Multigroup latent class model of musculoskeletal pain combinations in children/adolescents: identifying high-risk groups by gender and age

Narrative review of the prevalence and distribution of acute pain in children in the self-care setting

Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self-care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation-related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real-world setting.

Identification and Characteristics of the Three Subgroups of Pain in Chinese Children and Adolescents with Cancer

PURPOSE

Pain is a distressing symptom for children and adolescents with cancer and is experienced by individuals differently. This study sought to determine subgroups according to their pain experiences, and how demographic, clinical, and quality of life (QOL)-related characteristics might differ across subgroups.

DESIGN AND METHODS

This cross-sectional study recruited 187 pediatric patients with cancer aged 8 to 17 years old and asked them to complete measures of pain intensity, pain duration, pain interference and pain control using the Chinese translation of the validated questionnaire from the Pain Squad app, as well as 7 PROMIS measures assessing QOL-related outcomes. Latent profile analysis (LPA) was used to identify latent subgroups.

RESULTS

Three subgroups of children were identified: low-pain/low-duration (69.5%), moderate-pain/high-duration (19.8%), and high-pain/moderate-duration (10.7%). Hospitalized children were more likely to be in the moderate-pain/high-duration subgroup. Children in the high-pain/moderate-duration subgroup were more likely to be cared for by unemployed caregivers. Scores on depressive symptoms (p = 0.002), anger (p < 0.001), anxiety (p = 0.045), fatigue (p = 0.044), and mobility (p = 0.008) questionnaire were significantly worse in the high-pain/moderate-duration subgroup than the other two subgroup.

PRACTICE IMPLICATIONS

This study provides a scientific foundation for further studies exploring predictive factors related to pain experiences. More targeted treatment strategies targeting the specific characteristics of each subgroup will help improve patients' QOL and use of medical resources.

CONCLUSIONS

The 3 identified pain subgroups demonstrate the heterogeneity in pain experiences among pediatric patients with cancer. Knowledge of these subgroups can assist clinicians in better identifying and targeting pain treatment for children with cancer.

A Step Towards a Better Understanding of Pain Phenotypes: Latent Class Analysis in Chronic Pain Patients Receiving Multimodal Inpatient Treatment

Purpose

The number of non-responders to treatment among patients with chronic pain (CP) is high, although intensive multimodal treatment is broadly accessible. One reason is the large variability in manifestations of CP. To facilitate the development of tailored treatment approaches, phenotypes of CP must be identified. In this study, we aim to identify subgroups in patients with CP based on several aspects of self-reported health.

Patients and Methods

A latent class analysis (LCA) was carried out in retrospective data from 411 patients with CP of different origins. All patients experienced severe physical and psychosocial consequences and were therefore undergoing multimodal inpatient pain treatment. Self-reported measures of pain (visual analogue scales for pain intensity, frequency, and impairment; Pain Perception Scale), emotional distress (Patient Health Questionnaire, PHQ-9; Generalized Anxiety Disorder Scale, GAD-7) and physical health (Short Form Health Survey; SF-8) were collected immediately after admission and before discharge. Instruments assessed at admission were used as input to the LCA. Resulting classes were compared in terms of patient characteristics and treatment outcome.

Results

A model with four latent classes demonstrated the best model fit and interpretability. Classes 1 to 4 included patients with high (54.7%), extreme (17.0%), moderate (15.6%), and low (12.7%) pain burden, respectively. Patients in class 4 showed high levels of emotional distress, whereas emotional distress in the other classes corresponded to the levels of pain burden. While pain as well as physical and mental health improved in class 1, only the levels of depression and anxiety improved in patients in the other groups during multimodal treatment.

Conclusion

The specific needs of these subgroups should be taken into account when developing individualized treatment programs. However, the retrospective design limits the significance of the results and replication in prospective studies is desirable.

Prevalence, Risk Factors and Outcomes of Neck, Shoulders and Low-Back Pain in Secondary-School Children

BACKGROUND

Musculoskeletal pain (MSP) is a public health problem among school-adolescents. This study aimed to identify the prevalence, risk factors and consequences of neck, shoulders and low-back pain among school-adolescents.

STUDY DESIGN

A cross-sectional study.

METHODS

School-adolescents aged from 12 to 18 years between October 2017 and February 2018 in South of Tunisia were recruited. Eligible participants were randomly selected and were asked to respond a four-section questionnaire. Factors independently associated with MSP were determined through multivariate logistic regression analysis.

RESULTS

Among 1221 enrolled subjects, shoulders, low-back and neck pain were reported in 43%, 35.8% and 32%, respectively. Multivariate analysis showed that independent risk factors of neck pain were female gender (Adjusted odds ratio AOR=1.55; P=0.002), using computer ≥4 hours/week (AOR=1.50; P=0.010), too low desk (AOR=2.30; P<0.001) and carrying schoolbag ≥60 minutes (AOR=1.58; P=0.008). Female gender (AOR=3.30; P<0.001), BMI ≥25 Kg/m2 (AOR=1.6; P=0.018), playing videogames ≥2 hours/day (AOR=2.37; P<0.001) and schoolbag weight to body weight ≥10% (AOR=1.46; P=0.026) were independently associated with shoulders pain. For low back-pain, independent risk factors were high-school grade (AOR=2.70; P<0.001), playing videogames ≥2 hours/day (AOR=1.83; P<0.001), watching TV≥12 hours/week (AOR=1.5; P=0.016), too low seat backrest (AOR=1.4; P=0.005) and too far seat-to-black (board) distance (AOR=1.5; P=0.041). School-adolescents consumed drugs for MSP in 19.5%, had sleep disturbance in 34% and aggressive behaviors in 22.8%.

CONCLUSIONS

The prevalence of MSP was substantially high among school-adolescents and their associated risk factors included sociodemographic factors, leisure activities and classroom furniture. An ergonomic specific and behavior-based school program is urgently needed.