It hurts inside: a qualitative study investigating social exclusion and bullying among adolescents reporting frequent pain and high use of non-prescription analgesics

Participation in everyday life for young people with chronic pain in Saudi Arabia: "you feel lacking in life and you feel that time is flying by"

Introduction

Chronic pain is a common health problem that can have a significant impact on children and young people's daily life. Although research on pediatric chronic pain has been a priority globally, little is known about young people's experience of chronic pain in Saudi Arabia. Thus, this article reports on young people's experience of chronic pain and the impact on their lives in Saudi Arabia which forms part of a larger study.

Methods

Multiple case study design following Yin's (2018) approach was used. Purposeful and theoretical sampling were used to recruit young people aged 12 to 18 who had experienced chronic pain for at least three months, their parents, and their school personnel. The young people and their parents were recruited from a tertiary hospital located on the western side of Saudi Arabia while school personnel were recruited from the schools that young people attended. Data were collected through in-depth semi-structured face-to-face (n = 15) and telephone interviews (n = 25) from 40 participants (10 young people, 10 parents, and 20 school personnel). Interviews were recorded, transcribed verbatim, and translated from Arabic to English. Data were analyzed following two phases: (1) constant comparative analysis; and (2) cross-case analysis based on the work of Charmaz (2014) and Yin (2018) respectively.

Findings

Young people's experiences of chronic pain were categorized into three themes: (1) experiencing chronic pain; (2) impact of pain on quality of life; and (3) everyday strategies to manage chronic pain. All young people reported that their pain was caused by a chronic condition, where the most prevalent pains were musculoskeletal/joint pain, abdominal pain, and headache/migraine. Most young people had encountered challenges with misdiagnosis or delayed diagnosis as to the cause of their chronic pain. They described how their chronic pain interfered with their physical, psychological, and social functioning. They primarily managed their pain with medications and through self-care techniques. The findings also indicated that young people's generally positive attitude to their pain reflected their beliefs in Allah's power and the belief that such suffering should be borne according to their Islamic culture.

Conclusion

Chronic pain is a significant health phenomenon that tends to restrict the participation of young people in everyday life. However young people used a range of strategies to normalize the pain so that they could continue with their everyday activities like their peers.

Exposure to traumatic events and use of over-the-counter analgesics in adolescents: cross-sectional findings from the Young-HUNT study

OBJECTIVE

Frequent and increasing use of over-the-counter analgesics (OTCA) among adolescents is a public health concern. Prior research indicates that adolescents exposed to traumatic events may be at increased risk of suffering from headaches and musculoskeletal pain. In this study, we assessed the association between trauma exposure and use of OTCA for headaches and musculoskeletal pain.

DESIGN

A cross-sectional population study among adolescents, self-reported data on trauma exposure, pain and use of OTCA.

SETTING AND PARTICIPANTS

All 10 608 adolescents aged 13-19 years in a region of Norway were invited in this school-based survey, participation rate was 76%.

OUTCOME MEASURE

Frequency of OTCA use for headache and musculoskeletal pain served as separate outcomes in ordinal logistic regression analyses.

RESULTS

Trauma exposure was significantly and consistently related to higher frequency use of OTCA for headache and musculoskeletal pain, of which associations for bullying (OR 1.79, 95% CI 1.50 to 2.12, and OR 2.12, 95% CI 1.70 to 2.66), physical violence (OR 1.49, 95% CI 1.25 to 1.78 and OR 1.83, 95% CI 1.45 to 2.32) and sexual abuse (OR 1.83, 95% CI 1.55 to 2.18 and OR 1.53, 95% CI 1.18 to 1.90) were particularly strong. A dose-response relationship was found between interpersonal violence and OTCA use for headache (OR 1.46, 95% CI 1.29 to 1.66 for one type and OR 1.81, 95% CI 1.53 to 2.14 for two or more types) and musculoskeletal pain (OR 1.61, 95% CI 1.91 to 3.00 for one type and OR 2.39, 95% CI 1.91 to 3.00 for two or more types). The associations remained significant after adjustment for pain, although an attenuation in strength was observed.

CONCLUSION

Trauma exposed adolescents use OTCA for headaches and musculoskeletal pain more frequently than those not exposed. The higher frequency of pain conditions among trauma exposed only partially explained their more frequent OTCA use, indicating an increased risk relating to features beyond frequency of pain.

"There's Nothing Wrong With You": Pain-Related Stigma in Adolescents With Chronic Pain

OBJECTIVE

Adolescents with chronic pain often experience symptom disbelief and social rejection by others secondary to "medically unexplained" symptoms. Although chronic pain is common in adolescents, limited research has conceptualized these social experiences as pain-related stigma in this population. The purpose of this study was to identify and describe pain-related stigma among adolescents with chronic pain and their parents using focus group methodology.

METHODS

Five adolescent focus groups (N = 18; Age M = 15.33 years, SD = 1.28) and three parent focus groups (N = 9) were conducted. Directed content analysis was used to analyze focus group transcripts. Stigma categories were developed a priori (Felt Stigma, Anticipated Stigma, Internalized Stigma, Concealment, and Controllability) and new categories emerged during analysis. Two coders reached 87.16% agreement for all groups (adolescent group: 90.34%; Parent group: 79.55%) and consensus was achieved for discordant codes.

RESULTS

Adolescents and their parents endorsed pain-related stigma across all social domains. Analyses revealed four main categories for both groups (a) Felt Stigma (subcategories: pain dismissal, faking or exaggerating, and mental health stigma), (b) Anticipated Stigma and Concealment, (c) Internalized Stigma, and (d) Sources of Pain-Related Stigma (subcategories: pain invisibility, lack of chronic pain knowledge, lack of understanding, and controllability).

CONCLUSIONS

Adolescents with chronic pain experience pain-related stigma from medical providers, school personnel, family members, and peers, which may have negative social and health implications. More research is needed to evaluate the link between pain-related stigma and health outcomes for adolescents with chronic pain. Clinical approaches targeting pain-related stigma are discussed.

The association of social skills and behaviour problems with bullying engagement in Portuguese adolescents: From aggression to victimization behaviors

This study examines sex differences regarding social skills, behavior problems and bullying engagement, and the association of social skills and behavior problems with bullying engagement, in adolescents. Participants were 447 Portuguese adolescents (252 girls and 195 boys) aged between 12 and 19-years-old. Social skills and behavior problems were assessed using the self-report version of Social Skills Improvement System - Rating Scales. Bullying engagement was assessed using the Scale of Interpersonal Behavior at School. Girls scored higher on social skills and reported more internalizing and fewer externalizing problems than boys, whereas boys reported more aggressive verbal behaviors than girls. Adolescents exhibiting fewer social skills and more internalizing and externalizing problems engage more frequently in bullying aggressive behaviors. In addition, adolescents presenting more internalizing and externalizing problems are more often victimized by bullies. Furthermore, boys more frequently engage in bullying aggressive and victimization behaviors, whereas younger adolescents with more social skills tend to engage less frequently in bullying aggressive behaviors.

Social Exclusion and Impulsive Buying among Chinese College Students: The Mediating Role of Self-Esteem and the Moderating Role of Risk Preference

With the development of science and technology, buying has become much easier. At the same time, however, impulsive buying has many negative consequences for college students, such as dissatisfaction and debt; the causes of impulsive buying should, therefore, be explored urgently. There are numerous empirical studies indicating that social exclusion may be a potential factor of impulsive buying, and the underlying mechanisms of this association remain unclear. In this study, we used the Social Exclusion Scale, Self-Esteem Scale, Risk Preference Scale, and Impulsive Buying Scale, as well as a cross-sectional design to investigate the roles of self-esteem and risk preference in the relationship between social exclusion and impulsive buying among 768 college students (387 were female, M_age = 20.25 years). The results were as follows: (1) when controlling for gender, age, family monthly income, and monthly living expenses, social exclusion significantly and positively predicted impulsive buying; (2) self-esteem played a mediating role between social exclusion and impulsive buying; (3) risk preference moderated the relationship between the second half of the mediating path and the direct path. These results reveal the mechanism underlying impulsive buying in college students, that is, social exclusion will predict the decrease in college students’ self-esteem, and low self-esteem will further predict college students’ impulsive buying, which is a way for them to gain a sense of self-worth. Relatively low risk preference can well alleviate the negative impact of social exclusion and low self-esteem on impulsive buying. What is more, these results have implications for impulsive buying interventions and preventions. Schools should aim to create a good peer atmosphere by implementing certain rules that help to reduce social exclusion, and parents and education departments should cultivate students’ risk awareness to avoid risk behaviors in college students, such as impulsive buying behavior. This study fills the research gap regarding college students’ impulsive buying and explores its internal psychological mechanism.

Pre-vaccination vulnerability and suspected adverse events following HPV vaccination. A case-control study nested in the Danish national birth cohort

Previous studies have indicated that girls experiencing suspected adverse events (AE) following HPV vaccination were more vulnerable prior to vaccination. However, no study has previously investigated differences in vulnerability using prospectively collected self-reported measures of vulnerability. The objective of this study therefore was to describe the distribution of biological and psychosocial indicators of vulnerability in girls referred to a hospital setting due to suspected adverse events and compare it with a sample of non-referred HPV vaccinated girls. The study was conducted as a case control study based within the Danish National Birth Cohort. Cases were defined as HPV vaccinated girls referred to a hospital setting between 2015 and 2017 due to suspected adverse events (n = 80), and 5 controls were randomly selected from the remaining source population, matched to cases on age at vaccination, region of residence and year of vaccination. The final study population consisted of 480 girls. Prior exposures were based on information gathered from an 11 year follow up of the DNBC and included information on self-rated health, frequent health complaints, medication use, bullying, stressful life events and physical activity. Conditional logistic regression analysis was used to estimate the association between each exposure and referral. The percentage of individuals in the exposed category of each exposure was generally higher for cases than controls. Particularly, the odds of being referred were higher for those with low self-rated health compared to high (OR [95%-CI] 2.43 [1.07-5.5]1), those being bullied (OR 3.19 [1.17-8.73]), and those who had taken medication (OR 2.22 [1.32-3.67]). Overall, these results indicated that girls experiencing suspected AE following HPV vaccination were more vulnerable prior to vaccination.

The Association between Externalizing and Internalizing Problems with Bullying Engagement in Adolescents: The Mediating Role of Social Skills

Bullying has severe public health consequences, due to its high prevalence worldwide and devastating effects on physical and mental health. Therefore, it is relevant to further understand the factors that contribute to the emergence and maintenance of bullying. This study aimed to examine the differential mediating role of social skills in the relationship between (i) externalizing problems and engagement in aggressive bullying behaviors, and (ii) internalizing problems and the engagement in victimization bullying behaviors. Participants were 669 Portuguese adolescents aged between 12 and 19 years. The Social Skills Improvement System-Rating Scales and the Scale of Interpersonal Behavior at School were used to assess social skills and the engagement in bullying behaviors, respectively. Boys scored higher on aggressive behaviors and externalizing problems. Girls reported higher scores on internalizing problems, communication, cooperation and empathy. Social skills differently mediated the association between behavior problems and engagement in bullying. While empathy negatively mediated the association between externalizing problems and aggressive bullying behaviors, assertiveness negatively mediated the relationship between internalizing problems and victimization bullying behaviors. The risk factors for engaging in bullying are discussed, and so are the protective ones, which may help to prevent bullying behaviors and reduce their negative impact.

How environmental enrichment balances out neuroinflammation in chronic pain and comorbid depression and anxiety disorders

Depression and anxiety commonly occur in chronic pain states and the coexistence of these diseases worsens outcomes for both disorders and may reduce treatment adherence and response. Despite the advances in the knowledge of chronic pain mechanisms, pharmacological treatment is still unsatisfactory. Research based on exposure to environmental enrichment is currently under investigation and seems to offer a promising low-cost strategy with no side effects. In this review, we discuss the role of inflammation as a major biological substrate and aetiological factor of chronic pain and depression/anxiety and report a collection of preclinical evidence of the effects and mechanisms of environmental enrichment. As microglia participates in the development of both conditions, we also discuss microglia as a potential target underlying the beneficial actions of environmental enrichment in chronic pain and comorbid depression/anxiety. We also discuss how alternative interventions under clinical guidelines, such as environmental enrichment, may improve treatment compliance and patient outcomes.