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Tracy C, Lynch Milder M, Vater L, Lagges A, Lemanek K, Wrona S, Gilbert E, Hirsh AT, Miller MM, Donahue K, Streicher M, Williams AE. A retrospective review of psychosocial correlates of chronic pain in cisgender, transgender, and gender-diverse youth receiving evaluation in interdisciplinary pediatric pain clinics. Can J Pain 2025; 8:2477466. [PMID: 40242000 PMCID: PMC12001550 DOI: 10.1080/24740527.2025.2477466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 02/10/2025] [Accepted: 03/06/2025] [Indexed: 04/18/2025]
Abstract
Background Individuals who experience social marginalization, such as transgender and gender-diverse (TGD) youth, have increased risk for poor health outcomes, including chronic pain. A better understanding of the impact of chronic pain in these populations would improve treatment and aid in reducing health care disparities. Our retrospective review of clinical data examined psychosocial correlates of pain in TGD and cisgender youth with chronic pain. Aims The study aim was to explore differences in psychosocial variables between TGD and cisgender youth with chronic pain. In alignment with the minority stress model, we hypothesized worse pain and pain-related disability, poorer quality of life, and more internalizing symptoms in TGD patients. The secondary aim was to explore associations among psychosocial variables in TGD and cisgender youth. Methods Data were collected from 140 youth (48 TGD, 92 cisgender) evaluated in pediatric pain clinics. Independent samples t-tests examined group differences in pain intensity, functional disability, quality of life, pain catastrophizing, and internalizing symptoms. Bivariate correlations were conducted for each group, and differences in the strength of correlations were evaluated using Fisher r-to-z. Institutional review board (IRB) approval was obtained for all study procedures at each participating institution prior to extraction of retrospective clinical data (Indiana 240 University IRB Protocol No. 12506, The Ohio State University College of Medicine IRB Protocol No. 16-00937). Informed consent was not required or obtained due to the retrospective nature of the study. Results Cisgender patients reported worse pain intensity, whereas TGD patients reported lower quality of life and more internalizing symptoms. In the combined sample, pain intensity was correlated with worse functional disability, poorer quality of life, and more catastrophic thinking. No group differences in the strength of correlations were found. Conclusions Results suggest that for TGD youth with chronic pain, internalizing symptoms and quality of life are important targets for treatment and improvement.
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Affiliation(s)
- Crystal Tracy
- Department of Psychology, Indiana State University, Terre Haute, Indiana, USA
| | | | - Lindsey Vater
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Ann Lagges
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kathleen Lemanek
- Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sharon Wrona
- Department of Anesthesia and Pain Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Elaine Gilbert
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Adam T. Hirsh
- Department of Psychology, Indiana University–Indianapolis, Indianapolis, Indiana, USA
| | - Megan M. Miller
- Department of Pediatrics/Cincinnati Children’s Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Kelly Donahue
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Morgan Streicher
- Department of Psychology, Indiana University–Indianapolis, Indianapolis, Indiana, USA
| | - Amy E. Williams
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Stewart CE, Gambhir R, Aladin S, Logan DE. Measuring and Contextualizing School Refusal in Pediatric Chronic Pain: Establishing the Psychometric Properties of the SChool REfusal EvaluatioN Measure for Youth With Chronic Pain. Clin J Pain 2025; 41:e1278. [PMID: 39912283 DOI: 10.1097/ajp.0000000000001278] [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: 07/03/2024] [Accepted: 01/31/2025] [Indexed: 02/07/2025]
Abstract
OBJECTIVE School refusal is a longstanding difficulty for youth with chronic pain. Yet, research is hindered by a lack of adequate measurement tools to assess and describe the complex interpersonal and system-level factors contributing to school refusal. This study investigates the utility of the SChool REfusal EvaluatioN (SCREEN) measure and its psychometric properties in a sample of youth with chronic pain. MATERIALS AND METHODS Youth undergoing multidisciplinary evaluation at outpatient pain clinics completed self and parent-report questionnaires. Descriptive data examined school refusal. Internal consistency and construct validity were tested. Multiple regressions examined the parent and child factors related to school refusal. RESULTS In all, 698 youth with chronic pain participated. Two-thirds reported symptoms suggesting at-risk or clinically significant symptoms of school refusal. Cronbach alpha scores were in the acceptable to good range on the SCREEN. Convergent validity for the interpersonal discomfort subscale of the SCREEN was established. The child's fear of pain, stress, peer relationships, and parent protective behaviors significantly correlated with SCREEN total scores. Participants enrolled in fully in-person school during the study period reported significantly higher scores on the interpersonal discomfort scale than those enrolled in remote learning. DISCUSSION Our results provide evidence that youth with chronic pain experience significant challenges with school functioning and offer some support for the reliability and validity of the SCREEN in a sample of youth with chronic pain, a population for which few appropriate measures of school functioning have been established. The SCREEN measure may aid in assessing school refusal, with good clinical potential to quantify risk and identify modifiable factors.
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Affiliation(s)
- Catherine E Stewart
- Department of Psychiatry, Harvard Medical School, Brookline
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA
| | - Rupa Gambhir
- Department of Psychiatry, Harvard Medical School, Brookline
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston
| | - Sana Aladin
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston
| | - Deirdre E Logan
- Department of Psychiatry, Harvard Medical School, Brookline
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston
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Çankaya Ö, Akin E, Kabul EG, Tatar Z, Kilbaş G, Saraçoğlu İ, Çalik BB, Yüksel S. A psychometric study in children with juvenile idiopathic arthritis: Pain Catastrophizing Scale-Child (PCS-C)- Turkish. CHILDRENS HEALTH CARE 2025:1-13. [DOI: 10.1080/02739615.2025.2476072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2025]
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Moreno JE, Nestor BA, Mitcheson M, Nelson S. The Moderating Role of Ethnicity on Depressive and Anxiety Symptoms and Pain Catastrophizing in Hispanic/Latinx and Non-Hispanic/Latinx White Youth With Chronic Pain. Clin J Pain 2025; 41:e1272. [PMID: 39928544 DOI: 10.1097/ajp.0000000000001272] [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: 05/20/2024] [Accepted: 05/12/2024] [Indexed: 01/12/2025]
Abstract
OBJECTIVES Chronic pain (CP) significantly impacts emotional and physical well-being and overall quality of life across diverse populations in the United States (US). Notably, under-represented minoritized (URM) groups, such as Hispanic/Latinx (H/L) youth, may experience disproportionate effects due to health disparities and lack of access to quality health care. However, this remains understudied. This study aimed to examine the association between CP and its related psychosocial factors-depressive and anxiety symptoms, and pain catastrophizing-in H/L youth, as compared with Non-Hispanic White (NHW) youth. METHODS The current study sample included 58 self-identifying H/L and 58 NHW youth seeking CP treatment at a large Northeastern tertiary pain clinic, ages 12 to 18 years old, (M=15.49, SD=1.71), of which 88% identified as biologically female. Participant samples for each group were age and-sex-matched. RESULTS Significant associations were found between anxiety and depressive symptoms and pain catastrophizing for youth in both groups. Ethnicity significantly moderated the associations between pain catastrophizing and depressive symptoms and between anxiety and depressive symptoms, with NHW youth with pain exhibiting stronger relations between these constructs when compared with H/L youth with pain. DISCUSSION Our results suggested that for NHW youth with CP, greater tendencies toward catastrophizing and experiences of anxiety may more strongly contribute to depressive symptoms, when compared with their Hispanic/Latinx youth counterparts. Further investigation of pain-coping mechanisms among H/L youth and other youth from historically marginalized populations (e.g., racial/ethnic minoritized groups) will help advance clinical understanding of sociocultural variability in links between pain-related psychosocial outcomes in the CP experience.
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Affiliation(s)
- Joaquin E Moreno
- Program for Patient Safety and Quality, Boston Children's Hospital
| | | | - Morgan Mitcheson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital
- Department of Psychiatry, Harvard Medical School, Boston
| | - Sarah Nelson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital
- Department of Psychiatry, Harvard Medical School, Boston
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Sokol OE, Biggs EE, Berger AS, Simons LE, Bhandari RP. The Relationship Between Fatigue, Pain Interference, Pain-Related Distress, and Avoidance in Pediatric Hypermobile Ehlers-Danlos Syndrome. CHILDREN (BASEL, SWITZERLAND) 2025; 12:170. [PMID: 40003271 PMCID: PMC11854175 DOI: 10.3390/children12020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 01/23/2025] [Accepted: 01/27/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND/OBJECTIVES Fatigue is a known predictor of disability and reduced quality of life in youth with hypermobility and chronic pain in general. Given the added relationship between chronic fatigue and connective tissue disorders, including hypermobile Ehlers-Danlos Syndrome (hEDS), this study aims to investigate the comparative role of fatigue on important predictors of outcomes for youth with and without hEDS who have chronic pain. METHODS In this retrospective study, pediatric patients with chronic pain diagnosed with hEDS (n = 100) were compared to an age- and sex-matched group of youth with chronic pain without diagnosed hypermobility (n = 100). Participants completed measures of pain-related distress (PCS-C), avoidance (FOPQ-A), and pediatric PROMIS measures for fatigue, anxiety, and pain interference. Data were analyzed using chi-square tests, t-tests, and ANCOVAs in RStudio. RESULTS Fatigue scores were higher and clinically elevated fatigue was more prevalent in those with hEDS than in matched chronic pain peers. Fatigue was significantly positively related to pain interference, avoidance, and pain-related distress in youth with and without hEDS. CONCLUSIONS The current study supports the need for multidisciplinary treatment and rehabilitation for pediatric chronic pain and hypermobility and suggests that fatigue may be an important factor to consider when treating youth with hypermobility.
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Affiliation(s)
- Olivia E. Sokol
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (E.E.B.); (A.S.B.); (L.E.S.); (R.P.B.)
| | - Emma E. Biggs
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (E.E.B.); (A.S.B.); (L.E.S.); (R.P.B.)
| | - Ardin S. Berger
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (E.E.B.); (A.S.B.); (L.E.S.); (R.P.B.)
- Comfort Clinic, Berkeley, CA 94705, USA
| | - Laura E. Simons
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (E.E.B.); (A.S.B.); (L.E.S.); (R.P.B.)
| | - Rashmi P. Bhandari
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA; (E.E.B.); (A.S.B.); (L.E.S.); (R.P.B.)
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Liossi C, Laycock H, Radhakrishnan K, Hussain Z, Schoth DE. A Systematic Review and Meta-Analysis of Conditioned Pain Modulation in Children and Young People with Chronic Pain. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1367. [PMID: 39594942 PMCID: PMC11592744 DOI: 10.3390/children11111367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/28/2024] [Accepted: 11/01/2024] [Indexed: 11/28/2024]
Abstract
BACKGROUND/OBJECTIVES Conditioned pain modulation (CPM) is a psychophysical experimental measure of the endogenous pain inhibitory pathway in humans, wherein one pain stimulus (the conditioning stimulus) is used to inhibit an individual's perception of a second painful (test) stimulus. Research provides evidence of impaired endogenous inhibitory pain responses in adults with chronic pain. CPM is now increasingly applied in paediatric research and clinical practice. The primary aim of this systematic review was to examine the efficacy of CPM in paediatric chronic pain populations (6-24-year-olds) compared to pain-free children and young people (CYP). METHODS The protocol was registered on PROSPERO (CRD42020221927). A systematic search of seven databases was conducted from database inception to 20th June 2024. Study inclusion criteria were as follows: (i) recruited a sample of CYP aged 6 to 24 (inclusive) with chronic pain or who were pain-free; and (ii) applied a CPM paradigm comprising both a painful test and conditioning stimuli that were sufficiently detailed to allow for replication,(iii) adhered to a study design of randomised control trial, case control or cohort study, including cross-sectional or longitudinal; (iv) available in the English language. Study exclusion criteria were: (i) The CPM paradigm used a non-painful test or conditioning stimulus only; and (ii) was only available as an abstract, letter, poster, editorial, case report, or review with or without meta-analyses. Risk of bias was assessed using the Appraisal Tool for Cross Sectional Studies (AXIS). Meta-analyses were conducted in Comprehensive Meta Analysis 3.0 using random effects models to compare the overall CPM responses in CYP with chronic pain conditions to healthy control CYP. RESULTS Thirty-two studies were eligible for inclusion, six of which were included in one or more meta-analysis (n = 407 chronic pain, n = 205 control). Meta-analysis revealed significantly weaker CPM responses in CYP with a variety of chronic pain conditions compared to healthy controls (standardized mean difference (SMD) = 0.352), and significantly weaker CPM responses in CYP with abdominal pain conditions compared to healthy controls (SMD = 0.685). No significant difference in CPM response was found between CYP with migraine and healthy controls (SMD = -0.201). CONCLUSIONS Variable results were found across individual studies, and the meta-analysis of the small number of eligible studies provides tentative evidence for impaired CPM in CYP with chronic pain compared to healthy controls. Further research is clearly needed. In particular, studies should present CPM results separately for different age groups, ethnic groups, and sexes, as these variables shape clinical pain responses.
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Affiliation(s)
- Christina Liossi
- Pain Research Laboratory, School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK; (K.R.); (Z.H.); (D.E.S.)
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK;
| | - Helen Laycock
- Great Ormond Street Hospital for Children NHS Foundation Trust, London WC1N 3JH, UK;
| | - Kanmani Radhakrishnan
- Pain Research Laboratory, School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK; (K.R.); (Z.H.); (D.E.S.)
| | - Zara Hussain
- Pain Research Laboratory, School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK; (K.R.); (Z.H.); (D.E.S.)
| | - Daniel Eric Schoth
- Pain Research Laboratory, School of Psychology, University of Southampton, Highfield, Southampton SO17 1BJ, UK; (K.R.); (Z.H.); (D.E.S.)
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Zhou D, Wang LK, Wu HY, Gao L, Yang XD. Early-stage postoperative depression and anxiety following orthognathic surgery: a cross-sectional study. BMC Anesthesiol 2024; 24:338. [PMID: 39342085 PMCID: PMC11438367 DOI: 10.1186/s12871-024-02726-z] [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: 04/02/2024] [Accepted: 09/12/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND The objective of this study was to observe the incidence and potential risk factors of postoperative depression and anxiety in patients during the early period after undergoing orthognathic surgery. METHODS From March 7 to September 7, 2023, patients ≥ 18 years of age who were scheduled for elective orthognathic surgery under general anesthesia in Peking University School and Hospital of Stomatology were included in this study. We prospectively evaluated their degrees of pre- and postoperative depression and anxiety using the Patient Health Questionnaire-9 and the State Trait Anxiety Inventory. Associations between the perioperative factors and occurrences of postoperative anxiety and depression were evaluated using a multivariate logistic regression model. RESULTS A total of 371 patients were included in the analysis. Within five days after surgery, we observed the occurrence of depression in 32% (116) of the patients and anxiety in 72.8% (270) of them. Their preoperative depression score on the Pain Catastrophizing Scale and intraoperative urine output were significantly associated with a higher risk of postoperative depression. The presence of preoperative anxiety, postoperative moderate-to-severe pain, postoperative nausea and vomiting and postoperative insomnia were significantly associated with a higher risk of postoperative anxiety. Furthermore, a monthly income ≥ ¥10000 was found to be significantly associated with a lower risk of postoperative anxiety. CONCLUSIONS Postoperative depression and anxiety are common among patients who undergo orthognathic surgery. Moreover, preoperative psychological status and incidence of postoperative adverse events were associated with an increased risk of depression and anxiety after surgery. The results of the present study suggest that careful psychological assessment and appropriate management are necessary to improve patients' recovery following orthognathic surgery.
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Affiliation(s)
- Dan Zhou
- Department of Anesthesiology, Peking University Hospital of Stomatology, No.22, Zhongguancun South Street, Haidian District, Beijing, 100081, China
| | - Li-Kuan Wang
- Department of Anesthesiology, Peking University Hospital of Stomatology, No.22, Zhongguancun South Street, Haidian District, Beijing, 100081, China
| | - Hai-Yin Wu
- Department of Anesthesiology, Peking University Hospital of Stomatology, No.22, Zhongguancun South Street, Haidian District, Beijing, 100081, China
| | - Ling Gao
- Department of Anesthesiology, Peking University Hospital of Stomatology, No.22, Zhongguancun South Street, Haidian District, Beijing, 100081, China
| | - Xu-Dong Yang
- Department of Anesthesiology, Peking University Hospital of Stomatology, No.22, Zhongguancun South Street, Haidian District, Beijing, 100081, China.
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Bourchtein E, McLaughlin A, Walainis K, Hughes A, Scott EL, Foxen-Craft E. Psychological predictors of performance-based physical functioning among pediatric pain program participants. J Pediatr Rehabil Med 2024; 17:369-375. [PMID: 38427508 DOI: 10.3233/prm-220132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024] Open
Abstract
PURPOSE The purpose of the present study was to evaluate changes in performance-based physical functioning and investigate psychological predictors of physical functioning over time in pediatric patients with chronic pain who completed an interdisciplinary rehabilitation intensive outpatient program (IOP). METHODS Participants (N = 55; mean age = 14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain intensity and modifiable psychological factors (i.e., pain catastrophizing, kinesiophobia, anxiety and depressive symptoms). Participants were administered performance-based assessments of physical functioning (i.e., physical endurance, high-level motor abilities) before and after IOP completion. RESULTS Pain intensity was not significantly associated with physical functioning at either timepoint. There was significant improvement on measures of physical functioning after completion of the IOP when controlling for the effects of sex, race, and ethnicity. Depressive symptoms were associated with baseline physical endurance, β = - .28, p = .047, while pain catastrophizing was associated with baseline gross motor abilities, β = - .28, p = .032. CONCLUSION Participation in an IOP led to significant improvement in physical endurance and high-level motor ability. Depressive symptoms and pain catastrophizing were associated with physical functioning at baseline but not post-program completion. Integration of pain psychology and physical therapy in an IOP can help address the interrelated psychological and physical factors impacting physical functioning to improve outcomes for children with chronic pain.
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Affiliation(s)
- Elizaveta Bourchtein
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Alix McLaughlin
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | - Kimberly Walainis
- Ambulatory Rehabilitation Therapies Department, Michigan Medicine, Ann Arbor, MI, USA
| | - Amanda Hughes
- Ambulatory Rehabilitation Therapies Department, Michigan Medicine, Ann Arbor, MI, USA
| | - Eric L Scott
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Emily Foxen-Craft
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
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Dimitrijevic Carlsson A, Wahlund K, Kindgren E, Frodlund M, Alstergren P. Increase in stress contributes to impaired jaw function in juvenile idiopathic arthritis: a two-year prospective study. Pediatr Rheumatol Online J 2024; 22:30. [PMID: 38409027 PMCID: PMC10898012 DOI: 10.1186/s12969-024-00966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Stress in patients with Juvenile Idiopathic Arthritis (JIA) has been found to be associated with orofacial pain, psychological distress, jaw dysfunction and loss of daily activities in a cross-sectional study. The aim of this study was to investigate the relations between stress and change of stress over time versus changes in orofacial pain, psychosocial factors and jaw function over a two-year period in patients with JIA. METHODS This is a two-year prospective follow-up study involving 40 JIA patients. At baseline (2015) the median age was 12 years and at two-year follow up (2018) 14 years. The JIA patients were examined clinically and with questionnaires at baseline and follow-up with the diagnostic criteria for temporomandibular disorders (DC/TMD) and completed the same set of DC/TMD questionnaires regarding orofacial pain symptoms and psychosocial factors. RESULTS Change in stress was associated with change in catastrophizing, psychological distress as well as limitation in general function and jaw function. CONCLUSIONS This study emphasizes the importance of maintaining a low stress level in patients with JIA since an increase in stress level over a two-year period seems to impair jaw function as well as psychological distress and catastrophizing.
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Affiliation(s)
- Alexandra Dimitrijevic Carlsson
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
- Centre for Oral Rehabilitation, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Scandinavian Center for Orofacial Neurosciences, Malmö University, Malmö, Sweden.
| | - Kerstin Wahlund
- Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden
| | - Erik Kindgren
- Department of Pediatrics, Västervik Hospital, Västervik, Sweden
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden
| | - Martina Frodlund
- Rheumatology/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Alstergren
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences, Malmö University, Malmö, Sweden
- Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden
- Orofacial Pain Unit, Malmö University, Malmö, Sweden
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Walker SM, Peters J, Verriotis M, Farag F, Jay MA, Howard RF. Sensitivity and Specificity of a Neuropathic Screening Tool (Self-Report Leeds Assessment of Neuropathic Symptoms and Signs, S-LANSS) in Adolescents With Moderate-Severe Chronic Pain. THE JOURNAL OF PAIN 2024; 25:451-465. [PMID: 37741521 DOI: 10.1016/j.jpain.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/25/2023]
Abstract
Neuropathic screening tools improve recognition of neuropathic pain in adults. Although utilized in pediatric populations, the sensitivity, specificity and methodology of screening tool delivery have not been compared in children. We evaluated the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) in adolescents (10-18 years) referred to a tertiary pediatric pain clinic. History and examination by specialist clinicians and multidisciplinary assessment informed classification of the primary pain type. In a prospective cohort, scores were obtained at interview (S-LANSS interview; n = 161, 70% female), and following substitution of self-reported signs with examination findings in the primary pain region (Leeds Assessment of Neuropathic Symptoms and Signs, LANSS examination). Secondly, we retrospectively retrieved questionnaires self-completed by adolescents at their initial clinic appointment (S-LANSS self-completed; n = 456, 73% female). Thirdly, we explored relationships between patient-reported outcomes and S-LANSS scores. S-LANSS interview scores varied with pain classification, and S-LANSS self-completed scores were similarly highest with neuropathic pain (median [interquartile range]: 18 [11, 21]) and complex regional pain syndrome (21 [14, 24]), variable with musculoskeletal pain (13 [7, 19]) and lowest with visceral pain (6.5 [2, 11.5]) and headache (8.5 [4, 14]). As in adults, the cutpoint score of 12/24 was optimal. Sensitivity was highest with inclusion of examination findings and lowest with self-completion (LANSS examination vs S-LANSS interview vs S-LANSS self-completed: 86.3% vs 80.8% vs 74.7%), but specificity was relatively low (37.8% vs 36.7% vs 48%). High S-LANSS scores in non-neuropathic groups were associated with female sex and high pain catastrophizing. The S-LANSS is a sensitive screening tool for pain with neuropathic features in adolescents, but needs to be interpreted in the context of clinical evaluation (clinicaltrials.gov NCT03312881). PERSPECTIVE: This article reports high sensitivity of the S-LANSS screening tool for identifying pain with neuropathic features in adolescents with moderate-severe chronic pain. However, as sensitivity is lower than in adult populations, further interdisciplinary evaluation is necessary to inform diagnosis and management.
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Affiliation(s)
- Suellen M Walker
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Judy Peters
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Madeleine Verriotis
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Fadila Farag
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Matthew A Jay
- Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Richard F Howard
- Paediatric Pain Research Group, Developmental Neurosciences Program, UCL Great Ormond Street Institute of Child Health, London, United Kingdom; Department of Anaesthesia and Pain Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Cooke ME, Edwards RR, Wheeler GL, Schmitt WA, Nielsen LV, Streck JM, Schuster RM, Potter K, Evins AE, Gilman JM. Pain catastrophizing is associated with reduced neural response to monetary reward. FRONTIERS IN PAIN RESEARCH 2023; 4:1129353. [PMID: 37745802 PMCID: PMC10512714 DOI: 10.3389/fpain.2023.1129353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/25/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Pain catastrophizing, a measure of an individual's negative emotional and cognitive appraisals of pain, has been included as a key treatment target in many psychological interventions for pain. However, the neural correlates of pain catastrophizing have been understudied. Prior neuroimaging evidence suggests that adults with pain show altered reward processing throughout the mesocorticolimbic reward circuitry. Methods In this study, we tested the association between Pain Catastrophizing Scale (PCS) scores and neural activation to the Monetary Incentive Delay (MID) reward neuroimaging task in 94 adults reporting a range of pain, insomnia, and mood symptoms. Results Results indicated that PCS score but not pain intensity was significantly associated with blunted activation in the caudate and putamen in response to feedback of successful vs. unsuccessful trials on the MID task. Mediation analyses indicated that PCS score fully mediated the relationship between depression symptoms and reward activation. Discussion These findings provide evidence that pain catastrophizing is independently associated with altered striatal function apart from depression symptoms and pain intensity. Thus, in individuals experiencing pain and/or co- morbid conditions, reward dysfunction is directly related to pain catastrophizing.
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Affiliation(s)
- Megan E. Cooke
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Robert R. Edwards
- Harvard Medical School, Boston, MA, United States
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women’s Hospital, Chestnut Hill, MA, United States
| | - Grace L. Wheeler
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - William A. Schmitt
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Lindsay V. Nielsen
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Joanna M. Streck
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Tobacco Research and Treatment Center, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Randi M. Schuster
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Kevin Potter
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - A. Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jodi M. Gilman
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
- Athinoula A. Martinos Center in Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
- Harvard Medical School, Boston, MA, United States
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12
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Nilsson IM, Ekberg E, Michelotti A, Al-Khotani A, Alstergren P, Conti PCR, Durham J, Goulet JP, Hirsch C, Kalaykova S, Kapos FP, King CD, Komiyama O, Koutris M, List T, Lobbezoo F, Ohrbach R, Palermo TM, Peck CC, Penlington C, Restrepo C, Rodrigues MJ, Sharma S, Svensson P, Visscher C, Wahlund K, Rongo R. Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for children. J Oral Rehabil 2023; 50:99-112. [PMID: 36373958 DOI: 10.1111/joor.13390] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/19/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed. OBJECTIVE The aim of this study was to present comprehensive and short-form adaptations of Axis I and Axis II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings. METHODS Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children. RESULTS The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, (ii) adding anxiety and depression assessments that have been validated in children and (iii) adding three constructs (stress, catastrophising and sleep disorders) to assess psychosocial functioning in children. CONCLUSION The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted the first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.
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Affiliation(s)
- Ing-Marie Nilsson
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,Center for Oral Rehabilitation, FTV Östergötland, Norrköping, Sweden
| | - EwaCarin Ekberg
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Ambrosina Michelotti
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
| | - Amal Al-Khotani
- Dental Department, East Jeddah Hospital, Ministry of Health, Jeddah, Saudi Arabia.,Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden
| | - Per Alstergren
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden.,Dental Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Paulo Cesar Rodrigues Conti
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, Brazil.,Bauru Orofacial Pain Group, University of São Paulo, Bauru, Brazil
| | - Justin Durham
- Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Christian Hirsch
- Clinic of Pediatric Dentistry, University of Leipzig, Leipzig, Germany
| | - Stanimira Kalaykova
- Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Flavia P Kapos
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christopher D King
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Osamu Komiyama
- Department of Oral Function and Fixed Prosthodontics, Nihon University School of Dentistry at Matsudo, Japan
| | - Michail Koutris
- Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Thomas List
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,Scandinavian Center for Orofacial Neurosciences, Malmö, Sweden
| | - Frank Lobbezoo
- Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Richard Ohrbach
- Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Christopher C Peck
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chris Penlington
- Newcastle School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Maria Joao Rodrigues
- Institute for Occlusion and Orofacial Pain, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Sonia Sharma
- Department of Orofacial Pain and Jaw Function, Faculty of Odontology, Malmö University, Malmö, Sweden.,Department of Oral Diagnostic Sciences, University at Buffalo, Buffalo, New York, USA
| | - Peter Svensson
- Section for Orofacial Pain and Jaw Function, School of Dentistry and Oral Health, Aarhus, Denmark
| | - Corine Visscher
- Department of Orofacial pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kerstin Wahlund
- Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden
| | - Roberto Rongo
- School of Orthodontics, Department of Neurosciences, Reproductive Sciences and Oral Sciences, University of Naples Federico II, Naples, Italy
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13
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Pain Widespreadedness, and Not Primary Pain Location, is Associated With Comorbid Symptoms in Children With Chronic Pain. Clin J Pain 2023; 39:1-7. [PMID: 36524767 DOI: 10.1097/ajp.0000000000001083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 10/14/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Pediatric chronic pain represents heterogeneous diagnoses; often, primary pain location informs research classifications and treatment. In contrast, recent research has highlighted the role of widespread pain and this perspective has been adopted in assessments in specialty pediatric pain clinics. The lack of direct comparison between these 2 methods of categorizing pediatric chronic pain may hinder the adoption of evidence-based practices across the spectrum of care. Therefore, this study aimed to compare whether primary pain location or pain widespreadedness is more informative for pain-related symptoms in pediatric chronic pain. METHODS Youth (n=223) between the ages of 8 to 23 years (M=15.93, SD=2.11, 83% female) completed surveys upon intake at the pediatric chronic pain clinic. Free-text entries of primary pain location were coded into categories: headache, abdominal pain, and musculoskeletal pain. Additional domains assessed included widespread pain, pain interference, kinesiophobia, catastrophizing, anxiety, depression, sleep, and fatigue. RESULTS Differences based on primary pain location only emerged for kinesiophobia, F(2150)=8.20, P<0.001, with the highest scores among those with musculoskeletal pain. In contrast, controlling for sex, age, and pain intensity, pain widespreadedness was associated with pain interference, pain catastrophizing, fatigue, anxiety, and depression (P<0.05). DISCUSSION Pain widespreadedness was more consistently associated with pain-related outcomes among pediatric chronic pain patients than primary pain location, and body maps may be useful in determining a nociplastic pain mechanism to inform treatment. Improved assessment of pediatric pain mechanisms may help advance more precise treatment delivery.
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14
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Brosbe MS, Thompson CC, Flanders XC, Day A, Ward C, Slifer KJ. Pain Catastrophizing and Functional Disability in Youth with Chronic Pain: An Examination of Indirect Effects. J Clin Psychol Med Settings 2022; 29:546-556. [PMID: 35545726 DOI: 10.1007/s10880-022-09877-6] [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: 04/10/2022] [Indexed: 11/26/2022]
Abstract
Pediatric pain conditions are not uncommon and may lead to functional disability. The purpose of this study is to examine indirect effects of pain catastrophizing on functional disability through anxiety, depression, and pain in youth with chronic pain. Participants included 197 youth (144 females, Mage = 14.67 years) with chronic pain conditions. Youth completed self-report measures of pain catastrophizing, depression, anxiety, pain intensity, and functional disability. Caregivers also completed a measure of youth functional disability. Using a cross-sectional design, a multiple mediator model was estimated with pain catastrophizing as the predictor, functional disability as the outcome, and depression, anxiety, and pain intensity as mediators. Results supported a mediation model in which depression (B = 0.1145, SE = 0.0528, Z = 2.1686; B = 0.1512, SE = 0.0585, Z = 2.5846) and pain intensity (B = 0.1015, SE = 0.0422, Z = 2.4052; B = 0.0634, SE = 0.0343, Z = 1.8484) significantly mediated the effects of catastrophizing on child self-report and parent-report functional disability, respectively, while anxiety (B = - 0.0260, SE = 0.0439501, Z = - 0.5923; B = - 0.0637, SE = 0.0552, Z = - 1.1540) did not. Theoretical and clinical applications are discussed.
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Affiliation(s)
- Micah S Brosbe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, 1800 Orleans Street, Bloomberg 12, Baltimore, MD, 21287, USA.
| | - Caitlin C Thompson
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ximena C Flanders
- South Florida Pediatric Psychology, Parkland, FL, USA
- JDCH Pediatric Psychology, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Alyssa Day
- Department of Psychology, University of Houston, Houston, TX, USA
| | - Cynthia Ward
- North Atlanta Pediatric Psychology, Roswell, GA, USA
| | - Keith J Slifer
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Schneider MB, Manikowski A, Cohen L, Dampier C, Sil S. The distinct longitudinal impact of pain catastrophizing on pain interference among youth living with sickle cell disease and chronic pain. J Behav Med 2022; 45:622-631. [PMID: 35171440 PMCID: PMC9308676 DOI: 10.1007/s10865-021-00280-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/28/2021] [Indexed: 01/11/2023]
Abstract
Youth living with chronic sickle cell disease (SCD) pain are at risk for psychosocial distress and high levels of pain catastrophizing that contribute to functional impairment. This study aimed to identify the unique long-term impact of pain catastrophizing on pain impairment among youth with SCD. Youth with chronic SCD pain (N = 63, 10-18 years old, 58.3% female, 95.1% Black or African American) were recruited within comprehensive SCD clinics and completed a battery of measures at baseline and 4-months follow-up. A linear hierarchical regression examined baseline demographic and clinical characteristics (child SCD genotype, age, and average pain intensity), psychosocial functioning (anxiety, depression), and pain catastrophizing as predictors of pain interference at 4-months follow-up. Pain catastrophizing was the only unique predictor of pain interference at 4-months follow-up. Among youth with chronic SCD pain, pain catastrophizing warrants greater consideration as an important predictor that influences pain management and overall functioning.
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Affiliation(s)
- Mallory B Schneider
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 515 N Crossville Rd, Roswell, GA, 30075, USA.
- Emory University School of Medicine, Atlanta, USA.
| | - Alison Manikowski
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 515 N Crossville Rd, Roswell, GA, 30075, USA
- Emory University School of Medicine, Atlanta, USA
| | - Lindsey Cohen
- Emory University School of Medicine, Atlanta, USA
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Carlton Dampier
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 515 N Crossville Rd, Roswell, GA, 30075, USA
- Emory University School of Medicine, Atlanta, USA
| | - Soumitri Sil
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, 515 N Crossville Rd, Roswell, GA, 30075, USA
- Emory University School of Medicine, Atlanta, USA
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16
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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: 11] [Impact Index Per Article: 3.7] [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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17
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Kavallari D, Lau JYF. Testing a Combined Cognitive Bias Hypothesis of Pain and Pain-related Worry in Young People. THE JOURNAL OF PAIN 2022; 23:1082-1091. [PMID: 35131447 DOI: 10.1016/j.jpain.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 06/14/2023]
Abstract
Cognitive factors are thought to contribute and maintain pain experiences in young people. However, most of these factors have been assessed in isolation. Considering more than 1 cognitive factor could increase explanatory power and identify multiple targets for intervention. Here, we tested a Combined Cognitive Bias Hypothesis (CCBH) that suggests information-processing factors associate with each other and exert either additive and/or interactive influences on pain outcomes. We conducted secondary analysis of data from 243 adolescents aged 16 to 19 years, who had completed a task measuring pain-related attention control impairments (emotion-priming visual search task) and a task measuring biased interpretations towards threatening cues (Adolescent Interpretation of Bodily Threat task). These young people also completed measures of recent pain experiences and pain catastrophizing, which served as primary and secondary outcomes, respectively. Regression analyses revealed that difficulties with attention control (following presentation of pain-related stimuli) and tendencies to endorse threatening interpretations of ambiguous situations had significant additive effects on both pain outcomes. However, correlations between these factors were non-significant. They also did not interact to influence pain outcomes. These findings require replication in broader age ranges and clinical samples but potentially suggest that, measuring multiple cognitive factors increases explanatory power of youth pain outcomes. PERSPECTIVE: Weak attention control following exposure to pain cues and tendencies to endorse threat interpretations, uniquely and additively associate with self-reported pain experiences and pain catastrophizing in community youth. Measuring several cognitive factors simultaneously could improve our ability to explain pain outcomes in adolescent populations.
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Affiliation(s)
- Despoina Kavallari
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Jennifer Y F Lau
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Youth Resilience Unit, Institute of Population Health Sciences, Queen Mary University of London, London, UK.
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18
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Bhandari RP, Harrison LE, Richardson PA, Goya Arce AB, You DS, Rajagopalan A, Birnie KA, Sil S. Clinical Utility of CAT Administered PROMIS Measures to Track Change for Pediatric Chronic Pain. THE JOURNAL OF PAIN 2022; 23:55-64. [PMID: 34229073 PMCID: PMC11160558 DOI: 10.1016/j.jpain.2021.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
Patient Reported Outcomes (PROs) are utilized in clinical registries and trials, necessitating development of benchmarks to enhance interpretability. This study aimed to 1) examine if PROMIS measures administered via computer adaptive testing (CAT) were responsive to change, and 2) highlight one method of assessing clinically significant change for youth seen in a tertiary pain clinic. Clinically significant change was achieved if patients had significantly reliable pre-to-post-changes greater than Reliable Change Index (RCI) value and reported decreased symptoms by at least one severity level (e.g., moderate to mild). Participants were 328 youth (8-17 years old) seen in a tertiary pediatric pain management clinic. Small to moderate effect sizes were noted across PROMIS measures (except Peer Relations). Reliable magnitudes of change were estimated for this sample as approximately 6 point reduction for Pain Interference and Mobility, 9 for Fatigue, and 11 for Anxiety and Depression. Depending on the measure, 10 to 24% were categorized as improved, 3 to 6% as deteriorated, and 68 to 81% were either not clinically elevated at baseline or remained unchanged at 3 months. Overall, PROMIS CAT measures demonstrated responsiveness to change over time. Estimation of clinically significant change offers preliminary yet rigorous benchmarks for evaluating treatment response and sets the stage for understanding treatment effects. PERSPECTIVE: This study assesses responsiveness of CAT administered PROMIS measures and highlights one methodological approach of presenting clinical significance for assessing treatment outcomes in pediatric chronic pain. These benchmarks will allow clinicians and researchers to evaluate treatment response utilizing PROs while allowing for a deeper understanding of treatment effects.
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Affiliation(s)
- Rashmi P Bhandari
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, California.
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Patricia A Richardson
- Departments of Pediatric Psychology and Pediatric Pain and Palliative Medicine, Helen DeVos Children's Hospital, Grand Rapids, Michigan; Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, East Lansing, Michigan
| | - Ana B Goya Arce
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Dokyoung S You
- Department of Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Adithi Rajagopalan
- Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Soumitri Sil
- Department of Pediatrics, Emory University School of Medicine, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
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19
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Low A, Wing H, Lam J. Effects of Perceived Stress with Musculoskeletal Pain in Hong Kong. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_20_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Wauters A, Noel M, Van Ryckeghem DML, Soltani S, Vervoort T. The Moderating Role of Attention Control in the Relationship Between Pain Catastrophizing and Negatively-Biased Pain Memories in Youth With Chronic Pain. THE JOURNAL OF PAIN 2021; 22:1303-1314. [PMID: 33989787 DOI: 10.1016/j.jpain.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 11/19/2022]
Abstract
The present study examined the role of attention control in understanding the development of negatively-biased pain memories as well as its moderating role in the relationship between pain catastrophizing and negatively-biased pain memories. Youth with chronic pain (N = 105) performed a cold pressor task (CPT) and completed self-report measures of state/trait pain catastrophizing and attention control, with the latter comprising both attention focusing and attention shifting. Two weeks after the CPT, youth's pain-related memories were elicited via telephone allowing to compute pain and anxiety memory bias indices (ie, recalling pain intensity or pain-related anxiety, respectively, as higher than initially reported). Results indicated no main effects of attention control and pain catastrophizing on pain memories. However, both components of attention control (ie, attention focusing and attention shifting) moderated the impact of pain catastrophizing on youth's memory bias, with opposite interaction effects. Specifically, whereas high levels of attention shifting buffered the influence of high pain catastrophizing on the development of pain memory bias, high levels of attention focusing strengthened the influence of high pain catastrophizing on the development of anxiety memory bias. Interaction effects were confined to trait catastrophizing (ie, not state catastrophizing). Theoretical and clinical implications are discussed. PERSPECTIVE: This article investigates the role of attention control in the development of negatively-biased pain memories in children with chronic pain. Findings underscore the importance of targeting differential components of attention control and can inform intervention efforts to minimize the development of negatively biased pain memories in youth with chronic pain.
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Affiliation(s)
- Aline Wauters
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium.
| | - Melanie Noel
- Department of Psychology, Hotchkiss Brain Institute, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Dimitri M L Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
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Nabbijohn AN, Tomlinson RM, Lee S, Morrongiello BA, McMurtry CM. The Measurement and Conceptualization of Coping Responses in Pediatric Chronic Pain Populations: A Scoping Review. Front Psychol 2021; 12:680277. [PMID: 34659002 PMCID: PMC8519346 DOI: 10.3389/fpsyg.2021.680277] [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: 03/13/2021] [Accepted: 08/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Pediatric chronic pain is a prevalent condition that requires significant coping to encourage optimal functioning; however, relevant research is vast, heterogeneous, and difficult to interpret. To date, no attempt has been made to map and summarize the measurement and conceptualization of coping responses in the context of pediatric chronic pain. Objectives: A scoping review was conducted to map and summarize the participant characteristics, methodologies, theoretical frameworks, and measures used to assess coping responses in youth with chronic pain. The extent to which authors used definitions and examples of coping responses (conceptual clarity) as well as consistently used measures (measurement consistency) and their corresponding conceptualizations (conceptual consistency) relative to how they were intended to be used were assessed. Methods: Searches were conducted through MEDLINE (PubMed) and PsycINFO. Following title/abstract screening, full-text extractions were performed on 125 English-language publications on coping in youth with chronic pain. Results: Of the 125 studies, only 12.8% used a theoretical framework to explain the coping responses assessed, and even fewer (7.2%) used theory to guide measure selection. Conceptual clarity was rated "low/very low" (i.e., no definitions and/or examples) for 47.2% of studies. The majority of studies were conducted in the United States (67%) and a preponderance of White and female participants was sampled. The research primarily used quantitative methods (85%) and cross-sectional designs (67%). Parent- or self-report questionnaires were the most common methods for assessing coping (86%). Of the 95 studies that utilized one of the 14 questionnaires with known psychometric properties, 33.7 and 55.8% had one or more discrepancies for conceptual and measurement consistency, respectively. Conclusions: This review highlights the lack of clear descriptions and theoretical frameworks of coping responses for pediatric chronic pain. Inconsistencies in the measurement and conceptualization of coping responses limit research and clinical advancements. As a field, we need to strive toward using well-developed theory to create fewer, more well-established standardized measures with clearly defined coping responses. Opportunities for qualitative and observational research in more diverse patient populations should be considered for theory construction and measure validation. Clinical Trial Registration: https://osf.io/xvn2a/?view_only=eff04e0c0b9649be89d403b10e9ff082.
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Affiliation(s)
| | | | - Soeun Lee
- Department of Psychology, University of Guelph, Guelph, ON, Canada
| | | | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, ON, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON, Canada
- Children's Health Research Institute and Department of Paediatrics, Schulich School of Medicine and Dentistry, London, ON, Canada
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22
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Chabot B, Sweatman H, Ocay DD, Premachandran S, Roy M, Ferland CE. Pain Catastrophizing Throughout the Perioperative Period in Adolescents With Idiopathic Scoliosis. Clin J Pain 2021; 37:688-697. [PMID: 34265790 PMCID: PMC8360666 DOI: 10.1097/ajp.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/20/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pain catastrophizing in children and adolescents has been associated to unfavorable postsurgical outcomes. However, pain catastrophizing is rarely measured throughout the perioperative period. Using a prospective longitudinal approach, the present study aimed to identify how pain catastrophizing changes over the perioperative period in pediatric surgical patients with adolescent idiopathic scoliosis. MATERIALS AND METHODS Adolescent patients undergoing spinal fusion surgery completed the Pain Catastrophizing Scale for Children and additional questionnaires to assess pain intensity, state and trait anxiety, and kinesiophobia before surgery, and 1, 2, 5 days, 6 weeks, and 6 months after surgery. RESULTS Patients who had higher levels of pain catastrophizing before surgery were more likely to be anxious, avoid activity that may cause pain, report higher pain intensity before surgery and anticipate more pain after surgery. Low pain catastrophizers increased into a moderate level of pain catastrophizing before decreasing after discharge from the hospital. Meanwhile, moderate and high pain catastrophizers both decreased into lower and moderate levels of catastrophizing, respectively, after discharge from the hospital. DISCUSSION These findings demonstrate that pain catastrophizing in adolescents changes over the perioperative period. Observing changes in pain catastrophizing throughout the perioperative period may help in recognizing when patients are most vulnerable during this time. Decreasing pain catastrophizing before surgery or in the acute postoperative period through therapies that target pain catastrophizing may help reduce the patient's likelihood of experiencing unfavorable postoperative outcomes.
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Affiliation(s)
| | | | - Don D. Ocay
- Experimental Surgery
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
| | | | | | - Catherine E. Ferland
- Anesthesia
- Integrated Program in Neuroscience, McGill University
- Shriners Hospitals for Children-Canada, Montreal, QC, Canada
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Nelson S, Bento S, Enlow MB. Biomarkers of Allostatic Load as Correlates of Impairment in Youth with Chronic Pain: An Initial Investigation. CHILDREN (BASEL, SWITZERLAND) 2021; 8:709. [PMID: 34438600 PMCID: PMC8392178 DOI: 10.3390/children8080709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
Pediatric chronic pain is common and responsible for significant healthcare burden. However, the mechanisms underlying the development and/or maintenance of pediatric chronic pain remain poorly understood. Allostatic load (AL), or wear and tear on the nervous system following significant or prolonged stress, has been proposed to play a role in the maintenance of chronic pain, but minimal research has examined this possibility. This gap in research is particularly notable given the high exposure to adverse childhood experiences (ACEs; abuse/neglect, etc.) and psychological stress in this population. Accordingly, the current study aimed to preliminarily examine the measurement of AL in a treatment-seeking pediatric pain population. Biomarkers were collected during an already scheduled new patient pain evaluation and included salivary cortisol, dehydroepiandrosterone (DHEA), and C-reactive protein, in addition to waist-hip ratio, body-mass index, and blood pressure. A total of 61 children and adolescents with chronic pain (Mage = 14.47 years; 88.5% female and white/Caucasian) completed study procedures and were included in analyses. Preliminary results indicated that a multifactorial AL composite is feasible to assess for in a tertiary pain treatment setting and that over 50% of youth with chronic pain were classified as high risk for AL (two or more risk factors). Further, it was found that individual AL risk factors were significantly associated with functional disability and that AL may moderate the association between psychosocial and functional outcomes. Given the pilot nature of this study, results should be used to inform future investigations with larger and more diverse pediatric pain samples.
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Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA;
| | - Samantha Bento
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA;
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA;
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA 02115, USA
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24
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From One Pain to Many: The Emergence of Overlapping Pains in Children and Adolescents. Clin J Pain 2021; 37:404-412. [PMID: 33859112 DOI: 10.1097/ajp.0000000000000939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to compare children and adolescents with overlapping chronic pains (OCP) to those with single chronic pains (SCP) among youth presenting in specialized clinical settings, in an effort to identify potential risk factors for developing overlapping pains. METHODS A total of 1235 youth ages 8 to 18 seen in a tertiary care multidisciplinary pain clinic or a multidisciplinary headache clinic completed self-report measures of pain, disability, psychological functioning and clinical history and characteristics at the time of initial clinic visit. Information was captured in a chronic pain data repository and accessed for the current study. RESULTS Subsequent pain symptoms developed on average 11.9 months (SD=24.5 mo) after onset of the first pain symptom. Compared with patients with SCP, patients with OCP report more medical comorbidity, more developmental issues, and poorer current sleep and school functioning. They also scored significantly higher than patients with SCP on self-reported functional disability, pain catastrophizing, fear of pain, depression, anxiety, and psychological stress and lower quality of life (all Ps<0.001). In multivariate analysis, variables most strongly associated with presenting with OCP were age (odds ratio [OR]: 1.1, P<0.001), having a clinically significant high functional disability (OR: 1.4, P=0.3), and low quality of life (OR: 2.5, P<0.001). DISCUSSION Given their tendency toward more psychological and medical comorbidities, patients with OCP may require more intense and diverse treatment approaches. Some early life experiences may be a risk factor for development of OCP. Longitudinal studies are needed to fully evaluate the heightened risk for OCP associated with some of these factors.
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Battle of the Appraisals: Pain-Related Injustice Versus Catastrophizing as Mediators in the Relationship Between Pain Intensity and 3-Month Outcomes in Adolescents with Chronic Pain. THE JOURNAL OF PAIN 2021; 23:223-235. [PMID: 34403788 DOI: 10.1016/j.jpain.2021.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 07/19/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022]
Abstract
Pain appraisals are closely tied to pain and functional outcomes. Pain-related injustice and pain catastrophizing appraisals have both been identified as important cognitive-emotional factors in the pain experience of youth. Although pain-related injustice and catastrophizing have been linked to worse pain outcomes - as primary predictors and intermediary variables - little is known about whether they operate as independent or parallel mediators of the relationship between pain and functioning in youth. We tested pain-related injustice and catastrophizing appraisals as candidate mediators of the relationship between baseline pain intensity and 3-month functional outcomes in adolescents. Youth with chronic pain (N = 89, 76% female, 89% White, average age = 15 years) completed measures assessing pain intensity, pain-related injustice, and catastrophizing at baseline, as well as measures assessing functional disability and overall quality of life 3 months later. Multiple mediation analyses indicated that injustice mediated the relationship between pain intensity and 3 month quality of life. Exploratory analyses of specific quality of life domains indicated that injustice mediated the relationship between pain intensity and 3 month emotional functioning, whereas catastrophizing mediated the relationship between pain intensity and 3 month social functioning. The findings suggest these pain-related appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes. PERSPECTIVE: Pain-related injustice and catastrophizing appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes in youth with chronic pain. Treatments targeting pain-related injustice appraisals in pediatric populations are needed to complement existing treatments for catastrophizing.
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Miller MM, Williams AE, Scott EL, Trost Z, Hirsh AT. Anger as a Mechanism of Injustice Appraisals in Pediatric Chronic Pain. THE JOURNAL OF PAIN 2021; 23:212-222. [PMID: 34375744 DOI: 10.1016/j.jpain.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022]
Abstract
Mechanisms explaining the relationship between pain-related injustice appraisals and functional outcomes in youth with chronic pain have yet to be examined. In studies of adults, greater pain-related injustice is associated with worse depressive symptoms and greater pain through greater anger. No study to date has examined anger expression as a mediator in the relationships between pain-related injustice appraisals and physical and psychosocial functioning in youth with chronic pain. The current sample consisted of 385 youth with varied pain conditions (75% female, 88% White, Mage=14.4 years) presenting to a university-affiliated pain clinic. Patients completed self-report measures assessing anger expression (anger-out and anger-in), pain-related injustice, pain intensity, functional disability, and emotional, social, and school functioning. Bootstrapped mediation analyses indicated that only anger-out (indirect effect= -.12, 95% CI: -.21, -.05) mediated the relationship between pain-related injustice and emotional functioning, whereas both anger-out (indirect effect= -.17, 95% CI: -.27, -.09) and anger-in (indirect effect= -.13, 95% CI: -.09, -.001) mediated the relationship between pain-related injustice and social functioning. Neither mode of anger expression mediated the relationship between pain-related injustice and pain intensity, functional disability, or school functioning. Collectively, these findings implicate anger as one mechanism by which pain-related injustice impacts psychosocial outcomes for youth with chronic pain. Perspective: Anger expression plays a mediating role in the relationship between pain-related injustice appraisals and psychosocial outcomes for youth with chronic pain. Anger represents one target for clinical care to decrease the deleterious impact of pain-related injustice on emotional and social functioning.
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Affiliation(s)
- Megan M Miller
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
| | - Amy E Williams
- Department of Psychiatry, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana
| | - Eric L Scott
- Department of Pediatrics and Anesthesiology, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Zina Trost
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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27
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MacDonald TM, Fisk JD, Bernstein CN, El-Gabalawy R, Hitchon CA, Kornelsen J, Patten SB, Tisseverasinghe A, Marrie RA. The association between childhood maltreatment and pain catastrophizing in individuals with immune-mediated inflammatory diseases. J Psychosom Res 2021; 145:110479. [PMID: 33814193 DOI: 10.1016/j.jpsychores.2021.110479] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Childhood maltreatment is associated with pain catastrophizing. Both childhood maltreatment and pain catastrophizing are prevalent in certain immune-mediated inflammatory disease (IMID) populations. However, it is unknown whether childhood maltreatment contributes to the high rates of pain catastrophizing in IMID cohorts. We assessed the relationship between childhood maltreatment and pain catastrophizing in individuals with IMID, and whether this differed across IMID. METHODS Between November 2014 and July 2016 we recruited individuals with multiple sclerosis (MS), inflammatory bowel disease (IBD), and rheumatoid arthritis (RA). Participants completed the Childhood Trauma Questionnaire-Short Form, the Pain Catastrophizing Scale, and Hospital Anxiety and Depression Scale. We tested the association between childhood maltreatment and pain catastrophizing using multivariable logistic regression. RESULTS We included 577 individuals with IMID (MS: 232, IBD: 215, RA: 130). Overall, 265 (46%) participants with IMID reported any childhood maltreatment, with the most common type of maltreatment being emotional neglect. Childhood maltreatment was associated with pain catastrophizing (OR 3.32; 95% CI 1.89-5.85) independent of other risk factors, including sociodemographics and symptoms of anxiety and depression. CONCLUSION Pain catastrophizing is highly prevalent in our IMID population, and strongly associated with childhood maltreatment in this population. Interventions that consider childhood maltreatment and pain catastrophizing should be incorporated into the clinical management of IMID patients.
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Affiliation(s)
| | - John D Fisk
- Nova Scotia Health Authority, Departments of Psychiatry and Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Charles N Bernstein
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Renée El-Gabalawy
- Department of Clinical Health Psychology, Max Rady College of Medicine Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Departments of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Jennifer Kornelsen
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Division of Diagnostic Imaging, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada; Neuroscience Research Program, Kleysen Institute for Advanced Medicine, Winnipeg Health Sciences Centre, Winnipeg, MB, Canada.
| | - Scott B Patten
- Departments of Community Health Sciences & Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Annaliese Tisseverasinghe
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada; Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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28
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Phenotyping peripheral neuropathic pain in male and female adolescents: pain descriptors, somatosensory profiles, conditioned pain modulation, and child-parent reported disability. Pain 2021; 162:1732-1748. [PMID: 33394878 DOI: 10.1097/j.pain.0000000000002172] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
ABSTRACT Neuropathic pain (NeuP) can be difficult to diagnose and manage in children. Data regarding prevalence and sex-dependent differences are limited, and more detailed phenotyping is needed. This observational cohort study recruited adolescents (10-17 years) with NeuP or complex regional pain syndrome (CRPS). After pain history and NeuP questionnaires, quantitative sensory testing was performed. Individual z-score plots were calculated with body-region control measures and matched to mechanism-related sensory profiles (sensory loss, thermal hyperalgesia, and mechanical hyperalgesia). Conditioned pain modulation was assessed with pressure pain threshold and a contralateral cold conditioning stimulus, and meaningful conditioned pain modulation defined as twice the standard error of measurement. Patients and parents completed validated questionnaires for child quality of life (QoL), pain catastrophizing, and self-reported anxiety/depression. Males (n = 23) and females (n = 43) with NeuP (n = 52) or CRPS (n = 14) reported moderate-severe pain with neuropathic sensory descriptors. Mixed patterns of sensory gain/loss at pain sites were not sex-dependent. Thermal hyperalgesia was common in both NeuP and CRPS, whereas sensory loss occurred only with NeuP and in a smaller proportion than adult cohorts. Conditioned pain modulation was inhibitory in 54%, facilitatory in 14%, and nonresponders had variable cold conditioning sensitivity. Males and females reported marked impairment of QoL, increased emotional distress, and pain catastrophising. Child-parent QoL scores correlated, but catastrophizing scores were discordant when parents or adolescents reported higher anxiety/depression. NeuP in adolescents is associated with significant pain, physical impairment, and psychosocial impairment. Quantifying alterations in somatosensory profiles, descending modulation, child and parent psychological function will inform individualized therapy and stratification for future clinical trials.
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Randall ET, Cole-Lewis YC, Petty CR, Jervis KN. Understanding How Perfectionism Impacts Intensive Interdisciplinary Pain Treatment Outcomes: A Nonrandomized Trial. J Pediatr Psychol 2021; 46:351-362. [PMID: 33325522 DOI: 10.1093/jpepsy/jsaa111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 10/30/2020] [Accepted: 10/31/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Several factors are known to impact response to the intensive interdisciplinary pain treatment (IIPT) program described in this study, yet no research has explored the role of perfectionism. This secondary data analysis explored direct and indirect relations between perfectionism and functional disability (primary outcome) and pain severity (secondary outcome) after IIPT, with pain catastrophizing and fear of pain as mediators. METHODS Youth (N = 253) aged 8-21 with chronic pain and associated disability completed pre- and post-IIPT measures of self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), pain catastrophizing, fear of pain, functional disability, and pain characteristics for routine clinical care and this nonrandomized trial. Eight mediated models were run for the two predictors, two mediators, and two outcomes. RESULTS Pretreatment perfectionism (SOP and SPP) led to greater reductions in pain catastrophizing over the course of IIPT, which resulted in lower pain severity (β = -.02 [CI = -0.07, -0.01] for SOP and β = -.02 [CI = -0.06, -0.003] for SPP) and less functional disability (β = -.06 [CI = -0.13, -0.01] for SOP and β = -.06 [CI = -0.14, -0.01] for SPP). Independent of pain catastrophizing, pretreatment SPP was directly associated with more posttreatment functional disability (β = .16 [CI = 0.05, 0.27]). Fear of pain was not a mediator. CONCLUSIONS Findings suggest perfectionism has the potential to negatively impact IIPT outcomes. However, when perfectionistic youth with chronic pain learn to manage pain-related distress, they benefit. Results highlight the importance of assessing for and treating perfectionism and pain-related distress in youth with chronic pain.
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Affiliation(s)
- Edin T Randall
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School
| | - Yasmin C Cole-Lewis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital.,Department of Psychiatry, Boston Children's Hospital and Harvard Medical School
| | - Carter R Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital
| | - Kelsey N Jervis
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children's Hospital
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30
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Daenen F, McParland J, Baert F, Miller MM, Hirsh AT, Vervoort T. Child pain‐related injustice appraisals mediate the relationship between just‐world beliefs and pain‐related functioning. Eur J Pain 2020; 25:757-773. [DOI: 10.1002/ejp.1707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/28/2020] [Accepted: 11/26/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Frederick Daenen
- Department of Experimental‐Clinical and Health Psychology Ghent University Ghent Belgium
| | - Joanna McParland
- Department of Psychology Glasgow Caledonian University Glasgow UK
| | - Fleur Baert
- Department of Experimental‐Clinical and Health Psychology Ghent University Ghent Belgium
| | - Megan Marie Miller
- Department of Psychology Indiana University‐Purdue University Indianapolis Indianapolis IN USA
| | - Adam Todd Hirsh
- Department of Psychology Indiana University‐Purdue University Indianapolis Indianapolis IN USA
| | - Tine Vervoort
- Department of Experimental‐Clinical and Health Psychology Ghent University Ghent Belgium
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Siemer LC, Foxen-Craft E, Malviya S, Ramirez M, Li GY, James C, Voepel-Lewis T. The relationship between parental factors, child symptom profile, and persistent postoperative pain interference and analgesic use in children. Paediatr Anaesth 2020; 30:1340-1347. [PMID: 33010105 DOI: 10.1111/pan.14031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Both parental and child factors have been previously associated with persistent or recurrent postoperative pain in children. Yet, little is known about the relative contribution of parent factors or whether child symptom factors might impact the association between parent factors and long-term pain. The aim of this study was to explore the associations between parent factors, child symptomology, and the child's long-term pain outcomes after surgery. METHODS This prospective, longitudinal study included parents and their children who were scheduled to undergo spinal fusion for underlying scoliosis. Parents completed baseline surveys about their pain history, pain relief preferences (ie, preference to relieve their child's pain vs avoid analgesic risks), and pain catastrophizing (ie, beliefs about their child's pain). Children were classified previously into high vs low symptom profiles at baseline based on their self-reported pain, catastrophizing, fatigue, depression, and anxiety. Children were assessed 1-year after surgery for their long-term pain interference scores and analgesic use. Serial regression modeling was used to explore whether associations between parent factors and the outcomes were changed when accounting for child factors. RESULTS Seventy-six parent/child dyads completed all surveys. Parental preferences and catastrophizing were atemporally associated with the child's baseline psychological-somatic symptom profile. Though parent and child factors were both associated with the long-term pain outcomes, when all three factors were accounted for, the associations between parent factors and long-term pain was fully attenuated by the child's profile. DISCUSSION These findings suggest that the relationship between parent factors and long-term postoperative pain outcomes may be dependent on the child's symptom profile at baseline. Since there may be bidirectional relationships between parent and child factors, interventions to mitigate long-term pain should address child symptoms as well as parental factors.
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Affiliation(s)
- Lauren C Siemer
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily Foxen-Craft
- Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Shobha Malviya
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark Ramirez
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - G Ying Li
- Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Chrystina James
- Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Terri Voepel-Lewis
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Daffin M, Gibler RC, Kashikar-Zuck S. Measures of Juvenile Fibromyalgia. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:171-182. [PMID: 33091238 DOI: 10.1002/acr.24197] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Morgan Daffin
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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The Co-occurrence of Pediatric Chronic Pain and Depression: A Narrative Review and Conceptualization of Mutual Maintenance. Clin J Pain 2020; 35:633-643. [PMID: 31094934 DOI: 10.1097/ajp.0000000000000723] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Internalizing mental health issues co-occur with pediatric chronic pain at high rates and are linked to worse pain and functioning. Although the field has prioritized anxiety and posttraumatic stress disorder, little is known about co-occurring depression and chronic pain in youth, despite its high prevalence. The purpose of this narrative review was to examine the existing literature on the co-occurrence of pediatric chronic pain and depressive disorders and symptoms and propose a conceptual model of mutual maintenance to guide future research. METHODS The literature from both fields of pediatric pain and developmental psychology were searched to review the evidence for the co-occurrence of pediatric chronic pain and depression. Conceptual models of co-occurring mental health issues and chronic pain, as well as child depression, were reviewed. From both literatures, we provide evidence for a number of proposed child, parent, and neurobiological factors that may serve to mutually maintain both conditions over time. On the basis of this evidence, we propose a conceptual model of mutual maintenance and highlight several areas for future research in this area. RESULTS Evidence was found for the prevalence of depression in pediatric chronic pain as well as the co-occurrence of both conditions. The key mutually maintaining factors identified and proposed included neurobiological, intrapersonal (eg, cognitive biases, sleep disturbances, emotion regulation, and behavioral inactivation), and interpersonal (eg, parent mental health and pain, genes, and parenting) factors. DISCUSSION Given the dearth of research on mutual maintenance in this area, this review and conceptual model could drive future research in this area. We argue for the development of tailored treatments for this unique population of youth to improve outcomes.
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McGarrigle L, Wesson C, DeAmicis L, Connoly S, Ferreira N. Psychological mediators in the relationship between paediatric chronic pain and adjustment: An investigation of acceptance, catastrophising and kinesiophobia. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Gai N, Naser B, Hanley J, Peliowski A, Hayes J, Aoyama K. A practical guide to acute pain management in children. J Anesth 2020; 34:421-433. [PMID: 32236681 PMCID: PMC7256029 DOI: 10.1007/s00540-020-02767-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/21/2020] [Indexed: 01/20/2023]
Abstract
In the pediatric population, pain is frequently under-recognized and inadequately treated. Improved education and training of health care providers can positively impact the management of pain in children. The purpose of this review is to provide a practical clinical approach to the management of acute pain in the pediatric inpatient population. This will include an overview of commonly used pain management modalities and their potential pitfalls. For institutions that have a pediatric acute pain service or are considering initiating one, it is our hope to provide a useful tool to aid clinicians in the safe and effective treatment of pain in children.
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Affiliation(s)
- Nan Gai
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
| | - Basem Naser
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
| | - Jacqueline Hanley
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
| | - Arie Peliowski
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
| | - Jason Hayes
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada
| | - Kazuyoshi Aoyama
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Ave, #2211, Toronto, ON, M5G 1X8, Canada.
- Program in Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada.
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Managing childhood cancer pain into survivorship: recognition and emerging principles. Curr Opin Support Palliat Care 2020; 14:100-106. [PMID: 32304399 DOI: 10.1097/spc.0000000000000492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Continual refinement and further stratification of childhood cancer treatment has led to increased survivorship with recognized improvements in many long-term health outcomes. Despite this progress, persisting pain prevalence in childhood cancer survivors is increasing and emerging as a significant long-term health concern. RECENT FINDINGS Currently, there is no guidance on how to approach and manage persisting pain in survivors of childhood cancer. SUMMARY Clinicians should work with children and young people to optimize the management of pain and other symptoms on treatment. Focusing on an early post treatment screening for pain and other symptoms (including sleep and fatigue), and the role of on-going analgesic use. Follow-up should offer a multidisciplinary approach, aimed at lessening reliance on pharmacological approaches to pain management, addressing psychological concerns and promoting increased physical activity. The onus is on clinicians to mitigate the long-term risk of pharmacological reliance, particularly opioid dependency, in patients leaving their care and heading into adulthood. In this article, we highlight the emerging evidence of persisting pain in survivors of childhood cancer as a significant long-term health outcome and consider some initial principles of management.
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Higgins KS, Chambers CT, Rosen NO, Sherry S, Mohammadi S, Lynch ME, Campbell-Yeo M, Clark AJ. Child catastrophizing about parent chronic pain: A potential child vulnerability factor. Br J Health Psychol 2020; 25:339-357. [PMID: 32196873 PMCID: PMC7384016 DOI: 10.1111/bjhp.12410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/13/2019] [Indexed: 01/12/2023]
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