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Siegel S, Schenk T, Brabant G, Scholl RC, Buchfelder M, Kreitschmann-Andermahr I. Not Simply a Structural Problem: Psychological Determinants of Headache in Patients with Tumors of the Sellar Region. Exp Clin Endocrinol Diabetes 2022; 130:693-700. [PMID: 35977692 DOI: 10.1055/a-1851-5017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Headache in patients with tumors of the sellar region (TSR) has previously been attributed entirely to biomechanical causes. This study aimed to investigate the influence of psychological determinants for the occurrence of and disability due to headaches in patients with TSR. METHODS This was a cross-sectional single-center study with a logistic regression approach. Eighty-four patients (75%) with pituitary adenomas and 28 with other TSR prior to first-time neurosurgery were investigated. One-hundred and twelve patients received standardized questionnaires on personality, headache characteristics, and disability due to headache. Fifty-nine patients additionally filled in questionnaires about coping with stress and pain catastrophizing. Separate logistic regression models were used to predict the risk of headache occurrence and disability due to headache by personality, stress coping, and pain catastrophizing. RESULTS Conscientiousness, neuroticism, and pain catastrophizing were significant predictors of headache occurrence. The amount of explained variance for both models predicting headache occurrence was comparable to that in primary headache. Neuroticism, pain catastrophizing, and humor as a coping strategy predicted disability due to headache with a high variance explanation of 20-40%. CONCLUSION For the first time, we report data supporting a strong psychological influence on headache and headache-related disability in patients with TSR, which argue against purely mechanistic explanatory models. Physicians treating patients with TSR and headaches should adopt an integrative diagnostic and treatment approach, taking the biopsychosocial model of pain into account.
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Affiliation(s)
- Sonja Siegel
- Department of Neurosurgery and Spine Surgery, University Medicine Essen, University of Duisburg-Essen, Germany
| | - Thomas Schenk
- Clinical Neuropsychology, Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Georg Brabant
- Experimental and Clinical Endocrinology Medical Clinic I - University of Lübeck, Lübeck, Germany
| | | | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Altan A, Akkoç S, Erdil A, Çolak S, Demir O, Altan H. Effects of pain catastrophizing and anxiety on analgesic use after surgical removal of impacted mandibular third molars. J Dent Anesth Pain Med 2019; 19:379-388. [PMID: 31942453 PMCID: PMC6946835 DOI: 10.17245/jdapm.2019.19.6.379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/19/2019] [Accepted: 12/25/2019] [Indexed: 11/15/2022] Open
Abstract
Background In dentistry, pain is a factor that negatively affects treatments and drug use. The aim of this study was to evaluate the correlations of the postoperative analgesic use with pain catastrophizing and anxiety in patients who underwent removal of an impacted mandibular third molar. Methods We recruited 92 patients who underwent the extraction of impacted mandibular third molar. In this study, the Pederson index was used to preoperatively determine the difficulty of surgical extraction. Patients were asked to note the number of analgesics used for 7 postoperative days. Patients were divided into two groups based on the Pain Catastrophizing Scale: low and high score groups. State-Trait Anxiety Inventory-trait and State-Trait Anxiety Inventory-state questionnaires were used to determine the anxiety levels of the patients. The obtained data were examined to evaluate the correlations of pain catastrophizing and anxiety with the postoperative analgesic use. Results In this study, 92 patients, including 60 women and 32 men, were recruited. The analgesic use was higher in women than in men but with no significant difference (P > 0.05). Pain Catastrophizing Scale scores were higher in women than in men but with no significant difference (P > 0.05). The analgesic use was higher in patients with high pain catastrophizing than in those with low pain catastrophizing but with no significant difference (P > 0.05). State-Trait Anxiety Inventory-trait scores were higher in women than in men but with no significant difference. However, state-Trait Anxiety Inventory-state scores were significantly higher in women than in men (P < 0.05). Conclusion The postoperative analgesic use may be higher in patients who catastrophize pain than in others. Knowing the patient's catastrophic characteristics preoperatively would contribute to successful pain management and appropriate drug selection.
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Affiliation(s)
- Ahmet Altan
- Department of Oral and Maxillofacial Surgery, Tokat Gaziosmanpasa University Faculty of Dentistry, Tokat, Turkey
| | - Sümeyra Akkoç
- Department of Pediatric Dentistry, Tokat Gaziosmanpasa University Faculty of Dentistry, Tokat, Turkey
| | - Aras Erdil
- Department of Oral and Maxillofacial Surgery, Tokat Gaziosmanpasa University Faculty of Dentistry, Tokat, Turkey
| | - Sefa Çolak
- Department of Oral and Maxillofacial Surgery, Tokat Gaziosmanpasa University Faculty of Dentistry, Tokat, Turkey
| | - Osman Demir
- Department of Biostatistics, Tokat Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey
| | - Halenur Altan
- Department of Pediatric Dentistry, Tokat Gaziosmanpasa University Faculty of Dentistry, Tokat, Turkey
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Cederberg JT, Weineland S, Dahl J, Ljungman G. A preliminary validation of the Swedish version of the Pain Catastrophizing Scale for Children (PCS-C) for children and adolescents with cancer. J Pain Res 2019; 12:1803-1811. [PMID: 31239758 PMCID: PMC6559773 DOI: 10.2147/jpr.s191378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 04/29/2019] [Indexed: 12/05/2022] Open
Abstract
Objectives: Pain is reported as one of the most common and difficult symptoms for children and adolescents with cancer to cope with. Pain catastrophizing has been identified as a process clearly related to pain intensity and disability. The Pain Catastrophizing Scale for Children (PCS-C) has been validated in several languages and populations but remains to be validated in pediatric oncology. The aim of the study was to validate a Swedish version of the PCS-C for children and adolescents with cancer. Methods: All children, 7–18 years of age, being treated for cancer in Sweden at the time of the study were invited to participate. Study material was sent out to the registered address. Internal consistency, test–retest reliability and convergent validity were calculated. Factor structure was examined using principal component analysis (PCA). Descriptive statistics were used to investigate background data and norm values. Results: 61 children/adolescents were included in the analyses. The results did not support the original three-factor structure of the PCS-C, but rather suggested that a two-factor structure excluding item 8 best represented the data. The internal consistency of that solution was good (α=0.87), the test–rest reliability was excellent (ICC=0.75) and convergent validity was demonstrated (r=0.46). The mean (SD) for the PCS-C in the sample was 19.1 (9.2), without item 8. A statistically significant difference was shown between genders, where girls reported a higher level of pain catastrophizing than boys. No difference was found with regard to age. Discussion: The Swedish version of the PCS-C is now preliminarily validated for children and adolescents with cancer, for whom gender- and age-specific norm values are now available. Questions remain regarding the optimal factor structure of the PCS-C.
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Affiliation(s)
| | - Sandra Weineland
- Research and Development Center, Primary Health Care, Region Västra Götaland, Sweden.,Department of Psychology, University of Gothenburg, Göteborg, Sweden
| | - JoAnne Dahl
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Sciruicchio V, Simeone M, Foschino Barbaro MG, Tanzi RC, Delussi MD, Libro G, D'Agnano D, Basiliana R, de Tommaso M. Pain Catastrophizing in Childhood Migraine: An Observational Study in a Tertiary Headache Center. Front Neurol 2019; 10:114. [PMID: 30828315 PMCID: PMC6384232 DOI: 10.3389/fneur.2019.00114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/29/2019] [Indexed: 01/20/2023] Open
Abstract
Background: Migraine is the most common cause of primary headache in children leading to a decrease in the quality of life. During the last decade, pain catastrophizing construct became a major focus of interest in the study and treatment of pain. Aim of the study:To evaluate pain catastrophizing in episodic and chronic migraine children and adolescents selected in a tertiary headache Center. To test whether the children's pain catastrophizing might be associated (a) with the frequency of attacks and disability (b) with psychopathological aspects (c) with allodynia and total tenderness score as symptom of central sensitization. To test the best discriminating clinical variables and scores between episodic and chronic migraine, including pain catastrophizing.
Methods: We conducted a cross sectional observational study on consecutive pediatric patients affected by migraine. We selected 190 headache patients who met the diagnostic criteria for Migraine without aura, Migraine with aura and Chronic migraine. We submitted all children to the Child version of the Pain Catastrophizing Scale (PCS-C), and to the disability scale for migraine (PedMIDAS), general quality of life estimated by children (PedsQL) and parents (PedsQL-P), anxiety and depression (SAFA-A; SAFA-D) scales. We also evaluated headache frequency and the presence and severity of allodynia and pericranial tenderness. Results: No difference was detected in Total Pain Catastrophizing score (PCS-C) between chronic and episodic migraine groups (ANOVA F = 0.59, p = 0.70); the PedMIDAS, the PedsQL-P for physical functioning and the Total Tenderness Score were discriminant variables between episodic and chronic migraine. The PCS-C was not correlated with migraine related disability as expressed by Ped MIDAS, but it was significantly correlated with general low quality of life, allodynia, pericranial tenderness, anxiety, and depression. Conclusion: Pain catastrophizing seems a mental characteristic of a clinical phenotype with psychopathological traits and enhanced expression of central sensitization symptoms. This clinical profile causes general decline in quality of life in the child judgment, with a probable parents' underestimation. In childhood age, it would not be a feature of chronic migraine, but the possibility that it could predict this evolution is consistent and worthy of further prospective evaluation.
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Affiliation(s)
| | - Michele Simeone
- Associazione Italiana di Psicoterapia Cognitiva S.r.l (AIPC), Bari, Italy
| | - Maria Grazia Foschino Barbaro
- Associazione Italiana di Psicoterapia Cognitiva S.r.l (AIPC), Bari, Italy.,Psychological Pediatric Service, Policlinico General Hospital, Bari, Italy
| | | | - Marianna D Delussi
- Applied Neurophysiology and Pain Unit, Basic Medical, Neuroscience and Sensory System Department, Policlinico General Hospital, Bari Aldo Moro University, Bari, Italy
| | - Giuseppe Libro
- Applied Neurophysiology and Pain Unit, Basic Medical, Neuroscience and Sensory System Department, Policlinico General Hospital, Bari Aldo Moro University, Bari, Italy
| | | | | | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Basic Medical, Neuroscience and Sensory System Department, Policlinico General Hospital, Bari Aldo Moro University, Bari, Italy
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Shen B, Wu B, Abdullah TB, Zhan G, Lian Q, Vania Apkarian A, Huang L. Translation and validation of Simplified Chinese version of the Pain Catastrophizing Scale in chronic pain patients: Education may matter. Mol Pain 2018; 14:1744806918755283. [PMID: 29353539 PMCID: PMC5788090 DOI: 10.1177/1744806918755283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective Pain catastrophizing is linked to many aspects of pain perception and defines a unique dimension in predicting pain intensity and physical disability. Pain Catastrophizing Scale (PCS) is an effective, validated,self-report measure, commonly used in clinical trials. Here, we present a Simplified Chinese PCS (SC-PCS) version developed in Chinese patients suffering from chronic pain. Methods The SC-PCS was generated in five steps and tested on an initial patient cohort (N = 30). A convenience sample (N = 200) of in-hospital patients with non-malignant pain lasting for more than 12 weeks were recruited for the study, of which 81 completed 5 additional pain questionnaires. A subset (N = 24) of the patients completed an additional SC-PCS, 10 days after the initial query to assess test–retest validation. Results Intra-class correlations coefficient indicated high reproducibility and temporal consistency, (0.97), for the total score. Cronbach’s alpha determined high internal consistency across the SC-PCS total score and its three subscales (0.87, 0.85, 0.62, and 0.65). The SC-PCS total score moderately or weakly (R = −0.2 to 0.49), but significantly, correlated with other measurements, such as pain Visual Analog Scale, Beck Depression Inventory, Pain Anxiety Symptoms Scales, Positive and Negative Affect Schedule, and education. We used exploratory factor analysis to examine the dimensionality of the SC-PCS, which indicated instability of the current three-factor model. However, a confirmatory factor analysis indicated that the three-factor model had the best goodness-fitting. Conclusions We demonstrate the successful translational adaptation from English to Simplified Chinese as well as the reliability and validity of SC-PCS. An important discovery was education level significantly correlated with SC-PCS, identifying a future consideration for other cross-cultural development of self-reported measures.
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Affiliation(s)
- Bangli Shen
- 1 Department of Pain Medicine, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.,2 China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bo Wu
- 2 China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,3 Department of Information, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Taha B Abdullah
- 4 Department of Physiology, Northwestern University, Chicago, IL, USA
| | - Gonghao Zhan
- 1 Department of Pain Medicine, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qingquan Lian
- 2 China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Apkar Vania Apkarian
- 2 China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,4 Department of Physiology, Northwestern University, Chicago, IL, USA
| | - Lejian Huang
- 2 China-USA Neuroimaging Research Institute, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.,4 Department of Physiology, Northwestern University, Chicago, IL, USA
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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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Abstract
AIM Chronic and debilitating pediatric pain has a prevalence of 5% and as such constitutes a considerable health problem. The aim of this article is to provide an overview of current research activities on pediatric pain, available health care for children with chronic pain and education and training programs for health professionals. METHOD This overview is based on the authors' personal experience, information available from medical, research and professional associations, as well as a PubMed literature search for the time period 2012-2015 using "children";"pain" and "Germany" as search terms. RESULTS There are numerous research activities in Germany focusing on the epidemiology, the underlying psychobiological mechanisms and on the multimodal treatment of chronic pediatric pain. This research is internationally widely acknowledged and makes a significant contribution to current developments in pediatric pain research. By contrast, health services and basic science research is clearly lacking in Germany. Moreover, specialized health care for youth with chronic pain is far less institutionalized when compared to adults suffering from chronic pain. Indeed, primary and secondary care services have rarely been studied or even evaluated. CONCLUSION Similar to international trends, research on chronic pediatric pain has also grown and advanced in Germany. Indeed, not only the amount of research has increased but also its scope. Nonetheless, there is clearly a need for more research efforts with regard to the understanding of (pediatric) pain mechanisms, clinical studies and, especially, investigations on health care services. It is particularly important to focus on the implementation, improvement and systematic evaluation of specialized health care services which would be available and accessible for children and adolescents with chronic pain and not be restricted to tertiary care.
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Huijer HAS, Fares S, French DJ. The Development and Psychometric Validation of an Arabic-Language Version of the Pain Catastrophizing Scale. Pain Res Manag 2017; 2017:1472792. [PMID: 28190958 PMCID: PMC5278223 DOI: 10.1155/2017/1472792] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 12/15/2016] [Indexed: 11/17/2022]
Abstract
Context. The Pain Catastrophizing Scale (PCS) is the most widely used measure of pain-specific catastrophizing. Objectives. The purpose of the present study was to develop and psychometrically evaluate an Arabic-language version of the PCS. Methods. In Study 1, 150 adult chronic nonmalignant pain patients seeking treatment at a hospital setting completed the PCS-A and a number of self-report measures assessing clinical parameters of pain, symptoms of depression, and quality of life. Study 2 employed a cold pressor pain task to examine the PCS-A in a sample of 44 healthy university students. Results. Exploratory factor analyses suggested a two-factor structure. Confirmatory factor analysis comparing the 2-factor model, Sullivan's original 3-factor model, and a 1-factor model based on the total score all provided adequate fit to the data. Cronbach's alpha coefficients across all models met or exceeded accepted standards of reliability. Catastrophizing was associated with higher levels of depression and increased pain intensity and interference. Catastrophizing predicted decreased quality of life, even after controlling for the contribution of gender, employment, depression, and pain interference. PCS-A scores were positively correlated with heightened experimental pain severity and decreased pain tolerance. Conclusion. The present results provide strong support for the psychometric properties of the PCS-A.
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Affiliation(s)
| | - Souha Fares
- Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
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Pielech M, Ryan M, Logan D, Kaczynski K, White MT, Simons LE. Pain catastrophizing in children with chronic pain and their parents: proposed clinical reference points and reexamination of the Pain Catastrophizing Scale measure. Pain 2014; 155:2360-7. [PMID: 25180013 PMCID: PMC4253605 DOI: 10.1016/j.pain.2014.08.035] [Citation(s) in RCA: 142] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/15/2014] [Accepted: 08/26/2014] [Indexed: 01/29/2023]
Abstract
The current study aimed to validate the child and parent pain catastrophizing scale in a large chronic pain sample and to identify child pain catastrophizing clinical reference points. Patients and parents (n=697) evaluated at a pediatric pain program completed the Pain Catastrophizing Scale, child (PCS-C) and parent (PCS-P) reports, along with additional measures of psychological functioning. The measure's psychometric properties were examined, as were relations across demographic, pain, and psychological characteristics and pain catastrophizing. Clinical reference points were identified for the PCS-C from differences in pain catastrophizing across levels of disability, depressive symptoms, and anxiety. Overall, we did not find support for the hypothesized 3-dimension structure, and we recommend potentially removing items 7 and 8 for both the PCS-P and PCS-C as a result of floor/ceiling effects. The 11-item PCS-C is most parsimonious as a unitary construct, while the 11-item PCS-P comprises 2 factors. Although parent catastrophizing was significantly associated with child outcomes after controlling for pain level, it was no longer significant when accounting for child catastrophizing. When comparing PCS-C scores based on child outcomes, significant differences emerged for low, moderate, and high catastrophizing levels. It appears that the influence of parent catastrophizing on outcomes can be explained through its impact on child catastrophizing levels. PCS-C reference points derived from this large sample can aid clinicians in assessment and treatment planning, in turn increasing the utility of the PCS-C for both clinical and research purposes.
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Affiliation(s)
- Melissa Pielech
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Cambridge, MA, USA
| | - Maggie Ryan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Deirdre Logan
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - Karen Kaczynski
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - Matthew T White
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; P.A.I.N. Group, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA.
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Abstract
OBJECTIVE The current study provides the first measure of pain-related fear for pediatric headache patients. METHODS From a large pediatric headache clinic, a cross-sectional cohort of 206 children and adolescents completed measures of pain-related fear, anxiety sensitivity, catastrophizing, pain acceptance, functional disability, and school functioning. RESULTS The two-factor solution of the Fear of Pain Questionnaire (FOPQ) was confirmed from the originally derived structure with pediatric headache patients. Simultaneously regressing FOPQ subscales fear of pain and activity avoidance on theorized construct validity measures demonstrated that fear of pain was more closely linked with anxiety sensitivity and pain catastrophizing while activity avoidance had a strong negative association with pain acceptance (activity engagement and pain willingness). Pain-related fear was not significantly associated with pain level. After controlling for demographic factors and pain, fear of pain and activity avoidance accounted for an additional 26% of the variance in functional disability and school functioning outcomes, with activity avoidance accounting for much of this relationship. CONCLUSIONS Although typically considered an influential construct among musculoskeletal patients, pain-related fear is also an important factor influencing functioning among pediatric headache patients, with the dimension of activity avoidance particularly salient.
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Affiliation(s)
- Laura E Simons
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA Department of Psychiatry, Harvard Medical School, MA, USA
| | - Melissa Pielech
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
| | - Stefanie Cappucci
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, MA, USA
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