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Sarah A, Praveen Raj JD, Kompithra RZ, Mathew LG, Angelin S, John HB. Stories to Take the Edge Off Pain During Immunization for Preschoolers: A Randomized Controlled Trial. Am J Occup Ther 2023; 77:7703205120. [PMID: 37326569 DOI: 10.5014/ajot.2023.050086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
IMPORTANCE Fear and distress during immunization may lead to long-term preprocedural anxiety and nonadherence to immunization schedules. Pictorial stories provide a way of educating the parent and child about the procedure. OBJECTIVE To determine the efficacy of pictorial stories in reducing pain perception among children and anxiety among mothers during immunization. DESIGN Three-arm randomized controlled trial Setting: Immunization clinic of a tertiary care hospital in South India. PARTICIPANTS Fifty children ages 5 to 6 yr, who reported to the hospital for measles, mumps, and rubella and typhoid conjugate virus vaccines. Inclusion criteria were that the child was accompanied by the mother and maternal knowledge of either Tamil or English. Exclusion criteria were child hospitalization in the past year or neonatal intensive care unit admission in the neonatal period. INTERVENTION Pictorial story regarding immunization before the procedure that contained information related to immunization, coping strategies, and distraction techniques. OUTCOMES AND MEASURES Pain perception was evaluated using the Sound, Eye, Motor Scale; the Observation Scale of Behavioral Distress; and the Wong-Baker FACES Pain Rating Scale (FACES). Maternal anxiety was measured using the General Anxiety-Visual Analog Scale. RESULTS Of 50 children recruited, 17 were in the control group, 15 were in the placebo group, and 18 were in the intervention group. Children in the intervention group reported lower pain scores on the FACES (p = .04) compared with the placebo and control groups. CONCLUSIONS AND RELEVANCE A pictorial story is a simple and cost-effective intervention to reduce pain perception among children. What This Article Adds: Pictorial stories may be a feasible, simple, and cost-effective intervention to reduce pain perception during immunization.
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Affiliation(s)
- Addlin Sarah
- Addlin Sarah, BOT, is Occupational Therapist, Department of Occupational Therapy, Christian Medical College, Vellore, India;
| | - Jerome Dany Praveen Raj
- Jerome Dany Praveen Raj, MOT, is Assistant Professor, Department of Occupational Therapy, Christian Medical College, Vellore, India
| | - Rajeev Zachariah Kompithra
- Rajeev Zachariah Kompithra, DCH, is Senior Medical Officer, Department of Child Health, Christian Medical College, Vellore, India
| | - Leni Grace Mathew
- Leni Grace Mathew, DCH, MD, is Professor, Department of Child Health, Christian Medical College, Vellore, India
| | - Suja Angelin
- Suja Angelin, MOT, is Tutor, Department of Neonatology, Christian Medical College, Vellore, India
| | - Hima B John
- Hima B. John, BOT, MSc, is Tutor, Department of Neonatology, Christian Medical College, Vellore, India
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Clusters of facilitatory and inhibitory conditioned pain modulation responses in a large sample of children, adolescents, and young adults with chronic pain. Pain Rep 2022; 7:e1032. [PMID: 36213595 PMCID: PMC9534368 DOI: 10.1097/pr9.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 06/01/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Findings from the current study add to the literature by describing different clinical phenotypes of central pain mechanisms of youth with chronic pain. Introduction: When investigating the role of facilitatory and inhibitory pain mechanisms such as conditioned pain modulation (CPM) and temporal summation of pain (TSP), it is important to take both into consideration in a single experimental model to provide the most information on subgroups of patients. Therefore, the objective of this study was to identify subgroups in a large population of pediatric patients with chronic pain based on their facilitatory and inhibitory pain mechanisms and compare them with control subjects. Methods: Five hundred twenty-one female subjects and 147 male subjects between 8 and 21 years old underwent a CPM assessment using a 2-minute tonic noxious heat stimulation as the test stimulus and a 2-minute cold-pressor task (CPT) (12°C) as the conditioning stimulus. Results: The best partition of clusters of patients was 3 clusters accounting for 27.15% of the total variation in the data. Cluster 1 (n = 271) was best characterized by high pain intensity during the CPT, lack of TSP during the test stimuli, and efficient inhibitory CPM. Cluster 2 (n = 186) was best characterized by low pain intensity during the CPT, lack of TSP during the test stimuli, and efficient inhibitory CPM. Cluster 3 (n = 151) was best characterized by high pain intensity during the CPT, presence of TSP during the test stimuli, and inefficient inhibitory CPM. Discussion: A single thermal CPM experimental design can identify combinations of facilitatory and inhibitory pain modulation responses. Findings from the current study add to the literature by describing different clinical phenotypes of central pain mechanisms of youth with chronic pain.
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Constantin KL, Moline RL, Labonte L, McMurtry CM. A Multi-Method Approach to Understand Parent Behaviors During Child Acute Pain. J PSYCHOPHYSIOL 2021. [DOI: 10.1027/0269-8803/a000280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Parent behaviors strongly predict child responses to acute pain; less studied are the factors shaping parent behaviors. Heart rate variability (HRV) is considered a physiological correlate of emotional responding. Resting or “trait” HRV is indicative of the capacity for emotion regulation, while momentary changes or “state” HRV is reflective of current emotion regulatory efforts. This study aimed to examine: (1) parent state HRV as a contributor to parent verbal behaviors before and during child pain and (2) parent trait HRV as a moderator between parent emotional states (anxiety, catastrophizing) and parent behaviors. Children 7–12 years of age completed the cold pressor task (CPT) in the presence of a primary caregiver. Parents rated their state anxiety and catastrophizing about child pain. Parent HRV was examined at 30-second epochs at rest (“trait HRV”), before (“state HRV-warm”), and during their child’s CPT (“state HRV-cold”). Parent behaviors were video recorded and coded as coping-promoting or distress-promoting. Thirty-one parents had complete cardiac, observational, and self-report data. A small to moderate negative correlation emerged between state HRV-cold and CP behaviors during CPT. Trait HRV moderated the association between parent state catastrophizing and distress-promoting behaviors. Parents experiencing state catastrophizing were more likely to engage in distress-promoting behavior if they had low trait HRV. This novel work suggests parents who generally have a low (vs. high) HRV, reflective of low capacity for emotion regulation, may be at risk of engaging in behaviors that increase child distress when catastrophizing about their child’s pain.
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Affiliation(s)
| | | | | | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, ON, Canada
- Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Testing the intergenerational model of transmission of risk for chronic pain from parents to their children: an empirical investigation of social transmission pathways. Pain 2020; 160:2544-2553. [PMID: 31393280 DOI: 10.1097/j.pain.0000000000001658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Children of parents with chronic pain have higher rates of pain and internalizing (eg, anxiety and depressive) symptoms than children of parents without chronic pain. Parental modeling of pain behaviour and reinforcement of child pain have been hypothesized to underlie these relationships. These mechanisms were tested in a sample of 72 parents with chronic pain and their children (aged 8-15 years). Standardized measures were completed by parents (pain characteristics, pain interference, and child internalizing) and children (pain catastrophizing, pain over previous 3 months, and internalizing). In a laboratory session, children completed the cold pressor task in the presence of their parent, and parent-child verbalizations were coded. Significant indirect effects of parental pain interference on child self-reported (B = 0.12, 95% confidence interval [CI]: 0.01-0.29) and parent-reported (B = 0.16, 95% CI: 0.03-0.40) internalizing symptoms through child pain catastrophizing were found (parental modeling mechanism), and were not moderated by child chronic pain status. Significant indirect effects were found between parent pain-attending verbalizations and child self-reported (B = 2.58, 95% CI: 1.03-5.31) and parent-reported (B = 2.18, 95% CI: 0.93-4.27) cold pressor task pain intensity and tolerance (B = -1.02, 95% CI: -1.92 to -0.42) through child pain-attending verbalizations (parental reinforcement mechanism). Although further understanding of the temporal relationships between these variables is needed, the current study identifies constructs (eg, parent pain interference, child pain catastrophizing, and parent reinforcement of child pain) that should be further examined as potential targets for prevention and intervention of pain and internalizing symptoms in children of parents with chronic pain.
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Allyn K, Evans S, Seidman LC, Payne LA. "Tomorrow, I'll Be Fine": Impacts and coping mechanisms in adolescents and young adults with primary dysmenorrhoea. J Adv Nurs 2020; 76:2637-2647. [PMID: 32761654 DOI: 10.1111/jan.14460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/13/2020] [Accepted: 06/01/2020] [Indexed: 12/30/2022]
Abstract
AIMS To understand the experiences of adolescents and young adults with primary dysmenorrhoea through the lens of structured frameworks extant in contemporary pain literature. DESIGN Descriptive qualitative study. METHODS Thirty-nine adolescents and young adults (ages 16-24 years) with primary dysmenorrhoea participated in semi-structured in-person interviews. Transcripts of the interviews were analysed using deductive thematic analysis from November 2018 to April 2019. RESULTS Two overarching themes, each with subthemes, were identified. The first theme, primary dysmenorrhoea impacts the whole person, contained the following subthemes: biological, social, and psychological. The second theme, coping mechanisms of women with primary dysmenorrhoea, contained the following subthemes: primary, secondary, and passive coping. CONCLUSION Women experience several primary dysmenorrhoea-related impacts on their biological, social, and psychological functioning. Women employ a variety of coping mechanisms to manage their primary dysmenorrhoea pain. IMPACT This study emphasizes the significant effects of primary dysmenorrhoea on nearly every aspect of women's lives and contributes to an understanding of the ways women cope with this pain. The findings of this study underscore the need for continued consideration of primary dysmenorrhoea as a debilitating pain process as well as the need for additional interventions to help women manage this condition.
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Affiliation(s)
| | - Subhadra Evans
- School of Psychology, Deakin University, Geelong, Vic., Australia
| | | | - Laura A Payne
- McLean Hospital, Belmont, MA, USA.,Harvard Medical School, Boston, MA, USA
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Parent Factors are Associated With Pain and Activity Limitations in Youth With Acute Musculoskeletal Pain: A Cohort Study. Clin J Pain 2020; 35:222-228. [PMID: 30362984 DOI: 10.1097/ajp.0000000000000668] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Biopsychosocial models emphasize the influence of parent/family factors on pediatric chronic pain. Little is known about how parent factors differ across the acute to chronic pain continuum, or contribute to youths' pain experience in the acute pain period. The purpose of the study was to describe parent factors in youth with acute musculoskeletal pain (n=84) compared with youth with chronic pain (n=60) and youth without pain (n=61). Further, within the acute pain sample, we tested parent factors as predictors of child pain characteristics, as well as the moderating role of child sex on associations. METHODS Participants were 205 youth (age, 10 to 17) and one biological parent per child. Children reported on their own pain and activity limitations. Parents reported on their own chronic pain, somatization, and protective pain responses. RESULTS Parents of youth with acute pain had higher prevalence of chronic pain and greater somatization than parents of youth without pain. Parents of youth with acute and chronic pain did not differ. Linear regressions within the acute pain sample revealed presence of parent chronic pain and protective behavior were associated with child pain. Moreover, parent somatization was associated with child activity limitations. Within the acute pain sample, associations between parent protectiveness and child pain were moderated by child sex, with relationships stronger for female children. DISCUSSION Findings highlight the importance of parent factors on pain experiences of youth with acute musculoskeletal pain. Future longitudinal research can elucidate temporal associations that underlie how parent factors may impact transition from acute to chronic pain.
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Wallrath MK, Rubel J, Ohls I, Demiralay C, Hechler T. Bottom‐up or top‐down?: The role of child and parent chronic pain and anxiety in the context of parental catastrophizing and solicitousness. Eur J Pain 2019; 24:604-616. [DOI: 10.1002/ejp.1512] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/08/2019] [Accepted: 11/22/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Maren K. Wallrath
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents University of Trier Trier Germany
| | - Julian Rubel
- Department of Psychology Justus‐Liebig‐University Gießen Gießen Germany
| | - Isgard Ohls
- Department of Psychiatry and Psychotherapy University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Cüneyt Demiralay
- Department of Psychiatry and Psychotherapy University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Tanja Hechler
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents University of Trier Trier Germany
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Evans S, Moloney C, Seidman LC, Zeltzer LK, Tsao JCI. Parental Bonding in Adolescents With and Without Chronic Pain. J Pediatr Psychol 2019; 43:276-284. [PMID: 29048481 DOI: 10.1093/jpepsy/jsx110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/10/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Parental responses influence children's pain; however, the specific role of parental bonding in pediatric pain has not been examined. Depressive symptomology is frequently reported in children with chronic pain (CP) and may play a role in the relationship between parental bonding and pain. This study examined the connections between maternal/paternal bonding (perceived care and control) and symptoms of pain and depression in adolescents with CP and in healthy adolescents. Method Participants included 116 adolescents (aged 12-17) with CP (n = 55) and without (n = 61). Adolescents completed the Parental Bonding Instrument separately for their mother and father, as well as measures of depression and pain. Results Significant associations between parental bonding and adolescent pain and depression emerged in the pain group, but not in the healthy group. There were no differences in the impact of maternal versus paternal bonding on adolescent pain and depression. Mediation analyses revealed adolescent depression was a mediator of the relationship between maternal care and adolescent pain, and paternal control and adolescent pain in the group with CP. Conclusions This study highlights the importance of considering parental bonding and adolescent depression in pediatric CP, suggesting that high paternal control and low maternal care contribute to increased pain in adolescents through heightened adolescent depressive symptoms. The findings emphasize the need for family-based treatment for CP that addresses parent behaviors and adolescent mental health.
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Affiliation(s)
- Subhadra Evans
- School of Psychology, Deakin University, Geelong, Australia
| | | | - Laura C Seidman
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Lonnie K Zeltzer
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jennie C I Tsao
- Pediatric Pain and Palliative Care Program, David Geffen School of Medicine, University of California, Los Angeles, California
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Hwang PS, Ma ML, Spiegelberg N, Ferland CE. Current methodological approaches in conditioned pain modulation assessment in pediatrics. J Pain Res 2017; 10:2797-2802. [PMID: 29263694 PMCID: PMC5732558 DOI: 10.2147/jpr.s150857] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Conditioned pain modulation (CPM) paradigms have been used in various studies with healthy and non-healthy adult populations in an attempt to elucidate the mechanisms of pain processing. However, only a few studies so far have applied CPM in pediatric populations. Studies finding associations with chronic pain conditions suggest that deficiencies in underlying descending pain pathways may play an important role in the development and persistence of pain early in life. Twelve studies were identified using a PubMed search which examine solely pediatric populations, and these are reviewed with regard to demographics studied, methodological approaches, and conclusions reached. This review aimed to provide both clinicians and researchers with a brief overview of the current state of research regarding the use of CPM in children and adolescents, both healthy and clinical patients. The implications of CPM in experimental and clinical settings and its potential to aid in refining considerations to individualize treatment of pediatric pain syndromes will be discussed.
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Affiliation(s)
| | - My-Linh Ma
- Shriners Hospital for Children - Canada.,Research Institute - McGill University Health Centre.,Department of Experimental Surgery
| | | | - Catherine E Ferland
- Shriners Hospital for Children - Canada.,Research Institute - McGill University Health Centre.,Department of Experimental Surgery.,Department of Anesthesia, McGill University.,The Alan Edwards Centre for Research on Pain, Montreal, QC, Canada
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van der Veek SMC, de Haan E, Derkx HHF, Benninga MA, Boer F. Psychological factors addressed in cognitive behaviour therapy for paediatric functional abdominal pain: Which are most important to target? J Health Psychol 2017; 24:1282-1292. [DOI: 10.1177/1359105317694488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The effectiveness of cognitive behaviour therapy for paediatric functional abdominal pain leaves room for improvement. We studied which factors addressed in cognitive behaviour therapy relate most strongly to the physical and psychological functioning of children with functional abdominal pain and are thus most important to target. Questionnaires were filled out by 117 children with functional abdominal pain and their parents. Multiple regression analyses showed that children’s passive coping and parental and children’s positive cognitions relate to child functioning. Negative cognitions and parental solicitous behaviour were unrelated to child functioning. Cognitive behaviour therapy for functional abdominal pain may benefit most from changing children’s passive coping and promoting positive cognitions.
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Affiliation(s)
- Shelley MC van der Veek
- Academic Medical Center Amsterdam (AMC), The Netherlands
- Leiden University, Center for Child and Family Studies, The Netherlands
| | - Else de Haan
- Academic Medical Center Amsterdam (AMC), The Netherlands
- De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
| | - HHF Derkx
- Emma Children’s Hospital AMC, The Netherlands
| | | | - Frits Boer
- Academic Medical Center Amsterdam (AMC), The Netherlands
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