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Oetjen L, Johannsen A, Bean J, Sim L, Harrison T, Tsai Owens M, Harbeck-Weber C. The Goals and Outcomes of Adolescent and Young Adults with POTS Attending an Intensive Interdisciplinary Treatment Program. Occup Ther Health Care 2024; 38:768-782. [PMID: 36047810 DOI: 10.1080/07380577.2022.2116666] [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: 11/27/2020] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
Postural Orthostatic Tachycardia Syndrome (POTS) affects approximately 1% of adolescents, however, little research has been done in this area. This retrospective chart review describes the treatment goals and perceived progress as measured by the Canadian Occupational Performance Measure (COPM) of 111 adolescents and young adults (AYAs) aged 12-22 (M = 15.8, SD = 1.8) diagnosed with POTS who were admitted to an interdisciplinary intensive pain treatment program (IIPT). This study also examined the change in progress and satisfaction in goals over a 3-week intensive pain treatment program, as well as the utility and validity of the COPM as an outcome measure for AYAs attending an IIPT. Results indicated adolescents and young adults endorsed treatment goals focused on self-care, school, and leisure and found that performance and satisfaction scores significantly improved from admission to discharge. The findings also suggest that the COPM is a useful and valid outcome measure for this population.
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Affiliation(s)
- Laurel Oetjen
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Amanda Johannsen
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Jessica Bean
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tracy Harrison
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
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2
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Weiss KE, Li R, Wang X, Vandeleur D, Havkins S, Palermo TM. Longitudinal Pain Outcomes Following an Intensive Pediatric Pain Rehabilitation Program: Testing Potential Treatment Mechanisms. Clin J Pain 2024; 40:82-91. [PMID: 37921580 DOI: 10.1097/ajp.0000000000001171] [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: 04/17/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES This study tested performance measures of physical functioning and pain-related psychosocial measures as potential mechanisms of improvements in outcomes following intensive outpatient interdisciplinary pain rehabilitation for adolescents. We hypothesized that improvements in performance measures of physical functioning, fear of pain, pain catastrophizing, and self-efficacy during treatment would be related to improvements in pain, functional disability, and depressive symptoms. METHODS Seventy-seven adolescents, 10 to 18 years old, completed self-report measures before treatment, after the first week, at discharge, and at the 3-month follow-up. Participants completed physical performance measures of physical and exercise capacity and core strength on day 1, after the first week, and at discharge. Linear mixed models were used to examine the association between changes in potential mechanisms and changes in outcomes, adjusting for age, sex, pain duration, and baseline functional disability. RESULTS Statistically significant improvement in functional disability, pain, and depressive symptoms was demonstrated across the 4 time points. Improvements were also demonstrated in physical performance measures, fear of pain, pain catastrophizing, and self-efficacy. Improvements in pain catastrophizing predicted improvements in functional disability, pain, and depressive symptoms. Improvements in self-efficacy predicted improvements in all outcome variables except depression. Improvements in physical performance measures predicted improvements in some aspects of functional disability and pain, but not depressive symptoms. DISCUSSION This study contributes to the growing literature on the effectiveness of pediatric intensive interdisciplinary pain rehabilitation programs and mechanisms that influence improvements in outcomes, an area that is currently underexplored. Results are important to guide future research and inform clinical practice.
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Affiliation(s)
- Karen E Weiss
- Department of Anesthesiology and Pain Medicine, University of Washington
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute
| | - Rui Li
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute
| | - Xing Wang
- Biostatistics Epidemiology and Analytics in Research, Seattle Children's Research Institute
| | - Daron Vandeleur
- Department of Anesthesiology and Pain Medicine, University of Washington
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute
| | - Sabina Havkins
- Rehabilitation Medicine, Seattle Children's Hospital, Seattle, WA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute
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3
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Junghans-Rutelonis A, Sim L, Harbeck-Weber C, Dresher E, Timm W, Weiss KE. Feasibility of wearable activity tracking devices to measure physical activity and sleep change among adolescents with chronic pain-a pilot nonrandomized treatment study. FRONTIERS IN PAIN RESEARCH 2024; 4:1325270. [PMID: 38333189 PMCID: PMC10850299 DOI: 10.3389/fpain.2023.1325270] [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: 10/20/2023] [Accepted: 12/20/2023] [Indexed: 02/10/2024] Open
Abstract
Purpose Personal informatics devices are being used to measure engagement in health behaviors in adults with chronic pain and may be appropriate for adolescent use. The aim of this study was to evaluate the utilization of a wearable activity tracking device to measure physical activity and sleep among adolescents attending a three-week, intensive interdisciplinary pain treatment (IIPT) program. We also assessed changes in physical activity and sleep from baseline to the treatment phase. Methods Participants (57.1% female, average age 15.88, SD = 1.27) wore an activity tracking device three weeks prior to starting and during the treatment program. Results Of 129 participants contacted, 47 (36.4%) agreed to participate. However, only 30 (64%) complied with the instructions for using the device prior to programming and during program participation. Preliminary analyses comparing averages from 3-weeks pre-treatment to 3-weeks during treatment indicated increases in daily overall activity minutes, daily step counts, and minutes of moderate to vigorous physical activity (by 353%), as well as a corresponding decrease in sedentary minutes. There was more missing data for sleep than anticipated. Conclusions Wearable activity tracking devices can be successfully used to measure adolescent physical activity in-person, with more difficulty obtaining this information remotely. Adolescents with chronic pain experience improvements in objective measurements of physical activity over the course of a 3-week IIPT program. Future studies may want to spend more time working with pediatric patients on their understanding of how to use trackers for sleep and physical activity.
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Affiliation(s)
- Ashley Junghans-Rutelonis
- AJR & Co Consulting and Mental Health, St. Paul, MN, United States
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Leslie Sim
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Cynthia Harbeck-Weber
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
| | - Emily Dresher
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Wendy Timm
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Karen E. Weiss
- Department of Psychiatry & Psychology, Mayo Clinic, Mayo Clinic College of Medicine, Rochester, MN, United States
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4
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Mallick D, Goyal L, Chourasia P, Zapata MR, Yashi K, Surani S. COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review. Cureus 2023; 15:e36955. [PMID: 37009342 PMCID: PMC10065129 DOI: 10.7759/cureus.36955] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
POTS (Postural Orthostatic Tachycardia Syndrome) is a multisystem disorder characterized by the abnormal autonomic response to an upright posture, causing orthostatic intolerance and excessive tachycardia without hypotension. Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Prominent symptoms of POTS include fatigue, orthostatic intolerance, tachycardia, and cognitive impairment. The exact mechanisms of post-COVID-19 POTS are unclear. Still, different hypotheses have been given, including autoantibody production against autonomic nerve fibers, direct toxic effects of SARS-CoV-2, or sympathetic nervous system stimulation secondary to infection. Physicians should have a high suspicion of POTS in COVID-19 survival when presented with symptoms of autonomic dysfunction and should conduct diagnostic tests like the Tilt table and others to confirm it. The management of COVID-19-related POTS requires a comprehensive approach. Most patients respond to initial non-pharmacological options, but when the symptoms become more severe and they do not respond to the non-pharmacological approach, pharmacological options are considered. We have limited understanding and knowledge of post-COVID-19 POTS, and further research is warranted to improve our understanding and formulate a better management plan.
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Affiliation(s)
- Deobrat Mallick
- Internal Medicine, Christus Spohn Hospital, Corpus Christi, USA
| | - Lokesh Goyal
- Hospital Medicine, Christus Spohn Hospital, Corpus Christi, USA
| | - Prabal Chourasia
- Hospital Medicine, Mary Washington Hospital, Fredericksburg, USA
| | - Miana R Zapata
- Internal Medicine, University of the Incarnate Word School of Osteopathic Medicine, Corpus Christi, USA
| | - Kanica Yashi
- Internal Medicine, Bassett Health Care, Cooperstown, USA
| | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA
- Medicine, Texas A&M University, College Station, USA
- Medicine, University of North Texas, Dallas, USA
- Internal Medicine, Pulmonary Associates, Corpus Christi, USA
- Clinical Medicine, University of Houston, Houston, USA
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5
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Grubb AF, Grubb BP. Postural orthostatic tachycardia syndrome: New concepts in pathophysiology and management. Trends Cardiovasc Med 2023; 33:65-69. [PMID: 34695573 DOI: 10.1016/j.tcm.2021.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/22/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023]
Abstract
Postural orthostatic tachycardia syndrome (POTS) is a common and therapeutically challenging condition affecting numerous people worldwide. Recent studies have begun to shed light on the pathophysiology of this disorder. At the same time, both non-pharmacologic and pharmacologic therapies have emerged that offer additional treatment options for those afflicted with this condition. This paper reviews new concepts in both the pathophysiology and management of POTS.
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Affiliation(s)
- Alex F Grubb
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA.
| | - Blair P Grubb
- Division of Cardiology, The University of Toledo Medical Center, Toledo, Ohio, USA
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6
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Tafler L, Chaudry A, Cho H, Garcia A. Management of Post-Viral Postural Orthostatic Tachycardia Syndrome With Craniosacral Therapy. Cureus 2023; 15:e35009. [PMID: 36938206 PMCID: PMC10021347 DOI: 10.7759/cureus.35009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Postural Orthostatic Tachycardia Syndrome (POTS) is a rare disorder of the autonomic nervous system. The number of people afflicted with this dysautonomia has increased dramatically in recent years due to the long-term effects of coronavirus disease (COVID-19); however, it is largely underdiagnosed. This case report is about a patient with post-viral neuropathic POTS. Neuropathic POTS is believed to be due to the damage of small nerve fibers that regulate the constriction of the blood vessels in the limb and abdomen, which leads to interference with vasoconstriction, and therefore causes tachycardia. Current literature emphasizes a treatment that is based on lifestyle modifications, such as increasing water and salt intake, and symptomatic pharmacological treatment. In this case, the 39-year-old male ptient was treated with osteopathic manipulative treatment (OMT), specifically the compression of the fourth ventricle (CV4), which has been associated with the production of hyperparasympathetic and anti-inflammatory effects and, hence, helps overcome the small-fiber neuropathy caused by the viral illness. We found that the CV4 technique led to the successful remission of the patient's symptoms. Therefore, we propose craniosacral therapy as a successful single management modality in patients with POTS.
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Affiliation(s)
- Leonid Tafler
- Primary Care, Touro College of Osteopathic Medicine, New York City, USA
| | - Aysham Chaudry
- Medical School, Touro College of Osteopathic Medicine, Middletown, USA
| | - Heejin Cho
- Primary Care, Touro College of Osteopathic Medicine, New York City, USA
| | - Angeles Garcia
- Medical School, Touro College of Osteopathic Medicine, New York City, USA
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Hurtubise K, Brousselle A, Noel M, Caldwell K, Rayner L, Dawson M, Rasic N, Camden C. The effect domains, measures, and methods reported in pediatric-specialized multidisciplinary outpatient rehabilitation programs: An integrated review. Pain Pract 2023; 23:185-203. [PMID: 36251412 DOI: 10.1111/papr.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Specialized pain rehabilitation is recognized as the treatment of choice for youth with pain-related disability. Appropriate outcomes for program evaluation are critical. This study aimed to summarize the effect domains and methods used to evaluate pediatric-specialized outpatient pain rehabilition programs, map them to the PedIMMPACT statement, and highlight future directions. METHODS An integrated review framework, incorporating stakeholders, was used. Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycINFO, and Google Scholar were searched for studies published in 1999-2021 featuring the treatment effects of specialized outpatient pain rehabilitation on youth with pain-related disability and their parents. Selected studies were critically appraised using the Quality Assessment Tool for Studies of Diverse Design, organized by study characteristics, and analyzed using constant comparison. RESULTS From the 1951 potentially relevant titles, 37 studies were selected. Twenty-five effects targeted youth and 24 focused on parents, with a maximum of 15 youth and 11 parent effect domains (median = 5 domains per study). Although most studies measured a combination of effect domains and were inclusive of some recommended in the PedIMMPACT statement, no effect was measured consistently across studies. Youth physical functioning and parent emotional functioning were measured most often. Eighty-five instruments were used to assess youth outcomes and 59 for parents, with self-report questionnaires dominating. DISCUSSION A lack of standardization exists associated with the domains and methods used to evaluate the effects of pediatric-specialized outpatient pain rehabilitation programs, hindering comparisons. Future program evaluations should be founded on their theory, aim, and anticipated outcomes.
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Affiliation(s)
- Karen Hurtubise
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Québec, Québec, Canada.,Faculty of Health Sciences, School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, Victoria, British Columbia, Canada
| | - Melanie Noel
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Heritage Medical Research Building, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Health Research Innovation Centre, Calgary, Alberta, Canada
| | - Kathleen Caldwell
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Laura Rayner
- Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Matthew Dawson
- Department of Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
| | - Nivez Rasic
- Alberta Children's Hospital Research Institute, Heritage Medical Research Building, Calgary, Alberta, Canada.,Vi Riddell Children's Pain and Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Chantal Camden
- Faculté de Médecine et Sciences de la Santé, Université de Sherbrooke, Québec, Québec, Canada
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Claus BB, Stahlschmidt L, Dunford E, Major J, Harbeck-Weber C, Bhandari RP, Baerveldt A, Neß V, Grochowska K, Hübner-Möhler B, Zernikow B, Wager J. Intensive interdisciplinary pain treatment for children and adolescents with chronic noncancer pain: a preregistered systematic review and individual patient data meta-analysis. Pain 2022; 163:2281-2301. [PMID: 35297804 DOI: 10.1097/j.pain.0000000000002636] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chronic noncancer pain in children and adolescents can be impairing and results in substantial health care costs. Intensive interdisciplinary pain treatment (IIPT), an inpatient or day hospital treatment delivered by a team of 3 or more health professionals, may be an effective intervention for these children and adolescents. Based on previous reviews and meta-analyses, we updated findings regarding the description of available treatments and estimated the effectiveness of IIPT, overcoming methodological shortcomings of previous work by requesting and analyzing individual participant data. On June 26, 2021, we searched 5 literature databases (PubMed, PsycINFO, Web of Science, Cochrane Library, and PubPsych) for studies examining the effectiveness of IIPT. Included studies used a pre-post design, assessed patients younger than 22 years, and presented their results in English, German, French, or Spanish. We used standard methodological procedures expected by Cochrane to pool treatment effects and assess risk of bias. We identified 13 different treatment sites with similar treatment inclusion criteria and treatment components, but the descriptions of those treatments varied widely. Regarding treatment effectiveness, IIPT may result in large improvements in the mean pain intensity ( g = -1.28), disability ( g = -1.91), and number of missed school days at the 12-month follow-up ( g = -0.99), as well as moderate improvements in anxiety ( g = -0.77) and depression ( g = -0.76). The certainty of the evidence, however, was graded from very low to low. We recommend that future researchers use more scientific rigor to increase the certainty of the evidence for IIPT and standardize treatment outcomes for children and adolescents with chronic pain.
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Affiliation(s)
- Benedikt B Claus
- PedScience Research Institute, Datteln, Germany
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Emma Dunford
- Oxford Centre for Children and Young People in Pain (OXCCYPP), Oxford University Hospitals, Oxford, United Kingdom
| | - János Major
- Paediatric Pain Centre, HRC Bethesda Children's Hospital, Budapest, Hungary
- Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | | | - Rashmi Parekh Bhandari
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University Medical Center, Palo Alto, CA, United States
| | - Ardith Baerveldt
- Get Up and Go Persistent Pediatric Pain Service, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
- Bloorview Research Institute, Toronto, ON, Canada
| | - Verena Neß
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Kamila Grochowska
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Bettina Hübner-Möhler
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Boris Zernikow
- PedScience Research Institute, Datteln, Germany
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
| | - Julia Wager
- PedScience Research Institute, Datteln, Germany
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Witten/Herdecke University, Faculty of Health, School of Medicine, Witten, Germany
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9
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Sanromán L, Catalá P, Écija C, Suso-Ribera C, San Román J, Peñacoba C. The Role of Walking in the Relationship between Catastrophizing and Fatigue in Women with Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4198. [PMID: 35409880 PMCID: PMC8998906 DOI: 10.3390/ijerph19074198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/11/2022] [Accepted: 03/30/2022] [Indexed: 11/24/2022]
Abstract
Walking is one of the most beneficial treatments for fibromyalgia patients. However, adherence to walking behavior is low due to the initially associated symptoms (including pain and fatigue). Although the association of catastrophism with greater symptoms is known, the results regarding fatigue have not always been consistent. Nevertheless, it is unknown whether the association between catastrophism and fatigue could, in turn, be conditioned by whether the patients walk or not. Therefore, our goal was to explore the moderating effect of walking on the association between catastrophizing and fatigue in patients with fibromyalgia. A cross-sectional study was carried out with 203 women with fibromyalgia. We used the Multidimensional Fatigue Inventory to assess fatigue and the Pain Catastrophizing Scale to assess pain catastrophizing (differentiating between its three dimensions). An ad hoc item was used to evaluate walking (moderator). Lower scores for fatigue and pain catastrophizing were found among patients who walked versus those who did not. Walking moderated the relationship between rumination and fatigue (Beta = 0.16, t = 1.96, p = 0.049) and between magnification and fatigue (Beta = 0.22, t = 21.83, p = 0.047). Helplessness showed no direct or interaction effect for fatigue. Nevertheless, higher rumination and magnification were associated with higher fatigue only in patients who walked. Therefore, to promote adherence to walking and reduce the effects of catastrophizing on fatigue, it seems necessary to manage rumination and magnification among patients who walk.
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Affiliation(s)
- Lucía Sanromán
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain; (L.S.); (P.C.); (C.É.)
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain; (L.S.); (P.C.); (C.É.)
| | - Carmen Écija
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain; (L.S.); (P.C.); (C.É.)
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, 12006 Castellón de la Plana, Spain;
| | - Jesús San Román
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, 28922 Alcorcón, Spain;
| | - Cecilia Peñacoba
- Department of Psychology, Rey Juan Carlos University, 28922 Alcorcón, Spain; (L.S.); (P.C.); (C.É.)
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10
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Benito KG, Ramanathan A, Lobato D, Jandasek B, Mamaril E, McBride H, Feit LR. Symptoms, impairment and treatment needs among youth with orthostatic intolerance in a secondary care setting. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2047049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Kristen G. Benito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
| | - Amrita Ramanathan
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
| | - Debra Lobato
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Barbara Jandasek
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
| | - Erin Mamaril
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Haley McBride
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
| | - Lloyd R. Feit
- Pediatric Heart Center, Hasbro Children’s Hospital, Providence, RI, USA
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA
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11
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Herrera A, Behm J. Using the PEOP Model to Understand Barriers to Functioning in Postural Orthostatic Tachycardia Syndrome. Occup Ther Health Care 2021; 36:283-305. [PMID: 34431731 DOI: 10.1080/07380577.2021.1967548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Individuals with postural orthostatic tachycardia syndrome (POTS) experience many barriers that lead to decreased functioning and quality of life. At this time, there are limited resources regarding the functional impact of POTS on occupational performance. Therefore, this narrative review demonstrates how occupational therapy practitioners can conceptualize, categorize, and systematically organize their thinking around barriers individuals with POTS experience using the Person-Environment-Occupation-Performance (PEOP) model of practice.
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Affiliation(s)
| | - Joanna Behm
- Master of Occupational Therapy Program, Messiah University, Mechanicsburg, PA, USA
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12
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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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Activity Patterns and Functioning. A Contextual-Functional Approach to Pain Catastrophizing in Women with Fibromyalgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105394. [PMID: 34070136 PMCID: PMC8158359 DOI: 10.3390/ijerph18105394] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/04/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022]
Abstract
Background: The psychological flexibility model states that activity patterns are not deemed to be intrinsically functional or dysfunctional; it is considered that underlying factors, such as personal goals and contextual factors, are what will determine their effects on disability. Pain catastrophizing has frequently been associated with several important pain-related outcomes. Despite its recent conceptualization within affective–motivational approaches, its moderating role between activity patterns and dysfunction has not been analyzed. Methods: This study analyzes the moderating role of pain catastrophizing and its dimensions (Pain Catastrophizing Scale) between activity patterns (Activity Patterns Scale) and disease impact (Fibromyalgia Impact Questionnaire—Revised) in 491 women with fibromyalgia. Results: Activity avoidance (p < 0.001), excessive persistence (p < 0.001) and pacing (p < 0.01) patterns were positively associated with fibromyalgia impact. Helplessness shows a moderating role between pain avoidance (B = 0.100, t =2.30, p = 0.021, [0.01, 0.18]), excessive persistence (B = −0.09, t = −2.24, p = 0.02, [−0.18, −0.01]), pain persistence (B = −0.10, t = −2.04, p = 0.04, [−0.19, −0.004]) and functioning. Conclusion: Helplessness (within pain catastrophizing) is a relevant variable within psychological flexibility models applied to activity patterns. Specifically, pain avoidance is especially dysfunctional in patients with high helplessness. To improve excessive persistence and pain persistence, it is necessary to reduce helplessness before regulating activity patterns.
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Becoming flexible: Increase in parent psychological flexibility uniquely predicts better well-being following participation in a pediatric interdisciplinary pain rehabilitation program. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Junghans-Rutelonis AN, Postier A, Warmuth A, Schwantes S, Weiss KE. Pain Management In Pediatric Patients With Postural Orthostatic Tachycardia Syndrome: Current Insights. J Pain Res 2019; 12:2969-2980. [PMID: 31802934 PMCID: PMC6827519 DOI: 10.2147/jpr.s194391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/21/2019] [Indexed: 11/23/2022] Open
Abstract
Pediatric patients with postural orthostatic tachycardia syndrome (POTS) often present with co-occurring struggles with chronic pain (POTS+pain) that may limit daily activities. POTS is a clinical syndrome characterized by orthostatic symptoms and excessive postural tachycardia without orthostatic hypotension. Active research from the medical and scientific community has led to controversy over POTS diagnosis and treatment, yet patients continue to present with symptoms associated with POTS+pain, making treatment recommendations critical. This topical review examines the literature on diagnosing and treating pediatric POTS+pain and the challenges clinicians face. Most importantly, clinicians must employ an interdisciplinary team approach to determine the ideal combination of pharmacologic (e.g., fludrocortisone), non-pharmacologic (e.g., physical therapy, integrative medicine), and psychological (e.g., cognitive behavioral therapy, psychoeducation) treatment approaches that acknowledge the complexity of the child's condition, while simultaneously tailoring these approaches to the child's personal needs. We provide recommendations for treatment for youth with POTS+pain based on the current literature.
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Affiliation(s)
- Ashley N Junghans-Rutelonis
- Department of Pain Medicine, Palliative Care, and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Andrea Postier
- Department of Pain Medicine, Palliative Care, and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.,Children's Minnesota Research Institute, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Andrew Warmuth
- Department of Pain Medicine, Palliative Care, and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.,Department of Physical Medicine and Rehabilitation, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Scott Schwantes
- Department of Pain Medicine, Palliative Care, and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
| | - Karen E Weiss
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine & Seattle Children's Hospital, Seattle, DC, USA
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Factors Associated With Use of Nonoral Nutrition and Hydration Support in Adult Patients With Postural Tachycardia Syndrome. JPEN J Parenter Enteral Nutr 2018; 43:734-741. [DOI: 10.1002/jpen.1493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/25/2018] [Indexed: 12/12/2022]
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