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Donovan E, Green V, Feldman G, Tachdjian R, Curry C, Rice C, Zeltzer LK. The acceptability of Songs of Love for youth living with chronic pain. Int J Adolesc Med Health 2024; 36:161-168. [PMID: 38332697 DOI: 10.1515/ijamh-2023-0176] [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: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Music is helpful to young people in healthcare contexts, but less is known about the acceptability of music-based interventions for youth living at home with chronic pain who may be struggling to attend school and participate in social activities. The Songs of Love (SOL) foundation is a national nonprofit organization that creates free, personalized, original songs for youth facing health challenges. The aims of this study were (1) to assess acceptability of SOL from the perspective of youth with chronic pain receiving a song and singer-songwriters who created the songs, and (2) to explore the role of music more generally in the lives of young people living with pain. METHODS Twenty-three people participated. Fifteen youth (mean age 16.8) were interviewed and received a song, and six singer-songwriters were interviewed about creating the songs. (Two additional people participated in pilot interviews.) Acceptability was assessed by (1) proportion of youth who participated in a second interview about their song and (2) results of reflexive thematic analysis (RTA) to determine acceptability. Themes addressing the role of music in the lives of youth with pain were also explored using RTA. RESULTS The program was acceptable as 12 of 15 youth (80 %) participated in second interviews and themes met the definition of acceptability. Three themes addressing the role of music in the lives of youth living with pain were identified. CONCLUSIONS This is the first report of the acceptability and experience of SOL and contributes to research on the benefits of music for pain management.
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Affiliation(s)
| | - Vanya Green
- Creative Healing for Youth in Pain, Los Angeles, CA, USA
| | - Greg Feldman
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Raffi Tachdjian
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Children's Music Fund, Los Angeles, CA, USA
| | - Caitlin Curry
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Charlotte Rice
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Lonnie K Zeltzer
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Creative Healing for Youth in Pain, Los Angeles, CA, USA
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2
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Lee S, Tomlinson R, Lumley MN, Bax KC, Ashok D, McMurtry CM. Positive Schemas, Coping, and Quality of Life in Pediatric Recurrent Abdominal Pain. J Clin Psychol Med Settings 2024; 31:37-47. [PMID: 36952113 DOI: 10.1007/s10880-023-09952-6] [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] [Accepted: 02/24/2023] [Indexed: 03/24/2023]
Abstract
Pediatric recurrent abdominal pain is commonly associated with negative impacts on quality of life (QOL). Positive schemas (core beliefs about the self with subthemes of self-efficacy, optimism, trust, success, and worthiness) are a resilience factor that has not yet been examined within a pediatric recurrent pain context. This cross-sectional study examined (a) associations between positive schemas, pain coping, and youth QOL, and (b) exploratory analyses to investigate whether specific positive schema subthemes predicted QOL outcomes in youth with recurrent abdominal pain. Participants were 98 youth with recurrent abdominal pain (i.e., pain related to a disorder of gut-brain interaction [DGBI] or organic cause) who completed measures on positive schemas, QOL, and pain coping. Age and diagnostic status were controlled for in analyses. Positive schemas were significantly positively correlated with emotional, social, school, and overall QOL, as well as with approach and problem-focused avoidant coping, and significantly negatively correlated with emotion-focused coping. Worthiness was the strongest and only significant predictor of youth social functioning. Positive schemas may be an important cognitive resilience factor to consider within interventions for pediatric recurrent pain.
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Affiliation(s)
- Soeun Lee
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Rachel Tomlinson
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Margaret N Lumley
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Kevin C Bax
- Department of Paediatrics, Western University, London, ON, Canada
| | - Dhandapani Ashok
- Department of Paediatrics, Western University, London, ON, Canada
| | - C Meghan McMurtry
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
- Department of Paediatrics, Western University, London, ON, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Children's Health Research Institute, London, ON, Canada
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3
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Lamparyk K, Stellway J, Turnage C, Murphy TB, Echere J, Levy RL. Evolution of Parent-Targeted Interventions for Pain-Predominant Disorders of Gut-Brain Interactions: Research and Clinical Practice Considerations. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2023; 11:423-434. [PMID: 38433851 PMCID: PMC10907008 DOI: 10.1037/cpp0000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Objective Abdominal pain-related Disorders of Gut-Brain Interaction (DGBIs) in children are best understood from a biopsychosocial model, including particular attention to the child's environment. Interventions have begun to increasingly target parents as important agents of change in this population. The purpose of this manuscript is to summarize the evolution of parent-targeted interventions for pediatric pain-related DGBIs and provide recommendations for application of the model to clinical practice. Methods A topical review of literature regarding parent-targeted interventions and related factors in the treatment of pediatric pain-related DGBIs was conducted, followed by a discussion of these findings to clinical practice settings. Results A growing body of research has supported parent-targeted interventions in the treatment of pediatric pain-related disorders of gut-brain interactions (DGBI), although translation of these findings to practice settings is complicated by numerous factors. Strategies for obtaining physician buy-in and parental engagement are discussed, as are potential logistical considerations of multiple caregivers, child age, and billing considerations. Conclusions There is a promising and growing evidence-base for parent-targeted interventions for pain-related DGBIs, which have not yet been widely adopted into clinical practice recommendations. Engaging all stake-holders and attending to the nuances of this approach are recommended to successfully apply parent-targeted interventions into clinical practice settings.
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Affiliation(s)
| | - Jacklyn Stellway
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University
| | - Cathleen Turnage
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University
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Salamon KS, Dutta RA, Hildenbrand AK. Improved pain acceptance and interference following outpatient interdisciplinary pediatric chronic pain treatment. Psychol Health 2023; 38:1482-1493. [PMID: 35049389 DOI: 10.1080/08870446.2021.2024540] [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: 11/25/2020] [Revised: 12/02/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Intensive interdisciplinary chronic pain treatment programs have demonstrated that pain acceptance predicts positive treatment outcomes, but limited research has focused on less-intensive programs. This study aimed to examine associations between changes in pain acceptance and pain interference among youth participating in an outpatient interdisciplinary chronic pain treatment program. DESIGN Youth presenting to an evaluation within an interdisciplinary outpatient pediatric chronic pain program completed questionnaires at initial program evaluation (T1) and three months later (T2). MAIN OUTCOME MEASURES Youth (N = 94, Mage = 14.59 years, 74% female) completed the Chronic Pain Acceptance Questionnaire, Adolescent Version (CPAQ-A) and PROMIS Pediatric Pain Interference scale. RESULTS Pain acceptance increased significantly from T1 to T2 (p=.001), driven primarily by activity engagement (p=.001). Pain interference decreased from T1 to T2 (p<.001). Improvements in acceptance were strongly associated with reductions in interference (p<.001). An exploratory cross-lagged structural equation model revealed a number of direct and indirect effects between pain acceptance and pain interference at T1 and T2. CONCLUSION Pain acceptance and interference improved after three months in an outpatient chronic pain treatment program. Improvements in acceptance were strongly related to reductions in interference. Future research should examine these relationships over longer periods, in larger samples.
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Affiliation(s)
- Katherine S Salamon
- Division of Behavioral Health, Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
| | | | - Aimee K Hildenbrand
- Division of Behavioral Health, Department of Pediatrics, Nemours Children's Hospital, Wilmington, DE, USA
- Center for Healthcare Delivery Science, Nemours Children's Health, Wilmington, DE, USA
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Zachariades F, Maras D, Mervitz D, Martelli B, Prayal-Brown A, Hayawi L, Barrowman N, Lamontagne C. Virtual psychoeducation for improvement of pain catastrophizing in pediatric presurgical patients and caregivers: a proof-of-concept study. Can J Anaesth 2023; 70:1753-1764. [PMID: 37789219 DOI: 10.1007/s12630-023-02583-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 10/05/2023] Open
Abstract
PURPOSE Pain catastrophizing (PC) is the tendency to magnify the threat value of pain sensations and is associated with greater postsurgical pain intensity, functional disability, and pain chronicity. Higher parental PC predicts higher chronic postsurgical pain in youth. Treating PC in caregivers and youth prior to surgery may improve recovery and surgical outcomes. We developed and evaluated a psychoeducational workshop addressing PC for presurgical youth and their parents/caregivers. We hypothesized that parent/caregiver and youth PC scores would decrease over time. We also explored preintervention levels of youth anxiety and depression as moderators of outcome. METHODS Youth (n = 43) and caregivers (n = 41) attended a virtual, group-based single-session intervention (SSI). Single-session intervention content addressed pain neuroscience, PC, and adaptive coping strategies for managing pain and PC drawn from cognitive-behavioural, acceptance and commitment, and dialectical behaviour therapy approaches. Participants completed questionnaires assessing PC at preintervention, postintervention, and two weeks postsurgery. Youth mood and anxiety were assessed at preintervention. RESULTS Caregiver PC scores decreased from pre- to postintervention (P = 0.006), and this was maintained at postsurgery (P = 0.002). Youth PC scores decreased from preintervention to postsurgery, but only for those with higher preintervention anxiety (P = 0.01). CONCLUSION Our results provide proof-of-concept support for a virtual SSI targeting caregivers and youth PC during the perioperative period. The present findings highlight the possible need to screen presurgical candidates for symptoms of anxiety. Replication with larger and more diverse samples, and a more robust design are warranted.
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Affiliation(s)
| | - Danijela Maras
- Mental Health Service, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Deborah Mervitz
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Acute Pain Service, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Brenda Martelli
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
- Acute Pain Service, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Audrey Prayal-Brown
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lamia Hayawi
- Clinical Research Unit, Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nick Barrowman
- Clinical Research Unit, Research Institute, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Christine Lamontagne
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.
- Chronic Pain Services at the Children's Hospital of Eastern Ottawa, Ottawa, ON, Canada.
- Children's Hospital of Eastern Ontario, 401 Symth Rd., Ottawa, ON, K1H 8L1, Canada.
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Ciornei B, David VL, Popescu D, Boia ES. Pain Management in Pediatric Burns: A Review of the Science behind It. Glob Health Epidemiol Genom 2023; 2023:9950870. [PMID: 37745034 PMCID: PMC10516692 DOI: 10.1155/2023/9950870] [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: 08/13/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023] Open
Abstract
Pediatric burns are a significant medical issue that can have long-term effects on various aspects of a child's health and well-being. Pain management in pediatric burns is a crucial aspect of treatment to ensure the comfort and well-being of young patients. The causes and risk factors for pediatric burns vary depending on various factors, such as geographical location, socioeconomic status, and cultural practices. Assessing pain in pediatric patients, especially during burn injury treatment, poses several challenges. These challenges stem from various factors, including the age and developmental stage of the child, the nature of burn injuries, and the limitations of pain assessment tools. In pediatric pain management, various pain assessment tools and scales are used to evaluate and measure pain in children. These tools are designed to account for the unique challenges of assessing pain in pediatric patients, including their age, developmental stage, and ability to communicate effectively. Pain can have significant physical, emotional, and psychological consequences for pediatric patients. It can interfere with their ability to engage in daily activities, disrupt sleep patterns, and negatively affect their mood and behavior. Untreated pain can also lead to increased stress, anxiety, and fear, which can further exacerbate the pain experience. Acute pain, which is short-term and typically associated with injury or illness, can disrupt a child's ability to engage in physical activities and impede their overall recovery process. On the other hand, chronic pain, which persists for an extended period, can have long-lasting effects on physical functioning and quality of life in children. The psychological consequences of burns can persist long after the physical wounds have healed, leading to ongoing emotional distress and impaired functioning. Multimodal pain management, which involves the use of multiple interventions or medications targeting different aspects of the pain pathway, has gained recognition as an effective approach for managing pain in both children and adults. However, it is important to consider the specific needs and considerations of pediatric patients when developing evidence-based guidelines for multimodal pain management in this population. Over the years, there have been significant advances in pediatric pain research and technology, leading to a better understanding of pain mechanisms and the development of innovative approaches to assess and treat pain in children. Overall, pain management in pediatric burns requires a multidisciplinary approach that combines pharmacologic and nonpharmacologic interventions.
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Affiliation(s)
- Bogdan Ciornei
- Department of Paediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Vlad Laurentiu David
- Department of Paediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Diana Popescu
- Department of Pediatric Surgery, “Louis Turcanu” Emergency Children's Hospital, Timisoara, Romania
| | - Eugen Sorin Boia
- Department of Paediatric Surgery and Orthopedics, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
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Hale AE, Bujoreanu S, LaVigne TW, Coakley R. Rapid Mobilization of an Evidence-Based Psychological Intervention for Pediatric Pain during COVID-19: The Development and Deployment of the Comfort Ability ® Program Virtual Intervention (CAP-V). CHILDREN (BASEL, SWITZERLAND) 2023; 10:1523. [PMID: 37761484 PMCID: PMC10529482 DOI: 10.3390/children10091523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The gold standard of treatment for chronic pain is a multidisciplinary approach in which psychology plays a leading role, but many children and caregivers do not gain access to this treatment. The Comfort Ability® Program (CAP) developed a CBT-oriented group intervention for adolescents and caregivers designed expressly to address access to evidence-based psychological care for pediatric chronic pain. Before the COVID-19 disruption of in-person services, the CAP workshop had been disseminated to a network of 21 children's hospitals across three countries. In March 2020, a virtual (telehealth) format was needed to ensure that children with chronic pain could continue to access this clinical service throughout the CAP Network. METHODS A model of knowledge mobilization was used to adapt the CAP workshop to a virtual format (CAP-V) and disseminate it to network sites. A pilot study assessing participant and clinician perceptions of acceptability, feasibility, and treatment satisfaction included baseline, post-sessions, and post-program questionnaires. RESULTS A knowledge mobilization framework informed the rapid development, refinement, and mobilization of CAP-V. Data from a pilot study demonstrated feasibility and high acceptability across participants and clinicians. CONCLUSIONS A knowledge mobilizationframework provided a roadmap to successfully develop and deploy a virtual behavioral health intervention for adolescents with chronic pain and their caregivers during a worldwide pandemic. While CAP-V has demonstrated preliminary clinical feasibility and acceptability at the CAP hub, ongoing research is needed.
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Affiliation(s)
- Amy E. Hale
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
- Division of Gastroenterology, Hepatology & Nutrition, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Simona Bujoreanu
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
| | - Timothy W. LaVigne
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
| | - Rachael Coakley
- Pain Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (A.E.H.); (S.B.); (T.W.L.)
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8
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Aluko B, Mitchell AN, Tumin D, Zeldin E. Nation-wide decrease in the prevalence of pediatric chronic pain during the COVID-19 pandemic. Scand J Pain 2023; 23:608-612. [PMID: 36450241 DOI: 10.1515/sjpain-2022-0102] [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: 07/24/2022] [Accepted: 11/10/2022] [Indexed: 07/21/2023]
Abstract
OBJECTIVES The COVID-19 pandemic was expected to increase prevalence and severity of chronic pain. We compared pandemic-era and pre-pandemic prevalence of chronic pain among children in the US. METHODS Data were obtained from the 2019 and 2020 National Survey of Children's Health, a web-or mail-based survey representative of children living in the US (n=20,359 in 2019; 29,159 in 2020). Caregiver-reported prevalence of chronic pain was compared between survey years using bivariate and multivariable methods. RESULTS The prevalence of chronic pain among US children decreased from 11 to 8% in the first year of the pandemic. Multivariable analysis adjusting for children's and caregivers' demographics and socioeconomic characteristics confirmed that in 2020, odds of caregiver-reported chronic pain declined by 33% (95% confidence interval: 23%, 42%; p<0.001). CONCLUSIONS The encouraging finding of a nationwide decrease in the prevalence of chronic pain calls into question initial predictions anticipating the pandemic to contribute to onset or persistence of chronic pain among children.
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Affiliation(s)
- Boluwatife Aluko
- Brody School of Medicine at East Carolina University, Greenville, USA
| | | | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, Greenville, USA
| | - Evan Zeldin
- Department of Physical Medicine & Rehabilitation, Brody School of Medicine at East Carolina University, Greenville, USA
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9
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Abstract
Chronic pain in children is a relatively prevalent cause of functional disability. Contributing factors to this pain are best viewed through the biopsychosocial model. Although evidence is lacking for individual aspects of treatment, interdisciplinary care is considered the best treatment approach for children with chronic pain. Interdisciplinary care can include medication management with daily and as-needed medications, physical and occupational therapy focusing on function and movement, and psychological treatment with cognitive-behavioral therapy and acceptance focused treatment. In children with severe pain and disability, intensive interdisciplinary pain treatment may be needed to improve pain and function.
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Affiliation(s)
- Andrew B Collins
- Department of Pediatrics, University of Cincinnati College of Medicine; Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine; Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 4009, Cincinnati, OH 45229, USA; Division of Pediatric Pain Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue MLC 2001, Cincinnati, OH 45229, USA.
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10
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Sehdev M, Zoffness R, Fritz K, Ali SA. A Biopsychosocial Approach to Complex Regional Pain Syndrome in a Pediatric Inflammatory Bowel Disease Patient. JPGN REPORTS 2023; 4:e277. [PMID: 37181913 PMCID: PMC10174739 DOI: 10.1097/pg9.0000000000000277] [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: 01/18/2022] [Accepted: 11/17/2022] [Indexed: 05/16/2023]
Abstract
Pediatric chronic pain is typically framed as a purely biomedical problem requiring exclusively biomedical solutions. However, research indicates that pain is biopsychosocial, produced and reduced by a combination of biological, psychological, sociological, and environmental factors, and that treatment must therefore also be biopsychosocial, incorporating interventions such as pain psychology and physical therapy. We report a case of a 16-year-old patient with Crohn disease and complex regional pain syndrome, and the multidisciplinary approach to care that was crucial for his return to function.
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Affiliation(s)
| | | | | | - Sabina A. Ali
- Department of Pediatrics, Division of Pediatric Gastroenterology Hepatology and Nutrition, UCSF Benioff Children’s Hospital Oakland
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11
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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.
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12
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Tutelman PR, Chambers CT, Noel M, Heathcote LC, Fernandez CV, Flanders A, MacLeod J, Sherry SB, Simard S, Stern M, Stewart SH, Urquhart R. Pain and Fear of Cancer Recurrence in Survivors of Childhood Cancer. Clin J Pain 2022; 38:484-491. [PMID: 35686578 DOI: 10.1097/ajp.0000000000001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Theoretical models suggest that anxiety, pain intensity, and pain catastrophizing are implicated in a cycle that leads to heightened fear of cancer recurrence (FCR). However, these relationships have not been empirically examined. The objective of this study was to examine the relationships between anxiety symptoms, pain intensity, pain catastrophizing, and FCR in childhood cancer survivors and their parents and to examine whether pain catastrophizing predicts increased FCR beyond anxiety symptoms and pain intensity. METHODS The participants were 54 survivors of various childhood cancers (Mage=13.1 y, range=8.4 to 17.9 y, 50% female) and their parents (94% mothers). Children reported on their pain intensity in the past 7 days. Children and parents separately completed measures of anxiety symptoms, pain catastrophizing, and FCR. RESULTS Higher anxiety symptoms were associated with increased pain intensity, pain catastrophizing, and FCR in childhood cancer survivors. Higher anxiety symptoms and pain catastrophizing, but not child pain intensity, were associated with FCR in parents. Hierarchical linear regression models revealed that pain catastrophizing explained unique variance in both parent (ΔR2=0.11, P<0.01) and child (ΔR2=0.07, P<0.05) FCR over and above the effects of their own anxiety symptoms and child pain. DISCUSSION The results of this study provides novel data on the association between pain and FCR and suggests that a catastrophic style of thinking about pain is more closely related to heightened FCR than one's anxiety symptoms or the sensory pain experience in both childhood cancer survivors and their parents. Pain catastrophizing may be a novel intervention target for survivors and parents struggling with fears of recurrence.
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Affiliation(s)
- Perri R Tutelman
- Departments of Psychology and Neuroscience
- Centre for Pediatric Pain Research
| | - Christine T Chambers
- Departments of Psychology and Neuroscience
- Pediatrics
- Centre for Pediatric Pain Research
| | - Melanie Noel
- Department of Psychology
- Alberta Children's Hospital Research Institute, University of Calgary
- Hotchkiss Brain Institute, Calgary, AB
| | - Lauren C Heathcote
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Conrad V Fernandez
- Pediatrics
- Bioethics
- Division of Pediatric Hematology-Oncology, IWK Health Centre
| | | | | | | | - Sébastien Simard
- Département des sciences de la santé & Centre Intersectoriel en Santé Durable (CISD), Université du Québec à Chicoutimi (UQAC), Saguenay, QC
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13
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Harbeck-Weber C, Sim L, Morrow AS, Murad MH. What about parents? A systematic review of paediatric intensive interdisciplinary pain treatment on parent outcomes. Eur J Pain 2022; 26:1424-1436. [PMID: 35638305 DOI: 10.1002/ejp.1986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/04/2022] [Accepted: 05/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Intensive interdisciplinary pain treatment (IIPT) for youth with high impact chronic pain has been found to be effective in improving child symptoms and functioning. However, it remains unclear how these interventions impact the parents' own well-being, as well as cognitions and behaviours which are known to influence child pain and functioning. Thus, the current study sought to determine the effect of IIPT on parent mental health, cognitions and behaviours in parents of youth attending IIPT with their child. DATABASES AND DATA TREATMENT A search of the electronic databases CINAHL, Ovid EBM Reviews, Embase, Medline, APA PsychINFO, Scopus and web of Science was conducted. Studies were included if they comprised at least 10 parents of patients aged 9-22 with nonmalignant chronic pain attending an IIPT and were written in English. RESULTS A random-effects model was used to pool the standardized mean change (SMC) across seven prepost studies. At discharge, IIPT participation was associated with small to moderate improvements in direct parental outcomes (general mental health, anxiety, depression and parenting stress), a moderate improvement in pain catastrophizing and large improvements in psychological flexibility and parenting behaviours. Most improvements were maintained at follow-up. The risk of bias of all studies was rated as serious and the certainty of the evidence as low, suggesting limited confidence in the estimates. CONCLUSIONS Although parents appear to benefit from attending an IIPT with their child, RCTs are needed to substantiate the effect of these interventions on important aspects of parent well-being and functioning.
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Affiliation(s)
- Cynthia Harbeck-Weber
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Allison S Morrow
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - M Hassan Murad
- Kern Center for the Science of Healthcare Delivery, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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14
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Newton-John T. Extending the Biopsychosocial Conceptualisation of Chronic Post Surgical Pain in Children and Adolescents: The Family Systems Perspective. Can J Pain 2022; 6:143-152. [PMID: 35528040 PMCID: PMC9067468 DOI: 10.1080/24740527.2022.2038032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
A substantial number of children and adolescents undergoing surgical procedures, as many as 40% in some estimates, will go on to develop chronic postsurgical pain (CPSP). Because of the significant negative impact of CPSP on social and emotional milestones, as well as the child’s quality of life, it is important to identify modifiable factors that are associated with the onset and maintenance of the condition. Research has demonstrated that parent factors can play a role in pediatric chronic pain; however, there has been little examination of parent and family influences on the transition to CPSP. Family systems theories, which consider the influence of the family unit overall on the behavior of individuals members, have been applied to the eating disorders literature for decades. This narrative review proposes a novel application of family systems theory to pediatric CPSP and, in particular, highlights the role that parental dyadic factors may play in the development and maintenance of persistent pain following surgery in children and adolescents.
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Affiliation(s)
- Toby Newton-John
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney NSW 2008. Australia
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15
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McGurgan A, Wilson C, McGuire S. Parental experiences of psychological interventions for recurrent abdominal pain in childhood. J Health Psychol 2021; 27:2834-2846. [PMID: 34875912 DOI: 10.1177/13591053211064982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Active components of psychological intervention for RAP remain unclear. This study involved completing interviews about parental experience of psychological intervention for RAP to ascertain how and why psychological intervention can be effective. Difficulty making sense of RAP and barriers to treatment were identified as struggles. Acceptance and containment were key overlapping mechanisms, which allowed families to develop a changed relationship with the pain and manage the impact of pain. To further develop interventions, the role of containment should be considered and acceptance-based interventions explored, given the growing evidence base in this area. Practical implications of this research are also discussed.
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16
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Caruso A, Grolnick W, Mueller C, Kaczynski K, Chang CYH, Lebel A. Health Mindsets in Pediatric Chronic Headache. J Pediatr Psychol 2021; 47:391-402. [PMID: 34877604 DOI: 10.1093/jpepsy/jsab115] [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: 05/01/2021] [Revised: 10/12/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Given how frequently youth with chronic headache and migraine experience setbacks in treatment, identifying factors that promote coping and resilience is critical. Mindsets have gained attention as predictors of behavior and targets of intervention across contexts, including health. Health mindsets may help to explain how children with chronic pain interpret and respond to treatment. This study evaluated whether growth health mindsets might relate to adaptive outcomes in patients with chronic pediatric headache. METHODS Participants were 88 children and adolescents (ages 10-17 years) with headache or migraine contacted following an appointment at a pediatric headache clinic, and their parent. Patients rated their beliefs about health as more fixed versus growth-oriented. They were presented with vignettes depicting hypothetical treatment setbacks and instructed to reflect upon real-life setbacks. Patients completed questionnaires about their cognitive appraisals of setbacks, coping, quality of life, life satisfaction, and functional impairment. RESULTS The higher children rated their growth health mindsets, the less likely they were to appraise setbacks as threatening and endorse quality-of-life problems. Children with higher growth mindsets reported higher life satisfaction and lower functional disability. There was also an indirect relation between children's mindsets and coping through cognitive appraisals of setbacks as a threat, but not challenge. CONCLUSION This research extends the health mindsets literature by contributing preliminary evidence of health mindsets as tied to adaptive outcomes in youth with chronic headache. These findings may be of interest to clinicians and parents, as health mindsets may offer an avenue by which resilience is promoted and maladaptive appraisals are minimized.
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Affiliation(s)
- Alessandra Caruso
- Department of Psychology, Clark University, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA
| | | | - Claudia Mueller
- Department of Surgery, Stanford University School of Medicine, USA
| | - Karen Kaczynski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA.,Department of Psychiatry, Harvard Medical School, USA
| | - Cindy Yu-Hsing Chang
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA
| | - Alyssa Lebel
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, USA.,Department of Neurology, Harvard Medical School, USA
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17
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Ballard LM, Jenkinson E, Byrne CD, Child JC, Inskip H, Lokulo-Sodipe O, Mackay DJG, Wakeling EL, Davies JH, Temple IK, Fenwick A. Experiences of adolescents living with Silver-Russell syndrome. Arch Dis Child 2021; 106:1195-1201. [PMID: 33741574 DOI: 10.1136/archdischild-2020-321376] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The psychosocial impact of growing up with Silver-Russell syndrome (SRS), characterised by growth failure and short stature in adulthood, has been explored in adults; however, there are no accounts of contemporary lived experience in adolescents. Such data could inform current healthcare guidance and transition to adult services. We aimed to explore the lived experience of adolescents with SRS. DESIGN/SETTING/PATIENTS In-depth, semi-structured interviews were conducted between January 2015 and October 2016 with a sample of eight adolescents aged 13-18 (five girls) with genetically confirmed SRS from the UK. Qualitative interviews were transcribed and coded to identify similarities and differences using thematic analysis; codes were then grouped to form overarching themes. RESULTS We identified four themes from the interview data: (1) the psychosocial challenges of feeling and looking different; (2) pain, disability and fatigue; (3) anticipated stigma; and (4) building resilience and acceptance. Despite adolescents accepting SRS in their lives, they described ongoing psychosocial challenges and anticipated greater problems to come, such as stigma from prospective employers. CONCLUSIONS Adolescents with SRS may experience psychosocial difficulties from as young as 10 years old related to feeling and looking different; pain, disability and fatigue; anticipated stigma; and future challenges around employment. We discuss these findings in relation to recommendations for the care of adolescents with SRS to prepare them for adult life.
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Affiliation(s)
- Lisa Marie Ballard
- Clinical Ethics & Law, Faculty of Medicine, University of Southampton, Southampton, UK
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elizabeth Jenkinson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Christopher D Byrne
- Nutrition and Metabolism Unit, University of Southampton, Southampton, UK
- Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Oluwakemi Lokulo-Sodipe
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Emma L Wakeling
- North East Thames Regional Genetics Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Justin Huw Davies
- Department of Endocrinology, Southampton Children's Hospital, Southampton University Hospitals NHS Trust, Southampton, UK
| | - I Karen Temple
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Angela Fenwick
- Clinical Ethics & Law, Faculty of Medicine, University of Southampton, Southampton, UK
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18
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Klein IL, van de Loo KFE, Hoogeboom TJ, Janssen MCH, Smeitink JAM, van der Veer E, Verhaak CM, Custers JAE. Blended cognitive behaviour therapy for children and adolescents with mitochondrial disease targeting fatigue (PowerMe): study protocol for a multiple baseline single case experiment. Trials 2021; 22:177. [PMID: 33648576 PMCID: PMC7923335 DOI: 10.1186/s13063-021-05126-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Mitochondrial disease is a rare, hereditary disease with a heterogeneous clinical presentation. However, fatigue is a common and burdensome complaint in children and adolescents with mitochondrial disease. No psychological intervention targeting fatigue exists for paediatric patients with a mitochondrial disease. We designed the PowerMe intervention, a blended cognitive behaviour therapy targeting fatigue in children and adolescents with mitochondrial disease. The aim of the intervention is to reduce perceived fatigue by targeting fatigue-related cognitions and behaviours. Methods A multiple baseline single case experiment will be conducted in five children (8–12 years old) and 5 adolescents (12–18 years old) with mitochondrial disease and severe fatigue. Patients will be included in the study for 33 weeks, answering weekly questions about the fatigue. Patients will be randomly assigned a baseline period of 5 to 9 weeks before starting the PowerMe intervention. The intervention consists of face-to-face and online sessions with a therapist and a website with information and assignments. The treatment will be tailored to the individual. Each patient will work on their personalized treatment plan focusing on personally relevant goals. The primary outcome is perceived fatigue. Secondary outcomes are quality of life, school presence and physical functioning. Discussion The results of the PowerMe study will provide information on the efficacy of a blended cognitive behaviour therapy on reducing perceived fatigue and its impact on daily life in children and adolescents with mitochondrial disease. Strengths and limitations of the study design are discussed. Trial registration Dutch Trial Register NTR 7675. Registered on 17 December 2018. Identifier https://www.trialregister.nl/trial/7433
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Affiliation(s)
- I L Klein
- Radboud university medical center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands.
| | - K F E van de Loo
- Radboud university medical center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - T J Hoogeboom
- Radboud university medical center, Radboud Institute for Health Sciences, IQ Healthcare, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - M C H Janssen
- Radboud university medical center, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Internal Medicine, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - J A M Smeitink
- Radboud university medical center, Radboud Institute for Molecular Life Sciences, Radboud Center for Mitochondrial Medicine, Department of Pediatrics, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - E van der Veer
- International Mito Patients Association, Bergambacht, The Netherlands
| | - C M Verhaak
- Radboud university medical center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
| | - J A E Custers
- Radboud university medical center, Radboud Institute for Health Sciences, Radboud Center for Mitochondrial Medicine, Department of Medical Psychology, PO Box 9101, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, The Netherlands
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19
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Mishra P, Tomar A, Kumar A, Nath A, Sharma SK, Singh GK. Pain management in COVID-19 pediatric patients-An evidence- based review. Saudi J Anaesth 2021; 15:33-39. [PMID: 33824640 PMCID: PMC8016053 DOI: 10.4103/sja.sja_635_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Despite our growing knowledge about the COVID pandemic, not much concern has been focused upon the effective pain management in pediatric patients suffering from this SARS CoV2 virus. Symptoms with pain like myalgia (10%–40%), sore throat (5%–30%), headache (14%–40%) and abdominal pain (10%) are common in children suffering from COVID. (3-5) We conducted a systematic review regarding analgesia for COVID positive pediatric patients. Cochrane, PubMed, and Google scholar databases were searched for relevant literature. Owing to the novel status of COVID-19 with limited literature, we included randomized controlled trials (RCTs), observational studies, case series and case reports in the descending order of consideration. Articles in languages other than English, abstract only articles and non-scientific commentaries were excluded. The Primary outcome was evaluation of pain related symptoms and best strategies for their management. Our review revealed that a multidisciplinary approach starting from non-pharmacological techniques like drinking plenty of water, removing triggers like inadequate sleep, specific foods and psychotherapy including distraction, comfort and cognitive behavioural strategies should be used. Pharmacological approaches like acetaminophen, NSAIDS, spasmolytics etc. can be used if non-pharmacological therapy is inadequate. As per the current strength of evidence, acetaminophen and ibuprofen can be safely administered for pain management in children with COVID-19. Undertreated pain is a significant contributor to increased morbidity and poor prognosis. Integration of evidence based non-pharmacotherapies in the multidisciplinary pain management will contribute towards improved functioning, early recovery and better quality care for pediatric patients suffering from COVID.
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Affiliation(s)
- Priyanka Mishra
- Department of Anesthesiology and Critical Care, AIIMS, Rishikesh, India
| | - Anupama Tomar
- Department of Anesthesiology and Critical Care, AIIMS, Rishikesh, India
| | - Ajit Kumar
- Department of Anesthesiology and Critical Care, AIIMS, Rishikesh, India
| | - Amborish Nath
- Department of Burns and Plastic Surgery, AIIMS, Rishikesh, India
| | - Suresh K Sharma
- Professor and Principal, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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20
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Darling KE, Benore ER, Webster EE. Biofeedback in pediatric populations: a systematic review and meta-analysis of treatment outcomes. Transl Behav Med 2020; 10:1436-1449. [PMID: 31420986 DOI: 10.1093/tbm/ibz124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Biofeedback is commonly used for both pediatric and adult patients with a myriad of diagnoses in clinical settings. The majority of previous research has focused on the use of biofeedback in adults, with only a small body of literature examining the usefulness of biofeedback in treating children. The current systematic review and meta-analysis seeks to quantitatively examine the usefulness of biofeedback in addressing pediatric conditions. A systematic review of biofeedback interventions in children was conducted using four databases (Ovid MEDLINE, EMBASE, PsycINFO, and Cochrane CENTRAL). Outcomes included changes in symptoms of associated conditions or changes in physiological functioning. Out of 3,128 identified articles, 23 studies (with 24 effect sizes) were eligible for inclusion in the meta-analysis. Using a random effects model, the overall effect of pediatric biofeedback was statistically significant with a large effect size. Despite the large effect size, general study quality was low, limiting interpretation of findings. Despite widespread clinical use of biofeedback in pediatric populations, research is still limited concerning the efficacy of biofeedback in children. While findings suggest potential positive effects of biofeedback to address pediatric conditions, high-quality studies are necessary to fully support the use of biofeedback in children.
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Affiliation(s)
| | - Ethan R Benore
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Erin E Webster
- Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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21
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Nimbley E, Caes L, Jones A, Fisher E, Noel M, Jordan A. A linguistic analysis of future narratives in adolescents with Complex Regional Pain Syndrome and their pain-free peers. Eur J Pain 2020; 25:693-703. [PMID: 33259699 DOI: 10.1002/ejp.1704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/13/2020] [Accepted: 11/22/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Complex Regional Pain Syndrome (CRPS) is a chronic pain condition that often develops after injury, with a typical onset in adolescence. The impact of chronic pain is far-reaching, with many adolescents reporting atypical developmental trajectories compared with peers. Social Comparison Theory offers a framework for understanding how such comparisons influence well-being, whereby a heightened sense of disparity places adolescents at risk of poor cognitive, affective and social outcomes. Using a novel linguistic analysis programme, this study aims to investigate cognitive, affective and social language used by adolescents with CRPS in comparison to their peers during a task reflecting on their futures. METHODS A story completion task was completed by adolescents with CPRS (n = 49) and adolescents without pain (n = 48). This task involved asking adolescents to describe their imagined future. Narratives were analysed using a novel linguistic analysis programme, focusing on the cognitive, affective and social dimensions. RESULTS Findings revealed significant group differences in how adolescents with CRPS described their imagined futures. Adolescents with CRPS used significantly fewer positive affect and more negative affect, anger and sadness words, and greater insight and discrepancy words. No significant groups differences were found for social words. CONCLUSIONS Substantial differences in cognitive and affective words were found between adolescents with and without CRPS. Findings provide novel insights into current understandings of cognitive, affective and social processes in adolescents living with chronic pain, particularly with regard to adolescent developmental trajectories, and may in turn highlight potential targets in psychosocial interventions for adolescents living with chronic pain. SIGNIFICANCE Social comparisons are commonly undertaken by adolescents with CRPS in relation to peers, increasing risk for poor cognitive, affective and social outcomes. Findings promote the potential importance of targeting psychosocial factors in treatments for paediatric chronic pain.
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Affiliation(s)
- Emy Nimbley
- Department of Psychology, University of Bath, Bath, UK
| | - Line Caes
- Division of Natural Sciences, University of Stirling, Stirling, UK
| | - Abigail Jones
- Department of Psychology, University of Bath, Bath, UK.,Centre for Pain Research, University of Bath, Bath, UK
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK.,Department for Health, University of Bath, Bath, UK
| | - Melanie Noel
- Department of Psychology, University of Calgary, Alberta Children's Hospital Research Institute and Hotchkiss Brain Institute, Calgary, Canada
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK.,Centre for Pain Research, University of Bath, Bath, UK
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22
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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: 5] [Impact Index Per Article: 1.3] [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.
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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;
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23
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Lynch MK, Thompson KA, Dimmitt RA, Barnes MJ, Goodin BR. Pain and internalizing symptoms in youth with gastrointestinal conditions including recurrent abdominal pain, eosinophilic esophagitis, and gastroesophageal reflux disease. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1810575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mary K. Lynch
- Department of Psychiatry, Section of Psychology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathryn A. Thompson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Reed A. Dimmitt
- Department of Pediatrics, Division of Gastroenterology Hepatology, & Nutrition, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Margaux J. Barnes
- Department of Pediatrics, Division of Gastroenterology Hepatology, & Nutrition, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
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24
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Abootalebi M, Dehghani M, Akbarzadeh M. Implementing of mental health training programs for promotion of health affected teenage girls to premenstrual syndrome: A community-based study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2020; 9:155. [PMID: 32766340 PMCID: PMC7377132 DOI: 10.4103/jehp.jehp_118_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/07/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Mental health is one of the major determinants of a person's health which has a significant impact on the quality of life. Implementing of mental health training programs for promotion of health affected teenage girls to premenstrual syndrome (PMS) in Shiraz, southern Iran: a community-based study. MATERIALS AND METHODS This study is randomized controlled trial done on 100 teenage girls affected to PMS in Shiraz-Iran (selected from400 girls). Multistage cluster sampling method was used f or sampling. In the intervention group, six training sessions were held twice a week for 2 h. For data collection, Standard Goldberg Mental Health Questionnaire-28 and Premenstrual Symptoms Screening Tool were used. For data analysis, independent t-test and Chi-square statistics were used at significant level of 0.05. RESULTS The average age was (16.56 ± 0.92) and (16.24 ± 1.45) in the intervention and control groups, respectively. The average intensity of physical complaints, level of anxiety and sleep disorder, level of social functions disorders and depression were significantly lower in the group of training classes than control group (P < 0.001). CONCLUSION Appropriate training-care programs are effective in reducing stress and improving mental health, prevention and treatment of mental disorders, emotional growth, and development of communication skills among female students with premenstrual syndrome.
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Affiliation(s)
- Maliheh Abootalebi
- Department of Community Health Nursing, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mansoureh Dehghani
- Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Akbarzadeh
- Department of Midwifery, Maternal-Fetal Medicine Research Center, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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25
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Donado C, Lobo K, Berde CB, Bourgeois FT. Developing a pediatric pain data repository. JAMIA Open 2019; 3:31-36. [PMID: 32607485 PMCID: PMC7309240 DOI: 10.1093/jamiaopen/ooz062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/12/2019] [Accepted: 10/21/2019] [Indexed: 01/26/2023] Open
Abstract
The management of pediatric pain typically consists of individualized treatment plans and interventions that have not been systematically evaluated. There is an emerging need to create systems that can support the translation of clinical discoveries, facilitate the assessment of current interventions, and improve the collection of patient-centered data beyond routine clinical information. We present the development of the pediatric pain data repository, a custom-built system developed at Boston Children’s Hospital by a multidisciplinary pain treatment service. The Repository employs a web platform to collect standardized patient-reported outcomes and integrates this with electronic medical record data. To date, we have collected information on 2577 patients and anticipate adding approximately 500 new patients per year. Major strengths of the Repository include collection of extensive longitudinal patient-reported outcomes, automated clinical data abstraction, and integration of the system into clinical workflows to support medical decision making.
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Affiliation(s)
- Carolina Donado
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Kimberly Lobo
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Florence T Bourgeois
- Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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26
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Cousineau TM, Hobbs LM, Arthur KC. The Role of Compassion and Mindfulness in Building Parental Resilience When Caring for Children With Chronic Conditions: A Conceptual Model. Front Psychol 2019; 10:1602. [PMID: 31428005 PMCID: PMC6690403 DOI: 10.3389/fpsyg.2019.01602] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/25/2019] [Indexed: 01/20/2023] Open
Abstract
Compassion- and mindfulness-based interventions (CMBIs) and therapies hold promise to support parent resilience by enabling adaptive stress appraisal and coping, mindful parenting, and perhaps crucially, self-compassion. These contemplative modalities have recently been expanded to parents of children with chronic illness, building on successful applications for adults facing stress, chronic pain, or mental illness, and for healthcare professionals in response to caregiver burnout resulting from their work. The design and adaptation of interventions and therapies require a conceptual model of parent resilience in the context of childhood chronic illness that integrates mindfulness and compassion. The objective of this paper is to propose and describe such a model. First, we review the need for parent support interventions for this population. Second, we introduce a Model of Compassion, Mindfulness, and Resilience in Parental Caregiving. We highlight the mindful parenting approaches, guiding theories for adaptive coping, and family resilience frameworks that informed our model. Third, we describe a case of a parent to illustrate a practical application model. Finally, we outline future directions for intervention development and research to examine the impact of CMBIs on parent resilience.
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Affiliation(s)
- Tara M. Cousineau
- Counseling and Mental Health Services, Harvard University, Cambridge, MA, United States
- Center for Mindfulness and Compassion, Cambridge Health Alliance, Cambridge, MA, United States
| | - Lorraine M. Hobbs
- Youth, Family and Educational Programs, UCSD Center for Mindfulness, San Diego, CA, United States
| | - Kimberly C. Arthur
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA, United States
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Liossi C, Johnstone L, Lilley S, Caes L, Williams G, Schoth DE. Effectiveness of interdisciplinary interventions in paediatric chronic pain management: a systematic review and subset meta-analysis. Br J Anaesth 2019; 123:e359-e371. [PMID: 30916012 PMCID: PMC6676017 DOI: 10.1016/j.bja.2019.01.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 12/21/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Paediatric chronic pain is a significant problem that can have devastating impacts on quality of life. Multimodal interdisciplinary interventions are the mainstay of paediatric treatment. The aim of this article is to provide a comprehensive review of the effectiveness of interdisciplinary interventions in the management of paediatric chronic pain. METHODS Studies were identified via a search of nine databases. The search strategy included concept blocks pertaining to type of pain, study population, and type of intervention. Eligible studies reported the effects of an intervention co-ordinated by two or more healthcare professionals of different disciplines, and recruited a sample aged 22 yr or below with chronic pain. Twenty-eight studies were included, and 21 provided data for inclusion in between- and within-groups meta-analyses. RESULTS Patients randomised to interdisciplinary interventions reported significantly lower pain intensity 0-1 month post-intervention compared with patients randomised to the control groups. Within-groups analysis of patients receiving interdisciplinary interventions showed significant improvements pre- to post-intervention in pain intensity, functional disability, anxiety, depression, catastrophising, school attendance, school functioning, and pain acceptance. Few differences were found between interventions delivered in inpatient vs outpatient settings. Significant heterogeneity due mainly to differing outcome variables and intervention content was found in most analyses. CONCLUSIONS Overall, interdisciplinary interventions show promise in providing a range of clinical benefits for children with chronic pain. Methodologically robust randomised controlled trials using standardised outcome measures are needed, however, to guide clinical care.
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Affiliation(s)
- Christina Liossi
- University of Southampton, School of Psychology, Southampton, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Lauren Johnstone
- University of Southampton, School of Psychology, Southampton, UK
| | - Suzanne Lilley
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Line Caes
- University of Stirling, Psychology, Stirling, UK
| | - Glyn Williams
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Frygner-Holm S, Åsenlöf P, Ljungman G, Söderlund A. Physical therapists' experiences of learning and delivering a complex behavioral medicine intervention to adolescents with pain. Physiother Theory Pract 2019; 37:583-593. [PMID: 31305232 DOI: 10.1080/09593985.2019.1639232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective was to study physical therapists' (PTs') experiences of learning and delivering a complex intervention, a tailored behavioral medicine treatment (BMT) targeting adolescents with pain in primary care.Method: An explorative study with qualitative approach, using content analysis. Three primary care PTs delivering the treatments in a randomized controlled study were interviewed regarding their views on the BMT.Results: The participating PTs considered learning about and delivering the BMT as challenging but rewarding. The biopsychosocial approach, tailoring of the treatment and dialogues with parents were identified as key aspects of the BMT program. The process of formulating a functional behavioral analysis was perceived as strenuous. The supervision of the PTs throughout the study was regarded as crucial and necessary for learning about and providing tailored BMT.Conclusion: Learning about and delivering BMT targeting adolescents with persistent pain is fruitful but laborious and demanding according to three PTs experienced with treatment of pediatric pain in primary care. Extensive education and long periods of supervision seem to be crucial for success and safe delivery according to protocol.
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Affiliation(s)
| | | | - Gustaf Ljungman
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden
| | - Anne Söderlund
- School of Health Care and Social Welfare, Mälardalen University, Västerås, Sweden
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29
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Characterizing Social and Academic Aspects of School Anxiety in Pediatric Chronic Pain. Clin J Pain 2019; 35:625-632. [DOI: 10.1097/ajp.0000000000000720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yoon IA, Sturgeon JA, Feinstein AB, Bhandari RP. The role of fatigue in functional outcomes for youth with chronic pain. Eur J Pain 2019; 23:1548-1562. [DOI: 10.1002/ejp.1431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 05/11/2019] [Accepted: 05/21/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Isabel Angela Yoon
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
| | - John Andrew Sturgeon
- Department of Anesthesiology and Pain Medicine University of Washington School of Medicine, Center for Pain Relief Seattle Washington
| | - Amanda Beth Feinstein
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
| | - Rashmi Parekh Bhandari
- Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine, Stanford/Lucile Packard Pediatric Pain Management Clinic Menlo Park California
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Martin K, Geuens S, Asche JK, Bodan R, Browne F, Downe A, García García N, Jaega G, Kennedy B, Mauritz PJ, Pérez F, Soon K, Zmazek V, Mayre-Chilton KM. Psychosocial recommendations for the care of children and adults with epidermolysis bullosa and their family: evidence based guidelines. Orphanet J Rare Dis 2019; 14:133. [PMID: 31186066 PMCID: PMC6560722 DOI: 10.1186/s13023-019-1086-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/01/2019] [Indexed: 12/13/2022] Open
Abstract
Epidermolysis Bullosa (EB) is a group of rare genetic disorders resulting in skin fragility and other symptoms. Commissioned by DEBRA International and funded by DEBRA Norway, this evidence-bases guideline provides recommendations to optimise psychosocial wellbeing in EB.An international multidisciplinary panel of social and health care professionals (HCP) and people living with EB was formed. A systematic international literature review was conducted by the panel following the Scottish Intercollegiate Guidelines Network (SIGN) methodology. The resulting papers underwent systematic selection and critique processes. Included papers were allocated to 6 different outcome groups to allow data synthesis and exploration: quality of life, coping, family, wellbeing, access to HCP and pain. Based on the evidence in those papers, recommendations were made for individuals living with EB, family and caregivers and HCP working in the field.Few studies have investigated interventions and which factors lead to better outcomes, but general recommendations can be made. EB is a complex disease impacting enormously on every aspect of psychosocial life. People and families living with EB need access to multidisciplinary support, including psychological guidance, in order to improve quality of life and psychosocial wellbeing. Interventions should stimulate social participation to prevent isolation. People with EB and their families should be able to access a supportive network. HCP should be well supported and educated about the complexity of EB. They should work collaboratively with those around the individual with EB (e.g. schools, employers etc.) to provide psychosocial opportunity and care.Attention should be paid to the psychosocial impact of EB as well as physical needs. Directions for research are indicated.
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Affiliation(s)
- K. Martin
- University Hospitals Birmingham NHS Trust, Solihull Hospital, Solihull, B91 2JL, UK
| | - S. Geuens
- Universital Hospitals Leuven, Leuven, Belgium
| | - J. K. Asche
- DEBRA Norge and person living with JEB, Stavanger, Norway
| | - R. Bodan
- California State University, Fullerton, CA USA
| | - F. Browne
- Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - A. Downe
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
| | | | - G. Jaega
- Psychology graduate and person living with EBS, Liverpool, UK
| | - B. Kennedy
- Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland
| | - P. J. Mauritz
- The University Medical Center Groningen, Groningen, the Netherlands
| | | | - K. Soon
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | - K. M. Mayre-Chilton
- Guy’s and St Thomas’ Hospitals NHS Foundation Trust, London, UK
- DEBRA International, Vienna, Austria
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Kapadia M, Scheid A, Fine E, Zoffness R. Review of the Management of Pediatric Post-Concussion Syndrome-a Multi-Disciplinary, Individualized Approach. Curr Rev Musculoskelet Med 2019; 12:57-66. [PMID: 30758705 PMCID: PMC6388574 DOI: 10.1007/s12178-019-09533-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW Post-concussion syndrome (PCS), when the patient's concussion symptoms last longer than 4-6 weeks, affects 10-30% of concussion patients. PCS presents a significant source of morbidity to patients and a management challenge to providers. In this review, we present the current evidence and best management approaches for pediatric PCS. RECENT FINDINGS There is limited high-quality evidence in pediatric PCS. There is some evidence supporting pharmaceutical management of post-traumatic headaches, cognitive symptoms, and emotional symptoms. Vestibular-ocular dysfunction should be evaluated and managed appropriately. Neuropsychological recovery is expected, but requires appropriate attention to Return to Learn. Emotional symptoms are common in PCS and the evidence supports treatment with cognitive behavioral therapy. PCS presents a unique therapeutic challenge affecting multiple domains for patients-physical, sleep, cognitive, and emotional. Successful management of PCS requires a multi-disciplinary and individualized approach. There remains a significant need for further research, specifically looking into the outcomes and effective interventions in pediatric PCS.
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Affiliation(s)
- Mitul Kapadia
- Division of Pediatric Rehabilitation Medicine, Mission Hall, UCSF Benioff Children's Hospital, Box 0110, 550 16th Street, 4th Floor, San Francisco, CA, 34143, USA.
- University of California, San Francisco, CA, USA.
| | - Alison Scheid
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, USA
| | - Eric Fine
- Department of Neurology, University of California, San Francisco, CA, USA
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Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. CHILDREN-BASEL 2019; 6:children6020033. [PMID: 30795645 PMCID: PMC6406753 DOI: 10.3390/children6020033] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 12/13/2022]
Abstract
Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.
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Chronic Pediatric Pain Management: a Review of Multidisciplinary Care and Emerging Topics. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2019. [DOI: 10.1007/s40141-019-0211-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hurley-Wallace A, Wood C, Franck LS, Howard RF, Liossi C. Paediatric pain education for health care professionals. Pain Rep 2019; 4:e701. [PMID: 30801042 PMCID: PMC6370141 DOI: 10.1097/pr9.0000000000000701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Anna Hurley-Wallace
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Chantal Wood
- Centre de la Douleur Chronique CHU Dupuytren, Limoges Cedex, France
| | - Linda S. Franck
- Department of Family Health Care Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Richard F. Howard
- Pain Control Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Christina Liossi
- Pain Research Laboratory, Department of Psychology, University of Southampton, Southampton, United Kingdom
- Pain Control Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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36
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Khu M, Soltani S, Neville A, Schulte F, Noel M. Posttraumatic stress and resilience in parents of youth with chronic pain. CHILDRENS HEALTH CARE 2018. [DOI: 10.1080/02739615.2018.1514606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Melanie Khu
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
| | - Sabine Soltani
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Alexandra Neville
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Fiona Schulte
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Melanie Noel
- Alberta Children’s Hospital Research Institute, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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37
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Goldstein-Leever A, Cohen LL, Dampier C, Sil S. Parent pain catastrophizing predicts child depressive symptoms in youth with sickle cell disease. Pediatr Blood Cancer 2018; 65. [PMID: 29512881 PMCID: PMC5980707 DOI: 10.1002/pbc.27027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Youth with sickle cell disease (SCD) are at risk for recurrent pain and depressive symptoms, both of which contribute to poorer health outcomes. Furthermore, youth and family coping with child pain, including pain catastrophizing, is known to be associated with poorer psychosocial adjustment and greater functional disability among youth with SCD. In particular, child catastrophizing about pain and parent catastrophizing about their child's pain have been linked to increased pain and depressive symptoms in youth with chronic pain conditions. Despite this, the impact of child and parent pain catastrophizing on depressive symptoms remains unexplored in pediatric SCD. PROCEDURE The current study evaluated the predictive value of child and parent pain catastrophizing on child depressive symptoms in a sample of 100 youth with SCD. Differences in child and parent pain catastrophizing across youth with and without clinically elevated depressive symptoms were also examined. RESULTS Pain frequency and parent and child pain catastrophizing accounted for 35.9% of variance in child depressive symptoms, with only pain frequency and parent pain catastrophizing emerging as unique predictors of clinically elevated depressive symptoms. Additionally, parents of youth with clinically elevated depressive symptoms showed increased helplessness relative to parents of youth with minimal to mild depressive symptoms. CONCLUSIONS Findings support the value of depression screening and interventions to promote parent self-efficacy in managing childhood SCD pain.
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Affiliation(s)
- Alana Goldstein-Leever
- Nationwide Children’s Hospital, Division of Pediatric Psychology and Neuropsychology,The Ohio State University, Department of Pediatrics
| | - Lindsey L. Cohen
- Georgia State University, Department of Psychology,Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center
| | - Carlton Dampier
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center,Emory University School of Medicine, Department of Pediatrics
| | - Soumitri Sil
- Children’s Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center,Emory University School of Medicine, Department of Pediatrics
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38
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Caes L, Fisher E, Clinch J, Eccleston C. Current Evidence-Based Interdisciplinary Treatment Options for Pediatric Musculoskeletal Pain. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018; 4:223-234. [PMID: 30148046 PMCID: PMC6096755 DOI: 10.1007/s40674-018-0101-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW We review the prevalence of pediatric chronic musculoskeletal pain, the clinical need, the evidence for pharmacological, psychological, physical and, complementary approaches to pain management, and the possible future development of interdisciplinary and distance care. RECENT FINDINGS We summarize the Cochrane Systematic Reviews on pharmacological interventions, which show a lack of evidence to support or refute the use of all classes of medication for the management of pain. The trials for NSAIDs did not show any superiority over comparators, nor did those of anti-depressants, and there are no trials for paracetamol, or of opioid medications. There are studies of psychological interventions which show promise and increasing support for physical therapy. The optimal approach remains an intensive interdisciplinary programmatic treatment, although this service is not available to most. SUMMARY 1. Given the absence of evidence, a program of trials is now urgently required to establish the evidence base for analgesics that are widely prescribed for children and adolescents with chronic musculoskeletal pain. 2. Until that evidence becomes available, medicine review is an essential task in this population. 3. We need more examples and efficacy evaluations of intensive interdisciplinary interventions for chronic pain management, described in detail so that researchers and clinicians can unpack possible active treatment components. 4. Online treatments are likely to be critical in the future. We need to determine which aspects of treatment for which children and adolescents can be effectively delivered in this way, which will help reduce the burden of the large number of patients needing support from a small number of experts.
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Affiliation(s)
- Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Emma Fisher
- Centre for Pain Research, University of Bath, Bath, UK
| | - Jacqui Clinch
- Bristol Royal Children’s Hospital, University of Bristol and Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Christopher Eccleston
- Centre for Pain Research, University of Bath, Bath, UK
- Department of Experimental, Clinical and Health Psychology, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
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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).
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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
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Tumin D, Drees D, Miller R, Wrona S, Hayes D, Tobias JD, Bhalla T. Health Care Utilization and Costs Associated With Pediatric Chronic Pain. THE JOURNAL OF PAIN 2018; 19:973-982. [PMID: 29608973 DOI: 10.1016/j.jpain.2018.03.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/12/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
The population prevalence of pediatric chronic pain is not well characterized, in part because of a lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0 to 17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. In multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.62-2.47; P < .001), complementary and alternative medicine (OR = 2.32, 95% CI = 1.79-3.03; P < .001), and emergency care (OR = 1.62, 95% CI = 1.29-2.02; P < .001). In this population-based survey, children with chronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use. PERSPECTIVE Among children with chronic pain, we show high rates of use of emergency care but limited use of mental health care, which may suggest opportunities to increase multidisciplinary treatment of chronic pain.
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Affiliation(s)
- Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.
| | - David Drees
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Rebecca Miller
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Sharon Wrona
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Pulmonary and Critical Care Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio
| | - Tarun Bhalla
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio
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41
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Beals-Erickson SE, Connelly M. Current Understanding of Optimal Self-Management Strategies and Approaches for Youth With Amplified Musculoskeletal Pain Conditions. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0087-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change. CHILDREN-BASEL 2017; 4:children4120106. [PMID: 29215566 PMCID: PMC5742751 DOI: 10.3390/children4120106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/20/2017] [Accepted: 12/04/2017] [Indexed: 11/16/2022]
Abstract
Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.
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Pediatric chronic pain programs: current and ideal practice. Pain Rep 2017; 2:e613. [PMID: 29392228 PMCID: PMC5777676 DOI: 10.1097/pr9.0000000000000613] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/16/2017] [Accepted: 06/17/2017] [Indexed: 12/02/2022] Open
Abstract
This report may be useful for health care professionals and policy makers concerned with improving the care of children with chronic pain and their families. Introduction: The treatment of youth with chronic pain has improved in recent years. However, because pediatric chronic pain programs are not governed by international standards, the development and implementation of new initiatives may be limited. Objectives: The objectives of this study were to identify the features of programs as they exist at present and to determine what features they should have in an ideal state. Methods: A web-based international survey was used to collect information. The survey contained 86 questions seeking respondent professional demographic data and information about the pain program with which the respondent was affiliated at the time (program organization, types of pain problem treated, professionals involved, services provided, size of the program, research, professional training, public education and advocacy, and funding sources). Results: Respondents were 136 pediatric pain experts representing different specialties located in 12 countries. Most respondents indicated that ideal programs would have a multidisciplinary staff; provide a wide range of treatments for different chronic pain problems; integrate research, formal clinical training of specialists, and public education and advocacy into their activities; and be an accredited part of the public health system. Conclusions: The results of this survey may be useful for health care professionals interested in treating chronic pain in children and adolescents and for policy makers concerned with improving the care given to these children and their families.
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