1
|
Sidiq M, Muzaffar T, Janakiraman B, Masoodi S, Vasanthi RK, Ramachandran A, Bansal N, Chahal A, Kashoo FZ, Rizvi MR, Sharma A, Rai RH, Verma R, Sharma M, Alam S, Vajrala KR, Sharma J, Muthukrishnan R. Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: A randomized controlled trial. PLoS One 2024; 19:e0294302. [PMID: 38805446 PMCID: PMC11132453 DOI: 10.1371/journal.pone.0294302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/10/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Low back pain stands as a prevalent contributor to pain-related disability on a global scale. In addressing chronic low back pain (CLBP), there is a growing emphasis on incorporating psychological strategies into the management process. Among these, pain education interventions strive to reshape pain beliefs and mitigate the perceived threat of pain. This randomized controlled trial sought to assess the effects of pain education on various aspects, including pain levels, disability, quality of life, self-efficacy, and prognostic characteristics in individuals grappling with CLBP. METHODS The clinical trial, retrospectively registered with the Clinical Trials Registry of India (CTRI/2021/08/035963), employed a two-arm parallel randomized design. Ninety-two participants with CLBP were randomly assigned to either the standard physiotherapy care with a pain education program or the control group. Both groups underwent a 6-week intervention. Assessment of pain intensity (using NPRS), disability (using RMDQ), self-efficacy (using the general self-efficacy scale), and well-being (using WHO 5I) occurred both before and after the 6-week study intervention. FINDINGS Post-intervention score comparisons between the groups revealed that the pain education intervention led to a significant reduction in disability compared to the usual standard care at 6 weeks (mean difference 8.2, p < 0.001, effect size Cohen d = 0.75), a decrease in pain intensity (mean difference 3.5, p < 0.001, effect size Cohen d = 0.82), and an improvement in the well-being index (mean difference 13.7, p < 0.001, effect size Cohen d = 0.58). CONCLUSION The findings suggest that integrating a pain education program enhances the therapeutic benefits of standard physiotherapy care for individuals dealing with chronic LBP. In conclusion, the clinical benefits of pain education become apparent when delivered in conjunction with standard care physiotherapy during the management of chronic low back pain.
Collapse
Affiliation(s)
- Mohammad Sidiq
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Tufail Muzaffar
- Departmet of Physical Medicine & Rehabilitation, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | - Balamurugan Janakiraman
- SRM College of Physiotherapy, Faculty of Medicine and Health Sciences, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chennai, Tamil Nadu, India
- Madhav College of Physiotherapy, Faculty of Allied Health Sciences, Madhav University, Rajasthan, India
| | - Shariq Masoodi
- Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, India
| | | | - Arunachalam Ramachandran
- Madhav College of Physiotherapy, Faculty of Allied Health Sciences, Madhav University, Rajasthan, India
| | - Nitesh Bansal
- Jindal School of Public Health & Human Development, O P Jindal Global University, Sonipat, Haryana, India
| | - Aksh Chahal
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Faizan Zaffar Kashoo
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Moattar Raza Rizvi
- Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research Studies, Faridabad, Haryana, India
| | - Ankita Sharma
- Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research Studies, Faridabad, Haryana, India
| | - Richa Hirendra Rai
- School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Rituraj Verma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Monika Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Sajjad Alam
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Krishna Reddy Vajrala
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | - Jyoti Sharma
- Department of Physiotherapy, School of Allied Health Sciences, Galgotias University, Greater Noida, Uttar Pradesh, India
| | | |
Collapse
|
2
|
Lendraitienė E, Styraitė B, Šakalienė R, Misytė G, Bileviciute-Ljungar I. Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study. J Clin Med 2024; 13:2081. [PMID: 38610845 PMCID: PMC11012892 DOI: 10.3390/jcm13072081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/04/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Chronic non-specific low back pain is a non-harmous condition often found in the general population. It is one of the most significant disabilities and needs different treatment modalities. This study investigates the effects of pain neuroscience education and physiotherapy on pain intensity, fear of movement and functional status in a Lithuanian cohort with non-specific low back pain. Methods: The study was performed at the primary health care unit in Kaunas, Lithuania. The key inclusion criterion was persistent non-specific low back pain longer than three months and which affects daily life functions. Thirty participants (mean 33.47, SD 4.38 years age, 70% women) were randomised into two training groups with and without pain neuroscience education (for a total of 60 min of teaching). Physiotherapy was performed twice per week during 45 min/session for a period of 10 weeks with exercises which strengthen, stabilize, and stretch the spinal cord muscles. Outcomes included pain intensity, kinesiophobia and disability and these were measured by self-scored questionnaires (numeric rating scale, Tampa scale for kinesiophobia-11, Oswestry disability index and the Roland-Morris questionnaire, respectively). Results: The results indicate that both groups improved in the measured outcomes, with the only difference between them being a better improvement in kinesiophobia in the group receiving physiotherapy and pain neuroscience education. Conclusions: The results of this study confirm that a relatively short intervention of pain neuroscience education enhances the effects of physiotherapy and should be implemented in clinical practice.
Collapse
Affiliation(s)
- Eglė Lendraitienė
- Department of Rehabilitation, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (E.L.); (B.S.); (G.M.)
| | - Barbora Styraitė
- Department of Rehabilitation, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (E.L.); (B.S.); (G.M.)
| | - Rasa Šakalienė
- Department of Rehabilitation, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (E.L.); (B.S.); (G.M.)
| | - Gabija Misytė
- Department of Rehabilitation, Lithuanian University of Health Sciences, LT-44307 Kaunas, Lithuania; (E.L.); (B.S.); (G.M.)
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, 18288 Stockholm, Sweden
- Multidisciplinary Pain Clinic, Capio St. Göran Hospital, 11219 Stockholm, Sweden
| |
Collapse
|
3
|
Najem C, Wijma AJ, Meeus M, Cagnie B, Ayoubi F, Van Oosterwijck J, De Meulemeester K, Van Wilgen CP. Facilitators and barriers to the implementation of pain neuroscience education in the current Lebanese physical therapist health care approach: a qualitative study. Disabil Rehabil 2024; 46:524-532. [PMID: 36655277 DOI: 10.1080/09638288.2023.2168076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/07/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability. METHOD A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis. RESULTS Two topics were generated and constructed by the researchers: (1) "barriers to the implementation of pain neuroscience education, with subthemes including (a) "current health care approach," (b) "basic curriculum and continuing education," (c) "patients' barriers"; (2) "facilitators to the implementation of pain neuroscience education," with subthemes containing (a) "interest in the BPS model, (b) "therapeutic alliance," and (c) "motivation for future training on BPS approach." CONCLUSION The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach.IMPLICATIONS FOR REHABILITATIONThe exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists.The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management.The most important barriers were the dominant characteristic of the Lebanese physical therapist's health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective.
Collapse
Affiliation(s)
- C Najem
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
- Department of physiotherapy, Faculty of Public Health, Antonine University, Hadath Baabda, Lebanon
- Pain in Motion International Research Group www. paininmotion.be
| | - A J Wijma
- Pain in Motion International Research Group www. paininmotion.be
- Transcare Transdisciplinary Pain Management Center, Groningen, the Netherlands
- PAIN - VUB Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| | - M Meeus
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
- Pain in Motion International Research Group www. paininmotion.be
- MOVANT Research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - B Cagnie
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - F Ayoubi
- Department of physiotherapy, Faculty of Public Health, Antonine University, Hadath Baabda, Lebanon
- Department of physiotherapy, Faculty of Public Health, Lebanese University, Lebanon
| | - J Van Oosterwijck
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
- Pain in Motion International Research Group www. paininmotion.be
- MOVANT Research group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
- Research Foundation - Flanders (FWO), Belgium
| | - K De Meulemeester
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
- Pain in Motion International Research Group www. paininmotion.be
| | - C P Van Wilgen
- Pain in Motion International Research Group www. paininmotion.be
- Transcare Transdisciplinary Pain Management Center, Groningen, the Netherlands
- PAIN - VUB Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Belgium
| |
Collapse
|
4
|
Tiong K, Palmer GM, Jaaniste T. Attrition from Face-to-Face Pediatric Outpatient Chronic Pain Interventions: A Narrative Review and Theoretical Model. CHILDREN (BASEL, SWITZERLAND) 2024; 11:126. [PMID: 38275436 PMCID: PMC10814025 DOI: 10.3390/children11010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
There is limited understanding of attrition (premature treatment withdrawal and non-completion) from pediatric chronic pain services. This narrative review aimed to summarize attrition prevalence from face-to-face pediatric outpatient chronic pain interventions, identify associated factors and develop a theoretical model to account for attrition in this setting. A comprehensive search of the published literature revealed massive variability (0-100%) in the reported attrition rates from pediatric chronic pain interventions that varied in type and format (individual vs. group, single discipline vs. interdisciplinary, psychological only vs. multiple combined interventions, of different durations). The factors associated with attrition from pediatric chronic pain programs varied between the studies: some have assessed patient sex, psychological and other comorbidities, avoidance strategies, missed schooling, family composition/tensions, caregiver catastrophizing, scheduling, caregiver leave and clinic access. A theoretical model is presented depicting youth, caregiver and service factors that may impact attrition from pediatric chronic pain interventions. Where available, literature is drawn from the pediatric chronic pain context, but also from adult chronic pain and pediatric weight management fields. The implications for research and clinical practice are discussed, including improved reporting, patient screening and targeted supports to promote intervention completion. This review contributes to a better understanding of attrition, which is crucial for optimizing pediatric chronic pain service outcomes.
Collapse
Affiliation(s)
- Kristen Tiong
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| | - Greta M. Palmer
- Children’s Pain Management Service, Department of Anaesthesia and Pain Management, Royal Children’s Hospital, Melbourne, VIC 3052, Australia;
- Department of Paediatrics, University of Melbourne, Melbourne, VIC 3052, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
| | - Tiina Jaaniste
- School of Clinical Medicine, University of New South Wales, Kensington, NSW 2052, Australia;
- Department of Pain, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
| |
Collapse
|
5
|
Andrews NE, Ireland D, Vijayakumar P, Burvill L, Hay E, Westerman D, Rose T, Schlumpf M, Strong J, Claus A. Acceptability of a Pain History Assessment and Education Chatbot (Dolores) Across Age Groups in Populations With Chronic Pain: Development and Pilot Testing. JMIR Form Res 2023; 7:e47267. [PMID: 37801342 PMCID: PMC10589833 DOI: 10.2196/47267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The delivery of education on pain neuroscience and the evidence for different treatment approaches has become a key component of contemporary persistent pain management. Chatbots, or more formally conversation agents, are increasingly being used in health care settings due to their versatility in providing interactive and individualized approaches to both capture and deliver information. Research focused on the acceptability of diverse chatbot formats can assist in developing a better understanding of the educational needs of target populations. OBJECTIVE This study aims to detail the development and initial pilot testing of a multimodality pain education chatbot (Dolores) that can be used across different age groups and investigate whether acceptability and feedback were comparable across age groups following pilot testing. METHODS Following an initial design phase involving software engineers (n=2) and expert clinicians (n=6), a total of 60 individuals with chronic pain who attended an outpatient clinic at 1 of 2 pain centers in Australia were recruited for pilot testing. The 60 individuals consisted of 20 (33%) adolescents (aged 10-18 years), 20 (33%) young adults (aged 19-35 years), and 20 (33%) adults (aged >35 years) with persistent pain. Participants spent 20 to 30 minutes completing interactive chatbot activities that enabled the Dolores app to gather a pain history and provide education about pain and pain treatments. After the chatbot activities, participants completed a custom-made feedback questionnaire measuring the acceptability constructs pertaining to health education chatbots. To determine the effect of age group on the acceptability ratings and feedback provided, a series of binomial logistic regression models and cumulative odds ordinal logistic regression models with proportional odds were generated. RESULTS Overall, acceptability was high for the following constructs: engagement, perceived value, usability, accuracy, responsiveness, adoption intention, esthetics, and overall quality. The effect of age group on all acceptability ratings was small and not statistically significant. An analysis of open-ended question responses revealed that major frustrations with the app were related to Dolores' speech, which was explored further through a comparative analysis. With respect to providing negative feedback about Dolores' speech, a logistic regression model showed that the effect of age group was statistically significant (χ22=11.7; P=.003) and explained 27.1% of the variance (Nagelkerke R2). Adults and young adults were less likely to comment on Dolores' speech compared with adolescent participants (odds ratio 0.20, 95% CI 0.05-0.84 and odds ratio 0.05, 95% CI 0.01-0.43, respectively). Comments were related to both speech rate (too slow) and quality (unpleasant and robotic). CONCLUSIONS This study provides support for the acceptability of pain history and education chatbots across different age groups. Chatbot acceptability for adolescent cohorts may be improved by enabling the self-selection of speech characteristics such as rate and personable tone.
Collapse
Affiliation(s)
- Nicole Emma Andrews
- RECOVER Injury Research Centre, The University of Queensland, Herston, Australia
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- The Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Herston, Australia
| | - David Ireland
- Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
| | - Pranavie Vijayakumar
- Australian eHealth Research Centre, The Commonwealth Scientific and Industrial Research Organisation, Herston, Australia
- The Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Lyza Burvill
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Elizabeth Hay
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Daria Westerman
- Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Tanya Rose
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mikaela Schlumpf
- Queensland Interdisciplinary Paediatric Persistent Pain Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Jenny Strong
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- The Occupational Therapy Department, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Andrew Claus
- Tess Cramond Pain and Research Centre, The Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| |
Collapse
|
6
|
Selhorst M, Hoehn J, Schmitt L, Benedict J, Fernandez-Fernandez A. The Effect of a Psychologically Informed Video Series to Treat Adolescents With Patellofemoral Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther 2023; 53:634–642. [PMID: 37706686 DOI: 10.2519/jospt.2023.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE: To test whether a series of brief, psychologically informed educational videos added to physical therapy improved function among adolescents with patellofemoral pain. The secondary aims were to assess pain and psychological beliefs. DESIGN: A double-blinded randomized controlled trial. METHODS: Sixty-eight adolescents with patellofemoral pain were randomly assigned to view brief, psychologically informed videos (n = 34) or control videos (n = 34) in addition to usual care physical therapy. The psychologically informed videos targeted fear-avoidance beliefs, kinesiophobia, and pain catastrophizing. The control videos conveyed basic anatomy, biomedical factors, and lower extremity mechanics. Outcomes were assessed at baseline, 3 weeks, 6 weeks (primary end point), and 3 months. The primary outcome was change in the Anterior Knee Pain Scale. Secondary outcomes were changes in Numeric Pain-Rating Scale and psychological beliefs (Modified Fear-Avoidance Beliefs Questionnaire-Physical Activity, Tampa Kinesiophobia Scale-11, and Pain Catastrophizing Scale-Child). RESULTS: Adolescents in the psychologically informed group experienced significantly greater improvements in function (Anterior Knee Pain Scale mean difference = 8 points; 95% CI: 2.2, 13.2; P = .01) and pain (Numeric Pain-Rating Scale mean difference = 1.2 points; 95% CI: 0.1, 2.4; P = .04) at 6 weeks compared to the control group. The psychologically informed group had significantly greater reductions in psychological beliefs over time than the control group (P≤.001; partial η2 = 0.32). CONCLUSION: Incorporating psychologically informed education into physical therapy care improved function, pain, and psychological beliefs to a greater extent than the control group. J Orthop Sports Phys Ther 2023;53(10):1-9. Epub: 14 September 2023. doi:10.2519/jospt.2023.12041.
Collapse
|
7
|
Spekking K, Anink J, de Boer P, Bergstra SA, van den Berg JM, Schonenberg-Meinema D, van Suijlekom-Smit LWA, van Rossum MAJ, Koopman-Keemink Y, Cate RT, Allaart CF, Brinkman DMC, Muller PCEH. Significant pain decrease in children with non-systemic Juvenile Idiopathic Arthritis treated to target: results over 24 months of follow up. Pediatr Rheumatol Online J 2023; 21:90. [PMID: 37633893 PMCID: PMC10464062 DOI: 10.1186/s12969-023-00874-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/06/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND The aim of this study was to compare pain-scores in three targeted treatment-strategies in JIA-patients and to identify characteristics predicting persistent pain. METHODS In the BeSt-for-Kids-study 92 DMARD-naïve JIA-patients were randomized in 3 treatment-strategies: 1) initial sequential DMARD-monotherapy 2) initial methotrexate (MTX)/prednisolone-bridging or 3) initial MTX/etanercept. Potential differences in VAS pain scores (0-100 mm) over time between treatment-strategies were compared using linear mixed models with visits clustered within patients. A multivariable model was used to assess the ability of baseline characteristics to predict the chance of high pain-scores during follow-up. RESULTS Pain-scores over time reduced from mean 55.3 (SD 21.7) to 19.5 (SD 25.3) mm after 24 months. On average, pain-scores decreased significantly with β -1.37 mm (95% CI -1.726; -1.022) per month. No significant difference was found between treatment-strategies (interaction term treatment arm*time (months) β (95% CI) arm 1: 0.13 (-0.36; 0.62) and arm 2: 0.37 (-0.12; 0.86) compared to arm 3). Correction for sex and symptom duration yielded similar results. Several baseline characteristics were predictive for pain over time. Higher VAS pain [β 0.44 (95% CI 0.25; 0.65)] and higher active joint count [0.77 (0.19; 1.34)] were predictive of higher pain over time, whereas, low VAS physician [ -0.34 (-0.55; -0.06)], CHQ Physical [ -0.42 (-0.72; -0.11)] and Psychosocial summary Score [ -0.42 (-0.77; -0.06)] were predictive of lower pain. CONCLUSIONS Treatment-to-target seems effective in pain-reduction in non-systemic JIA-patients irrespective of initial treatment-strategy. Several baseline-predictors for pain over time were found, which could help to identify patients with a high risk for development of chronic pain. TRIAL REGISTRATION Dutch Trial Registry number 1574.
Collapse
Affiliation(s)
- Katinka Spekking
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands.
| | - Janneke Anink
- De Kinderkliniek, Flevo Hospital, Almere, The Netherlands
| | - Piroska de Boer
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| | - Sytske Anne Bergstra
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Lisette W A van Suijlekom-Smit
- Department of Pediatrics/Pediatric Rheumatology, Sophia Children's Hospital Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marion A J van Rossum
- Department of Pediatrics, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Pediatric Rheumatology, Amsterdam Rheumatology and Immunology Center | Reade, Amsterdam, The Netherlands
| | - Yvonne Koopman-Keemink
- Department of Pediatrics, Juliana Children's Hospital, Hagaziekenhuis, the Hague, The Netherlands
| | - Rebecca Ten Cate
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Daniëlle M C Brinkman
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| | - Petra C E Hissink Muller
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem-Alexander Children's Hospital, Leiden, The Netherlands
| |
Collapse
|
8
|
Menés Fernández L, Salvat I, Adillón C. Expressed Beliefs about the Cause of Pain in a Pediatric Population: A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1007. [PMID: 37371238 DOI: 10.3390/children10061007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
(1) Background: The aims of this study are to explore what beliefs children and adolescents manifest about the cause of the pain they describe, to compare whether there are differences between beliefs by age and the persistence of pain, and to relate the explanations of the cause of pain with current scientific evidence. (2) Methods: a cross-sectional qualitative study was used. The primary endpoint of the study was obtaining explanations of the cause of pain recorded by means of an open-ended question. The participants were school-age children attending a charted school in the province of Barcelona. (3) Results: The children and adolescents proposed a diverse range of explanations for the cause of pain that they reported in their responses. The most frequent explanation for the cause of pain were pathologies and injuries (45.95%), ergonomic issues (22.60%) and psychological issues (15.95%). (4) Conclusions: There is a lot of variety in the explanations that young people give about the cause of their pain in schoolchildren aged between 10 and 16 years old. There exists a high prevalence of explanations non-associated with tissue damage (ENAD) concerning the causes of pain described. It is necessary that future health prevention programs dedicated to early ages consider which beliefs about the cause of pain are the most frequent in the pediatric population.
Collapse
Affiliation(s)
- Laura Menés Fernández
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Isabel Salvat
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Cristina Adillón
- Department of Medicine and Surgery, Faculty of Medicine and Health Sciences, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| |
Collapse
|
9
|
Wickering L, Lautwein C, Nitsche H, Schneider M, Hechler T. Know Pain, No Pain? Preliminary Testing and Application of a New Tool to Assess Biopsychosocial Pain Concepts in Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050814. [PMID: 37238362 DOI: 10.3390/children10050814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
To deliver tailored pain science education, assessing children's biopsychosocial pain concepts is necessary. As validated tools are lacking, a new tool is presented, the biopsychosocial pain concept matrix (BiPS matrix), which assesses children's biological, psychological, and social pain concepts in five domains according to the Common-Sense Model of Self-Regulation (Hagger and Orbell, 2003): (1) illness identity, (2) causes, (3) consequences, (4) duration, and (5) treatment. The present preliminary study aims to (1) assess the items' readability and understandability in cognitive interviews with N = 9 healthy children (9 to 19 years, M = 13.78 years, SD = 3.05; 44% female) and (2) pre-test the BiPS matrix within an online survey of N = 27 healthy children (9 to 19 years, M = 13.76 years, SD = 3.03; 56% female). Results revealed difficulties in understanding some items. Children's understanding increased with age. Age, chronic pain status, and pain in the social environment were positively associated with the BiPS total score, whereas the latter explained the most variance in pain concepts of children. Patient-focused methods such as cognitive interviews proved essential in testing the readability and understanding of items in children. Future studies are warranted to further validate the BiPS matrix.
Collapse
Affiliation(s)
- Linda Wickering
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, 54296 Trier, Germany
| | - Catherina Lautwein
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, 54296 Trier, Germany
| | - Hanna Nitsche
- Department of Clinical Psychology and Psychotherapy for Children and Adolescents, University of Trier, 54296 Trier, Germany
| | - Michael Schneider
- Department of Educational Psychology, University of Trier, 54296 Trier, Germany
| | - Tanja Hechler
- Department of Clinical Psychology for Children and Adolescents, University of Münster, 48149 Münster, Germany
| |
Collapse
|
10
|
Pico M, Matey-Rodríguez C, Domínguez-García A, Menéndez H, Lista S, Santos-Lozano A. Healthcare Professionals’ Knowledge about Pediatric Chronic Pain: A Systematic Review. CHILDREN 2023; 10:children10040665. [PMID: 37189914 DOI: 10.3390/children10040665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Pediatric chronic pain is a common public health problem with a high prevalence among children and adolescents. The aim of this study was to review the current knowledge of health professionals on pediatric chronic pain between 15–30% among children and adolescents. However, since this is an underdiagnosed condition, it is inadequately treated by health professionals. To this aim, a systematic review was carried out based on a search of the electronic literature databases (PubMed and Web of Science), resulting in 14 articles that met the inclusion criteria. The analysis of these articles seems to show a certain degree of heterogeneity in the surveyed professionals about the awareness of this concept, especially regarding its etiology, assessment, and management. In addition, the extent of knowledge of the health professionals seems to be insufficient regarding these aspects of pediatric chronic pain. Hence, the knowledge of the health professionals is unrelated to recent research that identifies central hyperexcitability as the primary factor affecting the onset, persistence, and management of pediatric chronic pain.
Collapse
Affiliation(s)
- Mónica Pico
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Carmen Matey-Rodríguez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Ana Domínguez-García
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Héctor Menéndez
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Simone Lista
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH Strategic Research Group, Department of Health Sciences, Miguel de Cervantes European University (UEMC), 47012 Valladolid, Spain
- Research Institute of the Hospital 12 de Octubre (‘imas12’), 28041 Madrid, Spain
| |
Collapse
|
11
|
We need to talk: The urgent conversation on chronic pain, mental health, prescribing patterns and the opioid crisis. J Psychopharmacol 2023; 37:437-448. [PMID: 37171242 DOI: 10.1177/02698811221144635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
The opioid crisis’ pathways from first exposure onwards to eventual illnesses and fatalities are multiple, intertwined and difficult to dissect. Here, we offer a multidisciplinary appraisal of the relationships among mental health, chronic pain, prescribing patterns worldwide and the opioid crisis. Because the opioid crisis’ toll is especially harsh on young people, emphasis is given on data regarding the younger strata of the population. Because analgesic opioid prescription constitute a recognised entry point towards misuse, opioid use disorder, and ultimately overdose, prescribing patterns across different countries are examined as a modifiable hazard factor along these pathways of risk. Psychiatrists are called to play a more compelling role in this urgent conversation, as they are uniquely placed to provide synthesis and lead action among the different fields of knowledge and care that lie at the crossroads of the opioid crisis. Psychiatrists are also ideally positioned to gauge and disseminate the foundations for diagnosis and clinical management of mental conditions associated with chronic pain, including the identification of hazardous and protective factors. It is our hope to spark more interdisciplinary exchanges and encourage psychiatrists worldwide to become leaders in an urgent conversation with interlocutors from the clinical and basic sciences, policy makers and stakeholders including clients and their families.
Collapse
|
12
|
Saracoglu I, Akin E. Reply to "Pain neuroscience education for fibromyalgia syndrome". Int J Rheum Dis 2023. [PMID: 36806658 DOI: 10.1111/1756-185x.14633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Ismail Saracoglu
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya Health Sciences University, Kutahya, Turkey
| | - Esra Akin
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya Health Sciences University, Kutahya, Turkey
| |
Collapse
|
13
|
Ickmans K, Rheel E, Rezende J, Reis FJJ. Spreading the word: pediatric pain education from treatment to prevention. Arch Physiother 2022; 12:25. [PMID: 36376953 PMCID: PMC9663293 DOI: 10.1186/s40945-022-00151-4] [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: 02/24/2022] [Accepted: 09/04/2022] [Indexed: 11/16/2022] Open
Abstract
Pain affects everyone hence one can argue that it is in each individual’s interest to understand pain in order to hold correct and adaptive beliefs and attitudes about pain. In addition, chronic pain is reaching pandemic proportions and it is now well known that people living with chronic pain have a reduced life expectancy. To address and to prevent the growth of this public health disaster, we must start looking beyond adulthood. How children view pain has an impact on their behavioral coping responses which in turn predict persistent pain early in the lifespan. In addition, children who suffer from chronic pain and who are not (properly) treated for it before adolescence have an increased risk of having chronic pain during their adult life. Explaining pain to children and youth may have a tremendous impact not only on the individual child suffering from chronic pain but also on society, since the key to stop the pain pandemic may well lie in the first two decades of life. In order to facilitate the acquisition of adaptive behavioral coping responses, pain education aims to shift people’s view on pain from being an apparent threat towards being a compelling perceptual experience generated by the brain that will only arise whenever the conceivable proof of danger to the body is greater than the conceivable proof of safety to the body. Nowadays a lot of pain education material is available for adults, but it is not adapted to children’s developmental stage and therefore little or not suitable for them. An overview of the state-of-the-art pain education material for children and youth is provided here, along with its current and future areas of application as well as challenges to its development and delivery. Research on pediatric pain education is still in its infancy and many questions remain to be answered within this emerging field of investigation.
Collapse
|
14
|
Bonilla DA, Cardozo LA, Vélez-Gutiérrez JM, Arévalo-Rodríguez A, Vargas-Molina S, Stout JR, Kreider RB, Petro JL. Exercise Selection and Common Injuries in Fitness Centers: A Systematic Integrative Review and Practical Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912710. [PMID: 36232010 PMCID: PMC9565175 DOI: 10.3390/ijerph191912710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/25/2022] [Accepted: 10/02/2022] [Indexed: 05/08/2023]
Abstract
Weight resistance training (RT) is an essential component of physical conditioning programs to improve the quality of life and physical fitness in different ages and populations. This integrative review aimed to analyze the scientific evidence on the relationship between exercise selection and the appearance of musculoskeletal injuries in physical fitness centers (PFC). The PubMed or Medline, EMBASE or Science Direct, Google Scholar and PEDro databases were selected to examine the available literature using a Boolean algorithm with search terms. The review process was performed using the five-stage approach for an integrative review and it was reported according to the PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSiST) guidelines. A total of 39 peer-reviewed articles (Price index = 71.7%) met the inclusion criteria and evaluated the link between exercise selection and the incidence of injuries in exercisers who regularly attend PFC. Most injuries occur to the shoulders, elbows, vertebrae of the spine, and knees. Although the injury etiologies are multifactorial, the findings of the reviewed articles include the impacts of overuse, short post-exercise recovery periods, poor conditioning in the exercised body areas, frequent use of heavy loads, improper technique in certain exercises, and the abuse of performance- and image-enhancing drugs. Practical recommendations addressed to clinical exercise physiologists, exercise professionals, and health professionals are given in this paper. The exercise selection in RT programs requires professional supervision and adhering to proper lifting techniques and training habits that consider the anatomical and biomechanical patterns of the musculoskeletal structures, as well as genetic, pedagogical, and methodological aspects directly related to the stimulus-response process to mitigate the occurrence of RT-related injuries in PFC.
Collapse
Affiliation(s)
- Diego A. Bonilla
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- Research Group in Physical Activity, Sports and Health Sciences—GICAFS, Universidad de Córdoba, Montería 230002, Colombia
- Research Group in Biochemistry and Molecular Biology, Faculty of Sciences and Education, Universidad Distrital Francisco José de Caldas, Bogotá 110311, Colombia
- Sport Genomics Research Group, Department of Genetics, Physical Anthropology and Animal Physiology, Faculty of Science and Technology, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
- Correspondence: ; Tel.: +57-320-335-2050
| | - Luis A. Cardozo
- Research and Measurement Group in Sports Training (IMED), Faculty of Health Sciences and Sports, Fundación Universitaria del Área Andina, Bogotá 111221, Colombia
| | - Jorge M. Vélez-Gutiérrez
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- ARTHROS Centro de Fisioterapia y Ejercicio, Medellín 050012, Colombia
| | - Adrián Arévalo-Rodríguez
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- Centro de Capacitación en Acondicionamiento y Preparación Física (CCAPF), Bogotá 111511, Colombia
| | - Salvador Vargas-Molina
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- Faculty of Sport Sciences, EADE-University of Wales Trinity Saint David, 29018 Málaga, Spain
| | - Jeffrey R. Stout
- Physiology of Work and Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, FL 32816, USA
| | - Richard B. Kreider
- Exercise & Sport Nutrition Laboratory, Human Clinical Research Facility, Texas A&M University, College Station, TX 77843, USA
| | - Jorge L. Petro
- Research Division, Dynamical Business & Science Society—DBSS International SAS, Bogotá 110311, Colombia
- Research Group in Physical Activity, Sports and Health Sciences—GICAFS, Universidad de Córdoba, Montería 230002, Colombia
| |
Collapse
|
15
|
Geremek A, Ruby L, Lindner C, Niederberger U, Schild U, Jung M, Soyka O, Siniatchkin M. Child and adolescent psychiatry staff's knowledge on pain management. Clin Child Psychol Psychiatry 2022:13591045221125334. [PMID: 36062462 DOI: 10.1177/13591045221125334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the level of child and adolescent psychiatric staff's knowledge regarding pain management, to determine group differences between the medically more educated (physicians, nurses) and the less educated (psychologists, educators, special therapists) and to investigate the influence of gender, age, or professional experience as well as staff's own pain experiences. METHODS A total of 193 staff members from different professional backgrounds from three independent child and adolescent psychiatry clinics in Northern Germany were tested using the German version of the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Shriner's revision (PNKAS-Sr). RESULTS In total, the staff scored correctly 66% of the inventory questions. There was no difference between medically more educated and less educated staff members regarding the knowledge of pain management. The main factors influencing PNKAS score were age, profession, and pain education training. CONCLUSIONS Although chronic pain is not one of the main aspects of continuing education in child and adolescent psychiatry, the resulting level of knowledge was comparable to results of similar surveys with paediatric staffs. Nevertheless, further education is needed to enhance knowledge and understanding of children's pain in child psychiatry staff in order to professionally treat patients with chronic somatic and mental illnesses.
Collapse
Affiliation(s)
- Adam Geremek
- 440814Psychosomatikum, Kiel, Germany.,Child and Adolescent Psychiatric Clinic, 440814Helios Klinikum Schleswig, Schleswig, Germany
| | - Lisa Ruby
- Child and Adolescent Psychiatric Clinic, 440814Helios Klinikum Schleswig, Schleswig, Germany
| | | | - Uwe Niederberger
- Institute for Medical Psychology and Sociology, University of Kiel, Kiel, Germany
| | - Ursula Schild
- Child and Adolescent Psychiatric Clinic, 440814Psychiatrische Kliniken, Lüneburg, Germany
| | | | - Oliver Soyka
- Child and Adolescent Psychiatric Clinic, 581931Vorwerker Diakonie, Lübeck, Germany
| | - Michael Siniatchkin
- 39718University Clinic for Child and Adolescent Psychiatry, Bielefeld, Germany
| |
Collapse
|
16
|
Apaydin Cirik V, Bulut E, Aksoy B, Yalçin Cömert HS, Pate JW. The concept of pain inventory for children: The reliability and validity study of the Turkish version. J Pediatr Nurs 2022; 66:111-119. [PMID: 35709634 DOI: 10.1016/j.pedn.2022.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Pain experiences in childhood are very likely to be reflected in adulthood. The early evaluation of the concept of pain in children may eventually lead to. better patient outcomes in the future. Therefore, we aimed to culturally and developmentally adapt the Concept of Pain Inventory for Children (COPI) for Turkish children. METHODS This descriptive, correlational study was conducted with 239 post-operative children aged 8-12 years between June and December 2021. The research adhered to COSMIN guidelines. The data were collected using a descriptive information form and the COPI. Factor analysis, Cronbach's alpha, and item-total score analysis were used for the data analysis. RESULTS The resulting unidimensional scale consists of 12 items in Turkish. The scale explained 65% of the total variance. The exploratory factor analysis showed that the factor loadings of items ranged from 0.64 to 0.91. The confirmatory factor analysis showed that the factor loadings of items ranged from 0.66 to 0.92. Goodness of fit indexes were found to be as follows: Normed Fit Index >0.90; Incremental Fit Index >0.90; Comparative Fit Index >0.90; and the Root Mean Square Error of Approximation <0.08. The total Cronbach's alpha coefficient of the scale was 0.78 (reliable). CONCLUSIONS The 12-item Turkish translation of the COPI was deemed valid and reliable in 8-12-year-old children in a post-operative setting. PRACTICE IMPLICATIONS Evaluation of children's pain concepts during childhood may contribute to the identification of conceptual gaps for pain science education.
Collapse
Affiliation(s)
- Vildan Apaydin Cirik
- Karamanoğlu Mehmetbey University, Faculty of Health Sciences, Department of Midwifery, Child Health Nursing, Karaman, Turkey.
| | - Elif Bulut
- Karadeniz Technical University, Faculty of Health Sciences, Child Health Nursing Department, Trabzon, Turkey.
| | - Bahar Aksoy
- Gumushane University, Faculty of Health Sciences, Child Health Nursing Department, Gumushane, Turkey.
| | | | - Joshua W Pate
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| |
Collapse
|
17
|
The Effect of a Brief Physician-Delivered Neurobiologically Oriented, Cognitive Behavioural Therapy (Brief-CBT) Intervention on Chronic Pain Acceptance in Youth with Chronic Pain-A Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091293. [PMID: 36138601 PMCID: PMC9497203 DOI: 10.3390/children9091293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 12/04/2022]
Abstract
At the Stollery Children’s Chronic Pain Clinic, new referrals are assessed by an interdisciplinary team. The final part of the intake assessment typically involves an explanation and compassionate validation of the etiology of chronic pain and an invitation to the youth to attend the group outpatient Cognitive Behavioural Therapy (CBT) program, called Pain 101, or to individual outpatient CBT. It was hypothesized that a brief physician-delivered CBT (brief-CBT) intervention at first point of contact improves subsequent pain acceptance. Using a randomized double blinded methodology, 26 participants received a standard intake assessment and 26 the standard assessment plus the brief-CBT intervention. Measures were taken at three points: pre and post-intake assessment and after Pain 101 or individual CBT (or day 30 post-assessment for those attending neither). The primary outcome measure was the Chronic Pain Acceptance Questionnaire—Adolescent version (CPAQ-A). Comparing pre and post-intake measures, there was a significant (p = 0.002) increase in the CPAQ-A scores—four-fold more in the brief-CBT intervention group (p = 0.045). Anxiety (RCADS-T Score) was significantly reduced post-intake and significantly more reduced in the intervention group compared to the control group (p = 0.024). CPAQ-A scores were significantly increased (p < 0.001) (N = 28) and anxiety (RCADs-T) was significantly reduced by the end of Pain 101 (p < 0.003) (N = 29) as was fear of pain as measured by the Tampa Scale for Kinesiophobia (p = 0.021). A physician-delivered brief-CBT intervention significantly and meaningfully increased CPAQ-A scores and reduced anxiety in youth with chronic pain. Furthermore, CBT through Pain 101 is effective at increasing acceptance, as well as reducing anxiety and fear of movement.
Collapse
|
18
|
Wallwork SB, Noel M, Moseley GL. Communicating with children about 'everyday' pain and injury: A Delphi study. Eur J Pain 2022; 26:1863-1872. [PMID: 35829711 PMCID: PMC9545644 DOI: 10.1002/ejp.2008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/29/2022] [Accepted: 07/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND 'Everyday' pain experiences are potentially critical in shaping our beliefs and behaviours around injury and pain. Influenced by social, cultural and environmental contexts, they form the foundation of one's understanding of pain and injury that is taken into adulthood. How to best communicate to young children about their everyday pain experiences, in order to foster adaptive beliefs and behaviours, is unknown. METHODS In this Delphi survey, we sought expert opinion on the key messages and strategies that parents/caregivers can consider when communicating with young children (aged 2-7 years) about 'everyday' pain that is most likely to promote recovery, resilience and adaptive pain behaviours. Eighteen experts participated including specialists in paediatric pain, trauma, child development, and psychology; educators and parents. The survey included three rounds. RESULTS Response rate was over 88%. Two hundred fifty-three items were raised; 187 reached 'consensus' (≥80% agreement among experts). Key messages that the experts agreed to be 'very important' were aligned with current evidence-based understandings of pain and injury. Strategies to communicate messages included parent/caregiver role-modelling, responses to child pain, and discussion during and/or after a painful experience. Other key themes included promoting emotional development, empowering children to use active coping strategies, and resilience building. CONCLUSIONS This diverse set of childhood, pain and parenting experts reached consensus on 187 items, yielding 12 key themes to consider when using everyday pain experiences to promote adaptive pain beliefs and behaviours in young children.
Collapse
Affiliation(s)
- S B Wallwork
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| | - M Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - G L Moseley
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| |
Collapse
|
19
|
Simons L, Moayedi M, Coghill RC, Stinson J, Angst MS, Aghaeepour N, Gaudilliere B, King CD, López-Solà M, Hoeppli ME, Biggs E, Ganio E, Williams SE, Goldschneider KR, Campbell F, Ruskin D, Krane EJ, Walker S, Rush G, Heirich M. Signature for Pain Recovery IN Teens (SPRINT): protocol for a multisite prospective signature study in chronic musculoskeletal pain. BMJ Open 2022; 12:e061548. [PMID: 35676017 PMCID: PMC9185591 DOI: 10.1136/bmjopen-2022-061548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Current treatments for chronic musculoskeletal (MSK) pain are suboptimal. Discovery of robust prognostic markers separating patients who recover from patients with persistent pain and disability is critical for developing patient-specific treatment strategies and conceiving novel approaches that benefit all patients. Given that chronic pain is a biopsychosocial process, this study aims to discover and validate a robust prognostic signature that measures across multiple dimensions in the same adolescent patient cohort with a computational analysis pipeline. This will facilitate risk stratification in adolescent patients with chronic MSK pain and more resourceful allocation of patients to costly and potentially burdensome multidisciplinary pain treatment approaches. METHODS AND ANALYSIS Here we describe a multi-institutional effort to collect, curate and analyse a high dimensional data set including epidemiological, psychometric, quantitative sensory, brain imaging and biological information collected over the course of 12 months. The aim of this effort is to derive a multivariate model with strong prognostic power regarding the clinical course of adolescent MSK pain and function. ETHICS AND DISSEMINATION The study complies with the National Institutes of Health policy on the use of a single internal review board (sIRB) for multisite research, with Cincinnati Children's Hospital Medical Center Review Board as the reviewing IRB. Stanford's IRB is a relying IRB within the sIRB. As foreign institutions, the University of Toronto and The Hospital for Sick Children (SickKids) are overseen by their respective ethics boards. All participants provide signed informed consent. We are committed to open-access publication, so that patients, clinicians and scientists have access to the study data and the signature(s) derived. After findings are published, we will upload a limited data set for sharing with other investigators on applicable repositories. TRIAL REGISTRATION NUMBER NCT04285112.
Collapse
Affiliation(s)
- Laura Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Massieh Moayedi
- Centre for Multimodal Sensorimotor and Pain Research, University of Toronto Faculty of Dentistry, Toronto, Ontario, Canada
- Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada
| | - Robert C Coghill
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Stinson
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- The Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin S Angst
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Marina López-Solà
- Serra Hunter Programme, Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Marie-Eve Hoeppli
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Emma Biggs
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Ed Ganio
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Sara E Williams
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kenneth R Goldschneider
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Danielle Ruskin
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elliot J Krane
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Suellen Walker
- Developmental Neurosciences Department, UCL GOS Institute of Child Health, UCL, London, UK
| | - Gillian Rush
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Marissa Heirich
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| |
Collapse
|
20
|
Andias R, Sa-Couto P, Silva AG. Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial. Phys Ther 2022; 102:6575293. [PMID: 35485186 DOI: 10.1093/ptj/pzac048] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/07/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP). METHODS A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up. RESULTS There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found. CONCLUSION Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups.
Collapse
Affiliation(s)
- Rosa Andias
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Health Technology and Services Research (CINTESIS), Piso 2, Edifício nascente, Porto, Portugal
| | - Pedro Sa-Couto
- CINTESIS@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Anabela G Silva
- School of Health Sciences (ESSUA), University of Aveiro, Campus Universitário de Santiago, Aveiro, Portugal.,Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics (DMAT), University of Aveiro, Aveiro, Portugal
| |
Collapse
|
21
|
Birnie KA, Stinson J, Isaac L, Tyrrell J, Campbell F, Jordan IP, Marianayagam J, Richards D, Rosenbloom BN, Clement F, Hubley P. Mapping the current state of pediatric surgical pain care across Canada and assessing readiness for change. Can J Pain 2022; 6:108-120. [PMID: 35692556 PMCID: PMC9176261 DOI: 10.1080/24740527.2022.2038031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Preventing pediatric chronic postsurgical pain is a patient, parent/caregiver, health care professional, and policymaker priority. Poorly managed presurgical and acute postsurgical pain are established risk factors for pediatric chronic postsurgical pain. Effective perioperative pain management is essential to prevent the transition from acute to chronic pain after surgery. Aims The aim of this study was to identify current pediatric surgical pain management practices and assess health system readiness for change at health care institutions conducting pediatric surgery in Canada. Methods An online survey was completed by 85 multidisciplinary health care professionals (nurses, surgeons, anesthesiologists, allied health) from 20 health institutions in Canada regarding institutional pre- and postsurgical pediatric pain care, specialty pain services, and Organizational Readiness for Implementing Change (ORIC). Results Of all specialty pain services, acute and chronic/complex pain services were most common, primarily with physician and nursing involvement. Alignment to recommended practices for pediatric pre- and postsurgical pain care varied (38.1%–79.8% reported “yes, for every child”), with tertiary/quaternary children’s hospitals reporting less alignment than other institutions (community/regional or rehabilitation hospitals, community treatment centers). No significant differences were reported between health care institutions serving pediatric populations only versus those also serving adults. Health care professional experience/practice was the most reported strength in pediatric surgical pain care, with inconsistent standard of care the most common gap. Participants “somewhat agreed” that their institutions were committed and capable of change in pediatric surgical pain care. Conclusions There is a continued need to improve pediatric pain care during the perioperative period at Canadian health care institutions to effectively prevent the development of pediatric postsurgical pain.
Collapse
Affiliation(s)
- Kathryn A. Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4
- Department of Community Health Sciences, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4
- Alberta Children’s Hospital Research Institute, 3330 Hospital Dr NW, Calgary, AB T2N 4N1
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St., Toronto, ON M5G 0A4
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON M5T 1P8
| | - Lisa Isaac
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children555 University Ave, Toronto, ON M5G 1X8
- Department of Anesthesiology and Pain Medicine, University of Toronto, 123 Edward St., Toronto, ON M5G 1E2
| | - Jennifer Tyrrell
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON M5T 1P8
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children555 University Ave, Toronto, ON M5G 1X8
| | - Fiona Campbell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children555 University Ave, Toronto, ON M5G 1X8
- Department of Anesthesiology and Pain Medicine, University of Toronto, 123 Edward St., Toronto, ON M5G 1E2
| | | | | | - Dawn Richards
- Five02Labs, Inc., #502 – 25 Ritchie Ave, Toronto, ON M6R 2J6
| | - Brittany N. Rosenbloom
- Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St., Toronto, ON M5G 0A4
| | - Fiona Clement
- Department of Community Health Sciences, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4
| | - Pam Hubley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON M5T 1P8
- The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8
| |
Collapse
|
22
|
Connelly M, Lee RR. Technology to Assess and Treat Pain in Pediatric Rheumatology. Rheum Dis Clin North Am 2022; 48:31-50. [PMID: 34798955 DOI: 10.1016/j.rdc.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Advancements in eHealth offer unique opportunities for assisting in and augmenting aspects of evidence-based pain evaluation and management with children and adolescents. In this article, we present an overview of some of the opportunities and challenges in pain eHealth for pediatric rheumatologists to consider while caring for children and adolescents seen in their practice.
Collapse
Affiliation(s)
- Mark Connelly
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Rebecca Rachael Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
23
|
Andreani A, Lorusso M, Salomon M, Paci M, Brindisino F. The burden of words in shoulder pain: A case report of a water polo player. J Bodyw Mov Ther 2022; 29:215-222. [DOI: 10.1016/j.jbmt.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 08/09/2021] [Accepted: 10/30/2021] [Indexed: 11/29/2022]
|
24
|
Walker LS, Stone AL, Han GT, Garber J, Bruehl S, Smith CA, Anderson J, Palermo TM. Internet-delivered cognitive behavioral therapy for youth with functional abdominal pain: a randomized clinical trial testing differential efficacy by patient subgroup. Pain 2021; 162:2945-2955. [PMID: 34793406 PMCID: PMC8602868 DOI: 10.1097/j.pain.0000000000002288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/22/2021] [Indexed: 12/19/2022]
Abstract
ABSTRACT Inconsistent results of psychological treatments for pediatric functional abdominal pain (FAP) may be due to heterogeneity of patients' pain-related psychological characteristics. This randomized controlled trial tested whether statistically derived patient subgroups (high pain dysfunctional [HPD], high pain adaptive [HPA], and low pain adaptive [LPA]) moderated response to cognitive behavior therapy (CBT) for adolescents with FAP and their parents (n = 278 dyads; patients were 66% female, mean [SD] age was 14.62 [1.88] years, and parents were 95% female). Randomization to Internet-delivered CBT vs Internet-delivered pain education (EDU) was stratified by patient subgroup. Follow-up assessments of gastrointestinal (GI) symptoms (primary outcome), abdominal pain, and pain interference were at midtreatment, posttreatment, 6 months, and 12 months. Data were analysed using linear mixed effects models. Significant treatment × subgroup × time interaction effects showed that patient subgroup significantly moderated the effect of treatment on GI symptoms (t[853 = -2.93, P = 0.003) and abdominal pain (t(844) = -2.14, P = 0.03) across the treatment period. Among HPD youth, those in CBT had significantly greater GI symptom reduction than those in EDU through posttreatment. By contrast, among HPA and LPA youth, symptom improvement did not differ by treatment condition. Furthermore, among all patients assigned to CBT, HPD youth demonstrated significantly greater reductions in GI symptoms compared with HPA and LPA youth and greater reductions in abdominal pain compared with LPA youth. All subgroups maintained symptom reductions throughout the follow-up period. Results suggest that subgrouping FAP patients may inform treatment allocation and optimize treatment response.
Collapse
Affiliation(s)
- Lynn S. Walker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Gloria T. Han
- Child Study Center, Yale University School of Medicine, New Haven, CT
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Craig A. Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Julia Anderson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington
- Seattle Children’s Research Institute, Seattle, WA
| |
Collapse
|
25
|
Information Provision and Preparatory Interventions: Shaping the Lens for Children’s Understanding and Response to Painful Contexts. CHILDREN 2021; 8:children8090738. [PMID: 34572170 PMCID: PMC8469172 DOI: 10.3390/children8090738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022]
|
26
|
Bacardit Pintó P, Ickmans K, Rheel E, Iwens M, Meeus M, Nijs J, Pas R. Do Parental Pain Knowledge, Catastrophizing, and Hypervigilance Improve Following Pain Neuroscience Education in Healthy Children? CHILDREN-BASEL 2021; 8:children8050420. [PMID: 34065220 PMCID: PMC8161245 DOI: 10.3390/children8050420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
Pediatric chronic pain is a challenging problem for children and their families, although it is still under-recognized and under-treated. The aim of this study was to investigate whether a pain neuroscience education program for children (PNE4Kids) delivered to healthy children aged 8 to 12 years old and attended by their parents would result in improved parental knowledge about pain neurophysiology, decreased parental pain catastrophizing about their own pain and their children's, decreased parental pain vigilance and awareness, and decreased fear of pain in children. Twenty-seven healthy child-parent dyads received a 45 min PNE4Kids session. Demographic data were collected, and the Neurophysiology of Pain Questionnaire (NPQ), Fear of Pain Questionnaire-Parent Proxy Report (FOPQ-P), Pain Catastrophizing Scale (PCS), Pain Catastrophizing Scale for Parents (PCS-P), and the Pain Vigilance and Awareness Questionnaire (PVAQ) were completed by the parents before and after the PNE4Kids session. Twenty-six dyads completed study participation. In response to the PNE4Kids session, significant short-term (1 week) improvements were shown in the NPQ (p < 0.001) and the FOPQ-P (p = 0.002). Parents' level of pain knowledge and children's fear of pain, reported by their parents, improved after a 45 min PNE4Kids session. Thus, PNE4Kids should likewise be further investigated in healthy child-parent dyads as it might be useful to target parental and children's pain cognitions at a young age.
Collapse
Affiliation(s)
- Pere Bacardit Pintó
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussel, Belgium
- Research Foundation—Flanders (FWO), Egmontstraat 5, 1000 Brussel, Belgium
- Correspondence: ; Tel.: +32-(0)2-477-45-03
| | - Emma Rheel
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium
| | - Margot Iwens
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
| | - Mira Meeus
- Pain in Motion International Research Group;
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Wilrijk, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Campus UZ, Ghent University, 9000 Ghent, Belgium
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussel, Belgium
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Roselien Pas
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium; (P.B.P.); (E.R.); (M.I.); (J.N.); (R.P.)
- MOVANT Research Group, Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), 2610 Wilrijk, Belgium
| |
Collapse
|
27
|
Matthews J, Zoffness R, Becker D. Integrative pediatric pain management: Impact & implications of a novel interdisciplinary curriculum. Complement Ther Med 2021; 59:102721. [PMID: 33964407 DOI: 10.1016/j.ctim.2021.102721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Objectives of this paper are to: 1) Describe a novel interdisciplinary, integrative pain curriculum for pediatric residents. 2) Describe changes in residents' understanding of pain epidemiology, physiology, and management; application of the biopsychosocial model in pain management; and understanding and application of non-pharmacologic approaches to pain management. DESIGN, SETTING This study was done in a pediatric residency program within an urban pediatric teaching hospital. It employed both anonymous, Likert-scale surveys administered via Qualtrics, as well as open-ended, free response questions. INTERVENTIONS We provided a multidisciplinary pain education curriculum to pediatric residents with a focus on pain neuroscience, a history of pain management, the biopsychosocial model of care, and exposure to non-pharmacologic interventions to pain management over six hours of instruction conducted in two blocks of three hours each. OUTCOME MEASURES Self-identified changes via survey measuring resident physician knowledge, comfort, approach, and management of pediatric pain through an interdisciplinary pain curriculum. RESULTS Prior to this training, many residents were not confident in their understanding of pain neuroscience, the biopsychosocial model of care, and non-pharmacologic interventions. At completion of training, residents indicated positive changes in knowledge of, and comfort with, all of the domains taught. Ninety percent of residents indicated that the curriculum changed the way they conceptualized, approached, and/or managed pain, and reported thinking more holistically about pain management. Nearly all residents indicated they would like to have more training (98 %, N = 57) in integrative modalities. CONCLUSIONS Pediatric resident physicians are receptive to training in an interdisciplinary, integrative, pediatric pain management education intervention, and subsequently show positive changes in knowledge and comfort levels. There is a need and desire for additional pain education in resident training programs.
Collapse
Affiliation(s)
- Jenifer Matthews
- UCSF Benioff Children's Hospital Oakland, 5400 Telegraph Ave, Oakland, CA, 94609, United States; UCSF Osher Center for Integrative Medicine, 1545 Divisadero St, UCSF Box 1726, San Francisco, CA 94143, United States.
| | - Rachel Zoffness
- UCSF Benioff Children's Hospital Oakland, 5400 Telegraph Ave, Oakland, CA, 94609, United States.
| | - David Becker
- UCSF Osher Center for Integrative Medicine, 1545 Divisadero St, UCSF Box 1726, San Francisco, CA 94143, United States.
| |
Collapse
|
28
|
Development of the Conceptualization of Pain Questionnaire: A Measure to Study How Children Conceptualize Pain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073821. [PMID: 33917429 PMCID: PMC8038728 DOI: 10.3390/ijerph18073821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/24/2021] [Accepted: 04/02/2021] [Indexed: 11/24/2022]
Abstract
(1) Background: Research has shown that thoughts about pain are important for the management of chronic pain in children. In order to monitor changes in thoughts about pain over time and evaluate the efficacy of treatments, we need valid and reliable measures. The aims of this study were to develop a questionnaire to assess a child’s concept of pain and to evaluate its psychometric properties; (2) Methods: This is a cross-sectional, two-phase, mixed-method study. A total of 324 individuals aged 8 to 17 years old responded to the newly created questionnaire. The Conceptualization of Pain Questionnaire (COPAQ) was calibrated using the Rasch model. The chi-square test was used for the fit statistics. Underfit and overfit of the model were determined and a descriptive analysis of infit and outfit was conducted to identify who responded erratically. Internal consistency was measured using the Person Separation Index (PSI); (3) Results: Fit to the Rasch model was good. Suitable targeting indicated which items were simple to answer; Person Fit identified 9.56% children who responded erratically; PSI = 0.814; (4) Conclusions: The findings suggest that COPAQ is a measure of a child’s concept of pain that is easy to administer and respond to. It has a good fit and a good internal consistency.
Collapse
|
29
|
Hurtubise K, Brousselle A, Noel M, Jordan A, White J, Rasic N, Camden C. Youth and parent perceptions on participating in specialized multidisciplinary pain rehabilitation options: A qualitative timeline effect analysis. Can J Pain 2021; 5:1-21. [PMID: 33987520 PMCID: PMC7951173 DOI: 10.1080/24740527.2020.1858709] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 11/12/2022]
Abstract
Background: Little is known about how the specialized treatment journey is perceived by youth with pain-related disability and their parents. Aims: Describe and compare the treatment effects and outcomes as perceived by youth and their parents enrolled in intensive interdisciplinary pain treatment (IIPT) or multimodal treatment (MMT). Methods: Eleven IIPT youth and five parents and three MMT youth and five parents were recruited. All were asked to complete a treatment journey timeline, followed by separately conducted semistructured interviews. Transcribed interviews were analyzed using reflective thematic analysis. Results: The main themes spanned the treatment trajectory. All participants described similar initial struggles (Theme 1). Positive and negative treatment effects associated with acquisitions and disruptions (Theme 2), and outcomes post-discharge related to supports and realities (Theme 3) emerged. Knowledge, skills, and support acquisition during treatment and feeling empowered and confident to self-manage postdischarge were identified as IIPT benefits. However, the change effort and life disruptions required and the difficulty transitioning to real life postprogram were acknowledged as detrimental IIPT impacts. Continuing with life as usual and maintaining supports in daily contexts (e.g., school personnel, friends) were reported MMT benefits. However, the challenges of managing pain, treatment adherence within the competing demands of daily realities, and the lack of support to integrate strategies were emphasized as detrimental MMT impacts. Conclusions: Detailed impacts of two specialized multidisciplinary pain rehabilitation interventions on the lives of youth with pain-related disability and their parents are described. The treatments benefits and previously unexplored detrimental effects are unveiled.
Collapse
Affiliation(s)
- Karen Hurtubise
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Astrid Brousselle
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- School of Public Administration, University of Victoria, Victoria, British Columbia, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Health Research Innovation Centre, Calgary, Alberta, Canada
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, UK
| | - Jo White
- Department of Health and Social Sciences, University of the West of England–Bristol, Bristol, UK
| | - Nivez Rasic
- Department of Anesthesia & Pain Medicine, Foothills Hospital, Calgary, Alberta, Canada
| | - Chantal Camden
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Sherbrooke, Québec, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
30
|
Emerson ND, Bursch B. Communicating with Youth about Pain: Developmental Considerations. CHILDREN-BASEL 2020; 7:children7100184. [PMID: 33076255 PMCID: PMC7602494 DOI: 10.3390/children7100184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/01/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain experiences can negatively impact children and adolescents, leading to trauma symptoms and nonadherence to important health behaviors. Developmentally-tailored communication strategies may mitigate this risk. METHODS This article reviews cognitive and linguistic developmental factors, within the familial and cultural context, that are important to consider when communicating with youth about acute, procedural, and/or chronic pain. RESULTS Youth undergoing acute or procedural pain benefit from pain education, truthful information about the procedure, and advance preparation. The use of analogies may be particularly helpful for patient understanding of chronic pain development, maintenance, and treatment. Youth with developmental disabilities may express pain differently than their normative peers, requiring adaptation of communication strategies. CONCLUSION Developmentally-tailored pain communication is an important tool for caregivers and healthcare providers that may foster adaptive functioning in youth who experience pain.
Collapse
|
31
|
Koechlin H, Locher C, Prchal A. Talking to Children and Families about Chronic Pain: The Importance of Pain Education-An Introduction for Pediatricians and Other Health Care Providers. CHILDREN (BASEL, SWITZERLAND) 2020; 7:E179. [PMID: 33053802 PMCID: PMC7599921 DOI: 10.3390/children7100179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 12/26/2022]
Abstract
Chronic pain in children and adolescents is a common and debilitating health problem. This narrative review will give a brief overview on what pediatric chronic pain is and what treatment options there are for children and adolescents. The specific emphasis will be on pediatric chronic pain education and communication: this narrative review aims to show how important a good patient-health care provider relationship is-it builds the foundation for successful communication-and how this relationship can be established. In addition, we will present five steps that health care providers can perform to explain pediatric chronic pain to patients and their parents and what to keep in mind in their clinical routine. Our review is intended for pediatricians and other health care providers who treat pediatric patients with chronic pain but might feel uncertain on how to best communicate with them.
Collapse
Affiliation(s)
- Helen Koechlin
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115 USA;
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, 4055 Basel, Switzerland
| | - Cosima Locher
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115 USA;
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, 4055 Basel, Switzerland
- School of Psychology, University of Plymouth, Plymouth PL4 8AA, UK
| | - Alice Prchal
- Department of Psychosomatics and Psychiatry and Children’s Research Center, University Children’s Hospital Zurich, 8032 Zurich, Switzerland;
| |
Collapse
|
32
|
Pas R, Rheel E, Van Oosterwijck S, Foubert A, De Pauw R, Leysen L, Roete A, Nijs J, Meeus M, Ickmans K. Pain Neuroscience Education for Children with Functional Abdominal Pain Disorders: A Randomized Comparative Pilot Study. J Clin Med 2020; 9:jcm9061797. [PMID: 32526929 PMCID: PMC7356615 DOI: 10.3390/jcm9061797] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
This article explores the effectiveness of a newly developed Pain Neuroscience Education program for children (PNE4Kids) with functional abdominal pain disorder (FAPD). Children (6–12 years) with FAPD were randomly assigned to 1) the experimental group (n = 14), participating in one hypnotherapy session (i.e., usual care) and one additional PNE4Kids session, or 2) the control group (n = 14), participating in two hypnotherapy sessions. Parental pain catastrophizing, the child’s functional disability (parental-proxy), pain-related fear (parent-proxy) and pain intensity, were assessed at baseline and one and three weeks after each therapy session. Pressure algometry and a conditioned pain modulation paradigm were performed at baseline and three weeks after completion of the last therapy session. Parents from both the experimental as well as the control group showed significantly less parental pain catastrophizing (p < 0.01). Children showed significantly less functional disability (p < 0.05), pain-related fear (p < 0.01) and local pressure pain sensitivity (p < 0.05) at short-term follow-up (three weeks after last intervention) in both groups. No significant (p > 0.05) between-group differences were found. Hypnotherapy combined with PNE4Kids did not result in better clinical outcomes compared to hypnotherapy alone. Study limitations include the application of one single PNE4Kids session and the short follow-up time.
Collapse
Affiliation(s)
- Roselien Pas
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Correspondence: ; Tel.: +32-(0)2-477-45-29
| | - Emma Rheel
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Sophie Van Oosterwijck
- Pain in Motion International Research Group;
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
| | - Anthe Foubert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Pain in Motion International Research Group;
| | - Robby De Pauw
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Laurence Leysen
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ann Roete
- Antwerp University Hospital, department of Pediatrics, 2610 Wilrijk, Belgium;
| | - Jo Nijs
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Mira Meeus
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp (UA), D.S.022, 2610 Wilrijk, Belgium;
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Campus UZ, Corneel Heymanslaan 10, 9000 Ghent, Belgium;
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; (E.R.); (L.L.); (J.N.); (M.M.); (K.I.)
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Brussels, Belgium
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| |
Collapse
|
33
|
Andreucci A, Holden S, Bach Jensen M, Skovdal Rathleff M. The Adolescent Knee Pain (AK-Pain) prognostic tool: protocol for a prospective cohort study. F1000Res 2020; 8:2148. [PMID: 32399187 PMCID: PMC7194341 DOI: 10.12688/f1000research.21740.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: One in three children and adolescents experience knee pain. Approximately one in two adolescents with knee pain will continue to experience pain even five years later and have low quality of life. The general practitioner (GP) is the first point of contact for children and adolescents with knee pain in Denmark. There is a variety of treatments being delivered in general practice, despite similar symptoms and patients' characteristics. This suggests a need to support the GPs in identifying those at high risk of a poor outcome early on, in order to better allocate resources. The aim of this study is to develop a user-friendly prognostic tool to support GPs' management of children and adolescents' knee pain. Methods: A preliminary set of items in the prognostic tool were identified using systematic reviews and meta-analysis of individual participant data. Following feedback from GPs and children and adolescents on the content and understanding, the tool was piloted and implemented in general practice. A cohort of approximately 300 children and adolescents (age 8-19 years old) is being recruited from general practices (recruitment period, July 2019 - June 2020). Clinically meaningful risk groups (e.g. low/medium/high) for the recurrence/persistence of knee pain (at 3 and 6 months) will be identified. Discussion: If successful, this prognostic tool will allow GPs to gain insights into the likely prognosis of adolescents with knee pain and subsequently provide the first building blocks towards stratified care, where treatments will be matched to the patients' prognostic profile. This has the potential to improve the recovery of children and adolescents from knee pain, to improve the allocation of resources in primary care, and to avoid the decline in physical activity and potential associated health and social consequences due to adolescent knee pain. Registration: Registered with ClinicalTrials.gov on 24 June 2019 (ID NCT03995771).
Collapse
Affiliation(s)
- Alessandro Andreucci
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, North Denmark Region, 9220, Denmark
| | - Sinead Holden
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, North Denmark Region, 9220, Denmark.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, North Denmark Region, 9220, Denmark
| | - Martin Bach Jensen
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, North Denmark Region, 9220, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice at Aalborg University, Aalborg University, Aalborg, North Denmark Region, 9220, Denmark.,Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, North Denmark Region, 9220, Denmark
| |
Collapse
|
34
|
Pate JW, Heathcote LC, Simons LE, Leake H, Moseley GL. Creating online animated videos to reach and engage youth: Lessons learned from pain science education and a call to action. ACTA ACUST UNITED AC 2020; 2:131-138. [PMID: 35548258 PMCID: PMC8975222 DOI: 10.1002/pne2.12015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Joshua W. Pate
- Graduate School of Health University of Technology Sydney Sydney NSW Australia
| | - Lauren C. Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine Stanford CA USA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine Stanford CA USA
| | - Hayley Leake
- IIMPACT in Health University of South Australia Adelaide SA Australia
| | - G. Lorimer Moseley
- IIMPACT in Health University of South Australia Adelaide SA Australia
- Neuroscience Research Australia Sydney NSW Australia
| |
Collapse
|
35
|
Pate JW, Noblet T, Hush JM, Hancock MJ, Sandells R, Pounder M, Pacey V. Exploring the concept of pain of Australian children with and without pain: qualitative study. BMJ Open 2019; 9:e033199. [PMID: 31662406 PMCID: PMC6830706 DOI: 10.1136/bmjopen-2019-033199] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE A person's concept of pain can be defined as how they understand what pain actually is, what function it serves and what biological processes are thought to underpin it. This study aimed to explore the concept of pain in children with and without persistent pain. DESIGN In-depth, face-to-face interviews with drawing tasks were conducted with 16 children (aged 8-12 years) in New South Wales, Australia. Thematic analysis was used to analyse and synthesise the data. SETTING Children with persistent pain were identified from a pain clinic waiting list in Australia, and children without pain were identified through advertising flyers and email bulletins at a university and hospital. PARTICIPANTS Eight children had persistent pain and eight children were pain free. RESULTS Four themes emerged from the data: 'my pain-related knowledge', 'pain in the world around me', 'pain in me' and 'communicating my concept of pain'. A conceptual framework of the potential interactions between the themes resulting from the analysis is proposed. The concept of pain of Australian children aged 8-12 years varied depending on their knowledge, experiences and literacy levels. For example, when undertaking a drawing task, children with persistent pain tended to draw emotional elements to describe pain, whereas children who were pain free did not. CONCLUSIONS Gaining an in-depth understanding of a child's previous pain-related experiences and knowledge is important to facilitate clear and meaningful pain science education. The use of age-appropriate language, in combination with appropriate assessment and education tasks such as drawing and discussing vignettes, allowed children to communicate their individual concept of pain.
Collapse
Affiliation(s)
- Joshua W Pate
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Tim Noblet
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Julia M Hush
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Mark J Hancock
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
| | - Renee Sandells
- Department of Pain Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Meg Pounder
- Department of Pain Medicine, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Verity Pacey
- Department of Health Professions, Macquarie University, Sydney, New South Wales, Australia
- Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
36
|
Stone AL, Karlson CW, Heathcote LC, Rosenberg AR, Palermo TM. Topical Review: Pain in Survivors of Pediatric Cancer: Applying a Prevention Framework. J Pediatr Psychol 2019; 43:237-242. [PMID: 29048571 DOI: 10.1093/jpepsy/jsx114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/17/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To apply a biopsychosocial framework to understand factors influencing pain in survivors of pediatric cancer to inform pain prevention efforts and highlight the need for interdisciplinary care. Method This topical review draws from both pediatric cancer survivorship research and chronic noncancer pain research to illustrate how components of a preventative model can be applied to pain in survivorship. Results Pain is a common experience among long-term survivors of pediatric cancer. The pain experience in survivorship can be conceptualized in terms of biological disease and treatment factors, cognitive and affective factors, and social and contextual factors. We review literature pertinent to each of these biopsychosocial factors and tailor an existing public health prevention framework for pain in survivors of pediatric cancer. Conclusions Classifying survivors of pediatric cancer into pain risk categories based on their daily experiences of pain, pain-related functional impairment, and distress could help guide the implementation of pain-related prevention and intervention strategies in this population. Future research is needed to establish the efficacy of screening measures to identify patients in need of psychosocial pain and pain-related fear management services, and interdisciplinary pediatric chronic pain management programs in survivors of pediatric cancer.
Collapse
Affiliation(s)
- Amanda L Stone
- Department of Pediatrics, Hematology/Oncology, University of Mississippi Medical Center
- Department of Pediatrics, Oregon Health & Science University
| | - Cynthia W Karlson
- Department of Pediatrics, Hematology/Oncology, University of Mississippi Medical Center
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University
| | - Abby R Rosenberg
- Department of Pediatrics, Division of Hematology/Oncology, University of Washington
- Treuman Katz Center for Pediatric Bioethics, Center for Clinical and Translational Research, Seattle Children's Research Institute, and
| | - Tonya M Palermo
- Departments of Anesthesiology and Pain Medicine, Psychiatry, and Pediatrics, University of Washington School of Medicine
| |
Collapse
|
37
|
Kanstrup M, Jordan A, Kemani MK. Adolescent and Parent Experiences of Acceptance and Commitment Therapy for Pediatric Chronic Pain: An Interpretative Phenomenological Analysis. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E101. [PMID: 31500227 PMCID: PMC6770081 DOI: 10.3390/children6090101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/31/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Abstract
Pediatric chronic pain is common and can be related to reduced functioning in many domains for the young person and their parents. Existing psychological treatments such as Acceptance and Commitment Therapy (ACT) have shown to be effective, but improvements are needed. Qualitative approaches can help improve our understanding of treatment processes and outcomes. The aim of the present qualitative interview study was to explore the lived experiences of young people and parents who had participated in ACT for pediatric chronic pain. Four young persons and four parents were interviewed, and data was analyzed using Interpretative Phenomenological Analysis (IPA). Three themes were generated, each comprising two subthemes: (1) 'Warning system', which included experiences from being offered this psychological intervention, and the alternative explanations provided for pain; (2) 'Change and challenges', which suggested the importance of the values-based work, and of individual adaptation; and (3) 'A common language' in which the interaction with others and new ways to communicate around the pain experience were described. Findings highlight the importance of pain education, formulating and acting in line with personal values, and communication around the pain experience, as well as the need for developmental and individual adaptations of interventions.
Collapse
Affiliation(s)
- Marie Kanstrup
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| | - Abbie Jordan
- Centre for Pain Research, University of Bath, Bath, BA2 7AY, UK.
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Mike K Kemani
- Department of Clinical Neuroscience (CNS), K8, Psychology, Karolinska Institutet, 171 77 Stockholm, Sweden.
- Functional Area Medical Psychology, Karolinska University Hospital, 171 76 Stockholm, Sweden.
| |
Collapse
|
38
|
Harrison LE, Pate JW, Richardson PA, Ickmans K, Wicksell RK, Simons LE. Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain. J Clin Med 2019; 8:E1267. [PMID: 31438483 PMCID: PMC6780832 DOI: 10.3390/jcm8091267] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023] Open
Abstract
Chronic pain is a prevalent and persistent problem in middle childhood and adolescence. The biopsychosocial model of pain, which accounts for the complex interplay of the biological, psychological, social, and environmental factors that contribute to and maintain pain symptoms and related disability has guided our understanding and treatment of pediatric pain. Consequently, many interventions for chronic pain are within the realm of rehabilitation, based on the premise that behavior has a broad and central role in pain management. These treatments are typically delivered by one or more providers in medicine, nursing, psychology, physical therapy, and/or occupational therapy. Current data suggest that multidisciplinary treatment is important, with intensive interdisciplinary pain rehabilitation (IIPT) being effective at reducing disability for patients with high levels of functional disability. The following review describes the current state of the art of rehabilitation approaches to treat persistent pain in children and adolescents. Several emerging areas of interventions are also highlighted to guide future research and clinical practice.
Collapse
Affiliation(s)
- Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Joshua W Pate
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Patricia A Richardson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA
| | - Kelly Ickmans
- Research Foundation-Flanders (FWO), 1000 Brussels, Belgium
- Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Psychology division, Karolinska Institutet, 171 65 Stockholm, Sweden
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94304, USA.
| |
Collapse
|
39
|
Pas R, Ickmans K, Van Oosterwijck S, Van der Cruyssen K, Foubert A, Leysen L, Nijs J, Meeus M. Hyperexcitability of the Central Nervous System in Children with Chronic Pain: A Systematic Review. PAIN MEDICINE 2019; 19:2504-2514. [PMID: 29304243 DOI: 10.1093/pm/pnx320] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Objective Hyperexcitability of the central nervous system plays an important role in the development and maintenance of chronic pain in adults. This knowledge has led to improved treatment strategies within this population. In children, however, research on the presence of central hyperexcitability is scarce. To further investigate this topic in children with chronic pain, there is a need for a clear literature overview. Design Systematic review. Methods The literature search was performed using the electronic databases PubMed and Web of Science. An article was considered eligible if it included children (age two to 12 years) diagnosed with chronic pain. Articles had to report original research outcomes related to central hyperexcitability, and a comparison with a healthy control group was necessary. Characteristics of the study sample, the assessment, and conclusions regarding central hyperexcitability were extracted from each included article. Results Twelve case-control studies were included with moderate to good methodological quality (510 children with chronic pain and 670 healthy controls). After summarizing the articles' results on indices of central hyperexcitability, we concluded that secondary hyperalgesia might be present in children with recurrent abdominal pain, juvenile fibromyalgia, and juvenile idiopathic arthritis. Preliminary evidence exists for altered cortical nociceptive processing in children with migraine and recurrent abdominal pain. Conclusion Based on the results of this review, central hyperexcitability might be present in in several pediatric chronic pain conditions. Further research on other manifestations of central hyperexcitability (e.g., bottom-up and top-down mechanisms and nociceptive brain changes) is necessary to provide firm evidence about its presence in children with chronic pain.
Collapse
Affiliation(s)
- Roselien Pas
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| | - Sophie Van Oosterwijck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kelly Van der Cruyssen
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Anthe Foubert
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laurence Leysen
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Belgium
| | - Mira Meeus
- Pain in Motion International Research Group.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
40
|
Heathcote LC, Allen JM, Gunn KM, Fox S, Harvie DS, Olver I, Skinner IW, Smith AG, Stanton TR, Whitford HS, Moseley GL. Pain Education for Adolescents and Young Adults Living Beyond Cancer: An Interdisciplinary Meeting Report. J Adolesc Young Adult Oncol 2019; 8:529-533. [PMID: 31150299 DOI: 10.1089/jayao.2019.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pain is an understudied and undertreated consequence of cancer survival. Pain education is now a recommended treatment approach for persistent non-cancer pain, yet it has not been well applied to the context of adolescent and young adult (AYA) cancer survival. In March 2018, an interdisciplinary meeting was held in Adelaide, South Australia to set a research agenda for pain education in AYA cancer survivors. We identified that AYAs with persistent pain and those with heightened pain-related fear have the potential to benefit from pain education. We identified a number of unique challenges of engaging AYA survivors in pain education, and point towards future research directions.
Collapse
Affiliation(s)
- Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical School, Stanford, California
| | - Julie M Allen
- The Pentimento Project, Tarragindi, Queensland, Australia
| | - Kate M Gunn
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Simonie Fox
- AIA Australia, Sydney, New South Wales, Australia
| | - Daniel S Harvie
- The Hopkins Centre, Menzies Health Institute QLD, Griffith University, Gold Coast, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Ian Olver
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Ian W Skinner
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Andrew G Smith
- Leukaemia Foundation of Australia, Melbourne, Victoria, Australia
| | - Tasha R Stanton
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.,Neuroscience Research Australia, Sydney, Australia
| | - Hayley S Whitford
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - G Lorimer Moseley
- School of Health Sciences/University of South Australia Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.,Neuroscience Research Australia, Sydney, Australia
| |
Collapse
|
41
|
Sharma S, Jensen MP, Moseley GL, Abbott JH. Results of a feasibility randomised clinical trial on pain education for low back pain in Nepal: the Pain Education in Nepal-Low Back Pain (PEN-LBP) feasibility trial. BMJ Open 2019; 9:e026874. [PMID: 30918037 PMCID: PMC6475174 DOI: 10.1136/bmjopen-2018-026874] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The aims of this study were to: (1) develop pain education materials in Nepali and (2) determine the feasibility of conducting a randomised clinical trial (RCT) of a pain education intervention using these materials in Nepal. DESIGN A two-arm, parallel, assessor-blinded, feasibility RCT. SETTING A rehabilitation hospital in Kathmandu, Nepal. PARTICIPANTS Forty Nepalese with non-specific low back pain (mean [SD] age 41 [14] years; 12 [30%] women). INTERVENTIONS Eligible participants were randomised, by concealed, 1:1 allocation, to one of two groups: (1) a pain education intervention and (2) a guideline-based physiotherapy active control group intervention. Each intervention was delivered by a physiotherapist in a single, 1-hour, individualised treatment session. PRIMARY OUTCOME MEASURES The primary outcomes were related to feasibility: recruitment, retention and treatment adherence of participants, feasibility and blinding of outcome assessments, fidelity of treatment delivery, credibility of, and satisfaction with, treatment. Assessments were performed at baseline and at 1 week post-treatment. SECONDARY OUTCOME MEASURES Pain intensity, pain interference, pain catastrophising, sleep disturbance, resilience, global rating of change, depression and quality of life. Statistical analyses were conducted blind to group allocation. RESULTS Forty participants were recruited. Thirty-eight participants (95%) completed the 1-week post-treatment assessment. Most primary outcomes surpassed the a priori thresholds for feasibility. Several findings have important implications for designing a full trial. Secondary analyses suggest clinical benefit of pain education over the control intervention, with larger decrease in pain intensity (mean difference=3.56 [95% CI 0.21 to 6.91]) and pain catastrophising (mean difference=6.16 [95% CI 0.59 to 11.72]) in the pain education group. Pain intensity would seem an appropriate outcome for a full clinical trial. One minor adverse event was reported. CONCLUSION We conclude that a full RCT of pain education for back pain in Nepal is feasible and warranted. TRIAL REGISTRATION NUMBER NCT03387228; Results.
Collapse
Affiliation(s)
- Saurab Sharma
- Department of Physiotherapy, Kathmandu University School of Medical Sciences, Dhulikhel, Bagmati, Nepal
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | | | - J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| |
Collapse
|
42
|
Heathcote LC, Pate JW, Park AL, Leake HB, Moseley GL, Kronman CA, Fischer M, Timmers I, Simons LE. Pain neuroscience education on YouTube. PeerJ 2019; 7:e6603. [PMID: 30923652 PMCID: PMC6432903 DOI: 10.7717/peerj.6603] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 02/11/2019] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The Internet in general, and YouTube in particular, is now one of the most popular sources of health-related information. Pain neuroscience education has become a primary tool for managing persistent pain, based in part on the discovery that information about pain can change pain. Our objective was to examine the availability, characteristics, and content of YouTube videos that address the neuroscience of pain. METHODS We conducted a systematic review of videos on YouTube using the search terms "pain education", "what is pain", and "pain brain" in January 2018. Videos were included if they were in English, were under 10 minutes long, and included information on the neuroscience of pain. Videos were coded for (i) descriptive characteristics (e.g., number of views, duration on YouTube), (ii) source and style, (iii) whether or not they addressed seven pre-determined target concepts of pain neuroscience education (e.g., 'Pain is not an accurate marker of tissue state'), and (iv) how engaging they were. RESULTS We found 106 unique videos that met the inclusion criteria. The videos ranged from having four views to over five million views (Mdn = 1,163 views), with the three most highly viewed videos accounting for 75% of the total views. Animated videos were much more highly viewed than non-animated videos. Only a small number of videos had been posted by a clearly-identifiable reputable source such as an academic or medical institution (10%), although a number of videos were posted by healthcare professionals and professional medical societies. For a small number of videos (7%), the source was unclear. We found 17 videos that addressed at least one target concept of pain neuroscience science education, only nine of which were considered to be at least somewhat engaging. The target concept 'Pain is a brain output' was considered to be well addressed by the most videos (N = 11), followed by 'Pain is a protector' (N = 10). We found only one video that adequately addressed all seven target concepts of pain neuroscience education. DISCUSSION YouTube contains a variety of videos that practitioners, patients, and families may view to access pain neuroscience education information. A small portion of these videos addressed one or more target concepts of pain neuroscience education in an engaging manner. It is yet to be determined to what extent patients are able to learn information from these videos, to what extent the videos promote behavior change, and thus to what extent the videos may be useful for clinical practice.
Collapse
Affiliation(s)
- Lauren C. Heathcote
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Joshua W. Pate
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anna L. Park
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Hayley B. Leake
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - G. Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Corey A. Kronman
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Molly Fischer
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Inge Timmers
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Laura E. Simons
- Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| |
Collapse
|
43
|
Pack R, Gilliland R, Mecham A. The treatment of central sensitization in an adolescent using pain neuroscience education and graded exposure to activity: A case report. Physiother Theory Pract 2018; 36:1164-1174. [PMID: 30540222 DOI: 10.1080/09593985.2018.1551454] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Chronic pain affects 1.7 million children in the United States, and its effects often linger into adulthood. Unfortunately, chronic pediatric pain is often undertreated. The current case report discusses the use of pain neuroscience education (PNE) combined with progressive exposure to activity to treat persistent pain in a 13-year-old female diagnosed with central sensitization syndrome. Prior to the diagnosis, the patient underwent two unsuccessful episodes of physical therapy that focused on musculoskeletal sources of pain. The patient was then referred to a physical therapist specializing in pain management. Following a detailed evaluation, PNE and graded exposure were used over a 4-week period to address the patient's condition and her behavioral responses to it. Significant decreases were observed in lowest (67%) and usual (50%) pain ratings and the portion of the day her worst pain was felt (67%), while the portion of the day with bearable pain (80%). Significant improvements in her ability to dance (168%), hike (50%), and run (200%) were observed. Reconceptualizing pain and its meaning changed perceptions and behaviors, allowing improvement when other approaches failed. Although effective for this patient, more research is needed into the use of this approach in the treatment of chronic pediatric pain.
Collapse
Affiliation(s)
- Roger Pack
- Intermountain Healthcare, Utah Valley Pain Management , Orem, UT, USA
| | - Randy Gilliland
- Intermountain Healthcare, Utah Valley Pain Management , Orem, UT, USA
| | - Alisha Mecham
- Intermountain Healthcare, Orem Community Hospital , Orem, UT, USA
| |
Collapse
|
44
|
Vega E, Beaulieu Y, Gauvin R, Ferland C, Stabile S, Pitt R, Gonzalez Cardenas VH, Ingelmo PM. Chronic non-cancer pain in children: we have a problem, but also solutions. Minerva Anestesiol 2018; 84:1081-1092. [PMID: 29745621 DOI: 10.23736/s0375-9393.18.12367-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Chronic non-cancer pain in children and adolescents has been described as "a modern public health disaster" that has generated significant medical and economic burdens within society. Seen as a disease in its own right, chronic pain has short and long-term consequences that impact not only the patient's health but also that of friends and families, due to significant parenting stress and disruptions in family life and structure. The evidence supporting pharmacological treatments and interventional procedures is limited, and no single strategy has been shown to be completely effective in children with chronic non-cancer pain. Therefore, considering the multifactorial nature of chronic pain, these patients should be treated with a multidisciplinary, balanced approach that seeks a primary outcome of improved functioning rather than of pain reduction. Using a bio-psycho-social approach, a multidisciplinary team, including a physiotherapist, nurse, social worker, psychologist, and physician, has been effective in achieving this outcome of improved functioning in children and adolescents with chronic pain. In this review, we discuss the impact, associated conditions, and evolution of chronic pain, along with the crucial role of every member of a multidisciplinary chronic pain clinic involved in the care of the children and adolescents with chronic non-cancer pain.
Collapse
Affiliation(s)
- Eduardo Vega
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,Department of Anesthesia, School of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Yves Beaulieu
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Rachel Gauvin
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Catherine Ferland
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| | - Stephanie Stabile
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Rebecca Pitt
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada
| | - Victor H Gonzalez Cardenas
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada.,University Foundation for Health Sciences, Bogotá, Colombia
| | - Pablo M Ingelmo
- Chronic Pain Service, Department of Anesthesia, Montreal Children's Hospital, McGill University Health Center, Montreal, Canada - .,The Alan Edwards Centre for Research on Pain, McGill University, Montreal, Canada
| |
Collapse
|
45
|
Pas R, Meeus M, Malfliet A, Baert I, Oosterwijck SV, Leysen L, Nijs J, Ickmans K. Development and feasibility testing of a Pain Neuroscience Education program for children with chronic pain: treatment protocol. Braz J Phys Ther 2018; 22:248-253. [PMID: 29550259 PMCID: PMC5993952 DOI: 10.1016/j.bjpt.2018.02.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Current treatment for adults with chronic pain often includes Pain Neuroscience Education (PNE) to make people understand the nature underlying their pain and thus provides a clear rational for a biopsychosocial approach. Despite recommendations to use Pain Neuroscience Education as well in children with chronic pain, a specific program, tailored to children aged 6-12 years is lacking. OBJECTIVES The aim of this study was to develop a Pain Neuroscience Education program for children with chronic pain and test its feasibility. METHODS First the internet and scientific literature was searched for sources (e.g., books, videos, etc.) that might be supportive in teaching children about the neurophysiology of pain. Based on this content, we developed a Pain Neuroscience Education program for children, 'PNE4Kids', which was tested for feasibility in three groups of healthy children (n=18; 9 girls and 9 boys) aged between 6 and 12 years old. RESULTS AND CONCLUSIONS This paper provides both scientists and clinicians with a specific program to explain the neurophysiology of pain to children with chronic pain, since it is past high time to use a modern neuroscience approach in this vulnerable population. Further research should examine the effectiveness of this developed PNE4Kids program on pain-related outcomes in children with chronic pain. Registration number: NCT02880332 (https://clinicaltrials.gov/ct2/show/NCT02880332).
Collapse
Affiliation(s)
- Roselien Pas
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium.
| | - Mira Meeus
- Pain in Motion International Research Group(d); University of Antwerp (UA), Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Anneleen Malfliet
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium
| | - Isabel Baert
- Pain in Motion International Research Group(d); University of Antwerp (UA), Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Sophie Van Oosterwijck
- University of Antwerp (UA), Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Wilrijk, Belgium
| | - Laurence Leysen
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium
| | - Kelly Ickmans
- Pain in Motion International Research Group(d); Vrije Universiteit Brussel (VUB), Faculty of Physical Education & Physiotherapy, Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Brussels, Belgium
| |
Collapse
|
46
|
Cong X, Ramesh D, Perry M, Xu W, Bernier KM, Young EE, Walsh S, Starkweather A. Pain self-management plus nurse-led support in young adults with irritable bowel syndrome: Study protocol for a pilot randomized control trial. Res Nurs Health 2018; 41:121-130. [PMID: 29388674 DOI: 10.1002/nur.21862] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/19/2017] [Accepted: 12/26/2017] [Indexed: 12/17/2022]
Abstract
Irritable bowel syndrome (IBS) is a functional gut disorder that typically manifests in early adult years. IBS patients report that pain is the most distressing symptom with the greatest impact on quality of life. Pain-sensitivity genes and the gut microbiome may influence severity of symptoms as well as response to self-management (SM) interventions. Based on current understanding of the science of SM, pain neurophysiology, and the gut-brain axis, our team developed a pain SM intervention to be added to evidence-based self-management instruction to increase the individual's SM knowledge and skills (self-efficacy, self-regulation, and goal-setting). The purpose of this randomized controlled longitudinal pilot study is to examine the feasibility, acceptability, and preliminary effectiveness of the IBS-pain SM intervention on IBS-pain SM behaviors and related health outcomes. A sample of 80 young adults (age 18-29 years old) will be recruited and randomly assigned to the experimental or control group. Both groups will receive 10 electronic video modules focused on IBS-pain SM knowledge and skills. The experimental group also will receive nurse-led one-on-one phone consultations to facilitate monitoring and problem-solving. All participants will be followed over 12 weeks. Primary outcomes will be measured at baseline, 6 weeks, and 12 weeks, including IBS-pain SM behaviors, quality of life, and well-being. The influence of pain-sensitivity genes and the gut microbiome on IBS-pain SM behaviors and health outcomes also will be assessed.
Collapse
Affiliation(s)
- Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, Connecticut.,Center for Advancement in Managing Pain, University of Connecticut, Storrs, Connecticut.,Institute for Systems Genomics, University of Connecticut, Farmington, Connecticut
| | - Divya Ramesh
- School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Mallory Perry
- School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Wanli Xu
- School of Nursing, University of Connecticut, Storrs, Connecticut
| | | | - Erin E Young
- School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Stephen Walsh
- School of Nursing, University of Connecticut, Storrs, Connecticut
| | - Angela Starkweather
- School of Nursing, University of Connecticut, Storrs, Connecticut.,Center for Advancement in Managing Pain, University of Connecticut, Storrs, Connecticut.,P20 Center for Accelerating Precision Pain Self-Management, University of Connecticut, Storrs, Connecticut
| |
Collapse
|
47
|
Pate JW, Hush JM, Hancock MJ, Moseley GL, Butler DS, Simons LE, Pacey V. A Child's Concept of Pain: An International Survey of Pediatric Pain Experts. CHILDREN-BASEL 2018; 5:children5010012. [PMID: 29342976 PMCID: PMC5789294 DOI: 10.3390/children5010012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/23/2022]
Abstract
A child's 'concept of pain' refers to how they understand what pain actually is, what function pain serves, and what biological processes are thought to underpin it. We aimed to determine pediatric pain experts' opinions of: (1) the importance and usefulness of assessing a child's concept of pain in clinical and/or research settings; (2) the usefulness of the content of items within currently published adult-targeted resources for assessing a child's concept of pain; and (3) important domains of a child's concept of pain to assess. Forty-nine pediatric pain experts (response rate = 75.4%) completed an online survey. Descriptive statistics and frequency of responses were analyzed. Experts from all included disciplines reported that assessing a child's concept of pain is important and useful both clinically and in a research setting (>80% reported very or extremely useful for each item). Experts considered that the content of 13 items from currently published adult-targeted resources was useful, but the wording was too complex for children aged 8-12 years. Experts considered that all seven of the proposed domains of a child's concept of pain was important to assess. The findings can be used to inform the development of an assessment tool for a child's concept of pain.
Collapse
Affiliation(s)
- Joshua W Pate
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - Julia M Hush
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
| | - G Lorimer Moseley
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - David S Butler
- Sansom Institute for Health Research, University of South Australia, Adelaide, SA 5001, Australia.
| | - Laura E Simons
- Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Verity Pacey
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW 2109, Australia.
- The Children's Hospital at Westmead, Westmead, NSW 2145, Australia.
| |
Collapse
|
48
|
Reid K, Hartling L, Ali S, Le A, Norris A, Scott SD. Development and Usability Evaluation of an Art and Narrative-Based Knowledge Translation Tool for Parents With a Child With Pediatric Chronic Pain: Multi-Method Study. J Med Internet Res 2017; 19:e412. [PMID: 29242180 PMCID: PMC5746621 DOI: 10.2196/jmir.8877] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/12/2017] [Accepted: 10/29/2017] [Indexed: 11/26/2022] Open
Abstract
Background Chronic pain in childhood is increasingly being recognized as a significant clinical problem for children and their families. Previous research has identified that families want information about the causes of their child’s chronic pain, treatment options, and effective strategies to help their child cope with the pain. Unfortunately, parents have reported that finding this information can be challenging. Objective The aim of this study was to actively work together with children attending a pediatric chronic pain clinic and their parents to develop, refine, and evaluate the usability of an art and narrative-based electronic book (e-book) for pediatric chronic pain. Methods A multiphase, multi-method research design employing patient engagement techniques was used to develop, refine, and evaluate the usability of an art and narrative based e-book for pediatric chronic pain management to facilitate knowledge translation for parents with a child with chronic pain. The multiple phases included the following: (1) qualitative interviews to compile parents’ narratives using qualitative interviews; (2) qualitative data analysis; (3) development of an e-book prototype; (4) expert clinician feedback; (5) parent usability evaluation, knowledge change, and confidence in knowledge responses using an electronic survey; (6) e-book refinement; and (7) dissemination of the e-book. Results A 48-page e-book was developed to characterize the experiences of a family living with a child with chronic pain. The e-book was a composite narrative of the parent interviews and encompassed descriptions of the effects the condition has on each member of the family. This was merged with the best available research evidence on the day-to-day management of pediatric chronic pain. The e-book was vetted for clinical accuracy by expert pediatric pain clinicians. All parents that participated in the usability evaluation (N=14) agreed or strongly agreed the content of the e-book was easy to understand and stated that they would recommend the e-book to other families who have children with chronic pain. Our research identified up to a 21.4% increase in knowledge after using the e-book, and paired t tests demonstrated a statistically significant difference in confidence in answering two of the five knowledge questions (chronic pain is a disease involving changes in the nervous system; the use of ibuprofen is usually effective at controlling chronic pain); t13=0.165, P=.001 and t13=0.336, P=.002, respectively, after being exposed to the e-book. Conclusions Our results demonstrate that parents positively rated an e-book developed for parents with a child with chronic pain. Our results also identify that overall, parents’ knowledge increased after using the e-book, and confidence in their knowledge about chronic pain and its management increased in two aspects after e-book exposure. These results suggest that art and narrative-based knowledge translation interventions may be useful in transferring complex health information to parents.
Collapse
Affiliation(s)
- Kathy Reid
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Stollery Children's Hospital, Alberta Health Services, Edmonton, AB, Canada
| | - Lisa Hartling
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Anne Le
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Allison Norris
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.,Women & Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|