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Barak S, Landa J, Eisenstein E, Gerner M, Ravid Vulkan T, Neeman-Verblun E, Silberg T. Agreement and disagreement in pediatric functional neurological symptom disorders: Comparing patient reported outcome measures (PROMs) and clinician assessments. Comput Struct Biotechnol J 2024; 24:350-361. [PMID: 38741721 PMCID: PMC11089279 DOI: 10.1016/j.csbj.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Youth with functional neurological symptom disorder (FNSD) often perceive themselves as having limited capabilities, which may not align with clinical evaluations. This study assessed the disparities between clinician evaluations and patient-reported outcome measures (PROMs) regarding pain, motor function, and learning difficulties in youth with FNSD. Sixty-two youths with FNSD participated in this study, all of whom reported experiencing pain, motor problems, and/or learning difficulties. Clinicians also assessed these domains, resulting in a two-by-two categorization matrix: (1) agreement: child and clinician report "problems"; (2) agreement: child and clinician report "no problems"; (3) disagreement: child reports "problems" while the clinician does not; and (4) disagreement: clinician reports "problems" while the child does not. Agreement/disagreement differences were analyzed. No significant differences in prevalence were observed between the evaluators regarding pain (clinician-85%, child-88%), motor (clinician-98%, child-95%), or learning problems (clinician-69%, child-61%). More than 80% of the children and clinicians report pain and motor disorders. Instances in which children and clinicians reported learning problems (40.3%) exceeded cases in which both reported no problems (9.6%) or only the child reported problems (20.9%). Overall, the agreement between pain and motor function assessments was high (>90%), whereas that concerning learning difficulties was moderate (49.9%). Disagreement in pain/motor assessments was minimal (<5%), whereas for learning difficulties, disagreement rates were high (>20%). In conclusion, a significant concordance exists between PROMs and clinician assessments of pain and motor problems. However, the higher frequency of disagreements regarding learning difficulties emphasizes the importance of incorporating patient and clinician evaluations in pediatric FNSD treatment.
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Affiliation(s)
- S. Barak
- Department of Nursing, Faculty of Health Sciences, Ariel University, Ariel, Israel
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - J. Landa
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
- The Sackler School of Medicine, Tel Aviv University, Tel Aviv 39040, Israel
| | - E. Eisenstein
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - M. Gerner
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - T. Ravid Vulkan
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - E. Neeman-Verblun
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
| | - T. Silberg
- Department of Pediatric Rehabilitation, The Chaim Sheba Medical Center, The Edmond and Lily Safra Children's Hospital, Ramat-Gan 5262000, Israel
- Department of Psychology, Bar-Ilan University, Ramat-Gan 5290002, Israel
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Walker SM, Peters J, Verriotis M, Farag F, Jay MA, Howard RF. Sensitivity and Specificity of a Neuropathic Screening Tool (Self-Report Leeds Assessment of Neuropathic Symptoms and Signs, S-LANSS) in Adolescents With Moderate-Severe Chronic Pain. THE JOURNAL OF PAIN 2024; 25:451-465. [PMID: 37741521 DOI: 10.1016/j.jpain.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
Neuropathic screening tools improve recognition of neuropathic pain in adults. Although utilized in pediatric populations, the sensitivity, specificity and methodology of screening tool delivery have not been compared in children. We evaluated the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) in adolescents (10-18 years) referred to a tertiary pediatric pain clinic. History and examination by specialist clinicians and multidisciplinary assessment informed classification of the primary pain type. In a prospective cohort, scores were obtained at interview (S-LANSS interview; n = 161, 70% female), and following substitution of self-reported signs with examination findings in the primary pain region (Leeds Assessment of Neuropathic Symptoms and Signs, LANSS examination). Secondly, we retrospectively retrieved questionnaires self-completed by adolescents at their initial clinic appointment (S-LANSS self-completed; n = 456, 73% female). Thirdly, we explored relationships between patient-reported outcomes and S-LANSS scores. S-LANSS interview scores varied with pain classification, and S-LANSS self-completed scores were similarly highest with neuropathic pain (median [interquartile range]: 18 [11, 21]) and complex regional pain syndrome (21 [14, 24]), variable with musculoskeletal pain (13 [7, 19]) and lowest with visceral pain (6.5 [2, 11.5]) and headache (8.5 [4, 14]). As in adults, the cutpoint score of 12/24 was optimal. Sensitivity was highest with inclusion of examination findings and lowest with self-completion (LANSS examination vs S-LANSS interview vs S-LANSS self-completed: 86.3% vs 80.8% vs 74.7%), but specificity was relatively low (37.8% vs 36.7% vs 48%). High S-LANSS scores in non-neuropathic groups were associated with female sex and high pain catastrophizing. The S-LANSS is a sensitive screening tool for pain with neuropathic features in adolescents, but needs to be interpreted in the context of clinical evaluation (clinicaltrials.gov NCT03312881). PERSPECTIVE: This article reports high sensitivity of the S-LANSS screening tool for identifying pain with neuropathic features in adolescents with moderate-severe chronic pain. However, as sensitivity is lower than in adult populations, further interdisciplinary evaluation is necessary to inform diagnosis and management.
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Affiliation(s)
- Suellen M Walker
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Judy Peters
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Madeleine Verriotis
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fadila Farag
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Matthew A Jay
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Richard F Howard
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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3
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O'Neill OA, Barsade SG, Sguera F. The psychological and financial impacts of an emotional culture of anxiety and its antidote, an emotional culture of companionate love. Soc Sci Med 2023; 317:115570. [PMID: 36528946 DOI: 10.1016/j.socscimed.2022.115570] [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: 06/01/2021] [Revised: 09/01/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022]
Abstract
RATIONALE Anxiety is an increasingly common problem in society, including at work, yet the effects of an emotional culture of anxiety remain unexplored. We offer a new lens on anxiety in the workplace, examining its collective enactment in the form of an emotional culture of anxiety. OBJECTIVE This study examines the implications of an emotional culture of anxiety for psychological and financial outcomes within a poorly performing healthcare organization. We also examine whether an emotional culture of companionate love, which helps people "calm and connect", can counteract the negative effects of an emotional culture of anxiety. METHODS Drawing on survey data of 822 employees from 85 departments in a large US medical center and a time-lagged archival measure of financial performance across those departments, we used ordinary least squares regression and random coefficient regression modeling to examine the main effects of these two emotional cultures and the buffering effect of an emotional culture of companionate love on an emotional culture of anxiety for department costs, department psychological safety, and individual employee burnout and satisfaction. RESULTS We find significant direct relationships between an emotional culture of anxiety and an emotional culture of companionate love on employee burnout and satisfaction in the predicted directions. We also find a significant interaction between the two emotional cultures, with a culture of companionate love attenuating the relationship of a culture of anxiety on job satisfaction, burnout, and financial performance in the form of time-lagged department costs. CONCLUSIONS Our results indicate that a culture of companionate love can be a protective force against the negative outcomes of an emotional culture of anxiety. Examining these two emotional cultures concurrently offers a better understanding of how to address the pernicious effects of anxiety in organizations.
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Affiliation(s)
- Olivia Amanda O'Neill
- George Mason University, School of Business MS 1E6, 9900 Main Street Suite 200,Fairfax, VA ,22030, USA.
| | - Sigal G Barsade
- The Wharton School, University of Pennsylvania, 2000 Steinberg-Dietrich Hall, Philadelphia, PA, 19103, USA.
| | - Francesco Sguera
- Católica-Lisbon School of Business and Economics, Universidade Católica Portuguesa, Portugal.
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4
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Kauffman BY, Rogers AH, Garey L, Zvolensky MJ. Anxiety and depressive symptoms among adults with obesity and chronic pain: the role of anxiety sensitivity. Cogn Behav Ther 2022; 51:295-308. [PMID: 35001838 DOI: 10.1080/16506073.2021.2011396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Obesity and chronic pain frequently co-occur, and this co-occurrence can have potential negative consequences, particularly as it relates to mental health. As such, there is a need to understand potential risk factors for poor mental health among this co-morbid population. Thus, the current study examined the predictive role of anxiety sensitivity (and its sub-facets) on anxiety and depressive symptoms among adults (82.5% female, Mage = 40.2 years, SD = 10.92) with obesity and chronic pain. Results revealed that greater levels of anxiety sensitivity were associated with greater levels of both anxiety and depressive symptoms, with medium to large effect sizes. Post hoc analyses also indicated that specific sub-facets of anxiety sensitivity (cognitive and social concerns) were significant predictors of the criterion variables. The current study highlights the potential clinical utility in targeting anxiety sensitivity among individuals with co-occurring obesity and chronic pain in the treatment of anxiety and depressive symptoms.
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Affiliation(s)
| | - Andrew H Rogers
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Health Institute, University of Houston, Houston, TX, USA
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Aternali A, Slepian PM, Clarke H, Ladha KS, Katznelson R, McRae K, Seltzer Z, Katz J. Presurgical distress about bodily sensations predicts chronic postsurgical pain intensity and disability 6 months after cardiothoracic surgery. Pain 2022; 163:159-169. [PMID: 34086627 DOI: 10.1097/j.pain.0000000000002325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic postsurgical pain (CPSP) and disability after cardiothoracic surgery are highly prevalent and difficult to treat. Researchers have explored a variety of presurgical risk factors for CPSP and disability after cardiothoracic surgery, including one study that examined distress from bodily sensations. The current prospective, longitudinal study sought to extend previous research by investigating presurgical distress about bodily sensations as a risk factor for CPSP and disability after cardiothoracic surgery while controlling for several other potential psychosocial predictors. Participants included 543 adults undergoing nonemergency cardiac or thoracic surgery who were followed over 6 months postsurgically. Before surgery, participants completed demographic, clinical, and psychological questionnaires. Six months after surgery, participants reported the intensity of CPSP on a 0 to 10 numeric rating scale and pain disability, measured by the Pain Disability Index. Multinomial logistic regression analyses were conducted to evaluate the degree to which presurgical measures predicted pain outcomes 6 months after surgery. The results showed that CPSP intensity was significantly predicted by age and presurgical scores on the Symptom Checklist-90-Revised Somatization subscale (Nagelkerke R2 = 0.27, P < 0.001), whereas chronic pain disability was only predicted by presurgical Symptom Checklist-90-Revised Somatization scores (Nagelkerke R2 = 0.29, P < 0.001). These findings demonstrate that presurgical distress over bodily sensations predicts greater chronic pain intensity and disability 6 months after cardiothoracic surgery and suggest that presurgical treatment to diminish such distress may prevent or minimize CPSP intensity and disability.
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Affiliation(s)
- Andrea Aternali
- Department of Psychology, York University, Toronto, ON, Canada
| | - P Maxwell Slepian
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
| | - Hance Clarke
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
| | - Karim S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Department of Anesthesia and Pain Management, St. Michael's Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rita Katznelson
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
| | - Karen McRae
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
| | - Ze'ev Seltzer
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
- Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Joel Katz
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Anesthesia and Pain Management, Toronto General Hospital, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto, ON, Canada
- Centre for the Study of Pain, University of Toronto, Toronto, ON, Canada
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Avishai-Cohen H, Zerach G. Exposure to Potentially Traumatic Events, Posttraumatic Stress Symptoms, Pain Catastrophizing, and Functional Somatic Symptoms Among Individuals With Varied Somatic Symptoms: A Moderated Mediation Model. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP76-NP103. [PMID: 32326819 DOI: 10.1177/0886260520912587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The relationships between exposure to potentially traumatic events (PTEs), as well as posttraumatic stress symptoms (PTSS) and somatic syndromes, have recently been exemplified. Exposure to PTEs can also set in motion complex psychological processes such as pain catastrophizing that is associated with PTSS and somatic syndromes. However, the specific moderating role of pain catastrophizing in these links remains relatively unexamined. The present study aims to assess a moderated mediation model in which catastrophizing will moderate the indirect effect of exposure to PTEs on the number of somatic symptoms and chronic pain severity via PTSS, among individuals with somatic syndromes. A volunteers' sample of 175 Israeli adults with varied somatic symptoms responded to online validated self-report questionnaires in a cross-sectional designed study. Participants' self-reported PTSS rates (57.1%) were high. PTSS and pain catastrophizing, but not exposure to PTEs, were related to chronic pain severity. Interestingly, a moderated mediation analysis indicated that the indirect effect of catastrophizing in the relation between exposure to PTEs and the number of somatic symptoms via PTSS existed only among those with high levels of catastrophizing. The present study highlights the assumption that functional somatic syndromes (FSS) have much in common. Our findings support a moderated mediation model that begins with exposure to PTEs that leads to PTSS, which in turn increase the number of somatic symptoms. Higher levels of pain catastrophizing might attenuate this indirect link by affecting the interpretation of PTSS and create a vulnerability to more somatic symptoms. Thus, changes in cognitive-sensory processing in the form of catastrophic thinking can affect psychobiological processes and heighten sensitivity to stimuli arising in the body and should be considered as possible target for future research and psychological interventions.
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7
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Secular trends in childhood pain and comorbid psychiatric symptoms: a population-based study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1017-1026. [PMID: 35182159 PMCID: PMC9042999 DOI: 10.1007/s00127-022-02234-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 01/22/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Pain symptoms are common in childhood. They often lead to functional impairment and co-occur with psychiatric difficulties. Although children's lives have undergone enormous changes in recent decades, long-term data on changes in pain symptoms, and in comorbid psychiatric difficulties, is lacking. This knowledge is crucial, as co-occurring psychiatric symptoms are significant predictors of long-term outcome for children who suffer from pain. The main purpose of the present study was to explore secular changes in comorbid pain and psychiatric symptoms. METHODS Four population-based, cross-sectional surveys of 8-9-year-old children were conducted in Southwest Finland in 1989, 1999, 2005, and 2013. Identical methodologies and questionnaire-based measures were used each study year. Participation ranged from 891 to 986 over the study period. The children were asked about the frequency of headache, abdominal pain, and other pains. Children, their parents, and teachers provided information on the child's psychiatric difficulties, including internalizing and externalizing symptoms. RESULTS The cumulative odds ratios and 95% confidence intervals for the overall prevalence of pain symptoms increased among both genders from 1989 to 2013 and ranged from 1.4 (1.03-1.8) for other pains to 2.4 (1.7-3.3) for abdominal pain. Comorbid internalizing symptoms increased among girls with odd ratios and 95% CIs of 1.8 (1.03-3.1) for children with any kind of pain, and 3.0 (1.4-6.2) for children with headache. No changes were found among boys. CONCLUSION Overall pain symptoms doubled in both genders, but the most novel finding was that comorbid emotional difficulties tripled among girls who reported headaches. Further research is needed to confirm, and explain, these findings.
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8
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Paulus DJ, Rogers AH, Asmundson GJG, Zvolensky MJ. Pain severity and anxiety sensitivity interact to predict drinking severity among hazardous drinking college students. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:795-804. [PMID: 32931714 DOI: 10.1080/00952990.2020.1804921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Hazardous alcohol use among college students is a growing problem. Alcohol is commonly used in the context of pain due to acute analgesic effects, although the role of pain among hazardous drinkers has not been examined. Little is known regarding factors that may moderate pain-alcohol relations. One factor is anxiety sensitivity, which reflects the fear of physiological sensations. Pain severity and anxiety sensitivity may interact such that those with high anxiety sensitivity may have stronger pain-alcohol relations.Objectives: The current study examined interactive associations of pain severity and anxiety sensitivity in relation to hazardous drinking severity, alcohol consumption, and alcohol problems among hazardous drinking college students (n = 370; 78.1% female).Methods: Self report measures of alcohol use, pain severity, and anxiety sensitivity were collected and moderation analyses were conducted.Results: There was a significant interaction of pain severity and anxiety sensitivity in relation to hazardous drinking severity (β = 0.25, p = .037); pain severity was significantly related to hazardous drinking for high (β = 0.28, p < .001) but not low (β = 0.09, p = .202) anxiety sensitivity. There was a similar interaction for alcohol consumption (β = 0.35, p = .008). For alcohol problems, there was no significant interaction, but there were unique main effects of both pain severity (β = 0.23, p < .001) and anxiety sensitivity (β = 0.34, p < .001).Conclusions: These findings suggest that drinkers with high anxiety sensitivity may use alcohol hazardously (and in greater quantities) in the context of pain. If replicated with longitudinal samples, the findings may inform clinical practice in terms of screening for and treatment of anxiety sensitivity.
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Affiliation(s)
- Daniel J Paulus
- Department of Neuroscience, Medical University of South Carolina , Charlestion, SC, USA.,Department of Psychology, University of Houston , Houston, TX, USA
| | - Andrew H Rogers
- Department of Psychology, University of Houston , Houston, TX, USA
| | | | - Michael J Zvolensky
- Department of Psychology, University of Houston , Houston, TX, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center , Houston, TX, USA.,Health Institute, University of Houston , Houston, TX, USA
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9
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Tamplain P, Miller HL. What Can We Do to Promote Mental Health Among Individuals With Developmental Coordination Disorder? CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020; 8:24-31. [PMID: 34306965 DOI: 10.1007/s40474-020-00209-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose of the Review It is well-documented that individuals with DCD experience mental health problems, in both psychosocial and psychiatric domains. In this review, we propose a series of diverse options to improve mental health among individuals with DCD. Recent Findings Despite recognition of mental health problems in DCD, relatively little work has been done to develop effective interventions. There is an urgent need for action in this matter. We present and discuss options based on a societal perspective (awareness and understanding), parental perspective (access to services and resources), and child perspective (participation). Summary In order to improve mental health, interventions must take into account multiple levels in a complex framework that includes community, family, and the individual. While more research on intervention effectiveness is necessary, researchers, practitioners, and community advocates can use existing initiatives as a starting point to address the urgent need for improving mental health in DCD.
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Affiliation(s)
- Priscila Tamplain
- Department of Kinesiology, University of Texas at Arlington, 500 W Nedderman Dr, Arlington, TX 76019, USA
| | - Haylie L Miller
- Department of Physical Therapy, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76109, USA
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10
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Bartel A, Jordan J, Correll D, Devane A, Samuelson KW. Somatic burden and perceived cognitive problems in trauma‐exposed adults with posttraumatic stress symptoms or pain. J Clin Psychol 2019; 76:146-160. [DOI: 10.1002/jclp.22855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Alisa Bartel
- Department of PsychologyUniversity of Colorado Colorado SpringsColorado Springs Colorado
| | - Joshua Jordan
- Department of PsychiatryUniversity of California San FranciscoSan Francisco California
| | - Danielle Correll
- Department of PsychologyUniversity of Colorado Colorado SpringsColorado Springs Colorado
| | - Amanda Devane
- Department of PsychologyUniversity of Colorado Colorado SpringsColorado Springs Colorado
| | - Kristin W. Samuelson
- Department of PsychologyUniversity of Colorado Colorado SpringsColorado Springs Colorado
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11
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Lo Curto M, Maggio MC, Campisi F, Corsello G. The correlation of functional pain and psychological distress: a study in Italian school students. Ital J Pediatr 2019; 45:81. [PMID: 31300026 PMCID: PMC6626322 DOI: 10.1186/s13052-019-0668-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022] Open
Abstract
Background Functional Pain (not detectable organic cause) is often associated with psychological problems and, according to literature, it can lead to severe manifestations. The purpose of the study was to investigate the correlation between functional pain and psychological disagreement, in a series of school students. Methods An observational questionnaire-based study was performed. A questionnaire was given to a group of students of primary school; the following data were collected in the questionnaire: a) sex and age; b) functional pain; c) relation with relatives, teachers and schoolfellows: d) school failure. Statistical methods: P-value of concordance test and P-value of correlation have been performed with MINITAB 15.1 software. Results Eight hundred nine students, 354 females, 455 males, median age 14 years, participated to the study. Functional Pain was referred from 537/809 students (66%): 265 Females, 272 males: p = 0.155. The difference between the number of pain episodes in females vs. males was statistically significant (p = 0,511), as pain intensity vs. the number of episodes in females (p = 0.001). The most frequent location of pain was abdomen in females, limbs in males. Psychological disagreement was referred from 513/809 students (63%) (260 females; 253 males: p = 0,150). Psychological disagreement was reported with parents (19); siblings (22); other relatives (18); teachers: 42, schoolfellows: 366, relatives as well as school fellows: 46. The correlation between disagreement and functional pain in all the students included in the study was statistically significant (p < 0.001). Conclusions most students reported psychological disagreement and pain. The most frequent cause of disagreement was schoolfellows’ behaviour. The study shows a student’s lack of discussing of their problems with parents, teachers, peer. According to literature, confiance would be a useful treatment for avoiding psychological disagreements and functional pain.
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Affiliation(s)
- Margherita Lo Curto
- School of Specialisation in Paediatrics, University of Palermo, Palermo, Italy
| | - Maria Cristina Maggio
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, Palermo, Italy. .,Ospedale dei Bambini G. Di Cristina, via Benedettini 1, 90143, Palermo, Italy.
| | - Fabio Campisi
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Giovanni Corsello
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialities "G. D'Alessandro", University of Palermo, Palermo, Italy
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Jones PC, Salamon KS. Treating Pediatric Chronic Pain in Schools: A Primer for School Psychologists. JOURNAL OF APPLIED SCHOOL PSYCHOLOGY 2019. [DOI: 10.1080/15377903.2019.1619646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Paul C. Jones
- Pediatric Dentistry and Community Oral Health Sciences, Temple University Kornberg School of Dentistry, Philadelphia, Pennsylvania, USA
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13
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Francis SE, Noël VA, Ryan SL. A Systematic Review of the Factor Structure of Anxiety Sensitivity Among Children: Current Status and Recommendations for Future Directions. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09502-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Stone AL, Walker LS, Heathcote LC, Hernandez JM, Basch MC, Wilson AC, Simons LE. Somatic Symptoms in Pediatric Patients With Chronic Pain: Proposed Clinical Reference Points for the Children's Somatic Symptoms Inventory (Formerly the Children's Somatization Inventory). THE JOURNAL OF PAIN 2019; 20:932-940. [PMID: 30771592 DOI: 10.1016/j.jpain.2019.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/09/2019] [Accepted: 02/08/2019] [Indexed: 01/30/2023]
Abstract
Among youth with chronic pain, elevated somatic symptoms across multiple body systems have been associated with greater emotional distress and functional disability and could represent poor adaptation to pain. The Children's Somatic Symptoms Inventory (formerly the Children's Somatization Inventory) is commonly used to assess somatic symptoms in children. However, no studies have evaluated the clinical usefulness of the measure in the assessment of pediatric patients with chronic pain. This study evaluated the factor structure and clinical relevance of the 24-item Children's Somatic Symptoms Inventory (CSSI-24) in youth (n = 1,150) with mixed chronic pain complaints presenting to a tertiary pain clinic. The CSSI-24 total scores were equal or superior to factor scores as indicators of patients' clinical characteristics (functional disability, pain catastrophizing, fear of pain, and anxiety and depressive symptoms) and parental catastrophizing and protective responses. Tertile-derived clinical reference points for the CSSI-24 total score (<18, low; 19-31, moderate; ≥ 32, high) significantly differed on measures of clinical characteristics and parent factors. Controlling for age, sex, pain intensity, and primary pain complaint, the high somatic symptoms group exhibited significantly greater health care use compared with the moderate and low groups. The assessment of somatic symptoms in pediatric patients with chronic pain may provide useful information regarding patients' psychosocial risk and tendency to access health services. Perspective: Clinical reference points based on the CSSI-24 total scores meaningfully differentiated youth with chronic pain on measures of emotional distress, functioning, parent catastrophizing and protective responses, and health care use. Assessing somatic symptoms could provide useful information regarding a pediatric patient's psychosocial risk, tendency to access health services, and need for enhanced care coordination.
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Affiliation(s)
- Amanda L Stone
- Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, Tennessee.
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - J Maya Hernandez
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Molly C Basch
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida
| | - Anna C Wilson
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Laura E Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
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Tsur N, Defrin R, Lahav Y, Solomon Z. The traumatized body: Long-term PTSD and its implications for the orientation towards bodily signals. Psychiatry Res 2018; 261:281-289. [PMID: 29329049 DOI: 10.1016/j.psychres.2017.12.083] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 12/14/2017] [Accepted: 12/31/2017] [Indexed: 11/20/2022]
Abstract
Orientation to bodily signals is defined as the way somatic sensations are attended, perceived and interpreted. Research suggests that trauma exposure, particularly the pathological reaction to trauma (i.e., PTSD), is associated with catastrophic and frightful orientation to bodily signals. However, little is known regarding the long-term ramifications of trauma exposure and PTSD for orientation to bodily signals. Less is known regarding which PTSD symptom cluster manifests in the 'somatic route' through which orientation to bodily signals is altered. The current study examined the long-term implications of trauma and PTSD trajectories on orientation to bodily signals. Fifty-nine ex-prisoners of war (ex-POWs) and 44 controls were assessed for PTSD along three time-points (18, 30 and 35 years post-war). Orientation to bodily signals (pain catastrophizing and anxiety sensitivity-physical concerns) was assessed at T3. Participants with a chronic PTSD trajectory had higher pain catastrophizing compared to participants with no PTSD. PTSD symptom severity at T2 and T3 mediated the association between captivity and orientation. Among PTSD symptom clusters, hyperarousal at two time-points and intrusion at three time-point mediated the association between captivity and orientation. These findings allude to the cardinal role of long-term PTSD in the subjective experience of the body following trauma.
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Affiliation(s)
- Noga Tsur
- I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel; Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.
| | - Ruth Defrin
- Department of Physical Therapy, School of Allied Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yael Lahav
- I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel; Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Zahava Solomon
- I-Core Research Center for Mass Trauma, Tel-Aviv University, Israel; Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
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Burri A, Hilpert P, McNair P, Williams FM. Exploring symptoms of somatization in chronic widespread pain: latent class analysis and the role of personality. J Pain Res 2017; 10:1733-1740. [PMID: 28769589 PMCID: PMC5533562 DOI: 10.2147/jpr.s139700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Chronic widespread musculoskeletal pain (CWP) is a condition manifesting varied co-symptomatology and considerable heterogeneity in symptom profiles. This poses an obstacle for disease definition and effective treatment. Latent class analysis (LCA) provides an opportunity to find subtypes of cases in multivariate data. In this study, LCA was used to investigate whether and how individuals with CWP could be classified according to 12 additional somatic symptoms (migraine headaches, insomnia, stiffness, etc.). In a second step, the role of psychological and coping factors for the severity of these co-symptoms was investigated. Data were available for a total of N = 3,057 individuals (mean age = 56.6 years), with 15.4% suffering from CWP. In the latter group, LCA resulted in a three-class solution (ngroup1 = 123; ngroup2 = 306; ngroup3 = 43) with groups differing in a graded fashion (i.e., severity) rather than qualitatively for somatic co-symptom endorsements. A consistent picture emerged, with individuals in the first group reporting the lowest scores and individuals in group 3 reporting the highest. Additionally, more co-symptomatology was associated with higher rates of anxiety sensitivity and depression, as well as more extraversion and emotional instability. No group differences for any of the coping strategies could be identified. The findings suggest that CWP has several detectable subtypes with distinct psychological correlates. The identification of CWP subgroups is important for understanding disease mechanisms and refining prognosis as well as stratifying patients in clinical trials and targeting specific treatment at the subgroups most likely to respond.
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Affiliation(s)
- Andrea Burri
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology.,Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand
| | - Peter Hilpert
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Peter McNair
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology
| | - Frances M Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
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Kröner-Herwig B, Gorbunova A, Maas J. Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2017; 8:31-39. [PMID: 28405174 PMCID: PMC5378444 DOI: 10.2147/ahmt.s127501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of the current study was to identify predictors of recurrent headache and back pain in young adults (aged 18–27 years) from data assessed in childhood or adolescence, i.e., 9 years before the final survey. Our interest was whether psychological characteristics contribute to the risk of pain prevalence in adult age when controlling for already empirically supported risk factors such as parental pain, pediatric pain and sex. The study was part of a five-wave epidemiological investigation of >5000 families with children aged between 7 and 14 years when addressed first. In a multiple hierarchical regression analysis, the abovementioned three variables (Block-I variables) were entered first followed by five psychological trait variables (Block-II variables: internalizing, anxiety sensitivity, somatosensory amplification, catastrophizing and dysfunctional stress coping) to find out the extent of model improvement. The multivariable hierarchical regression analysis confirmed the hypothesis that the Block-I variables significantly enhance the risk of future pain at young adult age. None of the psychological variables did so. Thus, the hypothesis of a significant surplus predictive effect was not confirmed. The amount of total explained variance differed strongly between headache and back pain. In particular, a valid prediction of back pain was not possible. When analyzed separately in simple regression analysis, psychological variables turned out to be significant predictors, however, of very low effect size. The inclusion of Block-I variables in the model clearly reduced the impact of the psychological variables. This risk profile is discussed in the context of the different trajectories of headache and back pain from childhood to adult age, which were proposed by various studies. We propose that a biopsychological characteristic denoted as emotional negativity, especially regarding self-reference, might be a common factor behind all selected variables. Risk research in recurrent pain is a field where much more multidisciplinary research is needed before progress can be expected.
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Affiliation(s)
- Birgit Kröner-Herwig
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, University of Göttingen, Göttingen, Germany
| | - Anastasia Gorbunova
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, University of Göttingen, Göttingen, Germany
| | - Jennifer Maas
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institute of Psychology, University of Göttingen, Göttingen, Germany
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Childhood Irritable Bowel Syndrome Characteristics Are Related to Both Sex and Pubertal Development. J Pediatr 2017; 180:141-147.e1. [PMID: 27639531 PMCID: PMC5183501 DOI: 10.1016/j.jpeds.2016.08.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the relationship of both pubertal development and sex to childhood irritable bowel syndrome (IBS) clinical characteristics including gastrointestinal symptoms (eg, abdominal pain) and psychological factors. STUDY DESIGN Cross-sectional study with children ages 7-17 years (n = 143) with a pediatric Rome III IBS diagnosis recruited from both primary and tertiary clinics between January 2009 and January 2014. Subjects completed 14-day prospective pain and stool diaries, as well as validated questionnaires assessing several psychological factors (somatization, depression, anxiety) and Tanner stage. Stool form ratings were completed using the Bristol Stool Form Scale. RESULTS Girls with higher Tanner scores (more mature pubertal development) had both decreased pain severity and pain interference; in contrast, boys with higher Tanner scores had both increasing pain severity (β = 0.40, P = .02) and pain interference (β = 0.16, P = .02). Girls (vs boys), irrespective of pubertal status, had both increased somatic complaints (P = .005) and a higher percentage (P = .01) of hard (Bristol Stool Form Scale type 1 or 2) stools. Pubertal status and sex did not significantly relate to IBS subtype, pain frequency, stooling frequency, anxiety, or depression. CONCLUSIONS In children with IBS, both pubertal development and/or sex are associated with abdominal pain severity, stool form, and somatization. These differences provide insight into the role of pubertal maturation during the transition from childhood to adult IBS.
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Payne LA, Rapkin AJ, Lung KC, Seidman LC, Zeltzer LK, Tsao JCI. Pain Catastrophizing Predicts Menstrual Pain Ratings in Adolescent Girls with Chronic Pain. PAIN MEDICINE 2016. [PMID: 26218344 DOI: 10.1111/pme.12869] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The current study aimed to explore relationships among self-reported menstrual pain ratings, acute laboratory pain, pain catastrophizing, and anxiety sensitivity in a sample of girls without pain (No Pain group) and girls with a chronic pain condition (Chronic Pain group). SETTING A laboratory at an off-campus Medical School office building. SUBJECTS Eighty-four postmenarchal girls (43 No Pain, 41 Chronic Pain) ages 10-17 participated in the study. METHODS All participants completed self-report questionnaires assessing menstrual pain, pain catastrophizing, and anxiety sensitivity and completed a cold pressor task. Pain intensity during the task was rated on a 0 (no pain) to 10 (worst pain possible) numeric rating scale. RESULTS After controlling for age, average menstrual pain ratings (without medication) were significantly correlated with cold pressor pain intensity for the No Pain group only. In the Chronic Pain group, menstrual pain ratings were significantly correlated with pain catastrophizing and anxiety sensitivity. In a multiple linear regression analysis, after controlling for age, only pain catastrophizing emerged as a significant predictor of menstrual pain ratings in the Chronic Pain group. CONCLUSION Results demonstrate differences in relationships among menstrual pain, acute laboratory pain, and psychological variables in girls with no pain compared with girls with chronic pain. In addition, pain catastrophizing may be a particularly salient factor associated with menstrual pain in girls with chronic pain that warrants further investigation.
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Synergistic effects of pain intensity and anxiety sensitivity in relation to anxiety and depressive symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting. J Anxiety Disord 2016; 43:23-31. [PMID: 27475925 DOI: 10.1016/j.janxdis.2016.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/24/2016] [Accepted: 07/21/2016] [Indexed: 11/22/2022]
Abstract
The present investigation examined the interactive effects of anxiety sensitivity and pain intensity in relation to anxious arousal, social anxiety, and depressive symptoms and disorders among 203 Latino adults with an annual income of less than $30,000 (84.4% female; Mage=38.9, SD=11.3 and 98.6% used Spanish as their first language) who attended a community-based primary healthcare clinic. As expected, the interaction between anxiety sensitivity and pain intensity was significantly related to increased anxious arousal, social anxiety, and depressive symptoms as well as number of depressive/anxiety disorder diagnoses. The form of the significant interactions indicated that participants reporting co-occurring higher levels of anxiety sensitivity and pain intensity evinced the greatest levels of anxious arousal, social anxiety, and depressive symptoms as well as higher levels of depressive and anxiety disorders. These data provide novel empirical evidence suggesting that there is clinically-relevant interplay between anxiety sensitivity and pain intensity in regard to a relatively wide array of anxiety and depressive variables among Latinos in a primary care medical setting.
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Schoth DE, Golding L, Johnson E, Liossi C. Anxiety sensitivity is associated with attentional bias for pain-related information in healthy children and adolescents. J Health Psychol 2016; 21:2434-44. [DOI: 10.1177/1359105315578303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This investigation explored the association between anxiety sensitivity and attentional bias for threatening information in children and adolescents ( N = 40). Participants completed a pictorial version of the visual-probe task, featuring pain-related, health-threat and general-threat images presented for 500 and 1250 ms. Regression analyses revealed significant associations between anxiety sensitivity and attentional bias towards pain-related images presented for 500 ms and between state anxiety and attentional bias towards general-threat images presented for 1250 ms. These results suggest that in children and adolescents, anxiety sensitivity is associated with attentional bias for negative information of personal relevance.
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Carasco M, Kröner-Herwig B. Psychological predictors of headache remission in children and adolescents. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2016; 7:59-66. [PMID: 27186149 PMCID: PMC4847608 DOI: 10.2147/ahmt.s97925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Longitudinal studies on headaches often focus on the identification of risk factors for headache occurrence or "chronification". This study in particular examines psychological variables as potential predictors of headache remission in children and adolescents. METHODS Data on biological, social, and psychological variables were gathered by questionnaire as part of a large population-based study (N=5,474). Children aged 9 to 15 years who suffered from weekly headaches were selected for this study sample, N=509. A logistic regression analysis was conducted with remission as the dependent variable. In the first step sex, age, headache type, and parental headache history were entered as the control variables as some data already existed showing their predictive power. Psychological factors (dysfunctional coping strategies, internalizing symptoms, externalizing symptoms, anxiety sensitivity, somatosensory amplification) were entered in the second step to evaluate their additional predictive value. RESULTS Highly dysfunctional coping strategies reduced the relative probability of headache remission. All other selected psychological variables reached no significance, ie, did not contribute additionally to the explanation of variance of the basic model containing sex and headache type. Surprisingly, parental headache and age were not predictive. The model explained only a small proportion of the variance regarding headache remission (R(2) =0.09 [Nagelkerke]). CONCLUSION Successful coping with stress in general contributed to remission of pediatric headache after 2 years in children aged between 9 and 15 years. Psychological characteristics in general had only small predictive value. The issue of remission definitely needs more scientific attention in empirical studies.
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Affiliation(s)
- Marcel Carasco
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institut für Psychologie, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Birgit Kröner-Herwig
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller-Institut für Psychologie, Georg-August-Universität Göttingen, Göttingen, Germany
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Yılmaz S, Bilgiç A, Akça ÖF, Türkoğlu S, Hergüner S. Relationships among depression, anxiety, anxiety sensitivity, and perceived social support in adolescents with conversion disorder. Int J Psychiatry Clin Pract 2016; 20:10-8. [PMID: 26824691 DOI: 10.3109/13651501.2015.1117110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to assess the relationships of depression, anxiety, anxiety sensitivity, and perceived social support with conversion symptoms in adolescents with conversion disorder (CD). METHODS Fifty outpatients, aged 8-18 years, who had been diagnosed with CD and members of a control group were assessed using the psychological questionnaires. RESULTS Compared with controls, adolescents with CD scored higher on the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI) total, CASI physical and cognitive subscales, and Multidimensional Scale of Perceived Social Support family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the Somatoform Dissociation Questionnaire (SDQ) scores and that CDI and CASI total scores predicted the Children's Somatization Inventory (CSI) scores of subjects. CONCLUSIONS This study suggest that adolescents with CD had poor psychosocial well-being, and depression, global anxiety sensitivity and anxiety sensitivity cognitive concerns are related to conversion symptoms.
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Affiliation(s)
- Savaş Yılmaz
- a Department of Child and Adolescent Psychiatry , Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
| | - Ayhan Bilgiç
- a Department of Child and Adolescent Psychiatry , Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
| | - Ömer Faruk Akça
- a Department of Child and Adolescent Psychiatry , Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
| | - Serhat Türkoğlu
- b Department of Child and Adolescent Psychiatry , Selcuk University, School of Medicine , Konya , Turkey
| | - Sabri Hergüner
- a Department of Child and Adolescent Psychiatry , Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
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Abstract
PURPOSE OF REVIEW Functional gastrointestinal disorders (FGIDs) are some of the most common and challenging disorders in pediatrics. Recurrent abdominal pain is the central feature of pain-associated FGIDs such as irritable bowel syndrome. A thorough understanding of current pathophysiological concepts is essential to successful management. RECENT FINDINGS The brain-gut axis, role of microbiota and the biopsychosocial model are emerging concepts in FGIDs. The biopsychosocial model focuses on the interplay between genes, environment, and physical and psychosocial factors. Interactions between microbiota and the central, enteric and autonomic nervous systems form the link between gut functions and conscious perceptions. Irritable bowel syndrome is the most extensively studied and prototypical pain-associated FGIDs. An aberrant processing of pain or physiologic signals originating from the gut causes a state of visceral hypersensitivity - a central mechanism of functional pain. Psychosocial and autonomic influences also play large roles. Therapy is tailored to the individual patient and comorbid symptoms. SUMMARY This review highlights the complex mechanisms and the aberrant brain-gut neural connections forming the basis of FGIDs. Successful management of FGIDs requires knowledge of the underlying pathophysiology coupled with a multidisciplinary treatment approach. Management should focus on cognitive behavioral therapy, dietary factors along with gastrointestinal motility and psychotropic drug therapy.
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Cappucci S, Simons LE. Anxiety sensitivity and fear of pain in paediatric headache patients. Eur J Pain 2015; 19:246-52. [PMID: 24925092 PMCID: PMC4265313 DOI: 10.1002/ejp.542] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recent research suggests that anxiety sensitivity (AS) may be a critical factor in the maintenance of chronic pain. Converging lines of evidence also propose a relationship between AS and fear of pain (FOP) that may result from interoceptive fear conditioning in interoceptively biased individuals. While some AS and FOP research has been carried out in adults, literature exploring this relationship is sparse in clinical paediatric populations. METHODS This study investigated the hypotheses that FOP mediates the relationships between AS and disability as well as AS and somatization in children and adolescents with chronic headache pain. Mediation models were investigated using bootstrap regression analyses. RESULTS Results indicate that the AS-disability relationship is mediated by FOP, whereas AS seems to contribute both directly and indirectly to somatization. CONCLUSION These results provide evidence for the pivotal role of AS in the paediatric chronic pain model. The findings of this study further emphasize the application of the fear-avoidance model in children and provide new evidence for the critical role of AS in a paediatric headache population.
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Affiliation(s)
- Stefanie Cappucci
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital
| | - Laura E. Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital
- Department of Psychiatry, Harvard Medical School
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Akça ÖF, Ağaç Vural T, Türkoğlu S, Kılıç EZ. Anxiety sensitivity: changes with puberty and cardiovascular variables. Pediatr Int 2015; 57:49-54. [PMID: 25040018 DOI: 10.1111/ped.12443] [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: 03/25/2014] [Revised: 06/04/2014] [Accepted: 06/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anxiety sensitivity (AS) is a relatively stable dispositional variable that may increase the risk for anxiety-related symptoms, particularly panic attack, among individuals of all age groups. Changes in AS during adolescence in healthy individuals, however, has not been previously investigated. The aim of this study was therefore to investigate the relationship of AS with puberty level, pulse rate, and blood pressure in healthy adolescents. METHODS The sample consisted of 133 healthy adolescents (70 boys, 63 girls) aged 10-17 years. Puberty stage (i.e. Tanner stage), pulse rate, and blood pressure of each participant were determined. The Childhood Anxiety Sensitivity Inventory was used to identify AS. The correlations between AS and the clinical variables were assessed. RESULTS AS was negatively correlated with pubertal stage when age and gender were controlled. Also, AS was correlated with diastolic blood pressure when age, gender, and pubertal stage were controlled (P < 0.05). Neither systolic blood pressure nor heart rate were correlated with AS. CONCLUSION AS, which is reported to be a trait-like variable, may change during adolescence, due to the effect of pubertal growth and blood pressure interacting with AS during adolescence.
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Affiliation(s)
- Ömer Faruk Akça
- Department of Child and Adolescent Psychiatry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
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Kaiser P. Childhood anxiety and psychophysiological reactivity: hypnosis to build discrimination and self-regulation skills. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2014; 56:343-67. [PMID: 24938076 DOI: 10.1080/00029157.2014.884487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Clinically anxious, worried, and fearful children and teens need clinicians' assistance in reducing their exaggerated psychophysiological stress reactivity. Affective neuroscience finds that chronic activation of the body's emergency response system inhibits neurogenesis, disrupts neuronal plasticity, and is detrimental to physical and mental health. Patterns of faulty discrimination skills, for example, over-estimation of threat and danger and under-estimation of their coping capacity, fuel this over-arousal. Similarly, contributory patterns of reduced self-regulation skills are shown by "stuck" attention to and poor control of their exaggerated psychophysiological reactivity and somatization. This article considers the literature and focuses on cognitive hypnotherapy to enhance these under-developed capacities. A case illustration highlights various hypnotic phenomena and techniques, psychoeducation, and relaxation training that address the goals of interrupting these unproductive, interconnected patterns and fostering new patterns of more realistic and accurate discrimination capacities and sturdier psychophysiological self-regulation skills.
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Coenders A, Chapman C, Hannaford P, Jaaniste T, Qiu W, Anderson D, Glogauer M, Goodison-Farnsworth E, McCormick M, Champion D. In search of risk factors for chronic pain in adolescents: a case-control study of childhood and parental associations. J Pain Res 2014; 7:175-83. [PMID: 24707186 PMCID: PMC3971911 DOI: 10.2147/jpr.s48154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives This study was designed to investigate whether an individual and parental history of functional pain syndromes (FPS) is found more often in adolescents suffering from chronic pain than in their pain-free peers. Methods Our case–control study involved 101 adolescents aged 10–18 years. Cases were 45 patients of the Chronic Pain Clinic at Sydney Children’s Hospital with diverse chronic pain disorders. Controls consisted of 56 adolescent volunteers who did not have chronic pain. Adolescents and their parents filled out questionnaires assessing demographic data as well as known and potential risk factors for chronic pain. A history of FPS was assessed by questionnaire, including restless legs syndrome (RLS). Chi-squared tests and t-tests were used to investigate univariate associations between chronic pain in adolescents and lifetime prevalence of FPS. Logistic regression was used to test multivariate associations, while controlling for possible confounders. Results Migraine, non-migraine headaches, recurrent abdominal pain (RAP), and RLS were reported significantly more frequently in cases than controls (P-values of 0.01, <0.001, 0.01, and 0.03, respectively). Parental migraine, RAP, and RLS were also significantly associated with adolescent chronic pain in the multivariate analyses. Individual history of migraine, non-migraine headaches, and RAP, along with parental history of RAP and depression significantly accounted for 36%–49% of variance in chronic pain. Other associations with chronic pain were generally in accordance with previous reports. Discussion It may be helpful when assessing a child who has chronic pain or is at risk of chronic pain, to enquire about these associations. Based on the current findings, an individual history of migraine, non-migraine headaches, and RAP, as well as parental migraine, RAP, and RLS are symptoms that are of particular relevance to assess.
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Affiliation(s)
| | - Cindy Chapman
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Tiina Jaaniste
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia ; University of New South Wales, Kensington, NSW, Australia
| | - Wen Qiu
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - David Anderson
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Maline Glogauer
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Marianne McCormick
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - David Champion
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia ; University of New South Wales, Kensington, NSW, Australia
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Esteve R, Marquina-Aponte V, Ramírez-Maestre C. Postoperative Pain in Children: Association Between Anxiety Sensitivity, Pain Catastrophizing, and Female Caregivers' Responses to Children's Pain. THE JOURNAL OF PAIN 2014; 15:157-68.e1. [DOI: 10.1016/j.jpain.2013.10.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/12/2013] [Accepted: 10/06/2013] [Indexed: 01/27/2023]
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Williams AE, Czyzewski DI, Self MM, Shulman RJ. Are child anxiety and somatization associated with pain in pain-related functional gastrointestinal disorders? J Health Psychol 2013; 20:369-79. [PMID: 24155191 DOI: 10.1177/1359105313502564] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
This study investigated individual and incremental contributions of somatization and trait anxiety to pain report in children with pain-related functional gastrointestinal disorders. Eighty children (7-10 years) with pain-related functional gastrointestinal disorders completed the State-Trait Anxiety Inventory for Children, the Children's Somatization Inventory, and 2-week pain diaries (assessing pain frequency and maximum pain). Hierarchical regressions indicated that both trait anxiety and somatization were significantly related to maximum pain and pain frequency, with somatization explaining more variance. Trait anxiety did not significantly add to prediction above somatization. Assessment of somatization may assist with treatment planning for children with functional abdominal pain.
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Affiliation(s)
| | | | - Mariella M Self
- Baylor College of Medicine, USA Texas Children's Hospital, USA
| | - Robert J Shulman
- Baylor College of Medicine, USA Texas Children's Hospital, USA Children's Nutrition Research Center, USA
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Holm S, Ljungman G, Åsenlöf P, Söderlund A. How children and adolescents in primary care cope with pain and the biopsychosocial factors that correlate with pain-related disability. Acta Paediatr 2013; 102:1021-6. [PMID: 23845173 DOI: 10.1111/apa.12352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 06/26/2013] [Accepted: 07/09/2013] [Indexed: 01/14/2023]
Abstract
AIM To describe how children and adolescents cope with pain and to examine the biopsychosocial factors that correlate with pain-related disability (PRD) in a sample of primary care patients. METHODS This cross-sectional study included 133 patients, aged from eight to 16 years, who consulted primary care physiotherapy on a pain-related problem. Data were collected with the Functional Disability Inventory, the Pain Coping Questionnaire and a study-specific questionnaire. Linear multivariate regression analyses were applied to study the associations between PRD and (i) pain coping, (ii) individual-, pain-related and psychosocial variables. RESULTS Behavioural distraction, externalizing and catastrophizing explained 13% of the variance in PRD (regression model 1). In addition, pain intensity, worrying and the ability to reduce pain explained 21% of the variance in PRD (regression model 2). CONCLUSION Variance in PRD was partly explained by pain intensity, worrying and ability to reduce pain and by behavioural distraction, externalizing and catastrophizing. Future prospective longitudinal studies are needed to identify possible additional variables explaining PRD, establish causality and the potential benefits of addressing these variables in interventions in primary care.
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Affiliation(s)
- Sara Holm
- Department of Neuroscience; Uppsala University; Uppsala; Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
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Pagé MG, Campbell F, Isaac L, Stinson J, Katz J. Parental risk factors for the development of pediatric acute and chronic postsurgical pain: a longitudinal study. J Pain Res 2013; 6:727-41. [PMID: 24109194 PMCID: PMC3792832 DOI: 10.2147/jpr.s51055] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background The goal of this longitudinal study was to examine the associations among psychological factors and pain reports of children and their parents over the 12 month period after pediatric surgery. Materials and methods Included in the study were 83 children aged 8–18 years undergoing major surgery. In each case, the child and one of their parents completed measures of pain intensity and unpleasantness, psychological function, and functional disability at 48–72 hours, 2 weeks (child only), 6 months, and 12 months after surgery. Results The strength of the correlation coefficients between the psychological measures of the parent and their child increased significantly over time. There was a fair level of agreement between parent ratings of child acute and chronic pain (6 months after surgery) and the child’s actual ratings. Parent and child pain anxiety scores 48–72 hours after surgery interacted significantly to predict pain intensity, pain unpleasantness, and functional disability levels 2 weeks after discharge from hospital. Parent pain catastrophizing scores 48–72 hours after surgery predicted child pain intensity reports 12 months later. Conclusion These results raise the possibility that as time from surgery increases, parents exert greater and greater influence over the pain response of their children, so that by 12 months postsurgery mark, parent pain catastrophizing (measured in the days after surgery) is the main risk factor for the development of postsurgical pain chronicity.
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Affiliation(s)
- M Gabrielle Pagé
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
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Kröner-Herwig B, Maas J. The German Pain Catastrophizing Scale for Children (PCS-C) - psychometric analysis and evaluation of the construct. PSYCHO-SOCIAL MEDICINE 2013; 10:Doc07. [PMID: 23922617 PMCID: PMC3734764 DOI: 10.3205/psm000097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: The Pain Catastrophizing Scale, adapted for children (PCS-C) by Crombez et al. (2003), was translated into German (SKS-D) and evaluated regarding its factorial structure, its reliability and validity. The association of catastrophizing with various pain characteristics and disability measures was examined as well as its association to neighboring constructs. Method: The paper-and-pencil version of the SKS-D was used in two different samples of children and adolescents. Analyses were conducted on a subgroup of participants from an epidemiological sample [n=898; age: M=12.9 (SD=1.4)] who had experienced monthly headaches in the 6-months period before and a clinical sample [n=60; age: M=12.6 (SD=0.8)] seeking treatment for recurrent headaches. Results: Exploratory factor analysis (PCA) suggested a one-factor model in contrast to the 3-factor model suggested by Crombez et al. (2003). The unidimensional scale showed distinct homogeneity and satisfying reliability. The clinical sample showed significantly higher scores than the epidemiological group. Also girls scored higher than boys. The catastrophizing explained a considerable amount of variance in pain and disability parameters in both samples thus underlining its validity. The psychological variables internalising, anxiety sensitivity and somatosensory amplification showed significant small to moderate associations with pain catastrophizing and also with pain and disability. After controlling for the above mentioned psychological variables, catastrophizing still yielded an independent contribution to the explanation of variance in pain and disability parameters. Conclusions: The PCS-C in its German form is a valid and reliable instrument for assessing catastrophizing in children with recurrent pain, in particular headache, in the age of 10–16 years. Pain catastrophizing is suggested to be assessed especially in pediatric pain patients as it is a significant moderator of pain and disability. In children with a distinct tendency to catastrophize cognitive restructuring should become a target of pediatric pain therapy, as a reduction of catastrophizing cognitions may indirectly help to ameliorate pain and disability.
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Affiliation(s)
- Birgit Kröner-Herwig
- Georg-Elias-Müller-Institute, University of Göttingen, Dept. of Clinical Psychology and Psychotherapy, Göttingen, Germany
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Schoth DE, Yu K, Liossi C. The role of threat expectancy in attentional bias and thermal pain perception in healthy individuals. J Health Psychol 2013; 19:653-63. [DOI: 10.1177/1359105313476976] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The influence of threat expectancy upon attentional biases for pain-related information and pain thresholds was explored in healthy participants. Participants were randomized to receive either threatening ( n = 32) or nonthreatening ( n = 31) information regarding an upcoming computerized task assessing cold and heat pain thresholds. Participants receiving threatening information were more worried about the pain task and, relative to those receiving nonthreatening information, showed attentional bias toward sensory-pain words. No between-group differences were found in terms of cold and heat pain thresholds. These results show that the type of information participants receive can influence their attentional processes and emotional concerns.
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Pediatric fear-avoidance model of chronic pain: foundation, application and future directions. Pain Res Manag 2013; 17:397-405. [PMID: 23248813 DOI: 10.1155/2012/908061] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The fear-avoidance model of chronic musculoskeletal pain has become an increasingly popular conceptualization of the processes and mechanisms through which acute pain can become chronic. Despite rapidly growing interest and research regarding the influence of fear-avoidance constructs on pain-related disability in children and adolescents, there have been no amendments to the model to account for unique aspects of pediatric chronic pain. A comprehensive understanding of the role of fear-avoidance in pediatric chronic pain necessitates understanding of both child⁄adolescent and parent factors implicated in its development and maintenance. The primary purpose of the present article is to propose an empirically-based pediatric fear-avoidance model of chronic pain that accounts for both child⁄adolescent and parent factors as well as their potential interactive effects. To accomplish this goal, the present article will define important fear-avoidance constructs, provide a summary of the general fear-avoidance model and review the growing empirical literature regarding the role of fear-avoidance constructs in pediatric chronic pain. Assessment and treatment options for children with chronic pain will also be described in the context of the proposed pediatric fear-avoidance model of chronic pain. Finally, avenues for future investigation will be proposed.
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Tsao JCI, Jacob E, Seidman LC, Lewis MA, Zeltzer LK. Psychological aspects and hospitalization for pain crises in youth with sickle-cell disease. J Health Psychol 2013; 19:407-16. [PMID: 23407129 DOI: 10.1177/1359105312471570] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sickle-cell disease is a genetic disorder characterized by severe pain episodes or "vaso-occlusive crises" that may require hospitalization. This study examined the associations among emotion regulation, somatization, positive and negative affect, and hospitalizations for pain crises in youth with sickle-cell disease. Multivariate analyses indicated that emotional suppression and somatization were significantly associated with more frequent hospitalizations for pain crises in the previous year after controlling for sickle-cell disease type and pain. These results suggest that efforts to reduce emotional suppression and somatization may assist in decreasing the frequency of hospitalizations for pain crises among youth with sickle-cell disease.
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Payne LA, Seidman LC, Lung KC, Zeltzer LK, Tsao JCI. Relationship of neuroticism and laboratory pain in healthy children: does anxiety sensitivity play a role? Pain 2012; 154:103-109. [PMID: 23158759 DOI: 10.1016/j.pain.2012.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 09/11/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
Both neuroticism, a higher-order, stable personality trait, and anxiety sensitivity (AS), a lower-order pain-related construct, have been associated with pain, although no research exists examining the relationship of both these constructs to acute pain in children. In the current study, 99 healthy children (53 girls) completed self-report measures of neuroticism and AS before undergoing pain tasks involving cold and pressure pain. We hypothesized that both neuroticism and AS would be correlated with acute pain responses, but that AS would at least partially mediate the relationship between neuroticism and pain responses. Results indicated significant correlations between neuroticism, AS, and anticipatory anxiety, pain intensity and pain bother. Mediational models revealed that AS partially mediated relationships between neuroticism and pain intensity/bother, and fully mediated relationships between neuroticism and anticipatory anxiety. These data suggest that, at least in children, neuroticism may be best understood as a vulnerability factor for elevated pain responses, especially when coupled with a fear of bodily sensations.
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Affiliation(s)
- Laura A Payne
- Pediatric Pain Program, David Geffen School of Medicine, University of California, 10833 Le Conte Ave., 22-464 MDCC, Los Angeles, CA 90095-1752, United States
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Noel M, Chambers CT, Petter M, McGrath PJ, Klein RM, Stewart SH. Pain is not over when the needle ends: a review and preliminary model of acute pain memory development in childhood. Pain Manag 2012; 2:487-97. [DOI: 10.2217/pmt.12.41] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
SUMMARY Over the past several decades, the field of pediatric pain has made impressive advances in our understanding of the pain experience of the developing child, as well as the devastating impact of inadequately managed pain early in life. It is now well recognized that, from infancy, children are capable of developing implicit memories of pain that can influence their subsequent reactions to pain. The present review provides a synthesis of selected studies that made a significant impact on this field of inquiry, with particular emphasis on recent clinical and laboratory-based experimental research examining children’s explicit autobiographical memories for acute pain. Research has begun to move towards improving the precision with which children at risk for developing negatively estimated pain memories can be identified, given the adverse influence these memories can have on subsequent pain experiences. As such, several fear- and anxiety-related child and parent variables implicated in this process are discussed, and avenues for future research and clinical intervention are identified throughout. Finally, a preliminary empirically and theoretically derived model of acute pain memory development in childhood is presented to parsimoniously summarize the evidence accumulated to date and guide future investigation in this area.
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Affiliation(s)
- Melanie Noel
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Christine T Chambers
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5850/5980, University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, 5850 University Avenue, PO Box 9700, B3K 6R8, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans’ Memorial Lane, 8th floor, Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, Nova Scotia, B3H 2E2, Canada
| | - Mark Petter
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5850/5980, University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Patrick J McGrath
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5850/5980, University Avenue, Halifax, Nova Scotia, B3K 6R8, Canada
- Department of Pediatrics, Dalhousie University and the IWK Health Centre, 5850 University Avenue, PO Box 9700, B3K 6R8, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans’ Memorial Lane, 8th floor, Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, Nova Scotia, B3H 2E2, Canada
- Research, IWK Health Centre, 5850/5980 University Avenue, PO Box 9700, Halifax, NS B3K 6R8, Canada
| | - Raymond M Klein
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Sherry H Stewart
- Department of Psychology, Dalhousie University, Life Sciences Centre, PO Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
- Department of Psychiatry, Dalhousie University, 5909 Veterans’ Memorial Lane, 8th floor, Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, Nova Scotia, B3H 2E2, Canada
- Department of Community Health & Epidemiology, Centre for Clinical Research, 5790 University Avenue, Halifax, NS B3H 1V7, Canada
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Kröner-Herwig B, Gassmann J. Headache disorders in children and adolescents: their association with psychological, behavioral, and socio-environmental factors. Headache 2012; 52:1387-401. [PMID: 22789010 DOI: 10.1111/j.1526-4610.2012.02210.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This cross-sectional study on a randomly drawn population sample of children and adolescents (n = 3399; aged 9 to 15) aimed at the assessment of patterns of associations between psychosocial variables and primary headache disorders like migraine (MIG) or tension-type headache. A headache-free group served as a control. METHODS Data on headache and psychological trait variables (eg, internalizing symptoms), behavioral factors (eg, physical activities), and socio-environmental factors (eg, life events) were gathered by questionnaire. Logistic regression analyses were conducted with headache types (MIG, tension-type, and non-classifiable headache) as dependent variables. RESULTS The pattern of correlations was largely congruent between the headache disorders. Associations were closest regarding maladaptive psychological traits (in particular internalizing symptoms with an odds ratio > 4 regarding MIG) compared with socio-environmental factors and particularly the behavioral factors. Unfavorable psychological traits and socio-environmental strains demonstrated distinctly stronger associations with MIG than tension-type headache and explained more variance in the occurrence of pediatric headache disorders than parental headache. Sex-specific analyses showed similarities as well as differences regarding the correlations, and in general, the associations were stronger in girls than boys. CONCLUSIONS A common path model as posited by several researchers in the field may explain the parallelism in biopsychosocial vulnerability regarding the different headache disorders.
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Affiliation(s)
- Birgit Kröner-Herwig
- Department of Clinical Psychology and Psychotherapy, Georg-Elias-Müller Institute of Psychology, University of Göttingen, Göttingen, Germany.
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40
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Campo JV. Annual research review: functional somatic symptoms and associated anxiety and depression--developmental psychopathology in pediatric practice. J Child Psychol Psychiatry 2012; 53:575-92. [PMID: 22404290 DOI: 10.1111/j.1469-7610.2012.02535.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Medically unexplained physical symptoms, commonly referred to as functional somatic symptoms (FSS), are common in pediatric medical settings and associated with suffering, impairment, and medical help seeking. The association of pediatric FSS with anxiety and depressive symptoms and disorders across the life span is reviewed. METHOD Review and critique of controlled studies examining cross-sectional and longitudinal associations of FSS with anxiety and depressive symptoms and disorders in community-based and clinical samples of children and adolescents. RESULTS FSS are consistently associated cross-sectionally with anxiety and depressive symptoms and disorders in childhood and adolescence, and the likelihood of associated anxiety and depression increases with the number of reported FSS. The presence of one or more FSS early in life is associated with an increased likelihood of multiple FSS and anxiety and depressive symptoms and disorders later in life, and anxiety and depressive symptoms and disorders in childhood are associated with subsequent multiple FSS. CONCLUSION Strong associations between FSS, anxiety, and depression across the life span suggest the need to reconsider existing nosology and reconceptualize symptomatic relationships. Large, population-based longitudinal studies of FSS, anxiety, and depressive symptoms and disorders are needed to establish temporal relationships between the various symptoms and conditions.
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Affiliation(s)
- John V Campo
- Department of Psychiatry, Professor and chair, The Ohio State University, Columbus, Ohio, USA
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Mahrer NE, Montaño Z, Gold JI. Relations between anxiety sensitivity, somatization, and health-related quality of life in children with chronic pain. J Pediatr Psychol 2012; 37:808-16. [PMID: 22493024 DOI: 10.1093/jpepsy/jss054] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To further understand the influence of psychological variables on pain and functioning in children with chronic pain by examining the relations between pain, anxiety sensitivity (AS), somatization, and health-related quality of life (HRQOL), and whether they vary as a function of age and gender. METHODS 66 children (8-12 years) and adolescents (13-18 years) with chronic pain completed measures assessing pain intensity, AS (childhood anxiety sensitivity index), somatization (child somatization inventory), and HRQOL (pediatric quality of life inventory 4.0). RESULTS Somatization was significantly related to higher pain intensity. Somatization significantly predicted HRQOL over and above pain. AS was a significant predictor of impaired HRQOL for children and females in the sample, but not for adolescents or males. CONCLUSION Somatization and AS may be better predictors of HRQOL impairment than pain intensity in children with chronic pain. This may differ as a function of age and gender.
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Affiliation(s)
- Nicole E Mahrer
- Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles, CA 90027, USA
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Huguet A, McGrath PJ, Pardos J. Development and Preliminary Testing of a Scale to Assess Pain-Related Fear in Children and Adolescents. THE JOURNAL OF PAIN 2011; 12:840-8. [DOI: 10.1016/j.jpain.2011.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/29/2010] [Accepted: 01/19/2011] [Indexed: 11/16/2022]
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Simons LE, Sieberg CB, Carpino E, Logan D, Berde C. The Fear of Pain Questionnaire (FOPQ): Assessment of Pain-Related Fear Among Children and Adolescents With Chronic Pain. THE JOURNAL OF PAIN 2011; 12:677-86. [DOI: 10.1016/j.jpain.2010.12.008] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 11/05/2010] [Accepted: 12/14/2010] [Indexed: 11/29/2022]
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Gupta D, Pérez-Edgar K. The role of temperament in somatic complaints among young female adults. J Health Psychol 2011; 17:26-35. [PMID: 21562070 DOI: 10.1177/1359105311405351] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We examined a temperament-driven construct in relation to broad patterns of somatic behavior among young females (N = 215, 18-23 years). A multidimensional construct, socio-affective vigilance (SAV), encompassing affective, behavioral, and cognitive traits, along with sensitivity to sensory stimuli (low threshold), were used as predictors. SAV positively predicted somatic behavior and a low sensory threshold was associated with somatic complaints over and above SAV effects. A multidimensional construct, coupled with a low threshold, could underlie a vulnerability to somatization. These findings create a more comprehensive view of the temperament-somatization link by predicting a pattern of somatic behavior rather than individual symptom complaints.
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