health in diverse pediatric pain populations. FRONTIERS IN PAIN RESEARCH 2022; 3:1020287. [DOI: 10.3389/fpain.2022.1020287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/26/2022] [Indexed: 11/15/2022] Open
Abstract
Pediatric patients with invisible symptomology, such as chronic pain syndromes, are more likely to experience pain-related stigma and associated discrimination by others, including medical providers, peers, school personnel, and family members. The degree of this pain-related stigma may depend on several social dimensions, including observer (e.g., attentional and implicit biases) and patient characteristics (e.g., racial identity, socioeconomic stressors). In this mini-review, we introduce the concept of pain-related stigma, and the intersectionality of stigma, within the context of social determinants of health in pediatric pain populations. Stigma theory, observer attentional biases, healthcare provider implicit/explicit biases, adverse childhood experience, and psychophysiology of socio-environmental stressors are integrated. Several ethical, clinical, and research implications are also discussed. Because the study of pain-related stigma in pediatric pain is in its infancy, the purpose of this conceptual review is to raise awareness of the nuances surrounding this social construct, propose avenues through which stigma may contribute to health inequities, present frameworks to advance the study of this topic, and identify areas for further investigation.
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14
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Parsons RD, McParland JL, Halligan SL, Goubert L, Jordan A. Flourishing among adolescents living with chronic pain and their parents: A scoping review. PAEDIATRIC & NEONATAL PAIN 2022; 4:158-168. [PMID: 36618512 PMCID: PMC9798043 DOI: 10.1002/pne2.12088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/30/2022] [Accepted: 09/22/2022] [Indexed: 12/31/2022]
Abstract
Evidence exists regarding the impact of flourishing in individuals living with chronic pain, but there are currently no reviews which collate the literature on flourishing in adolescents living with chronic pain and their parents. Therefore, the aim of this scoping review was to map and review the current literature, to document how flourishing is defined and understood in the literature, and to identify gaps in the field. Six databases were searched (Web of Science, Medline, Embase, APA PsycNet and the Cochrane Central Register of Controlled Trials). In addition, a limited gray literature search was conducted. The resulting data were collated and reported in relation to the review questions, by examining the included papers to search for the presence of flourishing. Database searches resulted in 7326 papers after duplicate removal, with eight remaining papers being assessed for full-text eligibility. Following full-text screening, a final four papers were included in the review. Within the papers, flourishing was defined in relation to commonalities of benefit finding, enhanced maturity and growth, and social support. Gaps in the literature and directions for future research are considered. This review suggests that there is a dearth of knowledge and research regarding flourishing among adolescents living with chronic pain and their parents, despite aspects of flourishing identified in limited literature. This warrants further investigation.
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Affiliation(s)
- Ryan D. Parsons
- Department of PsychologyUniversity of BathBathUK,Centre for Pain ResearchUniversity of BathBathUK
| | | | - Sarah L. Halligan
- Department of PsychologyUniversity of BathBathUK,Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Liesbet Goubert
- Department of Experimental‐Clinical and Health PsychologyGhent UniversityGhentBelgium
| | - Abbie Jordan
- Department of PsychologyUniversity of BathBathUK,Centre for Pain ResearchUniversity of BathBathUK
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15
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The Effect of a Brief Physician-Delivered Neurobiologically Oriented, Cognitive Behavioural Therapy (Brief-CBT) Intervention on Chronic Pain Acceptance in Youth with Chronic Pain-A Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091293. [PMID: 36138601 PMCID: PMC9497203 DOI: 10.3390/children9091293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022]
Abstract
At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend the group outpatient Cognitive Behavioural Therapy (CBT) program, called Pain 101, or to individual outpatient CBT. It was hypothesized that a brief physician-delivered CBT (brief-CBT) intervention at first point of contact improves subsequent pain acceptance. Using a randomized double blinded methodology, 26 participants received a standard intake assessment and 26 the standard assessment plus the brief-CBT intervention. Measures were taken at three points: pre and post-intake assessment and after Pain 101 or individual CBT (or day 30 post-assessment for those attending neither). The primary outcome measure was the Chronic Pain Acceptance Questionnaire—Adolescent version (CPAQ-A). Comparing pre and post-intake measures, there was a significant (p = 0.002) increase in the CPAQ-A scores—four-fold more in the brief-CBT intervention group (p = 0.045). Anxiety (RCADS-T Score) was significantly reduced post-intake and significantly more reduced in the intervention group compared to the control group (p = 0.024). CPAQ-A scores were significantly increased (p < 0.001) (N = 28) and anxiety (RCADs-T) was significantly reduced by the end of Pain 101 (p < 0.003) (N = 29) as was fear of pain as measured by the Tampa Scale for Kinesiophobia (p = 0.021). A physician-delivered brief-CBT intervention significantly and meaningfully increased CPAQ-A scores and reduced anxiety in youth with chronic pain. Furthermore, CBT through Pain 101 is effective at increasing acceptance, as well as reducing anxiety and fear of movement.
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16
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Gremillion ML, Lang AC, Everhart SA, Davies WH, Stolzman SC, Weisman SJ, Hainsworth KR. Effects of Weight and Pain on Physical Activity: Insights from the Lived Experiences of Youth with Co-Occurring Chronic Pain and Obesity. Child Obes 2022; 18:301-308. [PMID: 34890258 DOI: 10.1089/chi.2021.0208] [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: 11/13/2022]
Abstract
Objective: Pediatric obesity and chronic pain are each associated with an increased risk for numerous poor physical and mental health outcomes. Co-occurring chronic pain and obesity (CPO) result in greater functional disability compared with either condition alone. The aim of the present study was to use qualitative methods to better understand the challenges experienced by adolescents with CPO, with a specific focus on physical activity. Methods: Semistructured interviews were conducted with 13 youth with CPO. Participants were questioned about pain, physical activity, coping strategies, and the perceived relationship between weight and pain. Interviews were audiorecorded, transcribed, and analyzed according to Interpretative Phenomenological Analysis. Results: Superordinate themes expressed by youth included: Impact of Chronic Pain on Relationships, Impact of Pain on Self-Perception, Using Food to Cope with Pain, Perceived Relationship between Pain and Weight after Onset of Pain, Attitudes toward Physical Activity, Barriers to Physical Activity, and Supports to Physical Activity. Conclusions: Participants identified challenges associated with CPO. Notably, participants identified pain as a greater barrier to exercise than weight, implicating the salience of chronic pain in the lives of youth with CPO. Furthermore, participants identified a desire to be more physically active, yet discussed struggles and concerns about attempts to increase their physical activity and indicated a desire for guidance about being more active. This study highlights the complexities of the relationship between CPO and underscores the importance of providers collaboratively working with patients to develop a practical plan to resume movement and physical activity.
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Affiliation(s)
- Monica L Gremillion
- Department of Anesthesiology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, USA
| | - Amy C Lang
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Samantha A Everhart
- Department of Psychology, Children's Hospital of Orange County, Orange, CA, USA
| | - W Hobart Davies
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Stacy C Stolzman
- Department of Physical Therapy, Concordia University Wisconsin, Mequon, WI, USA
| | - Steven J Weisman
- Department of Anesthesiology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, USA
| | - Keri R Hainsworth
- Department of Anesthesiology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI, USA
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17
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Neville A, Lund T, Soltani S, Jordan A, Stinson J, Killackey T, Birnie KA, Noel M. Pediatric Chronic Pain in the Midst of the COVID-19 Pandemic: Lived Experiences of Youth and Parents. THE JOURNAL OF PAIN 2022; 23:841-851. [PMID: 34915200 PMCID: PMC8710941 DOI: 10.1016/j.jpain.2021.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/16/2021] [Accepted: 11/18/2021] [Indexed: 01/23/2023]
Abstract
During the coronavirus 2019 (COVID-19) pandemic youth with chronic pain have experienced additional barriers to accessing treatment and managing their pain. This study explored the experiences of youth with chronic pain and their parents during the COVID-19 pandemic. Individual semi-structured interviews were conducted with 20 youth with chronic pain (aged 13-20 years) and one of their parents, recruited from a tertiary level pediatric chronic pain program. Interviews occurred between the months of June to August 2020 and enabled participants to describe their experiences of the COVID-19 pandemic according to their own unique perspectives. Transcripts were analyzed using inductive reflexive thematic analysis. Four themes were generated and labelled: "temporality, mental health, and pain," "coping with pain during a global pandemic," "impact on care," and "re-appraisal in the context of development and pandemic life." Across these themes, youth and parents described their unique challenges of living with pain as they adapted to changing circumstances of the COVID-19 pandemic. Notably, youth experienced increased difficulties managing their mental health and pain, which were intricately connected and related to social isolation, temporality, and uncertainty exacerbated by the COVID-19 pandemic. Restrictions due to the COVID-19 pandemic impacted youth's access to care and their abilities to engage in coping strategies to manage their pain. The COVID-19 pandemic was also perceived to have interrupted youth's development and growing autonomy, prompting youth to re-appraise their current circumstances and imagined futures. PERSPECTIVE: This manuscript provides an in-depth understanding of the impact of the COVID-19 pandemic on youth with chronic pain and their parents. Youth and their parents perceived the COVID-19 pandemic to have impacted youth's mental health, pain, socio-emotional development, and access to care.
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Affiliation(s)
- Alexandra Neville
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
| | - Tatiana Lund
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, UK
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Research Institute Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Research Institute Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Canada
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18
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Forgeron PA, Dick BD, Chambers C, Cohen J, Lamontagne C, Finley GA. Are They Still Friends? Friendship Stability of Adolescents With Chronic Pain: 1-Year Follow-Up. FRONTIERS IN PAIN RESEARCH 2022; 2:767236. [PMID: 35295468 PMCID: PMC8915730 DOI: 10.3389/fpain.2021.767236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/10/2021] [Indexed: 11/13/2022] Open
Abstract
Most adolescents identify their best friend as their main source of social support. Adolescents with chronic pain (ACP) report the loss of friendships due to pain. Friendships protect against loneliness and depression, yet adolescents with pain experience increased levels of loneliness and depression compared to peers. This longitudinal study examines the friendship stability of dyads that included an adolescent with chronic pain compared to non-pain friendship dyads as well as the factors contributing to a friendship breakup. Eighty-three participants from 61 same-sex friendship dyads across 3 sites participated in a 1-year follow-up survey designed to capture friendship features, indices of social-emotional well-being, pain characteristics, and friendship stability. Chi-square, repeated measures ANOVA, and logistic regression were used to analyze the data. Dyads that included an ACP experienced higher rates of friendship breakup. The shorter length of friendship and having chronic pain predicted a friendship breakup at time 2. ACP continues to experience worse scores on indices of social-emotional well-being that are not predicted with a friendship breakup. Understanding what contributes to positive long-term friendships for those with pain may inform strategies to maintain and improve friendships for those with pain and who experience social challenges.
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Affiliation(s)
- Paula A. Forgeron
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesia, Dalhousie University, Halifax, NS, Canada
- Children's Hospital of Eastern Ontario's Research Institute, Ottawa, ON, Canada
- *Correspondence: Paula A. Forgeron
| | - Bruce D. Dick
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Christine Chambers
- Pediatrics and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Psychology, Dalhousie University, Halifax, NS, Canada
| | - Janice Cohen
- Behavioural Neurosciences and Consultation Liaison Team, Mental Health, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Christine Lamontagne
- Children's Hospital of Eastern Ontario's Research Institute, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gordon Allen Finley
- Department of Anesthesia, Dalhousie University, Halifax, NS, Canada
- Psychology, Dalhousie University, Halifax, NS, Canada
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Joslin R, Donovan-Hall M, Roberts L. Exploring the Outcomes That Matter Most to Young People Treated for Chronic Pain: A Qualitative Study. CHILDREN 2021; 8:children8121170. [PMID: 34943368 PMCID: PMC8700210 DOI: 10.3390/children8121170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
Global and national policies state that all children and young people should be part of decision making and that outcomes that matter to them should take priority, yet patient-centred outcomes have been identified as a gap in the paediatric chronic pain literature. This study gave youths experiencing chronic pain a platform to have their views heard. Using novel methods, twenty-one young people, aged 11 to 18 years old, completed a semi-structured interview in which they constructed a timeline drawing to symbolise their treatment. They identified when aspects of their life changed (outcomes) and described the importance of these changes. Thematic analysis identified four themes that emerged at different stages of the treatment: “perfect storm”; “turning points”; “disconnect”; and; “free”. “Turning points” were points in time when the narrative of the young person took a turn in a different direction. At these points, the outcomes important to them also changed. Youths initially prioritised outcomes related to pain, then during treatment the focus became their emotional functioning, with role functioning and “going out” becoming the focus at the end. The stage of treatment as perceived by the young person impacted which outcomes mattered most.
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Affiliation(s)
- Rhiannon Joslin
- School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK; (M.D.-H.); (L.R.)
- Women’s and Children’s Department, University Hospitals Sussex, St. Richards Hospital, Chichester PO19 6SE, UK
- Correspondence:
| | - Maggie Donovan-Hall
- School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK; (M.D.-H.); (L.R.)
| | - Lisa Roberts
- School of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK; (M.D.-H.); (L.R.)
- Therapy Services Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
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20
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Wakefield EO, Belamkar V, Litt MD, Puhl RM, Zempsky WT. "There's Nothing Wrong With You": Pain-Related Stigma in Adolescents With Chronic Pain. J Pediatr Psychol 2021; 47:456-468. [PMID: 34871426 DOI: 10.1093/jpepsy/jsab122] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 10/20/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Adolescents with chronic pain often experience symptom disbelief and social rejection by others secondary to "medically unexplained" symptoms. Although chronic pain is common in adolescents, limited research has conceptualized these social experiences as pain-related stigma in this population. The purpose of this study was to identify and describe pain-related stigma among adolescents with chronic pain and their parents using focus group methodology. METHODS Five adolescent focus groups (N = 18; Age M = 15.33 years, SD = 1.28) and three parent focus groups (N = 9) were conducted. Directed content analysis was used to analyze focus group transcripts. Stigma categories were developed a priori (Felt Stigma, Anticipated Stigma, Internalized Stigma, Concealment, and Controllability) and new categories emerged during analysis. Two coders reached 87.16% agreement for all groups (adolescent group: 90.34%; Parent group: 79.55%) and consensus was achieved for discordant codes. RESULTS Adolescents and their parents endorsed pain-related stigma across all social domains. Analyses revealed four main categories for both groups (a) Felt Stigma (subcategories: pain dismissal, faking or exaggerating, and mental health stigma), (b) Anticipated Stigma and Concealment, (c) Internalized Stigma, and (d) Sources of Pain-Related Stigma (subcategories: pain invisibility, lack of chronic pain knowledge, lack of understanding, and controllability). CONCLUSIONS Adolescents with chronic pain experience pain-related stigma from medical providers, school personnel, family members, and peers, which may have negative social and health implications. More research is needed to evaluate the link between pain-related stigma and health outcomes for adolescents with chronic pain. Clinical approaches targeting pain-related stigma are discussed.
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Affiliation(s)
- Emily O Wakefield
- Divisions of Pain and Palliative Medicine and Pediatric Psychology, Connecticut Children's Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Vaishali Belamkar
- Department of Research, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Mark D Litt
- Division of Behavioral Science and Community Health, University of Connecticut Health Center, Farmington, CT, USA
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - William T Zempsky
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, CT, USA
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21
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Lafrenaye S, Dumas M, Gosselin É, Duhamel A, Bourgault P. Parents living with a child afflicted by a life-limiting medical condition: Typology of their narrative identity. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2021. [DOI: 10.4081/qrmh.2021.9174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parents of children suffering from a life-limiting medical condition struggle with difficult existential questions. Our objective was to understand why those parents’ interactions with the medical world were so different, ranging from hostile to collaborative, with the themes of identity, spirituality and serenity. A grounded theory design based on the narrative identity framework was used to interview sixteen parents. Three categories emerged: i) Parents in the Almighty category delegate all their power to God or medicine and are the most suffering parents as they do not author their life; ii) Parents in the Me category make every decision on their own causing much anxiety, and they become rebarbative to the medical world; iii) Parents in the Guide category take advice from others, while remaining the authors of their stories and are the most serene parents. Understanding and recognizing these categories can have a major impact on communication with those families.
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22
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Lynch Milder MK, Miller MM, Williams AE, Michel MA, Tolley J, Scott EL, Hirsh AT. Cross-Sectional Associations among Components of Injustice Appraisals and Functioning in Adolescents With Chronic Pain. J Pediatr Psychol 2021; 47:99-110. [PMID: 34472579 DOI: 10.1093/jpepsy/jsab083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Pain-related appraisals, including pain-related injustice, impact the development and maintenance of chronic pain. This cross-sectional study aimed to examine the relationship between the cognitive-emotional components of pain-related injustice-blame/unfairness and severity/irreparability of loss-and functioning in a mixed sample of adolescents with chronic pain. METHODS Pediatric patients age 11-18 years (N = 408) completed forms assessing pain-related injustice, pain intensity, and physical and psychosocial functioning as part of their routine assessment in a pediatric chronic pain clinic between January 2014 and January 2019. A series of hierarchical regressions were used to evaluate the relationships among the separate components of pain-related injustice appraisals and functioning. RESULTS Pain intensity and blame/unfairness appraisals were significantly associated with emotional functioning with blame/unfairness being the stronger association (β = -.27). Blame/unfairness appraisals, severity/irreparability appraisals, and pain intensity were significantly associated with physical functioning with pain intensity being the strongest association (β = .36). Pain intensity, blame/unfairness appraisals, and severity/irreparability appraisals were significantly associated with social functioning with blame/unfairness being the strongest association (β = -.34). Pain intensity and severity/irreparability appraisals were significantly associated with school functioning with severity/irreparability being the stronger association (β = -.19). CONCLUSIONS These results lend further support to incorporating pain-related injustice appraisals in standard clinical pain assessments. Treatment practices should target the specific injustice appraisals and domains of functioning impacted for each pediatric patient with chronic pain.
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Affiliation(s)
- Mary K Lynch Milder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Megan M Miller
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Amy E Williams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.,Indiana University Health Physicians, Indianapolis, IN, USA
| | - Martha A Michel
- Indiana University Health Physicians, Indianapolis, IN, USA.,Department of Anesthesiology Pediatric Division, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - James Tolley
- Department of Anesthesiology Pediatric Division, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA.,Department of Anesthesiology Pediatric Division, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eric L Scott
- Department of Pediatrics and Anesthesiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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23
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Wakefield EO, Puhl RM, Litt MD, Zempsky WT. "If It Ever Really Hurts, I Try Not to Let Them Know:" The Use of Concealment as a Coping Strategy Among Adolescents With Chronic Pain. Front Psychol 2021; 12:666275. [PMID: 34149560 PMCID: PMC8209248 DOI: 10.3389/fpsyg.2021.666275] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective Despite considerable evidence of chronic pain in adolescents, and its adverse consequences for their health and well-being, less is known about pain-related stigma that these youth face, such as pain disbelief by others. Adolescents with chronic pain may conceal their symptoms as a coping strategy to avoid pain-related stigma, contributing to further social isolation and disruptions in medical treatment. In the current study, we used focus group methodology to examine adolescent motivations for using concealment and the possible benefits and harmful consequences of this form of coping. Materials and Methods Five focus groups of 3–5 adolescents (ages 12–17) with chronic pain conditions (N = 18) were conducted as a part of a larger study to evaluate the impact of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric pain management clinic. Transcripts of focus group sessions were analyzed using directed content analysis for the main study, yielding anticipatory stigma and concealment categories. These categories were then explored using inductive content analysis for the current study. Results Adolescents described engaging in concealment of their pain symptoms. Our analysis revealed three social motivations for concealment: (1) avoidance of judgment; (2) avoidance of being a social burden; and (3) desire to be treated normally, and two harmful consequences of concealment: (1) social isolation and (2) cognitive burden. Conclusion Disbelief of pain symptoms may exacerbate the social isolation and disease-related burden in this population. Clinical implications of concealing pain symptoms are discussed, and points of intervention are proposed.
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Affiliation(s)
- Emily O Wakefield
- Division of Pain and Palliative Medicine, Connecticut Children's, Hartford, CT, United States.,Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, CT, United States
| | - Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, United States.,Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, United States
| | - Mark D Litt
- Division of Behavioral Science and Community Health, University of Connecticut Health Center, Farmington, CT, United States
| | - William T Zempsky
- Division of Pain and Palliative Medicine, Connecticut Children's, Hartford, CT, United States.,Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, CT, United States
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24
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Fegran L, Johannessen B, Ludvigsen MS, Westergren T, Høie M, Slettebø Å, Rohde G, Helseth S, Haraldstad K. Experiences of a non-clinical set of adolescents and young adults living with persistent pain: a qualitative metasynthesis. BMJ Open 2021; 11:e043776. [PMID: 33875442 PMCID: PMC8057544 DOI: 10.1136/bmjopen-2020-043776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Around 15%-30% of adolescents and young adults (AYAs) experience persistent or chronic pain. The purpose of this study was to synthesise evidence from qualitative primary studies on how AYAs in a non-clinical population experience living with persistent pain. METHOD A qualitative metasynthesis guided by Sandelowski and Barroso's guidelines was used. The databases Medline, Embase, Cinahl, PsycINFO, Mednar and ProQuest were searched for studies from 1 January 2005 to 15 February 2021. Inclusion criteria were AYAs aged 13-24 years with first-hand experience of living with persistent, recurrent or episodic non-clinical pain in any body site. Pain associated with a medical diagnosis, malignant diseases, medical procedures or sport activities was excluded. RESULTS Of 2618 screened records, data from nine studies conducted in a Western cultural context including 184 participants (127 female and 57 male aged 11-28 years) were analysed into metasummaries and a metasynthesis. Headaches was the most focused pain condition (n=5), while three of the studies did not specify type of pain. The participants' experiences were characterised by (1) juggling pain with everyday life; (2) exploring sources of information to manage pain; (3) AYAs' use of medication to find relief and (4) non-pharmacological strategies for pain relief. CONCLUSION These AYAs experience of how pain influences everyday life, and their striving to find relief from pain by support from family, friends, professionals and the Internet should be strongly respected. Public health nurses and other healthcare professionals encountering AYAs need to respect their pain experiences, and to support them in healthy coping strategies. Further studies on this issue are needed, especially research focusing on AYAs pain in exposed populations and AYAs from non-Western cultures.
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Affiliation(s)
- Liv Fegran
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Vest-Agder, Norway
- Department of Pediatrics, Sørlandet Sykehus HF, Kristiansand, Norway
| | - Berit Johannessen
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Vest-Agder, Norway
| | - Mette Spliid Ludvigsen
- Department of Clinical Medicine, Randers Regional Hospital, Randers, Midtjylland, Denmark
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - Thomas Westergren
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Vest-Agder, Norway
| | - Magnhild Høie
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Åshild Slettebø
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Gudrun Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Vest-Agder, Norway
- Department of Clinical Research, Sørlandet Sykehus HF, Kristiansand, Norway
| | - Sølvi Helseth
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kristin Haraldstad
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Vest-Agder, Norway
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25
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Ndengeyingoma A, Lebel V, Bigras M, Jacob MH, Lacelle M. Youngsters' perceptions of the experience of pain and utilisation of over-the-counter pain medication as needed in community: A qualitative study. J SPEC PEDIATR NURS 2021; 26:e12323. [PMID: 33393731 DOI: 10.1111/jspn.12323] [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: 06/01/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Pain is common in youngsters. No matter its nature, youngsters' consideration of pain is complex since its communications vary as a function of several components. The aim of this study is to explore the youngsters' perception linked to their experience of physiological pain at the home/family setting, as well as their experience with the utilisation of over-the-counter pain medication as needed. DESIGN AND METHODS A qualitative exploratory study was undertaken with 22 youngsters aged 5-17 years old. Semidirected interviews led to the understanding of these components by means of the pain experiences. Thematic analysis allowed the detection of the themes and subthemes emerging from the verbatim collected with the participants. RESULTS The way pain is described is influenced by the child's development, previous experiences, and the projection of having pain. The pain communication is influenced by the severity perceived, the beliefs of the youngster experiencing pain, the comparison of the pain communication with his brothers and sisters, as well as the anticipated consequences of expressing his pain. The choice of behaviour towards pain is influenced by self-management through nonpharmacological management, with medicines if needed, and by family modelization. PRACTICE IMPLICATIONS This study confirms that previous pain experiences, beliefs related to pain tolerance and intended reactions of parents exert influence not only on the communication of pain, but also on youngsters' behaviour towards pain. It is important to consider these elements whenever youngsters' pain is evaluated.
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Affiliation(s)
| | - Valérie Lebel
- Department of Nursing, Université du Quebec en Outaouais, St-Jerome, Quebec, Canada
| | - Magali Bigras
- Centre intégré de santé et de services sociaux de l'Outaouais, GMF Universitaire de Gatineau, Gatineau, Quebec, Canada
| | - Maria H Jacob
- Department of Nursing, Université du Quebec en Outaouais, Gatineau, Québec, Canada
| | - Marika Lacelle
- Centre intégré de santé et de services sociaux de l'Outaouais, GMF Universitaire de Gatineau, Gatineau, Quebec, Canada
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26
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Corey JR, Heathcote LC, Mahmud F, Kronman C, Mukerji C, McGinnis E, Noel M, Sieberg C, Simons LE. Longitudinal Narrative Analysis of Parent Experiences During Graded Exposure Treatment for Children With Chronic Pain. Clin J Pain 2021; 37:301-309. [PMID: 33555695 PMCID: PMC7953686 DOI: 10.1097/ajp.0000000000000921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Parents have a vital influence over their child's chronic pain treatment and management. Graded exposure in vivo treatment (GET) is emerging as a promising intervention for youth with chronic pain. Yet, little is known about how parents perceive GET and its impact on their child's pain condition. This study aimed to characterize caregivers' experiences over the course of their child's GET using longitudinal coding and thematic analysis of parent narratives. MATERIALS AND METHODS Parent narratives of 15 youth who participated in GET for pediatric chronic pain (GET Living) were elicited from an unstructured dialogue at the start of each treatment session held between the parent(s) and pain psychologist. Narratives were coded for affect and content, and trends were examined in these codes across sessions. Common themes in parent narratives were developed through inductive thematic analysis. RESULTS Parents showed an increase in positive affect, treatment confidence, and optimism over the course of treatment. Narratives also expressed more benefit-finding/growth and less anxiety and protectiveness across GET sessions, with more parents having a resolved orientation towards their child's pain by the final session. Five common themes were generated: Self-Awareness, Understanding of Their Child's Perspective, Perceived Treatment Benefit, Internalization of Treatment Principles, and Hopeful Concern for the Future. DISCUSSION Analysis of parent narratives provides a rich and unique method for understanding a parent's journey during their child's chronic pain treatment. Clinical application of our findings can be used to guide future developments of targeted topics and interventions in the context of parenting a child with chronic pain.
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Affiliation(s)
- Jenelle R. Corey
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School
| | - Lauren C. Heathcote
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | - Farah Mahmud
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital
| | - Corey Kronman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
| | | | - Ellen McGinnis
- Department of Psychiatry, University of Vermont Medical Center
| | - Melanie Noel
- Department of Psychology, University of Calgary; Alberta Children’s Hospital Research Institute; Hotchkiss Brain Institute
| | - Christine Sieberg
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School
- P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine
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27
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Cooke M, Richards J, Tjondronegoro D, Raj Chakraborty P, Jauncey-Cooke J, Andresen E, Theodoros J, Paterson R, Schults J, Raithatha B, Wilson S, Alcock M. myPainPal: Co-creation of a mHealth app for the management of chronic pain in young people. Inform Health Soc Care 2021; 46:291-305. [PMID: 33784952 DOI: 10.1080/17538157.2021.1892697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Chronic pain is common in young people aged 10-14 years. Interdisciplinary, clinician-delivered treatments, while effective, are often criticized for failing to be readily accessible. Mobile health applications (mHealth apps) have been proposed as effective treatment adjuncts that address these challenges, while meeting the needs of tech-savvy young people. The objectives of this study were to co-create a mHealth app with consumers and health care professionals and evaluate the acceptability and feasibility of the resulting mHealth app (myPainPal). A phased, qualitative approach within a consumer engagement framework was employed. Interviews with young people (n = 14), parents (n = 12) and health care professionals (n = 8) identified key health needs that formed the underlying structure of the myPainPal app. Testing showed that the app is an acceptable and feasible platform to facilitate young people's self-management of chronic pain. The myPainPal app has the potential to positively influence young people's experiences of chronic pain. Further testing in controlled settings is required.
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Affiliation(s)
- Marie Cooke
- Griffith University, Menzies Health Institute Queensland, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Julianne Richards
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | | | | | | | - Elizabeth Andresen
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Joanne Theodoros
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Rebecca Paterson
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | - Jessica Schults
- Griffith University, Menzies Health Institute Queensland, Brisbane, Australia.,School of Nursing and Midwifery, Griffith University, Brisbane, Australia.,Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Brisbane, Australia
| | - Bhavesh Raithatha
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Susan Wilson
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Mark Alcock
- Queensland Interdisciplinary Paediatric Persistent Pain Service (QIPPPS), Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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28
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Jones A, Caes L, McMurtry CM, Eccleston C, Jordan A. Sociodevelopmental Challenges Faced by Young People with Chronic Pain: A Scoping Review. J Pediatr Psychol 2021; 46:219-230. [PMID: 33211876 DOI: 10.1093/jpepsy/jsaa101] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/21/2020] [Accepted: 10/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Map the current literature investigating autonomy development, identity development, and peer relationships in young people aged 10-24 years with chronic pain. METHODS A scoping review method was used to systematically search four databases (APA PsycNET, PubMed, Web of Science, and Cinahl) for peer-reviewed articles. Search results were screened against inclusion and exclusion criteria to ensure they met the objective. Eligible papers were assessed for quality, their data relating to the objective were extracted, and results are synthesized. RESULTS Searches returned 3,815 papers after the removal of duplicates, with 42 papers included in the full review. The majority of papers investigated peer relationships (86%). Fewer papers investigated autonomy (43%) and identity (21%) development. Included papers were mostly quantitative (64%), with fewer qualitative (34%) and mixed-methods papers (2%). Overall, we found bidirectional relationships between chronic pain in young people, their social development, and a range of functional outcomes. However, the mechanisms underlying these relationships remain relatively unexplored. CONCLUSIONS Review results are mapped onto the model proposed by Palermo et al. (2014). Guided by this model, clinical treatment for young people with chronic pain should consider social development. The model also sets out a future research agenda focused on exploring: (a) identity development, (b) the mechanisms underlying the relationships between social-developmental domains, pain, and outcomes, (c) a variety of participants and populations, and (d) a variety of methods, including longitudinal study designs.
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Affiliation(s)
- Abigail Jones
- Department of Psychology, University of Bath.,Centre for Pain Research, University of Bath
| | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph.,Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath.,Department of Health, University of Bath
| | - Abbie Jordan
- Department of Psychology, University of Bath.,Centre for Pain Research, University of Bath
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29
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Hurtubise K, Brousselle A, Noel M, Jordan A, White J, Rasic N, Camden C. Youth and parent perceptions on participating in specialized multidisciplinary pain rehabilitation options: A qualitative timeline effect analysis. Can J Pain 2021; 5:1-21. [PMID: 33987520 PMCID: PMC7951173 DOI: 10.1080/24740527.2020.1858709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/12/2022]
Abstract
Background: Little is known about how the specialized treatment journey is perceived by youth with pain-related disability and their parents. Aims: Describe and compare the treatment effects and outcomes as perceived by youth and their parents enrolled in intensive interdisciplinary pain treatment (IIPT) or multimodal treatment (MMT). Methods: Eleven IIPT youth and five parents and three MMT youth and five parents were recruited. All were asked to complete a treatment journey timeline, followed by separately conducted semistructured interviews. Transcribed interviews were analyzed using reflective thematic analysis. Results: The main themes spanned the treatment trajectory. All participants described similar initial struggles (Theme 1). Positive and negative treatment effects associated with acquisitions and disruptions (Theme 2), and outcomes post-discharge related to supports and realities (Theme 3) emerged. Knowledge, skills, and support acquisition during treatment and feeling empowered and confident to self-manage postdischarge were identified as IIPT benefits. However, the change effort and life disruptions required and the difficulty transitioning to real life postprogram were acknowledged as detrimental IIPT impacts. Continuing with life as usual and maintaining supports in daily contexts (e.g., school personnel, friends) were reported MMT benefits. However, the challenges of managing pain, treatment adherence within the competing demands of daily realities, and the lack of support to integrate strategies were emphasized as detrimental MMT impacts. Conclusions: Detailed impacts of two specialized multidisciplinary pain rehabilitation interventions on the lives of youth with pain-related disability and their parents are described. The treatments benefits and previously unexplored detrimental effects are unveiled.
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Affiliation(s)
- Karen Hurtubise
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Astrid Brousselle
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- School of Public Administration, University of Victoria, Victoria, British Columbia, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Health Research Innovation Centre, Calgary, Alberta, Canada
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, UK
| | - Jo White
- Department of Health and Social Sciences, University of the West of England–Bristol, Bristol, UK
| | - Nivez Rasic
- Department of Anesthesia & Pain Medicine, Foothills Hospital, Calgary, Alberta, Canada
| | - Chantal Camden
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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30
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Rafaelli de Carvalho D, Araújo de Castro L, Morita AA, Loyola WS, Fujisawa DS, Probst VS. The impact of chronic obstructive pulmonary disease in patients' lives: The perception of the health professionals. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 26:e1886. [PMID: 33164269 DOI: 10.1002/pri.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 09/15/2020] [Accepted: 10/12/2020] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The perception of health professionals about chronic obstructive pulmonary disease (COPD) has not been thoroughly investigated. OBJECTIVE To analyze the perception of health professionals about the impact of COPD on the lives of affected individuals. MATERIALS AND METHODS Qualitative and cross-sectional study with five health professionals: two nurses, two physiotherapists, and one medical doctor. They participated in a focus group (FG) session, with semistructured questions covering: definition of COPD, activities of daily living (ADL), and physical activity of daily living (PADL), as well as the importance of these outcomes in the lives of individuals with COPD. DATA ANALYSIS The FG was recorded, transcribed, and analyzed according to the content analysis. RESULTS The FG highlighted four main themes: physical-functional and emotional impairment of individuals, the importance of patient-health professional contact, repercussions of COPD on the patients' physical activity, and strategies for promoting physical activity. Based on the four themes exposed, the health professionals reported that there is a progression in the lives of individuals' with COPD, which is divided into three phases: adaptation, reluctance, and dependence. CONCLUSION There was a negative perception of the health professionals regarding the functionality and emotion of patients with COPD. Emotional aspects, family support, and architectural structure can positively or negatively influence patients' ADL and PADL. Finally, there was a perception of progression in the life of patients with COPD, since their initial adaptation, evolving to physical and emotional dependence.
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Affiliation(s)
- Débora Rafaelli de Carvalho
- Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil.,Physiotherapy Department, Masters and Doctoral Programme in Rehabilitation Sciences, Londrina State University and University of North Parana, Londrina, Brazil
| | - Larissa Araújo de Castro
- Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil.,Physiotherapy Department, Masters and Doctoral Programme in Rehabilitation Sciences, Londrina State University and University of North Parana, Londrina, Brazil
| | - Andrea Akemi Morita
- Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil.,Physiotherapy Department, Masters and Doctoral Programme in Rehabilitation Sciences, Londrina State University and University of North Parana, Londrina, Brazil
| | - Walter Sepúlveda Loyola
- Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil.,Physiotherapy Department, Masters and Doctoral Programme in Rehabilitation Sciences, Londrina State University and University of North Parana, Londrina, Brazil
| | - Dirce Shizuko Fujisawa
- Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil.,Physiotherapy Department, Masters and Doctoral Programme in Rehabilitation Sciences, Londrina State University and University of North Parana, Londrina, Brazil
| | - Vanessa Suziane Probst
- Centre of Research and Post-Graduation in Health Sciences, Londrina State University, Londrina, Brazil.,Physiotherapy Department, Masters and Doctoral Programme in Rehabilitation Sciences, Londrina State University and University of North Parana, Londrina, Brazil
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31
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Jacobs K, Smith A, Heathcote LC, Caes L. Which passengers are on your bus? A taxonomy of the barriers adolescents with chronic pain face in achieving functional recovery. Eur J Pain 2020; 25:348-358. [PMID: 33063388 DOI: 10.1002/ejp.1673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite evidence that intensive interdisciplinary pain treatment (IIPT) is effective in facilitating functional recovery in adolescents with chronic pain, engagement with IIPT is suboptimal among adolescents. A key aspect of IIPT is to support functional recovery via (re)engagement with age-appropriate daily activities. The aim of this study was to gain a comprehensive insight into adolescents' perceptions of the barriers they need to overcome to engage with age-appropriate activities in order to achieve functional recovery. METHODS Forty-one adolescents who were starting an IIPT programme completed the 'passenger-on-the-bus metaphor', an exercise in which they identify and describe their perceived barriers (i.e. 'passengers' on their bus) that prevent them from engaging with age-appropriate activities. The responses were analysed using inductive thematic analyses to generate a taxonomy of perceived barriers to functional recovery. RESULTS We generated a taxonomy of seven different barriers that participants described facing on their road to functional recovery: physical constraints, being 'fed up', low self-confidence and self-esteem, perfectionism, avoidance of engagement with pain, feelings (such as sadness, anger, guilt, anxiety) and social barriers (received from a range of sources such as parents, friends, school and wider society). CONCLUSION The findings reveal a variety of barriers that were perceived to hinder functional recovery through reduced engagement with age-appropriate activities and thereby hamper progress within IIPT. The Passenger on the bus metaphor can be used to identify similar barriers faced by adolescents in an individualized treatment approach, thereby making it possible for clinicians to target their IIPT more precisely.
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Affiliation(s)
- Konrad Jacobs
- Oxford Centre for Children and Young People in Pain, Oxford University Hospitals, Oxford, UK.,Department of Children's Psychological Medicine, Children's Hospital, Oxford, UK
| | - Alisha Smith
- Oxford Centre for Children and Young People in Pain, Oxford University Hospitals, Oxford, UK
| | - Lauren C Heathcote
- Department of Anaesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
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Khanom S, McDonagh JE, Briggs M, Bakir E, McBeth J. Adolescents' experiences of fluctuating pain in musculoskeletal disorders: a qualitative systematic review and thematic synthesis. BMC Musculoskelet Disord 2020; 21:645. [PMID: 33008357 PMCID: PMC7532580 DOI: 10.1186/s12891-020-03627-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/02/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Adolescents with chronic musculoskeletal pain experience daily fluctuations in pain. Although not all fluctuations are bothersome, pain flares are a distinct type of symptom fluctuation with greater impact. Since literature on the experience of pain flares is non-existent, the aim of this review was to (i) synthesise the qualitative literature on adolescents' experiences of fluctuating pain in musculoskeletal disorders in order to (ii) identify knowledge gaps to inform future research on pain flares. METHODS Electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO), grey literature and reference lists were searched from inception to June 2018 for qualitative studies reporting adolescents' experiences of pain. Comprehensiveness of reporting was assessed using the Consolidated Criteria for Reporting Qualitative Health Research. Studies were analysed using thematic synthesis. RESULTS Of the 3787 records identified, 32 studies (n = 536) were included. Principal findings were synthesised under three key themes: 1) symptom experience, 2) disruption and loss, and 3) regaining control. The first theme (symptom experience) describes adolescent's perception and interpretation of pain fluctuations. The second theme (disruption and loss) describes the physical, social and emotional constraints faced as a result of changes in pain. The third theme (regaining control) describes coping strategies used to resist and accommodate unpredictable phases of pain. Each theme was experienced differently depending on adolescents' characteristics such as their developmental status, pain condition, and the duration of the pain experience. CONCLUSIONS Adolescents with chronic musculoskeletal pain live with a daily background level of symptoms which frequently fluctuate and are associated with functional and emotional difficulties. It was not clear whether these symptoms and challenges were experienced as part of 'typical' fluctuations in pain, or whether they reflect symptom exacerbations classified as 'flares'. Further research is needed to explore the frequency and characteristics of pain flares, and how they differ from their typical fluctuations in pain. The review also highlights areas relating to the pain experience, symptom management and health service provision that require further exploration to support more personalised, tailored care for adolescents with chronic musculoskeletal pain.
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Affiliation(s)
- Sonia Khanom
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michelle Briggs
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ebru Bakir
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John McBeth
- Centre for Epidemiology Versus Arthritis , School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, 2.706 Stopford Building, Oxford Road, Manchester, M13 9PT, UK
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Woodgate RL, Tennent P, Barriage S, Legras N. The lived experience of anxiety and the many facets of pain: A qualitative, arts-based approach. Can J Pain 2020; 4:6-18. [PMID: 33987507 PMCID: PMC7942822 DOI: 10.1080/24740527.2020.1720501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/10/2020] [Accepted: 01/21/2020] [Indexed: 01/22/2023]
Abstract
Background: Findings reported in this article emerged from the study titled "Youth's Voices: Their Lives and Experiences of Living with an Anxiety Disorder." Though the initial focus of this study was not on the pain experiences of youth living with an anxiety disorder, it became apparent from the very first interviews that pain and suffering was key in the youth lived experience, permeating their everyday lives and impeding their participation and functioning in the world. Aims: The aim of this article is to highlight the ways in which pain is a central experience for young people living with an anxiety disorder. Methods: The study was approached from the qualitative research design of hermeneutic phenomenology. Fifty-eight young people who were living with anxiety disorders and their parents participated in the study. Youth took part in multiple qualitative open-ended interviews and the participatory arts-based method of photovoice. Themes were developed using van Manen's method of data analysis. Results: The overall theme emerged as "anxiety is very much about pain." The four subthemes are (1) embodied experience of anxiety: physical pain; (2) a prominent symptom of anxiety: mental-emotional pain; (3) difficult interpersonal relationships: social pain; and (4) articulating their pain. Conclusions: Use of qualitative, arts-based methodologies provided the opportunity and space for youth with anxiety to articulate their multifaceted experience with pain in their own words. This work reinforces the need for use of qualitative approaches to understanding pain experiences in young people.
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Affiliation(s)
- Roberta Lynn Woodgate
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pauline Tennent
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Barriage
- School of Information Science, College of Communication & Information, University of Kentucky, Lexington, Kentucky, USA
| | - Nicole Legras
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Loss-adjusting: Young People's Constructions of a Future Living With Complex Regional Pain Syndrome. Clin J Pain 2020; 36:932-939. [PMID: 32925189 DOI: 10.1097/ajp.0000000000000880] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that can present specific difficulties when occurring in adolescence. There is limited work exploring future narratives of healthy adolescents, and how these may differ for those who have chronic health conditions, but there is no research on the future narratives of adolescents who have CRPS. MATERIALS AND METHODS In this study, 50 adolescents (44 females, 5 males, 1 preferred not to say) aged 14 to 25 years (mean=19.8, SD=3.68), completed an online story completion task, with a further sample of 10 completing a follow-up telephone interview. RESULTS Story completion data were initially analyzed deductively based on the work of Morley and colleagues using hoped-for and feared-for future codes, revealing higher instances of hope (291 over 48 stories) than fear (99 over 27 stories). These codes were subsequently analyzed alongside the in-depth interview data using inductive thematic analysis, generating 2 themes that represent distinct, yet related, approaches of how adolescents incorporate CRPS into their future narratives: (1) the centrality of loss theme identifies the ways some adolescents described how CRPS brings loss, with narratives focused on how these adolescents imagine such losses continuing into the future, and (2) the adjusting to loss theme illustrates the ways other adolescents were able to imagine a future in which they were able to adjust to the losses which CRPS may bring. DISCUSSION CRPS may damage the future plans of adolescents. However, being or learning how to be flexible about these goals, may help them to build more positive future narratives.
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Pas R, Rheel E, Van Oosterwijck S, Foubert A, De Pauw R, Leysen L, Roete A, Nijs J, Meeus M, Ickmans K. Pain Neuroscience Education for Children with Functional Abdominal Pain Disorders: A Randomized Comparative Pilot Study. J Clin Med 2020; 9:jcm9061797. [PMID: 32526929 PMCID: PMC7356615 DOI: 10.3390/jcm9061797] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
This article explores the effectiveness of a newly developed Pain Neuroscience Education program for children (PNE4Kids) with functional abdominal pain disorder (FAPD). Children (6–12 years) with FAPD were randomly assigned to 1) the experimental group (n = 14), participating in one hypnotherapy session (i.e., usual care) and one additional PNE4Kids session, or 2) the control group (n = 14), participating in two hypnotherapy sessions. Parental pain catastrophizing, the child’s functional disability (parental-proxy), pain-related fear (parent-proxy) and pain intensity, were assessed at baseline and one and three weeks after each therapy session. Pressure algometry and a conditioned pain modulation paradigm were performed at baseline and three weeks after completion of the last therapy session. Parents from both the experimental as well as the control group showed significantly less parental pain catastrophizing (p < 0.01). Children showed significantly less functional disability (p < 0.05), pain-related fear (p < 0.01) and local pressure pain sensitivity (p < 0.05) at short-term follow-up (three weeks after last intervention) in both groups. No significant (p > 0.05) between-group differences were found. Hypnotherapy combined with PNE4Kids did not result in better clinical outcomes compared to hypnotherapy alone. Study limitations include the application of one single PNE4Kids session and the short follow-up time.
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Affiliation(s)
- Roselien Pas
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Correspondence: ; Tel.: +32-(0)2-477-45-29
| | - Emma Rheel
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Sophie Van Oosterwijck
- Pain in Motion International Research Group;
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
| | - Anthe Foubert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Pain in Motion International Research Group;
| | - Robby De Pauw
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Laurence Leysen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ann Roete
- Antwerp University Hospital, department of Pediatrics, 2610 Wilrijk, Belgium;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Mira Meeus
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
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Nieto R, Sora B, Boixadós M, Ruiz G. Understanding the Experience of Functional Abdominal Pain Through Written Narratives by Families. PAIN MEDICINE 2020; 21:1093-1105. [PMID: 31361016 DOI: 10.1093/pm/pnz147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although functional abdominal pain (FAP) is one of the most common pain problems in children, there is a lack of qualitative studies on this topic. Our aim was to increase knowledge in this field by testing an innovative written narrative methodology designed to approach the experiences of children with FAP and their parents. METHODS We analyzed the FAP experiences of 39 families who completed a written narrative task (children and parents separately). Some of the families (N = 20) had previously completed an online psychosocial intervention, whereas others had not, because a complementary objective was to explore possible differences between parent and child narratives, and between those who had and had not completed the intervention. RESULTS Families wrote about abdominal pain (characteristics, triggers, pain consequences, and coping strategies), their well-being, the diagnostic process, future expectations, and the positive effects of an online psychosocial intervention. Children tended to mention pain characteristics more, whereas parents tended to write more about triggers and the diagnostic process. CONCLUSIONS A written narrative methodology was found to be a useful approach for understanding families' experiences. Results confirmed that FAP affects families at the emotional, behavioral, and social levels and that an online psychosocial intervention can help families.
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Affiliation(s)
| | - Beatriz Sora
- eHealth Lab, Faculty of Psychology and Education
| | - Mercè Boixadós
- PSiNET Research Group, Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Shorey S, Ng ED. The Lived Experiences of Children and Adolescents with Non-Communicable Disease: A Systematic Review of Qualitative Studies. J Pediatr Nurs 2020; 51:75-84. [PMID: 31926405 DOI: 10.1016/j.pedn.2019.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/13/2019] [Accepted: 12/20/2019] [Indexed: 12/15/2022]
Abstract
PROBLEM Children and adolescents with non-communicable disease face more difficulties in achieving developmental milestones than their healthy peers, which affect their life and overall wellbeing. A non-disease-specific approach is important in identifying common challenges faced by children and adolescents across multiple non-communicable diseases. ELIGIBILITY CRITERIA Qualitative studies reporting first-hand accounts of children and adolescents aged 4 to19 years with non-communicable disease. SAMPLE A library search was conducted in five electronic databases (CINAHL, Embase, PsycINFO, PubMed, Scopus, and ProQuest Dissertations and Theses) for original qualitative English language papers. Fifty-five articles met the inclusion criteria and were subjected to a two-step meta-synthesis. RESULTS Initial reports of negative emotional experiences and disease perceptions were mixed with gradual acceptances of their diseases and positive coping strategies. Children and adolescents with non-communicable disease all desired a normal life, but physical limitations often led to social exclusions and self-imposed restrictions. Although most were highly appreciative of the support received from family, friends, and healthcare providers, they still struggled with disease management, the need for autonomy, and the fear of illness disclosure. CONCLUSIONS The impacts of non-communicable disease on children and adolescent's lives suggest a need for joint efforts between parents, clinicians, and educators to ensure children and adolescents' positive development of the self, acceptance and positive coping. IMPLICATIONS This review is able to inform the development of future educational and psychosocial intervention programs in the school and healthcare setting, and also encourages a revision of education policies to be more flexible and accommodating.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Esperanza Debby Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Neville A, Jordan A, Beveridge JK, Pincus T, Noel M. Diagnostic Uncertainty in Youth With Chronic Pain and Their Parents. THE JOURNAL OF PAIN 2019; 20:1080-1090. [DOI: 10.1016/j.jpain.2019.03.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 01/29/2019] [Accepted: 03/15/2019] [Indexed: 12/11/2022]
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Characterizing Social and Academic Aspects of School Anxiety in Pediatric Chronic Pain. Clin J Pain 2019; 35:625-632. [DOI: 10.1097/ajp.0000000000000720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tran ST, Koven ML, Castro AS, Goya Arce AB, Carter JS. Sociodemographic and Environmental Factors are Associated with Adolescents' Pain and Longitudinal Health Outcomes. THE JOURNAL OF PAIN 2019; 21:170-181. [PMID: 31255798 DOI: 10.1016/j.jpain.2019.06.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 02/04/2023]
Abstract
Research in adult populations indicates that several sociodemographic and environmental variables increase risk for pain and poor outcomes. There is little research exploring the impact of household income, health insurance coverage, barriers to health care, neighborhood and school safety, violence experienced, and neighborhood isolation on pediatric chronic pain. Data from the Add Health Study, a longitudinal examination of a nationally-representative adolescent sample were analyzed. The relationships between demographic variables, risk factors, chronic pain, and long-term health outcomes were examined. Adolescents with chronic pain had lower income, more health care barriers, greater safety concerns, and experienced more violence compared to those without pain. In a model together, female sex, White race/ethnicity, and greater health care barriers, safety concerns, and violence exposure conferred significant risk for chronic pain. Additional analyses revealed nuances in the strength of risk factors between racial/ethnic groups. Systemic health care barriers were significantly associated with chronic pain and may delay symptom alleviation and return to functioning. Considering access to care is necessary in prevention efforts. Among adolescents with chronic pain, greater safety concerns predicted poor mental health outcomes, particularly for White females. The cumulative stress of environmental concerns, such as safety, and managing chronic pain may worsen functioning. PERSPECTIVE: Adolescents with chronic pain had lower income, and more health care barriers, safety concerns, and violence exposure compared to those without chronic pain. Access to care is a significant problem in youth with chronic pain. The relationships between race/ethnicity, risk factors, and health outcomes are complex and require additional research.
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Affiliation(s)
- Susan T Tran
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois.
| | - Marissa L Koven
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois
| | - Ashley S Castro
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois
| | - Ana B Goya Arce
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois
| | - Jocelyn S Carter
- Department of Psychology, DePaul University, Cook County, Chicago, Illinois
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Ebrahimpour F, Pashaeypoor S, Salisu WJ, Cheraghi MA, Sadat Hosseini AS. Children's description of pain through drawings and dialogs: A concept analysis. Nurs Open 2019; 6:301-312. [PMID: 30918682 PMCID: PMC6419297 DOI: 10.1002/nop2.211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/16/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022] Open
Abstract
AIM To present a concept analysis of pain in children's drawings and dialogs. INTRODUCTION The complexity and subjectivity of the concept of pain in children remain ambiguous. As a result, children are exposed to inappropriate diagnosis and inadequate treatment. Children can describe or draw their painful experiences. Analysing the concept of pain based on children's experiences can help identify, assess and properly manage and treat pain in children. DESIGN Concept analysis. METHODS Walker and Avant's framework for concept analysis was used in this current study. RESULTS Major aspects of pain revealed in this concept analysis are affected by children's different concerns about pain. The description of pain in children with chronic diseases or chronic pain is completely different from that in healthy children. Children perceive pain to be internal, external and emotional. Pain in children is associated with poor psychological and emotional conditions, which add new features and aspects to the concept of pain. Children's descriptions and drawings of pain indicate different concepts of pain in their minds. From the perspective of children, pain has an identity that is formed based on reality. CONCLUSION When developing pain evaluation tools, it is necessary to address the characteristics of pain. In the case of chronic pain, emotional effects of pain on children's psyche need extra attention. Child-based pain management guidelines can then be formulated with the results of relevant concept analyses. Pain assessment is a major part of pain management in children. By considering the characteristics of the concept of pain, the efficiency and usefulness of developed tools can be enhanced to create advancement in paediatric pain management.
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Affiliation(s)
- Fatemeh Ebrahimpour
- School of Nursing & MidwiferyTehran University of Medical SciencesTehranIran
| | - Shahzad Pashaeypoor
- School of Nursing & MidwiferyTehran University of Medical SciencesTehranIran
| | - Waliu Jawula Salisu
- School of Nursing & MidwiferyTehran University of Medical SciencesTehranIran
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Jordan A, Noel M, Caes L, Connell H, Gauntlett-Gilbert J. A developmental arrest? Interruption and identity in adolescent chronic pain. Pain Rep 2018; 3:e678. [PMID: 30324170 PMCID: PMC6172819 DOI: 10.1097/pr9.0000000000000678] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/19/2018] [Accepted: 07/15/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Although the pediatric pain literature has explored the role of developmental factors in young children's acute pain, relatively less is known about specific developmental challenges in adolescents with chronic pain. OBJECTIVES To meet this knowledge gap, this study sought to adopt an idiographic phenomenological approach to examine how adolescents make sense of their own development in the context of living with chronic pain. METHODS Semistructured interviews were conducted with ten adolescents (12-17 years; 7 females) recruited from a tertiary care pain treatment programme. Interview data were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. RESULTS Study findings identified 2 themes: "An externally imposed lens on identity" and "Paradoxes of developmental progress." The first theme highlighted an understanding of how adolescent identity is perceived. Some adolescents perceived identity as distinct from pain, whereas others perceived identity as part of their chronic pain condition. This theme also detailed how identity was negotiated by adolescents and others through engagement with valued activities. The second theme represented an understanding of how chronic pain disrupts and alters adolescent developmental trajectories at an individual level, suggesting possibilities of enhanced and delayed trajectories. Enhanced trajectories were associated with increased management of emotionally difficult situations and resulted in mastery of complex interpersonal skills. CONCLUSION Findings provided a nuanced understanding of developmental progress in the context of adolescent chronic pain and suggested challenges with drawing normative comparisons. Future research could extend findings by adopting a longitudinal approach to studying adolescent development and eliciting accounts from broader social groups.
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Affiliation(s)
- Abbie Jordan
- Department of Psychology, Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Melanie Noel
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Line Caes
- Department of Psychology, University of Stirling, Stirling, United Kingdom
| | - Hannah Connell
- Bath Centre for Pain Services, Royal United Hospitals NHS Trust, Bath, United Kingdom
| | - Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal United Hospitals NHS Trust, Bath, United Kingdom
- Faculty for Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
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Soltani S, Neville A, Hurtubise K, Hildenbrand A, Noel M. Finding Silver Linings: A Preliminary Examination of Benefit Finding in Youth With Chronic Pain. J Pediatr Psychol 2017; 43:285-293. [DOI: 10.1093/jpepsy/jsx126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/27/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sabine Soltani
- Department of Psychology, University of Calgary
- Behaviour and the Developing Brain Theme, Alberta Children’s Hospital Research Institute
| | - Alex Neville
- Department of Psychology, University of Calgary
- Behaviour and the Developing Brain Theme, Alberta Children’s Hospital Research Institute
| | - Karen Hurtubise
- Faculty of Medicine and Health Sciences, University of Sherbrooke
| | | | - Melanie Noel
- Department of Psychology, University of Calgary
- Behaviour and the Developing Brain Theme, Alberta Children’s Hospital Research Institute
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Sørensen K, Christiansen B. Adolescents' experience of complex persistent pain. Scand J Pain 2017; 15:106-112. [PMID: 28850332 DOI: 10.1016/j.sjpain.2017.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/03/2017] [Accepted: 02/09/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Persistent (chronic) pain is a common phenomenon in adolescents. When young people are referred to a pain clinic, they usually have amplified pain signals, with pain syndromes of unconfirmed ethology, such as fibromyalgia and complex regional pain syndrome (CRPS). Pain is complex and seems to be related to a combination of illness, injury, psychological distress, and environmental factors. These young people are found to have higher levels of distress, anxiety, sleep disturbance, and lower mood than their peers and may be in danger of entering adulthood with mental and physical problems. In order to understand the complexity of persistent pain in adolescents, there seems to be a need for further qualitative research into their lived experiences. The aim of this study was to explore adolescents' experiences of complex persistent pain and its impact on everyday life. METHODS The study has an exploratory design with individual in-depth interviews with six youths aged 12-19, recruited from a pain clinic at a main referral hospital in Norway. A narrative approach allowed the informants to give voice to their experiences concerning complex persistent pain. A hermeneutic analysis was used, where the research question was the basis for a reflective interpretation. RESULTS Three main themes were identified: (1) a life with pain and unpleasant bodily expressions; (2) an altered emotional wellbeing; and (3) the struggle to keep up with everyday life. The pain was experienced as extremely strong, emerging from a minor injury or without any obvious causation, and not always being recognised by healthcare providers. The pain intensity increased as the suffering got worse, and the sensation was hard to describe with words. Parts of their body could change in appearance, and some described having pain-attacks or fainting. The feeling of anxiety was strongly connected to the pain. Despair and uncertainty contributed to physical disability, major sleep problems, school absence, and withdrawal from leisure activities. Their parents were supportive, but sometimes more emotionally affected than themselves. The adolescents described how they strived for normality and to not become an outsider. Being met with necessary facilitation from school was important, as well as keeping up with friends. These adolescents had all been treated by an interdisciplinary pain team, and stated that they had an optimistic view of the future, despite still having some symptoms. CONCLUSIONS The study provides new insights into adolescents' own experiences of complex persistent pain occurring unexpectedly, developing dramatically over time, and influencing all parts of their everyday lives. The adolescents entered vicious cycles, with despair and decreased physical and social functioning, with the risk of isolation and role-loss. However, these young people seem to have a strong motivation to strive for normalcy. IMPLICATIONS These findings may encourage healthcare providers to perceive adolescents' persistent pain through the lenses of a biopsychosocial approach. We suggest that further research into adolescents with persistent pain should include longitudinal studies of quality of life and gender perspectives.
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Affiliation(s)
- Kari Sørensen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,Lovisenberg Diaconal University College, Olso, Norway
| | - Bjørg Christiansen
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Postbox 4, St. Olavs pl., N-0130Oslo, Norway
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Graungaard AH, Siersma V, Lykke K, Ertmann RK, Knudsen LE, Mäkelä M. Maternal pain influences her evaluation of recurrent pain in 6- to 11-year-old healthy children. Acta Paediatr 2016; 105:183-90. [PMID: 26383986 DOI: 10.1111/apa.13216] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 05/19/2015] [Accepted: 09/11/2015] [Indexed: 11/29/2022]
Abstract
AIM Children with recurrent pain rely on their parents to acknowledge it. We compared pain reported by healthy children and their mothers, to evaluate their agreement, and also looked at the effect of maternal health on children's pain. METHODS This was a cross-sectional questionnaire-based survey in Danish public schools. The participants were 131 healthy children aged 6-11 years and their mothers. The main outcome measures were the prevalence of recurrent pain reported by the mother and child, agreements between their reports and any associations between the child's pain, socio-demographic characteristics and maternal health factors. RESULTS Recurrent pain was reported by nearly one-third (31%) of the children and their mothers. A quarter (25%) of the mother-child pairs disagreed on the existence of pain in the child, and a third (33%) disagreed on the frequency and duration. When the data were adjusted for child characteristics and socio-demographic parameters, mothers who had chronic pain were five times more likely to report frequent pain in their children than mothers without pain. This is a new finding. CONCLUSION Maternal health factors may influence her evaluation of her child's pain. Family health and pain behaviour should be considered when recurrent pain is suspected in a child.
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Affiliation(s)
- Anette Hauskov Graungaard
- Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Copenhagen Denmark
- The University Clinic of Primary Health Care; Copenhagen Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Kirsten Lykke
- Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Ruth Kirk Ertmann
- Research Unit for General Practice and Section of General Practice; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Lisbeth E. Knudsen
- Section of Environmental Health; Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Marjukka Mäkelä
- Section of General Practice; Department of Public Health; University of Copenhagen; Copenhagen Denmark
- Finnish Office for HTA (FINOHTA); National Institute of Health and Welfare; Helsinki Finland
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To Befriend or Not: Naturally Developing Friendships Amongst a Clinical Group of Adolescents with Chronic Pain. Pain Manag Nurs 2015; 16:721-32. [DOI: 10.1016/j.pmn.2015.04.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/12/2015] [Accepted: 04/16/2015] [Indexed: 11/22/2022]
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Rohde G, Westergren T, Haraldstad K, Johannessen B, Høie M, Helseth S, Fegran L, Slettebø Å. Teachers' experiences of adolescents' pain in everyday life: a qualitative study. BMJ Open 2015; 5:e007989. [PMID: 26338838 PMCID: PMC4563248 DOI: 10.1136/bmjopen-2015-007989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES More adolescents report pain now than previously. In Norway, episodic pain problems have been reported by 60% of children and adolescents aged 8-18 years, with 21% reporting duration of pain of more than 3 months. Since adolescents spend much time at school, the attitude and behaviour of teachers play important roles regarding the experience of pain felt by adolescents in everyday life. Yet research on how teachers perceive the pain experienced by adolescents in a school setting is limited. We therefore seek to gain insight to teachers' classroom experiences with (1) adolescent's self-reported pain symptoms; (2) adolescents management of their pain and (3) how to help adolescents manage their pain. SETTING Teachers in 5 junior high schools in Norway representing municipalities in 3 rural areas and 2 cities. RESEARCH DESIGN A qualitative study with an explorative design comprising 5 focus group interviews. Each group consisted of 3-8 junior high school teachers. A semistructured interview guide was used to cover the issues. The transcribed text was analysed with qualitative content analysis. PARTICIPANTS 22 teachers participated (5 men, 17 women; age range 29-62 years) with teaching experience ranging from 3 to nearly 40 years. RESULTS The main theme describing the experience of teachers with adolescents' pain in everyday life is that pain and management of pain is a social, physical and psychological interwoven phenomenon. Through empirical analyses, 3 subcategories emerged: (1) everyday pain--expressing strenuous life; (2) managing pain--escaping struggle and (3) strategies of teachers--support and normalisation. CONCLUSIONS Teachers have a biopsychosocial understanding and approach to pain experienced by adolescents. This understanding influences the role of teachers as significant others in the lives of adolescents with regard to pain and management of their pain in a school setting.
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Affiliation(s)
- Gudrun Rohde
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Thomas Westergren
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Kristin Haraldstad
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Berit Johannessen
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Magnhild Høie
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
| | - Sølvi Helseth
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences, Oslo, Norway
| | - Liv Fegran
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Åshild Slettebø
- Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Stommen N, Verbunt J, Goossens M. Future goals of adolescents and young adults with chronic musculoskeletal pain. Eur J Pain 2015; 20:564-72. [DOI: 10.1002/ejp.762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2015] [Indexed: 11/12/2022]
Affiliation(s)
- N.C. Stommen
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Department of Rehabilitation Medicine; Zuyderland Medical Centre; Heerlen The Netherlands
- RAP Rehabilitation Clinic; Heerlen The Netherlands
| | - J.A. Verbunt
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Department of Rehabilitation Medicine; Maastricht University Medical Centre; The Netherlands
| | - M.E. Goossens
- Department of Rehabilitation Medicine; Maastricht University Medical Centre; The Netherlands
- Department of Clinical Psychological Science; Maastricht University; The Netherlands
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Tighe PJ, Goldsmith RC, Gravenstein M, Bernard HR, Fillingim RB. The painful tweet: text, sentiment, and community structure analyses of tweets pertaining to pain. J Med Internet Res 2015; 17:e84. [PMID: 25843553 PMCID: PMC4400316 DOI: 10.2196/jmir.3769] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 12/17/2014] [Accepted: 01/21/2015] [Indexed: 01/22/2023] Open
Abstract
Background Despite the widespread popularity of social media, little is known about the extent or context of pain-related posts by users of those media. Objective The aim was to examine the type, context, and dissemination of pain-related tweets. Methods We used content analysis of pain-related tweets from 50 cities to unobtrusively explore the meanings and patterns of communications about pain. Content was examined by location and time of day, as well as within the context of online social networks. Results The most common terms published in conjunction with the term “pain” included feel (n=1504), don’t (n=702), and love (n=649). The proportion of tweets with positive sentiment ranged from 13% in Manila to 56% in Los Angeles, CA, with a median of 29% across cities. Temporally, the proportion of tweets with positive sentiment ranged from 24% at 1600 to 38% at 2400, with a median of 32%. The Twitter-based social networks pertaining to pain exhibited greater sparsity and lower connectedness than did those social networks pertaining to common terms such as apple, Manchester United, and Obama. The number of word clusters in proportion to node count was greater for emotion terms such as tired (0.45), happy (0.43), and sad (0.4) when compared with objective terms such as apple (0.26), Manchester United (0.14), and Obama (0.25). Conclusions Taken together, our results suggest that pain-related tweets carry special characteristics reflecting unique content and their communication among tweeters. Further work will explore how geopolitical events and seasonal changes affect tweeters’ perceptions of pain and how such perceptions may affect therapies for pain.
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Affiliation(s)
- Patrick J Tighe
- University of Florida College of Medicine, Department of Anesthesiology, Gainesville, FL, United States.
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