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Lootens CC, Rapoff MA. Measures of pediatric pain: 21-numbered circle Visual Analog Scale (VAS), E-Ouch Electronic Pain Diary, Oucher, Pain Behavior Observation Method, Pediatric Pain Assessment Tool (PPAT), and Pediatric Pain Questionnaire (PPQ). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S253-62. [PMID: 22588749 DOI: 10.1002/acr.20634] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Anthony KK, Schanberg LE. Assessment and management of pain syndromes and arthritis pain in children and adolescents. Rheum Dis Clin North Am 2007; 33:625-60. [PMID: 17936179 DOI: 10.1016/j.rdc.2007.07.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic musculoskeletal pain, whether it is idiopathic or disease-related, is common in childhood. Pediatric rheumatologists and other pediatric health care providers must understand the epidemiology of musculoskeletal pain as part of childhood, diagnose pain syndromes in children and rule out rheumatic disease, and be willing to initiate treatment of pain in children and adolescents. Practitioners' ability to carry out these tasks is enhanced by an awareness of the biopsychosocial model of pain, which integrates biologic, environmental, and cognitive behavioral mechanisms in describing the causes and maintenance of children's pain. A growing body of research in rheumatic diseases, such as JIA, and idiopathic musculoskeletal pain syndromes, such as JPFS, highlights the importance of environmental and cognitive behavioral influences in the pain experience of children in addition to the contribution of disease activity. These influences include factors innate in the child, such as emotional distress, daily stress, coping, and mood, and familial factors, such as parental psychologic health, parental pain history, and the nature of family interactions. Addressing these issues, while providing aggressive traditional medical management, optimizes pain treatment and improves overall quality of life for children who have musculoskeletal pain.
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Affiliation(s)
- Kelly K Anthony
- Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 2906, Durham, NC 27710, USA
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von Baeyer CL, Spagrud LJ. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain 2006; 127:140-50. [PMID: 16996689 DOI: 10.1016/j.pain.2006.08.014] [Citation(s) in RCA: 422] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Revised: 07/15/2006] [Accepted: 08/11/2006] [Indexed: 01/17/2023]
Abstract
Observational (behavioral) scales of pain for children aged 3 to 18 years were systematically reviewed to identify those recommended as outcome measures in clinical trials. This review was commissioned by the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (www.immpact.org). In an extensive literature search, 20 observational pain scales were identified for review including behavior checklists, behavior rating scales, and global rating scales. These scales varied in their reliance on time sampling and inclusion of physiological items, facial and postural items, as well as their inclusion of multiple dimensions of assessment (e.g., pain and distress). Each measure was evaluated based on its reported psychometric properties and clinical utility. Scales were judged to be indicated for use in specific acute pain contexts rather than for general use. Two scales were recommended for assessing pain intensity associated with medical procedures and other brief painful events. Two scales were recommended for post-operative pain assessment, one for use in hospital and the other at home. Another scale was recommended for use in critical care. Finally, two scales were recommended for assessing pain-related distress or fear. No observational measures were recommended for assessing chronic or recurrent pain because the overt behavioral signs of chronic pain tend to habituate or dissipate as time passes, making them difficult to observe reliably. In conclusion, no single observational measure is broadly recommended for pain assessment across all contexts. Directions for further research and scale development are offered.
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Affiliation(s)
- Carl L von Baeyer
- Department of Psychology, University of Saskatchewan, Saskatoon, Canada S7N 5A5.
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Anthony KK, Schanberg LE. Pediatric pain syndromes and management of pain in children and adolescents with rheumatic disease. Pediatr Clin North Am 2005; 52:611-39, vii. [PMID: 15820381 DOI: 10.1016/j.pcl.2005.01.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article introduces important issues related to pain in children with musculoskeletal pain syndromes and rheumatic disease, using juvenile primary fibromyalgia syndrome (JPFS) and juvenile idiopathic arthritis (JIA) as models. A brief summary of the prevalence of pain in healthy children is followed by a summary of existing pain-assessment techniques. The remainder of the article describes the pain experience of children with JPFS and JIA and discusses issues related to pain management.
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Affiliation(s)
- Kelly K Anthony
- Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 3527, Durham, NC 27710, USA
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Villanueva MR, Smith TL, Erickson JS, Lee AC, Singer CM. Pain Assessment for the Dementing Elderly (PADE): reliability and validity of a new measure. J Am Med Dir Assoc 2003; 4:1-8. [PMID: 12807590 DOI: 10.1097/01.jam.0000043419.51772.a3] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To establish the reliability and validity of a measure to assess pain in individuals with advanced dementia. DESIGN Sixty-five residents of long-term care facilities were assessed using a new rating tool, the Pain Assessment for the Dementing Elderly (PADE), in two separate studies: (1) Residents were assessed simultaneously by two different raters, at Time 1 and 2, to establish interrater reliability, stability, and internal consistency. (2) Validity was established by assessing the correlation between an agitation scale and the PADE; by comparing groups with pain as a significant clinical factor (as assessed by an independent rater) versus not a significant factor, and by assessing individuals receiving versus not receiving psychoactive medications. SETTING Four different long-term care facilities, three skilled nursing facilities, and a locked dementia assisted-living facility. PARTICIPANTS Twenty-five residents of long-term care facilities with advanced levels of dementia in Study 1, and 40 residents with similar level of dementia in Study 2; 42% of the total sample were rated as having significant painful conditions. MEASUREMENTS For Study 1, the PADE was administered; for Study 2, the PADE and the Cohen-Mansfield Agitation Inventory (CMAI) were administered. RESULTS Reliability coefficients were adequate (interrater = 0.54-0.95; stability = 0.70-0.98; and internal consistency = 0.24-0.88). Validity coefficients were likewise encouraging, with the PADE demonstrating the expected relationship with a measure of agitation. The PADE also differentiated between groups that were independently judged to suffer clinically problematic pain versus those who were not. CONCLUSION The PADE is a reliable and valid tool to assess pain in dementing elderly residents of long-term care facilities.
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Miller ML, LeBovidge J, Feldman B. Health-related quality of life in children with arthritis. Rheum Dis Clin North Am 2002; 28:493-501, vi. [PMID: 12380367 DOI: 10.1016/s0889-857x(02)00019-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Health status results from an individual's values placed on the interactions among a person's physical state, associated mental perceptions and emotions, resulting behaviors, and environment. Improving health-related quality of life is the goal of all disease treatment. This article reviews the components of health status, summarizes relevant studies in children with rheumatic and related diseases, and considers the role that future studies will play in improving care for children with rheumatic diseases.
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Affiliation(s)
- Michael L Miller
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL 60614, USA.
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Akikusa J, Allen R. Reducing the impact of rheumatic diseases in childhood. Best Pract Res Clin Rheumatol 2002. [DOI: 10.1053/berh.2002.0232] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
A variety of reliable and valid psychosocial assessment instruments have been developed. Many of these instruments are brief and easily incorporated into clinical practice settings. Measures of coping, self-efficacy, helplessness, and cognitive distortion are especially useful in understanding the pain experience in rheumatic disease populations. Information gleaned from psychosocial assessments is increasingly being used to guide pain treatment efforts. Recent research, suggests that treatment outcomes can be improved if one tailors psychosocial pain management protocols to address the particular problems identified by comprehensive psychosocial assessments. Considered overall, psychosocial assessment methods have much to offer the clinician working with patients having persistent pain. The current status of this field is promising, and as psychosocial assessment methods become even more fully integrated into clinical practice, they are likely to yield even greater insights into the pain experience of patients with rheumatic diseases.
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Affiliation(s)
- F J Keefe
- Department of Psychology, Ohio University, Athens, USA
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Bradley LA, Alberts KR. Psychological and behavioral approaches to pain management for patients with rheumatic disease. Rheum Dis Clin North Am 1999; 25:215-32, viii. [PMID: 10083965 DOI: 10.1016/s0889-857x(05)70061-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the efficacy of the psychological and behavioral pain management interventions that have been evaluated among adult patients with rheumatoid arthritis (RA), osteoarthritis (OA), and fibromyalgia (FM). Using published criteria for empirically validated interventions, it is concluded that cognitive-behavioral therapies and the Arthritis Self-Management Program represent well-established treatments for pain among patients with RA and OA. These interventions involve education, training in relaxation and other coping skills, and rehearsal of these skills in patients' home and work environments. There currently are no psychological or behavioral interventions for pain among FM patients that can be considered as well-established treatments. Future intervention research should use clinically meaningful change measures in addition to conventional tests of statistical significance, attend to the pain management needs of children, and assess whether outcomes produced in university-based treatment centers generalize to those in local treatment settings.
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Affiliation(s)
- L A Bradley
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, USA.
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Kuis W, Heijnen CJ, Sinnema G, Kavelaars A, van der Net J, Helders PJ. Pain in childhood rheumatic arthritis. BAILLIERE'S CLINICAL RHEUMATOLOGY 1998; 12:229-44. [PMID: 9890096 DOI: 10.1016/s0950-3579(98)80017-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pain is a major symptom in chronic inflammatory arthropathies such as rheumatoid arthritis and affects the health status of arthritis patients negatively. There has been much debate about the role of pain in juvenile chronic arthritis and this review deals with the controversies about this subject. Pain in children is best understood as a multifactorial concept in which pain is the result of somatosensory, behavioural and environmental factors. The role of the different factors contributing to pain will be assessed with special reference to mechanisms relevant to children with chronic pain, the various instruments to measure pain, such as visual analogue scales and algometry, and the treatment of chronic pain in juvenile chronic arthritis. For a true understanding of chronic pain in children, these multidimensional assessments should be integrated into a biobehavioral model, by means of which a better understanding should lead to new therapeutic interventions for one of the most common symptoms of rheumatic diseases in childhood: pain.
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Affiliation(s)
- W Kuis
- Department of Immunology, University Children's Hospital Het Wilhelmina Kinderziekenhuis, Nieuwegracht, LK Utrecht, The Netherlands
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Graham TB, Giannini EH. Juvenile rheumatoid arthritis--assessment. Indian J Pediatr 1996; 63:283-91. [PMID: 10830003 DOI: 10.1007/bf02751520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The assessment of overall health status of a child with juvenile rheumatoid arthritis (JRA) is complex and multi-dimensional. The general physical examination is complemented by a rheumatological evaluation that includes determination of articular indices of inflammation and duration of inactivity stiffness. Laboratory assessment plays a critical role in monitoring side effects of pharmacologic management, but is limited in its ability to portray accurately the degree of active inflammation. Newly measureable indicators of inflammatory activity, such as serum cytokine and soluble cytokine receptors will likely become part of routine laboratory assessment in the future. Radiographs remain a useful tool for assessing disease progression, but may be replaced in the future by magnetic resonance imaging. In recent years, rheumatologists have realized that measurement of overall physical and psycho-social functional ability, quality of life, and pain are major descriptors to consider during routine follow-up. They are also critical in the assessment of long-term clinical effectiveness. The importance of nutritional assessment has also been realized. This section seeks to describe some of the methodologic approaches currently used to assess the variables mentioned above, and includes a brief discussion of the evolving instrumentation which attempts to measure variables of a more cognitive or subjective aspect.
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Affiliation(s)
- T B Graham
- William S. Rowe Division of Rheumatology, Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH 45229-2899, USA
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Schanberg LE, Keefe FJ, Lefebvre JC, Kredich DW, Gil KM. Pain coping strategies in children with juvenile primary fibromyalgia syndrome: correlation with pain, physical function, and psychological distress. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1996; 9:89-96. [PMID: 8970266 DOI: 10.1002/1529-0131(199604)9:2<89::aid-anr1790090204>3.0.co;2-j] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The purpose of this study was twofold: 1) to describe the coping strategies used by children with juvenile primary fibromyalgia syndrome (JPFS), and 2) to examine how pain coping relates to measures of pain, disability/function, psychological distress, and pain behavior. METHODS Sixteen children with JPFS completed the Child Version of the Coping Strategies Questionnaire (CSQ-C), the visual analog scale for pain, the McGill Pain Questionnaire, the Fibromyalgia Impact Questionnaire modified for children, the Arthritis Impact Measurement Scales 2, and the Symptom Checklist-90-Revised. Subjects also also underwent pain behavior observation. Pearson's product moment correlations were conducted to examine the relationship of coping to measures of pain and disability. RESULTS The Pain Control and Rational Thinking composite factor score on the CSQ-C correlated with measures of pain severity, functional disability, and psychological distress. Results supported the internal reliability of the CSQ-C in assessing pain coping. CONCLUSIONS These results suggest that the CSQ-C may provide a reliable measure for assessing variations in pain coping in JPFS patients. Behavioral interventions aimed at increasing the perception of pain control may be beneficial in treating JPFS.
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Bellamy N, Bradley LA. Workshop on chronic pain, pain control, and patient outcomes in rheumatoid arthritis and osteoarthritis. ARTHRITIS AND RHEUMATISM 1996; 39:357-62. [PMID: 8607883 DOI: 10.1002/art.1780390302] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- N Bellamy
- University of Western Ontario, London, Canada
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