Cognitive processing styles of children and adolescents with headache and back pain: a longitudinal epidemiological study

Comparison of Children with Migraine and Those with Tension-Type Headache for Psychiatric Symptoms and Quality of Life

This study compared the severity of depression, anxiety, somatization, anxiety sensitivity, sleep disturbances, and quality of life (QoL) among children with migraine, children with tension-type headache (TTH), and healthy children. A total of 37 children with migraine, 22 with TTH, and a healthy control group (n = 35) participated in this study. Children with migraine exhibited higher depression and somatization and lower QoL scores than those in the control group. General sleep disturbances, bedtime resistance, sleep onset delay, sleep duration, sleep anxiety, night wakings, sleep-disordered breathing, and daytime sleepiness scores were also higher in those in the migraine group than in the control group. Regression models indicated that the severity of headache and depression scores significantly affected the QoLs of children with headache disorder as a whole. Migraine is associated with depression, somatization, sleep disturbances, and poor QoL, whereas TTH is associated with only sleep disturbances in childhood. The impact of headache on the QoL occurs mainly through the headache-specific and psychiatric factors.

Chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain from childhood to young adulthood: a systematic review with meta-analysis

PURPOSE

To report evidence of chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain in children, adolescents, and young adults.

METHODS

This systematic review and meta-analysis included cohort and inception cohort studies that investigated potential risk factors for back pain in young people. Potential risk factors of interest were chronic physical illnesses, mental health disorders (e.g. depression, anxiety), and other psychological features (e.g. coping, resistance). Searches were conducted in MEDLINE, Embase, CINAHL, and Scopus from inception to July 2019.

RESULTS

Nineteen of 2167 screened articles were included in the qualitative synthesis, and data from 12 articles were included in the meta-analysis. Evidence from inception cohort studies demonstrated psychological distress, emotional coping problems, and somatosensory amplification to be likely risk factors for back pain. Evidence from non-inception cohort studies cannot distinguish between risk factors or back pain triggers. However, we identified several additional factors that were associated with back pain. Specifically, asthma, headaches, abdominal pain, depression, anxiety, conduct problems, somatization, and 'feeling tense' are potential risk factors or triggers for back pain. Results from the meta-analyses demonstrated the most likely risk factors for back pain in young people are psychological distress and emotional coping problems.

CONCLUSION

Psychological features are the most likely risk factors for back pain in young people. Several other factors were associated with back pain, but their potential as risk factors was unclear due to risk of bias. Additional high-quality research is needed to better elucidate these relationships. These slides can be retrieved under Electronic Supplementary Material.

Potential risk factors and triggers for back pain in children and young adults. A scoping review, part I: incident and episodic back pain

Background

The one-month prevalence of back pain in children and adolescents has been reported at 33, 28 and 48% at ages 9, 13 and 15 respectively. There are many suspected risk factors and triggers of back pain in young people.

Objective

The purpose of this scoping review was to identify potential risk factors and potential triggers for back pain in young people. The purpose of part I was to identify potential risk factors for incident and episodic back pain in young people. Part II included all eligible studies with unclear or mixed types of back pain.

Methods

Due to the vast number of studies on "risk factors" for back pain, a two-part scoping review of the literature was chosen as the best way to summarise the evidence. We adhered to the PRISMA-ScR guideline for scoping reviews. General potential risk factors and triggers for back pain in children and young adults (≤ 24 years) were included, incorporating physical, environmental, and/or physiological factors. A search was conducted using PubMed and Cochrane databases from inception to September 2018, limited to the English language. Within part I, and because of their importance, only the results of the studies that investigated risk factors of incident back pain and back pain episodes are presented.

Results

The search identified 7356 articles, of which 91 articles were eligible for this scoping review. The majority of the eligible articles had an unclear definition of back pain (results presented in scoping review part II). There were 7 inception cohort studies included and 1 cohort study that met the criteria for part I. The most consistent risk factors for incident and episodic back pain are female sex and older age.

Conclusion

Due to inconsistent ways of reporting on the type of back pain, no definitive risk factor for back pain has been identified. In general, females often report more symptoms, also for other diseases, and older age is not a useful risk factor as it merely indicates that the onset may not be in childhood. Clearly, the time has come to study the causes of back pain from different angles.

Mindfulness for female outpatients with chronic primary headaches: an internet-based bibliotherapy

Our aim was to investigate effectiveness of mindfulness by bibliotherapy on disability, distress, perceived pain and mindfulness in women with tension headaches and migraines. Primary headaches have been of great interest to mental health researchers because of the high prevalence, as well as significant disability and distress in the affected people. Despite the promising results of in-person treatment and some limitations that such interventions may cause, patients may be encountered with problems when using health care services. The present study is a quasi-experimental randomized design with pre-test, post-test, and control group. The study population consisted of 1396 women with migraine headache referring to headache clinic of Baqiyatallah Hospital in Tehran. Of these, 30 patients (including tboh experimental and control group) were selected by objective sampling method and were randomly assigned to the two groups. The experimental group, in addition to medical treatment as usual, was treated for a period of 8 sessions by Mindfulness-based Stress Reduction Internet-based Bibliotherapy, but the control group used only the medical treatment. The sample had no attritions. Data were collected by the four scales of (DASS-21), Migraine Disability Assessment Test (MIDAS), McGill's Short Form Questionnaire (MPQ-SF), and Mindfulness Inventory (MAAS). We used covariance analysis to analyze the findings in the measured scales. MBSR-IBB treatment had no significant effect on pain sensory dimension (P <0.44), despite improvement of mindfulness (P <0.0001). In contrast, the greatest effect was on the level of disability (P <0.0001). We observed also a significant improvement in distress (P <0.0001). In conclusion, in spite of the presence of headaches, the mindfulness improved the quality of life and reduced the level of mental distress. In addition, using the Internet-based bibliotherapy method, these services can be used with easier access, lower cost, and more flexibility.

Somatosensory amplification - An old construct from a new perspective

The paper reviews and summarizes the history and the development of somatosensory amplification, a construct that plays a substantial role in symptom reports. Although the association with negative affect has been supported by empirical findings, another key elements of the original concept (i.e. body hypervigilance and the tendency of focusing on mild body sensations) have never been appropriately addressed. Recent findings indicate that somatosensory amplification is connected with phenomena that do not necessarily include symptoms (e.g. modern health worries, or expectations of symptoms and medication side effects), and also with the perception of external threats. In conclusion, somatosensory amplification appears to refer to the intensification of perceived external and internal threats to the integrity of the body ("somatic threat amplification") rather than amplification of perceived or actual bodily events only. Practical implications of this new approach are also discussed.

Predicting the occurrence of headache and back pain in young adults by biopsychological characteristics assessed at childhood or adolescence

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.

Exploring Temporal Patterns of Stress in Adolescent Girls with Headache

As part of a larger study on perceived stress and headaches in 2009, momentary perceived stress, head pain levels and stress-related symptom data were collected. This paper explores a temporal analysis of the patterns of stress, as well as an analysis of momentary and retrospective stress-related symptoms compared by level of headache activity. Adolescent girls (N = 31) ages 14-18 were randomly cued by electronic diaries 7 times per day over a 21-day period responding to momentary questions about level of head pain, perceived stress and stress-related symptoms. Multivariate general linear modelling was used to determine significant differences among headache groups in relation to temporal patterns of stress. Significant headache group differences were found on retrospective and momentary stress-related symptom measures. A total of 2841 diary responses captured stress levels, head pain and related symptoms. The chronic headache (CH) group reported the highest levels of hourly and daily stress, followed by the moderate headache (MH) and low headache (LH) groups. Patterns of stress for the three headache groups were statistically distinct, illustrating increased stress in girls with more frequent head pain. This evidence suggests that because of increased stress, girls with recurrent head pain are likely a vulnerable population who may benefit from stress-reducing interventions. Copyright © 2016 John Wiley & Sons, Ltd.

The relationship between back pain and schoolbag use: a cross-sectional study of 5,318 Italian students

BACKGROUND CONTEXT

Back pain at a young age is considered to be predictive of chronicity. Several studies have investigated the relationship between the use of a schoolbag and back pain, although some aspects are still unclear.

PURPOSE

The aim of this study was to evaluate back pain due to schoolbag use in terms of (1) prevalence and intensity, (2) differences between male and female pupils, and (3) predisposing factors.

STUDY DESIGN

This is a cross-sectional study.

PATIENT SAMPLE

The sample was composed of 5,318 healthy pupils aged 6 to 19 years (classified according to three age groups: children, younger adolescents, and older adolescents).

OUTCOME MEASURES

Schoolbag-related pain was assessed by means of an ad hoc questionnaire. The intensity of pain was assessed using the Wong scale.

METHODS

Subjects underwent a face-to-face interview using an ad hoc questionnaire. The intensity of pain was assessed using the Wong scale. On the basis of the prevalence and intensity of back pain, we divided our population into two groups: (1) no or mild pain group and (2) moderate or severe pain group. The "schoolbag load" (ratio between schoolbag and pupil weight multiplied by 100) was calculated for each subject.

RESULTS

More than 60% of the subjects reported pain. Although the schoolbag load decreased from children to young and older adolescents, schoolbag-related pain significantly increased (p<.001). Girls reported significantly more frequent and more severe pain than boys. The logistic model confirmed that adolescent girls are the group at greatest risk of suffering from intense pain. The schoolbag load had a weak impact on back pain, whereas the schoolbag carrying time was a strong predictor.

CONCLUSIONS

Adolescent girls have the highest risk of experiencing severe back pain, regardless of schoolbag load. This suggests that other factors (anatomical, physiological, or environmental) might play an important role in pain perception. These aspects should be investigated to plan appropriate preventive and rehabilitative strategies.

Perspectives on the clinical significance of functional pain syndromes in children

Functional pain syndromes (FPS) characterize a subset of individuals who experience pain and related symptoms and disability without clear structural or disease etiology. In the pediatric population, FPS hold high clinical importance due to significant prevalence rates and potential to persist into adulthood. Although extensive research has been executed to disambiguate FPS, the syndromes that fall within its spectrum remain conceptually complex and sometimes ill-defined. This paper provides an overview of available research on the classification and multifaceted etiology of FPS in youth and their effects on interpersonal, psychological, and familial function. Vital aspects of a successful multidisciplinary approach to treating this population are described; however, it is evident that future research requires more longitudinal studies.