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Grothus S, Sommer A, Stahlschmidt L, Hirschfeld G, Höfel L, Linder R, Zernikow B, Wager J. Pediatric chronic pain grading: a revised classification of the severity of pediatric chronic pain. Pain 2024; 165:2087-2097. [PMID: 38595202 DOI: 10.1097/j.pain.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 02/08/2024] [Indexed: 04/11/2024]
Abstract
ABSTRACT In this study, we describe the development and validation of a revised Pediatric Chronic Pain Grading (P-CPG) for children aged 8 to 17 years that adds emotional impairment to previously used measures of pain intensity and functional impairment. Such a measure enables the assessment of chronic pain severity in different epidemiological and clinical populations, the stratification of treatment according to pain severity, and the monitoring of treatment outcome. The P-CPG was developed using a representative sample of school children with chronic pain (n = 454; M age = 12.95, SD = 2.22). Construct validity and sensitivity to change were examined within a sample of N = 2448 children and adolescents (M age = 12.71, SD = 2.47) comprising 3 subsamples (school n = 1562, primary care n = 129, and tertiary care n = 757) affected by chronic pain to varying extents. Results showed that P-CPG grades differed significantly among the 3 subsamples, with school children being least affected by chronic pain and tertiary care patients being most affected. As P-CPG grade increased, so did pain intensity, functional impairment, pain-related school absence, and emotional impairment. Convergent validity was demonstrated by significant positive correlations between the P-CPG and global ratings of pain severity as well as objective claims data; the latter reflects greater health care costs with increasing P-CPG scores. Sensitivity to change was supported by a significant reduction in baseline P-CPG grades 3 and 6 months after intensive interdisciplinary pain treatment in tertiary care sample. In conclusion, the P-CPG is an appropriate measure of pain severity in children and adolescents with chronic pain in clinical as well as epidemiological settings.
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Affiliation(s)
- Susanne Grothus
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Ariane Sommer
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lorin Stahlschmidt
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Gerrit Hirschfeld
- Faculty of Business, CareTech OWL University of Applied Sciences Bielefeld, Bielefeld, Germany
| | - Lea Höfel
- Center for Pain Therapy for Young People, Garmisch-Partenkirchen, Germany
| | | | - Boris Zernikow
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, Witten, Germany
- PedScience Research Institute, Datteln, Germany
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Greenough MJ, Jibb L, Lewis KB, Bucknall T, Lamontagne C, Demery Varin M, Sokalski A, Squires JE. A systematic review of the biopsychosocial dimensions affected by chronic pain in children and adolescents: identifying reliable and valid pediatric multidimensional chronic pain assessment tools. Pain Rep 2023; 8:e1099. [PMID: 38033716 PMCID: PMC10686605 DOI: 10.1097/pr9.0000000000001099] [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: 12/20/2022] [Revised: 05/27/2023] [Accepted: 06/03/2023] [Indexed: 12/02/2023] Open
Abstract
Pediatric chronic pain is a complex experience that is often challenging to describe and measure. Multidimensional tools that evaluate the biopsychosocial impact of chronic pain in pediatric patients can help clinicians to prioritize and tailor interdisciplinary pain care; yet, the psychometric value and clinical utility of such tools has not yet been systematically studied in the literature. The purpose of this review was to identify multidimensional biopsychosocial tools used in pediatric chronic pain, synthesize their reliability and validity evidence, and draw on this evidence to describe the relationships between chronic pain and biopsychosocial domains. The search involved 2 phases to (1) identify eligible tools and (2) conduct a measured forward citation search of tool development articles. Tool eligibility was guided by the Multidimensional Biobehavioral Model of Pediatric Pain and study eligibility was focused on primary chronic pain diagnoses unrelated to disease. Data extraction was focused on reliability and validity evidence of eligible tools, guided by the Standards for Educational and Psychological Testing. Results yielded 6 tools that included 64 eligible studies, highlighting 84 significant relationships between pain and functional interference across 11 biopsychosocial variables. All tools were shown to have good internal consistency and evidence of validity, primarily through relationships to other variables. Of the 6 tools, the most brief and easy to use were the most under studied. Further psychometric research is warranted for these tools to investigate their clinical utility and psychometric properties in guiding and prioritizing pain care for children and adolescents.
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Affiliation(s)
- Megan J. Greenough
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Lindsay Jibb
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Pediatric Nursing Research, SickKids Hospital, Toronto, ON, Canada
| | | | - Tracey Bucknall
- School of Nursing, Deakin University, Burwood Victoria, Melbourne, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Geelong, Australia
| | - Christine Lamontagne
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Ashley Sokalski
- Chronic Pain Services at The Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Janet Elaine Squires
- University Research Chair in Health Evidence Implementation & School of Nursing, University of Ottawa, Ottawa, ON, Canada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Gould D, Dowsey M, Spelman T, Bailey J, Bunzli S, Rele S, Choong P. Established and Novel Risk Factors for 30-Day Readmission Following Total Knee Arthroplasty: A Modified Delphi and Focus Group Study to Identify Clinically Important Predictors. J Clin Med 2023; 12:747. [PMID: 36769396 PMCID: PMC9917714 DOI: 10.3390/jcm12030747] [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: 12/13/2022] [Revised: 01/03/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
Thirty-day readmission following total knee arthroplasty (TKA) is an important outcome influencing the quality of patient care and health system efficiency. The aims of this study were (1) to ascertain the clinical importance of established risk factors for 30-day readmission risk and give clinicians the opportunity to suggest and discuss novel risk factors and (2) to evaluate consensus on the importance of these risk factors. This study was conducted in two stages: a modified Delphi survey followed by a focus group. Orthopaedic surgeons and anaesthetists involved in the care of TKA patients completed an anonymous survey to judge the clinical importance of risk factors selected from a systematic review and meta-analysis and to suggest other clinically meaningful risk factors, which were then discussed in a focus group designed using elements of nominal group technique. Eleven risk factors received a majority (≥50%) vote of high importance in the Delphi survey overall, and six risk factors received a majority vote of high importance in the focus group overall. Lack of consensus highlighted the fact that this is a highly complex problem which is challenging to predict and which depends heavily on risk factors which may be open to interpretation, difficult to capture, and dependent upon personal clinical experience, which must be tailored to the individual patient.
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Affiliation(s)
- Daniel Gould
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
| | - Michelle Dowsey
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
- Department of Orthopaedics, St. Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
| | - Tim Spelman
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
| | - James Bailey
- School of Computing and Information Systems, University of Melbourne, Melbourne, VIC 3010, Australia
| | - Samantha Bunzli
- Nathan Campus, School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia
- Physiotherapy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
| | - Siddharth Rele
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
| | - Peter Choong
- Department of Surgery, University of Melbourne, St. Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
- Department of Orthopaedics, St. Vincent’s Hospital Melbourne, Melbourne, VIC 3065, Australia
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Miró J, Roman-Juan J, Sánchez-Rodríguez E, Solé E, Castarlenas E, Jensen MP. Chronic Pain and High Impact Chronic Pain in Children and Adolescents: A Cross-Sectional Study. THE JOURNAL OF PAIN 2022; 24:812-823. [PMID: 36577459 DOI: 10.1016/j.jpain.2022.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/26/2022]
Abstract
The aims of this study were to: 1) estimate the prevalence of chronic pain (CP) and high impact chronic pain (HICP) in a community sample of children and adolescents; and 2) compare groups (those without CP, those with CP but no HICP, and those with HICP) with respect to demographic variables, pain variables, and physical, psychological, and school-related function. One thousand one hundred and fifteen children and adolescents participated (56% girls; age: ߂ = 11.67; SD = 2.47; range = 8-18 years). The prevalence of CP and HICP was 46% and 5%, respectively, and was higher in girls and increased with age. Participants with HICP reported greater pain intensity and higher pain frequency than those with CP but no HICP. In addition, participants with HICP reported lower mobility, greater fatigue, worst sleep quality, more anxiety and depression symptoms, worst cognitive function, missing more school days, and worse perceived school performance. HICP is a prevalent condition in children and adolescents and is associated with many negative consequences. Stakeholders must be aware of this and ensure that treatment programs are available to reduce the individual and societal impact of HICP in young individuals. PERSPECTIVE: This article provides information on CP and HICP prevalence and impact in children and adolescents. By better understanding the nature and score of these conditions, we will be able to develop more effective early interventions to help this population and thereby reduce their long-term negative impact.
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Affiliation(s)
- Jordi Miró
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain.
| | - Josep Roman-Juan
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Elena Castarlenas
- Universitat Rovira i Virgili; Department of Psychology, URV, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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Trottier ED, Ali S, Doré-Bergeron MJ, Chauvin-Kimoff L. Les pratiques exemplaires pour l’évaluation et le traitement de la douleur chez les enfants. Paediatr Child Health 2022; 27:429-448. [PMCID: PMC9732860 DOI: 10.1093/pch/pxac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Résumé
L’évaluation et le traitement de la douleur sont des aspects essentiels des soins pédiatriques. L’évaluation de la douleur adaptée au développement représente une première étape importante pour en optimiser la prise en charge. L’autoévaluation de la douleur est à prioriser. Si c’est impossible, des outils appropriés d’évaluation du comportement, adaptés au développement, doivent être utilisés. Des directives et stratégies de prise en charge et de prévention de la douleur aiguë, qui combinent des approches physiques, psychologiques et pharmacologiques, doivent être accessibles dans tous les milieux de soins. Le meilleur traitement de la douleur chronique fait appel à une combinaison de modalités thérapeutiques et de counseling, dans l’objectif premier d’obtenir une amélioration fonctionnelle. La planification et la mise en œuvre de stratégies de prise en charge de la douleur chez les enfants doivent toujours être personnalisées et axées sur la famille.
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Affiliation(s)
- Evelyne D Trottier
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Samina Ali
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Marie-Joëlle Doré-Bergeron
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
| | - Laurel Chauvin-Kimoff
- Société canadienne de pédiatrie, comité des soins aigus, section de la pédiatrie hospitalière, section de la médecine d’urgence pédiatrique , Ottawa (Ontario) Canada
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Trottier ED, Ali S, Doré-Bergeron MJ, Chauvin-Kimoff L. Best practices in pain assessment and management for children. Paediatr Child Health 2022; 27:429-448. [PMID: 36524020 PMCID: PMC9732859 DOI: 10.1093/pch/pxac048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/14/2022] [Indexed: 09/04/2023] Open
Abstract
Pain assessment and management are essential components of paediatric care. Developmentally appropriate pain assessment is an important first step in optimizing pain management. Self-reported pain should be prioritized. Alternatively, developmentally appropriate behavioural tools should be used. Acute pain management and prevention guidelines and strategies that combine physical, psychological, and pharmacological approaches should be accessible in all health care settings. Chronic pain is best managed using combined treatment modalities and counselling, with the primary goal of attaining functional improvement. The planning and implementation of pain management strategies for children should always be personalized and family-centred.
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Affiliation(s)
- Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Samina Ali
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Marie-Joëlle Doré-Bergeron
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
| | - Laurel Chauvin-Kimoff
- Canadian Paediatric Society, Acute Care Committee, Hospital Paediatrics Section, Paediatric Emergency Medicine Section, Ottawa, Ontario, Canada
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What Works When Treating Children and Adolescents With Low Back Pain? J Orthop Sports Phys Ther 2022; 52:419-424. [PMID: 35584032 DOI: 10.2519/jospt.2022.10768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Low back pain is a common health condition for all ages. One quarter to a third of children report persistent pain, including low back pain. CLINICAL QUESTION The aim of this Clinical Commentary is to provide an overview of evidence-based treatment approaches for children and adolescents with low back pain. KEY RESULTS Physical, psychological, and pharmacological interventions are effective in reducing pain intensity and disability. Interdisciplinary and patient- and family-centered treatment approaches are the gold standard for persistent pain in children and adolescents. Communication between health professionals, children, and parents is a key part of a therapeutic alliance. The use of holistic and complementary therapies is not supported by compelling evidence. CLINICAL APPLICATION Physical interventions can be delivered alone or as a component of other interventions. The interventions are delivered over 8 to 12 weeks. Psychological therapies are mostly delivered as a component of a multidisciplinary treatment program: cognitive behavioral therapy is most often used, and interventions usually run from 4 to 10 weeks. Pharmacological interventions should be delivered in combination with physical and psychological interventions. Tailor family-centered interventions to personal aspects, such as age, gender, and family structure. When communicating with children and adolescents, use simple language that is clear and direct. Aim to support trust between health professionals and parents to facilitate family decision making. J Orthop Sports Phys Ther 2022;52(7):419-424. Epub: 18 May 2022. doi:10.2519/jospt.2022.10768.
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Tsai Owens MS, Biggs BK, Fahrenkamp AC, Geske J, Hofschulte DR, Harbeck-Weber C, Fischer PR. Physical Symptoms, Distress, and Functional Disability in Youth With Chronic Orthostatic Intolerance. J Pediatr Psychol 2022; 47:1185-1194. [PMID: 35699566 PMCID: PMC9960074 DOI: 10.1093/jpepsy/jsac052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Youth with chronic orthostatic intolerance (OI) can experience significant physical, social, and academic functional debilitation. Previous studies have indicated associations among symptom severity, psychosocial factors, and functional disability. However, empirically tested models explaining how different medical and psychosocial factors may contribute to functional disability are lacking. The current cross-sectional study aimed to evaluate mediation, moderation, and additive models of the effect of physical symptoms and psychological distress on functional disability. METHODS One hundred and sixty-five youth (13-22 years old) undergoing medical evaluation of chronic OI symptoms completed measures of autonomic dysfunction symptom severity, depressive and anxiety symptoms, and functional disability. Models were evaluated using tests of indirect effects and linear and logistic regression analyses. RESULTS Results supported the mediation and additive effects models for depressive symptoms. Mediation, moderation, and additive models for hypothesized effects of anxiety symptoms were not supported. CONCLUSIONS Results provide preliminary support for models in which OI symptoms affect functional debility via their effects on mood and in which depressive symptoms have unique and additive effects on functioning. Findings lay the foundation for longitudinal and experimental evaluation of biopsychosocial models of functional disability in youth with chronic OI and related conditions. Implications include the importance of a biopsychosocial conceptualization of OI symptoms and debility as a complex interplay of factors rather than as a purely physiological or psychological process.
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Affiliation(s)
| | - Bridget K Biggs
- All correspondence concerning this article should be addressed to Bridget Biggs, PhD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. E-mail:
| | - Amy C Fahrenkamp
- Pain, Palliative Care, and Integrative Medicine Department, Children’s Hospitals and Clinics of Minnesota, USA
| | - Jennifer Geske
- Department of Quantitative Health Sciences, Mayo Clinic, USA
| | | | | | - Philip R Fischer
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, USA,Department of Pediatrics, Sheikh Shakhbout Medical City, United Arab Emirates,Khalifa University, United Arab Emirates
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Miró J, Sánchez-Rodríguez E, Ferreira-Valente A, Pais-Ribeiro J, Ciaramella A. Effects of COVID-19 Social Distancing Measures in Individuals with Chronic Pain Living in Spain in the Late Stages of the Lockdown. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11732. [PMID: 34831489 PMCID: PMC8624638 DOI: 10.3390/ijerph182211732] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/05/2023]
Abstract
Social distancing measures during the lockdown have had a negative impact on chronic pain patients' function. Research, however, has only focused on the early stages of the first lockdowns. The aim of this study was to improve the understanding of the effects of COVID-19 social distancing measures on individuals with chronic pain living in Spain during the late stages of the lockdown. A group of 361 adults with pain participated in this study. They responded to an online survey and provided information on sociodemographic issues, pain, fatigue, perceived health, and quality of life. The data showed that most participants suffered moderate to severe pain and interferences with pain treatment and an increase in pain intensity during the lockdown. Most participants also informed us that fatigue had worsened during the lockdown (62%). Importantly, females with lower monthly family income and lower education have been found to be associated with greater levels of pain and fatigue. Despite this, participants perceived themselves as having good health and good quality of life. The findings from this study can be used to inform policy and specific responses for future COVID-19 waves and future pandemics where social distancing measures must be implemented.
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Affiliation(s)
- Jordi Miró
- Research Center for Behavior Assessment (CRAMC), Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Universitat Rovira i Virgili, 43007 Catalonia, Spain;
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Catalonia, Spain
| | - Elisabet Sánchez-Rodríguez
- Research Center for Behavior Assessment (CRAMC), Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Universitat Rovira i Virgili, 43007 Catalonia, Spain;
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43003 Catalonia, Spain
| | - Alexandra Ferreira-Valente
- William James Center for Research, ISPA—University Institute, 1100-304 Lisbon, Portugal; (A.F.-V.); (J.P.-R.)
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA
| | - José Pais-Ribeiro
- William James Center for Research, ISPA—University Institute, 1100-304 Lisbon, Portugal; (A.F.-V.); (J.P.-R.)
- Faculty of Psychology and Education Sciences, University of Porto, 4099-002 Porto, Portugal
| | - Antonella Ciaramella
- Lab. of Psychosomatic, GIFT Institute of Integrative Medicine, 56126 Pisa, Italy;
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10
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Improving the Quality of Life of Cancer Survivors in School: Consensus Recommendations Using a Delphi Study. CHILDREN 2021; 8:children8111021. [PMID: 34828734 PMCID: PMC8618439 DOI: 10.3390/children8111021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/23/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022]
Abstract
Successful school re-entry is important for children following cancer treatment. However, this process is a challenge for teachers. Objectives: To identify (1) the difficulties and needs that teachers have in helping youth cancer survivors be successful in school, (2) the most effective resources that teachers are currently using for helping them, and (3) the ideal contents for a program that could help teachers in this area. Methods: Twenty-eight teachers participated in a Delphi study. Results: A lack of knowledge regarding how to best help and having to deal with the student’s problems were identified as difficulties. Specific training, psychological support, and advice from health professionals were the most commonly reported needs. Maintaining contact with the family and the students and providing personalized attention were viewed as the most useful resources. Finally, knowledge about the disease itself and how to facilitate successful school re-entry were identified as important program components. Conclusion: The findings provide important new information regarding the lack of both resources and support for teachers who seek to help youth cancer survivors. The findings can be used to inform the development of an intervention to help teachers become more successful in facilitating successful school re-entry.
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11
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Educational Needs and Resources for Teachers Working with Students with Chronic Pain: Results of a Delphi Study. SUSTAINABILITY 2021. [DOI: 10.3390/su13084510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children and adolescents spend most of their time at school. Therefore, teachers could be of help to improve the quality of life of students with chronic pain while they are at school. The aim of this study was to identify teachers’ educational needs and resources to help improve the adjustment to and function in the school of students with chronic pain. A Delphi survey including two rounds was conducted. Overall, 49 needs were identified in the first round. They were related to education, training, organization/logistics, and communication with the family and the health care center. Among the most important needs, based on the importance given and consensus reached, were (1) having information about the most appropriate attitudes and responses to a student with chronic pain, (2) how to reduce absenteeism, (3) how to ease the return to school after a long absence due to his or her pain problem, and (4) how to establish effective communication with the family. The results of this study provide new important data on the educational needs and resources which teachers would like to have to help their students with chronic pain at school, which could be used to develop educative programs for teachers.
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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: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Llorens-Vernet P, Miró J. The Mobile App Development and Assessment Guide (MAG): Delphi-Based Validity Study. JMIR Mhealth Uhealth 2020; 8:e17760. [PMID: 32735226 PMCID: PMC7428935 DOI: 10.2196/17760] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/28/2020] [Accepted: 06/03/2020] [Indexed: 12/28/2022] Open
Abstract
Background In recent years, there has been an exponential growth of mobile health (mHealth)–related apps. This has occurred in a somewhat unsupervised manner. Therefore, having a set of criteria that could be used by all stakeholders to guide the development process and the assessment of the quality of the apps is of most importance. Objective The aim of this paper is to study the validity of the Mobile App Development and Assessment Guide (MAG), a guide recently created to help stakeholders develop and assess mobile health apps. Methods To conduct a validation process of the MAG, we used the Delphi method to reach a consensus among participating stakeholders. We identified 158 potential participants: 45 patients as potential end users, 41 health care professionals, and 72 developers. We sent participants an online survey and asked them to rate how important they considered each item in the guide to be on a scale from 0 to 10. Two rounds were enough to reach consensus. Results In the first round, almost one-third (n=42) of those invited participated, and half of those (n=24) also participated in the second round. Most items in the guide were found to be important to a quality mHealth-related app; a total of 48 criteria were established as important. “Privacy,” “security,” and “usability” were the categories that included most of the important criteria. Conclusions The data supports the validity of the MAG. In addition, the findings identified the criteria that stakeholders consider to be most important. The MAG will help advance the field by providing developers, health care professionals, and end users with a valid guide so that they can develop and identify mHealth-related apps that are of quality.
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Affiliation(s)
- Pere Llorens-Vernet
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Tarragona, Spain
| | - Jordi Miró
- Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Tarragona, Spain
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Pate JW, Hancock MJ, Hush JM, Gray K, Pounder M, Pacey V. Prognostic factors for pain and functional disability in children and adolescents with persisting pain: A systematic review and meta-analysis. Eur J Pain 2020; 24:722-741. [PMID: 31997486 DOI: 10.1002/ejp.1539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to investigate prognostic factors for pain and functional disability in children and/or adolescents with persisting pain. DATABASES AND DATA TREATMENT To be included, studies had to be published, peer-reviewed prospective cohort studies of children and/or adolescents with persisting pain at baseline, that reported at least one baseline prognostic factor and its relationship with pain or functional disability at least 1 month after baseline. Two reviewers independently assessed study eligibility, completed data extraction and undertook quality assessment. Meta-analyses were performed when a prognostic factor was reported in two or more studies. RESULTS Of 10,992 studies identified from electronic database searches, 18 were included, investigating 62 potential prognostic factors. In clinical settings, insufficient data were available for meta-analysis. Some positive associations with pain and/or disability were reported by single studies for older age, baseline pain intensity and baseline functional disability across multiple combinations of follow-up times and outcomes. In community settings, meta-analyses of two studies found that prognostic factors for the ongoing presence of pain at medium-term (1-year) follow-up were older age (OR 1.25; 95% CI = 1.05-1.47), weekly day tiredness (OR 1.69; 95% CI = 1.14-2.51), weekly abdominal pain (OR 1.44; 95% CI = 1.03-2.02) and waking during the night (OR 1.49; 95% CI = 1.05-2.13). No studies in community settings reported on prognostic factors for functional disability. CONCLUSIONS Prognostic factors having significant associations with future pain and disability were identified; however, as few were investigated in more than one comparable study, the results need to be interpreted with caution. SIGNIFICANCE Prognostic factors from across the biopsychosocial spectrum are important to consider in paediatric pain clinical practice. However, most prognostic factors that experts have previously agreed upon have not been assessed in prospective cohort studies to date. The findings may help with prioritising data to collect during clinical assessments of children presenting with pain, in the context of pain and functional disability outcomes.
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Affiliation(s)
- Joshua W Pate
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Mark J Hancock
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Julia M Hush
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Kelly Gray
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Meg Pounder
- Department of Pain Medicine, The Children's Hospital, Westmead, New South Wales, Australia
| | - Verity Pacey
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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15
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Castarlenas E, Solé E, Galán S, Racine M, Jensen MP, Miró J. Construct Validity and Internal Consistency of the Catalan Version of the Pain Self-Efficacy Questionnaire in Young People With Chronic Pain. Eval Health Prof 2018; 43:213-221. [DOI: 10.1177/0163278718820410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to evaluate the construct validity and reliability of the Catalan version of the Pain Self-Efficacy Questionnaire (PSEQ) in a sample of young people with chronic pain. Two hundred twenty-seven young people with chronic pain (age range = 12–24 years, mean age = 17.87 years, SD = 3.08 years) participated in this study. The findings support a one-factor structure of the PSEQ, and the scale demonstrated excellent internal consistency reliability in our sample. In addition, convergent validity was supported by a loading of average variance extracted (AVE) greater than .50, and discriminant validity was supported by the finding that self-efficacy and pain-related anxiety AVEs were greater than the shared variance between both constructs. Further support for the measure’s construct validity was shown by (1) significant and positive associations between PSEQ scores and adaptive coping strategies and (2) negative and significant associations between PSEQ scores and maladaptive coping strategies and catastrophizing thoughts. The results of this study indicate that the Catalan version of the PSEQ is reliable and valid when used to assess pain self-efficacy beliefs in young people with chronic pain.
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Affiliation(s)
- Elena Castarlenas
- Unit for the Study and Treatment of Pain—ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Unit for the Study and Treatment of Pain—ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Santiago Galán
- Unit for the Study and Treatment of Pain—ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - Mélanie Racine
- Department of Clinical and Neurological Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jordi Miró
- Unit for the Study and Treatment of Pain—ALGOS, Universitat Rovira i Virgili, Catalonia, Spain
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, Universitat Rovira i Virgili, Catalonia, Spain
- Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
- Universitat Rovira i Virgili-Fudación Grünenthal, Catalonia, Spain
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16
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Miró J, Solé E, Gertz K, Jensen MP, Engel JM. Pain Beliefs and Quality of Life in Young People With Disabilities and Bothersome Pain. Clin J Pain 2017; 33:998-1005. [PMID: 28118258 PMCID: PMC5522362 DOI: 10.1097/ajp.0000000000000482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Pain beliefs have been hypothesized to play an important role in pediatric pain. However, research examining the associations between pain-related beliefs and measures of function in youths with disabilities is limited. METHODS In total, 84 youths (mean age, 14.26 y; SD, 3.27) with physical disabilities who indicated they also had bothersome pain were interviewed and asked to rate their average pain intensity in the past week and to complete measures of pain-related beliefs and health-related quality of life. RESULTS A number of pain beliefs were associated with different physical and psychosocial function domains, although different beliefs appeared to play different roles, depending on the function domain examined. Across all of the health-related quality-of-life domains studied, a belief that pain is influenced by one's emotions was associated with lower levels of function. No differences were found in pain beliefs related to age. In addition, a small difference in pain beliefs was found for sex; specifically, girls were more likely than boys to endorse the belief that pain is influenced by emotions. DISCUSSION The findings provide new information regarding the role that pain beliefs have in predicting function and have important clinical implications regarding how youth with physical disabilities and pain might be most effectively treated.
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Affiliation(s)
- Jordi Miró
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain - ALGOS
- Research Center for Behavior Assessment (CRAMC), Department of Psychology
- Institut d’Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Ester Solé
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain - ALGOS
- Research Center for Behavior Assessment (CRAMC), Department of Psychology
- Institut d’Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili, Catalonia, Spain
| | - Kevin Gertz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Joyce M. Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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17
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Stinson J, Connelly M, Kamper SJ, Herlin T, Toupin April K. Models of Care for addressing chronic musculoskeletal pain and health in children and adolescents. Best Pract Res Clin Rheumatol 2017; 30:468-482. [PMID: 27886942 DOI: 10.1016/j.berh.2016.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/03/2016] [Accepted: 08/08/2016] [Indexed: 12/22/2022]
Abstract
Chronic musculoskeletal pain among children and adolescents is common and can negatively affect quality of life. It also represents a high burden on the health system. Effective models of care for addressing the prevention and management of pediatric musculoskeletal pain are imperative. This chapter will address the following key questions: (1) Why are pediatric-specific models of pain care needed? (2) What is the burden of chronic musculoskeletal pain among children and adolescents? (3) What are the best practice approaches for early identification and prevention of chronic musculoskeletal pain in children and adolescents? (4) What are the recommended strategies for clinical management of chronic pain, including pharmacological, physical, psychological and complementary, and alternative approaches? (5) What are the most effective strategies for implementing models of pain care across different care settings? (6) What are the research priorities to improve models of care for children and adolescents with chronic musculoskeletal pain?
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Affiliation(s)
- Jennifer Stinson
- The Hospital for Sick Children, Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 069715, Toronto, ON, M5G 0A4, Canada.
| | - Mark Connelly
- Division of Developmental and Behavioral Sciences, The Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA.
| | - Steven J Kamper
- The George Institute, University of Sydney, PO Box M201 Missenden Rd, Camperdown, NSW 2050 Australia.
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200 Aarhus N, Denmark.
| | - Karine Toupin April
- Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, 401 Smyth Road Ottawa, Ontario, K1H 8L1, Canada.
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18
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Developing measures of food and nutrition security within an Australian context. Public Health Nutr 2017; 20:2513-2522. [DOI: 10.1017/s1368980017001288] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo develop a measure of food and nutrition security for use among an Australian population that measures all pillars of food security and to establish its content validity.DesignThe study consisted of two phases. Phase 1 involved focus groups with experts working in the area of food security. Data were assessed using content analysis and results informed the development of a draft tool. Phase 2 consisted of a series of three online surveys using the Delphi technique. Findings from each survey were used to establish content validity and progressively modify the tool until consensus was reached for all items.SettingAustralia.SubjectsPhase 1 focus groups involved twenty-five experts working in the field of food security, who were attending the Dietitians Association of Australia National Conference, 2013. Phase 2 included twenty-five experts working in food security, who were recruited via email.ResultsFindings from Phase 1 supported the need for an Australian-specific tool and highlighted the failure of current tools to measure across all pillars of food security. Participants encouraged the inclusion of items to measure barriers to food acquisition and the previous single item to enable comparisons with previous data. Phase 2 findings informed the selection and modification of items for inclusion in the final tool.ConclusionsThe results led to the development of a draft tool to measure food and nutrition security, and supported its content validity. Further research is needed to validate the tool among the Australian population and to establish inter- and intra-rater reliability.
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Stoner A, Jastrowski Mano K, Weisman S, Hainsworth K. Obesity impedes functional improvement in youth with chronic pain: An initial investigation. Eur J Pain 2017; 21:1495-1504. [DOI: 10.1002/ejp.1051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - S.J. Weisman
- Medical College of Wisconsin/Children's Hospital of Wisconsin; Milwaukee USA
| | - K.R. Hainsworth
- Medical College of Wisconsin/Children's Hospital of Wisconsin; Milwaukee USA
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20
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Robertson S, Kremer P, Aisbett B, Tran J, Cerin E. Consensus on measurement properties and feasibility of performance tests for the exercise and sport sciences: a Delphi study. SPORTS MEDICINE-OPEN 2017; 3:2. [PMID: 28054257 PMCID: PMC5215201 DOI: 10.1186/s40798-016-0071-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/13/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Performance tests are used for multiple purposes in exercise and sport science. Ensuring that a test displays an appropriate level of measurement properties for use within a population is important to ensure confidence in test findings. The aim of this study was to obtain subject matter expert consensus on the measurement and feasibility properties that should be considered for performance tests used in the exercise and sport sciences and how these should be defined. This information was used to develop a checklist for broader dissemination. METHODS A two-round Delphi study was undertaken including 33 exercise scientists, academics and sport scientists. Participants were asked to rate the importance of a range of measurement properties relevant to performance tests in exercise and sport science. Responses were obtained in binary and Likert-scale formats, with consensus defined as achieving 67% agreement on each question. RESULTS Consensus was reached on definitions and terminology for all items. Ten level 1 items (those that achieved consensus on all four questions) and nine level 2 items (those achieving consensus on ≥2 questions) were included. Both levels were included in the final checklist. CONCLUSIONS The checklist developed from this study can be used to inform decision-making and test selection for practitioners and researchers in the exercise and sport sciences. This can facilitate knowledge sharing and performance comparisons across sub-disciplines, thereby improving existing field practice and research methodological quality.
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Affiliation(s)
- Sam Robertson
- Centre for Exercise and Sport Science, Deakin University, Geelong, Victoria, Australia. .,Institute of Sport Exercise and Active Living (ISEAL), Victoria University, Footscray Park campus, PO Box 14428, Melbourne, Victoria, 8001, Australia.
| | - Peter Kremer
- Centre for Exercise and Sport Science, Deakin University, Geelong, Victoria, Australia
| | - Brad Aisbett
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia
| | - Jacqueline Tran
- Centre for Exercise and Sport Science, Deakin University, Geelong, Victoria, Australia
| | - Ester Cerin
- Centre for Physical Activity and Nutrition Research, Deakin University, Burwood, Victoria, Australia.,School of Public Health, The University of Hong Kong, Hong Kong, China
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21
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Miró J, Castarlenas E, de la Vega R, Roy R, Solé E, Tomé-Pires C, Jensen MP. Psychological Neuromodulatory Treatments for Young People with Chronic Pain. CHILDREN (BASEL, SWITZERLAND) 2016; 3:E41. [PMID: 27929419 PMCID: PMC5184816 DOI: 10.3390/children3040041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/15/2016] [Accepted: 11/30/2016] [Indexed: 01/02/2023]
Abstract
The treatment of young people with chronic pain is a complex endeavor. Many of these youth do not obtain adequate relief from available interventions. Psychological neuromodulatory treatments have been shown to have potential benefit for adults with chronic pain. Here, we review and summarize the available information about the efficacy of three promising psychological neuromodulatory treatments-neurofeedback, meditation and hypnosis-when provided to young people with chronic pain. A total of 16 articles were identified and reviewed. The findings from these studies show that hypnotic treatments are effective in reducing pain intensity for a variety of pediatric chronic pain problems, although research suggests variability in outcomes as a function of the specific pain problem treated. There are too few studies evaluating the efficacy of neurofeedback or meditation training in young people with chronic pain to draw firm conclusions regarding their efficacy. However, preliminary data indicate that these treatments could potentially have positive effects on a variety of outcomes (e.g., pain intensity, frequency of pain episodes, physical and psychological function), at least in the short term. Clinical trials are needed to evaluate the effects of neurofeedback and meditation training, and research is needed to identify the moderators of treatment benefits as well as better understand the mechanisms underlying the efficacy of all three of these treatments. The findings from such research could enhance overall treatment efficacy by: (1) providing an empirical basis for better patient-treatment matching; and (2) identifying specific mechanisms that could be targeted with treatment.
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Affiliation(s)
- Jordi Miró
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Elena Castarlenas
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Rocío de la Vega
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105, USA.
| | - Rubén Roy
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Ester Solé
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Catarina Tomé-Pires
- Chair in Pediatric Pain URV-Fundación Grünenthal, Unit for the Study and Treatment of Pain, ALGOS, 43007 Tarragona, Catalonia, Spain.
- Research Center for Behavior Assessment (CRAMC), Department of Psychology, 43007 Tarragona, Catalonia, Spain.
- Institut d'Investigació Sanitària Pere Virgili, Reus 43202, Catalonia, Spain.
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98105, USA.
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23
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Chronic Abdominal Pain in Children and Adolescents: Parental Threat Perception Plays a Major Role in Seeking Medical Consultations. Pain Res Manag 2016; 2016:3183562. [PMID: 28003776 PMCID: PMC5143725 DOI: 10.1155/2016/3183562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 01/23/2023]
Abstract
Background. Pain symptoms, associated impairment, and parental perception of threat are reported to be predictors of health care utilization (HCU) in childhood chronic abdominal pain (CAP). However, mediating variables and their interrelations have not yet been systematically studied. Objectives. This study aims to identify mediating pathways of influence between child's abdominal pain and the number of pain-related medical visits. Methods. In a multicenter study, we recruited N = 151 parent-child dyads with children aged 6-17 years suffering from CAP. A composite measure of pain symptoms was defined as predictor and the number of pain-related medical visits as outcome variable. This relation was analyzed by serial mediation, including child- and parent-reported impairment and parental threat perception as mediators. Results. Only parental threat perception significantly linked child's pain symptoms to the number of medical visits. Measures of impairment did not have a significant effect. Conclusions. Parental pain-related threat perception is strongly related to health care seeking in childhood CAP. Addressing threat perception might be a fruitful parent-centered approach in clinical practice.
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Castarlenas E, Solé E, Racine M, Sánchez-Rodríguez E, Jensen MP, Miró J. Locus of control and pain: Validity of the Form C of the Multidimensional Health Locus of Control scales when used with adolescents. J Health Psychol 2016; 23:1853-1862. [PMID: 27682338 DOI: 10.1177/1359105316669860] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this study was to examine the factor structure, reliability, and validity of the Form C of the Multidimensional Health Locus of Control scales in adolescents. A confirmatory factor analysis indicated that adequate fit of a four-factor model and the internal consistency of the scales were adequate. Criterion validity of the four scales of the Form C of the Multidimensional Health Locus of Control was also supported by significant correlations with measures of pain-related self-efficacy, anxiety, and coping strategies. The results indicate that the four Form C of the Multidimensional Health Locus of Control scale scores are reliable and valid and therefore support their use to assess pain-related locus of control beliefs in adolescents.
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Abstract
Assessment provides the foundation for diagnosis, selection of treatments, and evaluation of treatment effectiveness for pediatric patients with acute, recurrent, and chronic pain. Extensive research has resulted in the availability of a number of valid, reliable, and recommended tools for assessing children's pain. Yet, evidence suggests children's pain is still not optimally measured or treated. In this article, we provide an overview of pain evaluation for premature neonates to adolescents. The difference between pain assessment and measurement is highlighted; and the key steps to follow are identified. Information about self-report and behavioral pain assessment tools appropriate for children are provided; and factors to be considered when choosing a specific one are outlined. Finally, we preview future approaches to personalized pain medicine in pediatrics that include harnessing the use of potential digital health technologies and genomics.
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Galán S, de la Vega R, Tomé Pires C, Racine M, Solé E, Jensen M, Miró J. What are the needs of adolescents and young adults after a cancer treatment? A Delphi study. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12488] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2016] [Indexed: 01/17/2023]
Affiliation(s)
- S. Galán
- Unit for the Study and Treatment of Pain - ALGOS; Catalonia Spain
- Department of Psychology; Research Center for Behavior Assessment (CRAMC); Universitat Rovira i Virgili; Catalonia Spain
- Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
| | - R. de la Vega
- Unit for the Study and Treatment of Pain - ALGOS; Catalonia Spain
- Department of Psychology; Research Center for Behavior Assessment (CRAMC); Universitat Rovira i Virgili; Catalonia Spain
- Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
| | - C. Tomé Pires
- Unit for the Study and Treatment of Pain - ALGOS; Catalonia Spain
- Department of Psychology; Research Center for Behavior Assessment (CRAMC); Universitat Rovira i Virgili; Catalonia Spain
- Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
| | - M. Racine
- Lawson Health Research Institute; London ON Canada
- Beryl & Richard Ivey Rheumatology Day Programs; St. Joseph's Health Care; London ON Canada
- Clinical and Neurological Sciences Department; Schulich School of Medicine & Dentistry; University of Western Ontario; London ON Canada
| | - E. Solé
- Unit for the Study and Treatment of Pain - ALGOS; Catalonia Spain
- Department of Psychology; Research Center for Behavior Assessment (CRAMC); Universitat Rovira i Virgili; Catalonia Spain
- Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
| | - M.P. Jensen
- Department of Rehabilitation Medicine; University of Washington; Seattle WA USA
| | - J. Miró
- Unit for the Study and Treatment of Pain - ALGOS; Catalonia Spain
- Department of Psychology; Research Center for Behavior Assessment (CRAMC); Universitat Rovira i Virgili; Catalonia Spain
- Institut d'Investigació Sanitària Pere Virgili; Universitat Rovira i Virgili; Catalonia Spain
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Sánchez-Rodríguez E, Castarlenas E, de la Vega R, Roset R, Miró J. On the electronic measurement of pain intensity: Can we use different pain intensity scales interchangeably? J Health Psychol 2016; 22:1658-1667. [DOI: 10.1177/1359105316633284] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objective of this work was to study the agreement between four pain intensity scales when administered electronically: the Numerical Rating Scale-11, the Faces Pain Scale-Revised, the Visual Analogue Scale and the Coloured Analogue Scale. In all, 180 schoolchildren between 12 and 19 years old participated in the study. They had to report the maximum intensity of their most frequent pain using the electronic versions of the four scales. Agreement was calculated using the Bland–Altman method. Results show that the electronic versions of Numerical Rating Scale-11, Coloured Analogue Scale and Visual Analogue Scale can be used interchangeably.
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Westendorp T, Verbunt J, Remerie S, de Blécourt A, van Baalen B, Smeets R. Social functioning in adulthood: Understanding long-term outcomes of adolescents with chronic pain/fatigue treated at inpatient rehabilitation programs. Eur J Pain 2016; 20:1121-30. [DOI: 10.1002/ejp.836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/10/2022]
Affiliation(s)
- T. Westendorp
- Rijndam Rehabilitation Center; Rotterdam The Netherlands
- Department of Rehabilitation Medicine; CAPHRI; Maastricht University; Maastricht The Netherlands
| | - J.A. Verbunt
- Department of Rehabilitation Medicine; CAPHRI; Maastricht University; Maastricht The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Department of Rehabilitation Medicine; Maastricht University Medical Center (MUMC+); Maastricht The Netherlands
| | - S.C. Remerie
- Rijndam Rehabilitation Center; Rotterdam The Netherlands
| | - A.C.E. de Blécourt
- Center for Rehabilitation; University Medical Center Groningen; University of Groningen; Groningen The Netherlands
| | - B. van Baalen
- Rijndam Rehabilitation Center; Rotterdam The Netherlands
| | - R.J.E.M. Smeets
- Department of Rehabilitation Medicine; CAPHRI; Maastricht University; Maastricht The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology; Hoensbroek The Netherlands
- Department of Rehabilitation Medicine; Maastricht University Medical Center (MUMC+); Maastricht The Netherlands
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Evans JR, Jastrowski Mano K, Guite JW, Weisman SJ, Hainsworth KR. Psychometric Properties of the Pain Stages of Change Questionnaire: New Insights on the Measurement of Readiness to Change in Adolescents, Mothers, and Fathers. THE JOURNAL OF PAIN 2015; 16:645-56. [PMID: 25863171 DOI: 10.1016/j.jpain.2015.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Revised: 03/13/2015] [Accepted: 03/28/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED There is increasing interest in the measurement of "readiness to change," or willingness to engage in a self-management approach to pain coping, as a predictor of treatment response in pediatric pain populations. The primary aim of the present study was to provide cross-validation of the Pain Stages of Change Questionnaire-Adolescent and -Parent versions in a new, independent pediatric chronic pain sample by examining aspects of reliability, validity, and generalizability of the factor structures identified in the initial validation study. Secondary aims were to 1) expand upon previously identified differences between the Pain Stages of Change Questionnaire-Adolescent and -Parent versions and 2) examine previously unreported aspects of father data. Although slight differences emerged, the factor structures identified in the initial validation were largely replicated, suggesting that the psychometric properties of the measure are robust across pediatric outpatient chronic pain samples. Variability between parent and adolescent reports suggests that there may be meaningful differences in the interpretation of each measure and that factors other than readiness to change may influence response patterns. Findings highlight the need for more fine-tuned analyses of the way the construct operates in youth with pediatric pain and their parents. PERSPECTIVE Findings provide further validation of the Pain Stages of Change Questionnaire-Adolescent and -Parent versions measures in a new outpatient pediatric chronic pain sample. Previously uninvestigated father data showed good reliability and patterns of findings similar to validated mother reports. Moreover, the study suggests that the adolescent and parent versions may function in meaningfully different ways.
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Affiliation(s)
- Jenny R Evans
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
| | - Kristen Jastrowski Mano
- Department of Psychology, McMicken College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Jessica W Guite
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Steven J Weisman
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Keri R Hainsworth
- Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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30
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Miró J, Castarlenas E, de la Vega R, Solé E, Tomé-Pires C, Jensen MP, Engel JM, Racine M. Validity of three rating scales for measuring pain intensity in youths with physical disabilities. Eur J Pain 2015; 20:130-7. [PMID: 25833415 DOI: 10.1002/ejp.704] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is growing evidence confirming that youths with physical disabilities are at risk for chronic pain. Although many scales for assessing pain intensity exist, it is unclear whether they are all equally suitable for youths. The aim of this study was to address this knowledge gap by comparing the validity of the Numerical Rating Scale (NRS-11), the Wong Baker FACES Pain Rating Scale (FACES), and a 6-point categorical Verbal Rating Scale (VRS-6) for assessing pain intensity among youths (aged 8-20) with physical disabilities. METHODS One hundred and thirteen youths (mean age = 14.19 years; SD = 2.9) were interviewed and asked to rate their current pain intensity and recalled (in the past week) worst, least, and average pain with the NRS-11 and the FACES. Participants were also asked to rate their average pain intensity during the past 4 weeks using a VRS-6, and were administered measures assessing pain interference, disability and psychological functioning. RESULTS Analyses showed that all of the pain intensity measures were associated positively with each other. Nevertheless, the NRS-11 appeared to out-perform both the VRS-6 and in particular the FACES scale with respect to: (1) the associations with the validity criterion (i.e. pain interference, disability and psychological functioning) and (2) a lack of any moderating effect of age on the association between the measure and the criterion variables. CONCLUSIONS The findings support the validity of the NRS-11 for assessing pain intensity in youths with physical disabilities between the ages of 8 and 20 years.
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Affiliation(s)
- J Miró
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain.,Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - E Castarlenas
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain.,Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - R de la Vega
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain.,Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - E Solé
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain.,Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - C Tomé-Pires
- Unit for the Study and Treatment of Pain - ALGOS, Universitat Rovira i Virgili, Catalonia, Spain.,Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Catalonia, Spain.,Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Catalonia, Spain
| | - M P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
| | - J M Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, USA
| | - M Racine
- Lawson Health Research Institute, University of Western Ontario, London, Canada.,Beryl & Richard Ivey Rheumatology Day Programs, St. Joseph's Health Care, University of Western Ontario, London, Canada.,Clinical and Neurological Sciences Department, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
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31
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Wager J, Zernikow B, Darlington A, Vocks S, Hechler T. Identifying subgroups of paediatric chronic pain patients: A cluster-analytic approach. Eur J Pain 2014; 18:1352-62. [DOI: 10.1002/j.1532-2149.2014.497.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 01/24/2023]
Affiliation(s)
- J. Wager
- German Paediatric Pain Centre; Children's and Adolescents' Hospital; Datteln Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine; Witten/Herdecke University; Germany
| | - B. Zernikow
- German Paediatric Pain Centre; Children's and Adolescents' Hospital; Datteln Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine; Witten/Herdecke University; Germany
| | - A. Darlington
- Faculty of Health Sciences; University of Southampton; UK
| | - S. Vocks
- Department of Psychology; Clinical Psychology and Psychotherapy; Osnabrück University; Germany
| | - T. Hechler
- German Paediatric Pain Centre; Children's and Adolescents' Hospital; Datteln Germany
- Department of Children's Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine; Witten/Herdecke University; Germany
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32
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Coenders A, Chapman C, Hannaford P, Jaaniste T, Qiu W, Anderson D, Glogauer M, Goodison-Farnsworth E, McCormick M, Champion D. In search of risk factors for chronic pain in adolescents: a case-control study of childhood and parental associations. J Pain Res 2014; 7:175-83. [PMID: 24707186 PMCID: PMC3971911 DOI: 10.2147/jpr.s48154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives This study was designed to investigate whether an individual and parental history of functional pain syndromes (FPS) is found more often in adolescents suffering from chronic pain than in their pain-free peers. Methods Our case–control study involved 101 adolescents aged 10–18 years. Cases were 45 patients of the Chronic Pain Clinic at Sydney Children’s Hospital with diverse chronic pain disorders. Controls consisted of 56 adolescent volunteers who did not have chronic pain. Adolescents and their parents filled out questionnaires assessing demographic data as well as known and potential risk factors for chronic pain. A history of FPS was assessed by questionnaire, including restless legs syndrome (RLS). Chi-squared tests and t-tests were used to investigate univariate associations between chronic pain in adolescents and lifetime prevalence of FPS. Logistic regression was used to test multivariate associations, while controlling for possible confounders. Results Migraine, non-migraine headaches, recurrent abdominal pain (RAP), and RLS were reported significantly more frequently in cases than controls (P-values of 0.01, <0.001, 0.01, and 0.03, respectively). Parental migraine, RAP, and RLS were also significantly associated with adolescent chronic pain in the multivariate analyses. Individual history of migraine, non-migraine headaches, and RAP, along with parental history of RAP and depression significantly accounted for 36%–49% of variance in chronic pain. Other associations with chronic pain were generally in accordance with previous reports. Discussion It may be helpful when assessing a child who has chronic pain or is at risk of chronic pain, to enquire about these associations. Based on the current findings, an individual history of migraine, non-migraine headaches, and RAP, as well as parental migraine, RAP, and RLS are symptoms that are of particular relevance to assess.
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Affiliation(s)
| | - Cindy Chapman
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Tiina Jaaniste
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia ; University of New South Wales, Kensington, NSW, Australia
| | - Wen Qiu
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - David Anderson
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Maline Glogauer
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | | | - Marianne McCormick
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia
| | - David Champion
- Department of Anaesthesia and Pain Medicine, Sydney Children's Hospital, Randwick, NSW, Australia ; University of New South Wales, Kensington, NSW, Australia
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Validation and clinical application of a biopsychosocial model of pain intensity and functional disability in patients with a pediatric chronic pain condition referred to a subspecialty clinic. PAIN RESEARCH AND TREATMENT 2013; 2013:143292. [PMID: 24251035 PMCID: PMC3819919 DOI: 10.1155/2013/143292] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/01/2013] [Indexed: 01/25/2023]
Abstract
Background. Pediatric chronic pain is considered to be a multidimensional construct that includes biological, psychological, and social components. Methods. The 99 enrolled study patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed a series of health-related questionnaires at the time of their initial appointment in a pediatric chronic pain medicine clinic. Results. Significant correlations (r ≥ 0.30, P < 0.05) were observed between pediatric chronic pain intensity and patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, and parent functional disability. Pediatric chronic pain intensity was significantly associated with patient anxiety (P = 0.002). Significant correlations (r ≥ 0.30, P < 0.05) were observed between pediatric functional disability and patient chronic pain intensity, patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, parent functional disability, parent anxiety, parent depression, and parent stress. Pediatric functional disability was significantly associated with patient chronic pain intensity (P = 0.025), patient anxiety (P = 0.021), patient pain coping (P = 0.009), and parent functional disability (P = 0.027). Conclusions. These findings provide empirical support of a multidimensional Biobehavioral Model of Pediatric Pain. However, the practical clinical application of the present findings and much of the similar previously published data may be tenuous.
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Sil S, Lynch-Jordan A, Ting TV, Peugh J, Noll J, Kashikar-Zuck S. Influence of family environment on long-term psychosocial functioning of adolescents with juvenile fibromyalgia. Arthritis Care Res (Hoboken) 2013; 65:903-9. [PMID: 23281206 DOI: 10.1002/acr.21921] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 11/27/2012] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Little is known about the impact of family environment on the long-term adjustment of patients with juvenile-onset fibromyalgia (JFM). Our objective was to evaluate whether family environment in early adolescence predicted later physical functioning and depressive symptoms of adolescents with JFM as they transitioned to early adulthood in the context of a controlled long-term followup study. METHODS Participants consisted of 39 youth (mean age 18.7 years) with JFM and 38 healthy matched controls who completed web-based surveys about their health status (Short Form 36 health survey) and depressive symptoms (Beck Depression Inventory II) ~4 years after a home-based, in-person assessment of child and family functioning. During the initial assessment, parents of the participants (94% mothers) completed the Family Environment Scale and adolescents (mean age 14.8 years) completed self-report questionnaires about pain (visual analog scale) and depressive symptoms (Children's Depression Inventory). RESULTS The results indicated that family environment during early adolescence significantly predicted greater depressive symptoms in early adulthood for both the JFM group and the healthy controls. In particular, a controlling family environment (use of rules to control the family and allowing little independence) during early adolescence was the driving factor in predicting poorer long-term emotional functioning for patients with JFM. Family environment did not significantly predict longer-term physical impairment for either group. CONCLUSION Adolescents with JFM from controlling family environments are at an increased risk for poorer emotional functioning in early adulthood. Behavioral and family interventions should foster independent coping among adolescents with JFM and greater parenting flexibility to enhance successful long-term coping.
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Affiliation(s)
- Soumitri Sil
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Sil S, Kashikar-Zuck S. Understanding why cognitive-behavioral therapy is an effective treatment for adolescents with juvenile fibromyalgia. ACTA ACUST UNITED AC 2013; 8. [PMID: 24416078 DOI: 10.2217/ijr.13.3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Recent studies have demonstrated that cognitive-behavioral therapy (CBT) is an effective treatment for children and adolescents with juvenile fibromyalgia. Unfortunately, the specific psychological changes that occur during treatment that explain why CBT works are not well understood. Historically, the increased use of specific coping strategies learned during CBT was thought to be the primary reason for why CBT was effective. However, evidence to support the notion that increases in adaptive coping directly lead to patient improvement is minimal. Instead, a growing number of studies in adults suggest that CBT results in more global changes of psychological perceptions of the pain itself (cognitive appraisals) and one's ability to manage the pain. This report discusses the role of coping and aspects of cognitive appraisal as potential psychological changes that explain CBT-related improvements for youths with juvenile fibromyalgia.
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Affiliation(s)
- Soumitri Sil
- Division of Behavioral Medicine & Clinical Psychology, Cincinnat Children's Hospital Medical Center, Cincinnat, OH 45229, USA
| | - Susmita Kashikar-Zuck
- Division of Behavioral Medicine & Clinical Psychology, Cincinnat Children's Hospital Medical Center, Cincinnat, OH 45229, USA ; Department of Pediatrics, University of Cincinnat College of Medicine, Cincinnat, OH, USA
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36
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Pediatric fear-avoidance model of chronic pain: foundation, application and future directions. Pain Res Manag 2013; 17:397-405. [PMID: 23248813 DOI: 10.1155/2012/908061] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The fear-avoidance model of chronic musculoskeletal pain has become an increasingly popular conceptualization of the processes and mechanisms through which acute pain can become chronic. Despite rapidly growing interest and research regarding the influence of fear-avoidance constructs on pain-related disability in children and adolescents, there have been no amendments to the model to account for unique aspects of pediatric chronic pain. A comprehensive understanding of the role of fear-avoidance in pediatric chronic pain necessitates understanding of both child⁄adolescent and parent factors implicated in its development and maintenance. The primary purpose of the present article is to propose an empirically-based pediatric fear-avoidance model of chronic pain that accounts for both child⁄adolescent and parent factors as well as their potential interactive effects. To accomplish this goal, the present article will define important fear-avoidance constructs, provide a summary of the general fear-avoidance model and review the growing empirical literature regarding the role of fear-avoidance constructs in pediatric chronic pain. Assessment and treatment options for children with chronic pain will also be described in the context of the proposed pediatric fear-avoidance model of chronic pain. Finally, avenues for future investigation will be proposed.
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37
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Siu YF, Chan S, Wong KM, Wong WS. The Comorbidity of Chronic Pain and Sleep Disturbances in a Community Adolescent Sample: Prevalence and Association with Sociodemographic and Psychosocial Factors. PAIN MEDICINE 2012; 13:1292-303. [DOI: 10.1111/j.1526-4637.2012.01473.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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38
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Stinson JN, Connelly M, Jibb LA, Schanberg LE, Walco G, Spiegel LR, Tse SML, Chalom EC, Chira P, Rapoff M. Developing a standardized approach to the assessment of pain in children and youth presenting to pediatric rheumatology providers: a Delphi survey and consensus conference process followed by feasibility testing. Pediatr Rheumatol Online J 2012; 10:7. [PMID: 22490427 PMCID: PMC3366881 DOI: 10.1186/1546-0096-10-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 04/10/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pain in children with rheumatic conditions such as arthritis is common. However, there is currently no standardized method for the assessment of this pain in children presenting to pediatric rheumatologists. A more consistent and comprehensive approach is needed to effectively assess, treat and monitor pain outcomes in the pediatric rheumatology population. The objectives of this study were to: (a) develop consensus regarding a standardized pain assessment tool for use in pediatric rheumatology practice and (b) test the feasibility of three mediums (paper, laptop, and handheld-based applications) for administration. METHODS In Phase 1, a 2-stage Delphi technique (pediatric rheumatologists and allied professionals) and consensus meeting (pediatric pain and rheumatology experts) were used to develop the self- and proxy-report pain measures. In Phase 2, 24 children aged 4-7 years (and their parents), and 77 youth, aged 8-18 years, with pain, were recruited during routine rheumatology clinic appointments and completed the pain measure using each medium (order randomly assigned). The participant's rheumatologist received a summary report prior to clinical assessment. Satisfaction surveys were completed by all participants. Descriptive statistics were used to describe the participant characteristics using means and standard deviations (for continuous variables) and frequencies and proportions (for categorical variables) RESULTS Completing the measure using the handheld device took significantly longer for youth (M = 5.90 minutes) and parents (M = 7.00 minutes) compared to paper (M = 3.08 and 2.28 minutes respectively p = 0.001) and computer (M = 3.40 and 4.00 minutes respectively; p < 0.001). There was no difference in the number of missed responses between mediums for children or parents. For youth, the number of missed responses varied across mediums (p = 0.047) with the greatest number of missed responses occurring with the handheld device. Most children preferred the computer (65%, p = 0.008) and youth reported no preference between mediums (p = 0.307). Most physicians (60%) would recommend the computer summary over the paper questionnaire to a colleague. CONCLUSIONS It is clinically feasible to implement a newly developed consensus-driven pain measure in pediatric rheumatology clinics using electronic or paper administration. Computer-based administration was most efficient for most users, but the medium employed in practice may depend on child age and economic and administrative factors.
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Affiliation(s)
- Jennifer N Stinson
- University of Toronto Lawrence S, Bloomberg Faculty of Nursing, 155 College Street, Toronto ON M5T 1P8, Canada.
| | - Mark Connelly
- Children's Mercy Hospitals and Clinics, Pain Management Program, 2401 Gillham Road, Kansas City MO 64108, USA
| | - Lindsay A Jibb
- University of Toronto Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Toronto ON M5T 1P8, Canada
| | - Laura E Schanberg
- Duke Medical Center, Department of Pediatrics, DUMC 3212, Durham NC 27710, USA
| | - Gary Walco
- Seattle Children's Hospital, Department of Anesthesia and Pain Medicine, 4800 Sand Point, Way NE Seattle WA 98105, USA
| | - Lynn R Spiegel
- University of Toronto, Department of Pediatrics, 1 King's College Circle, Toronto ON M5S 1A8, Canada,The Hospital for Sick Children, Department of Pediatrics, 555 University Avenue, Toronto ON M5G 1X8, Canada
| | - Shirley ML Tse
- University of Toronto, Department of Pediatrics, 1 King's College Circle, Toronto ON M5S 1A8, Canada,The Hospital for Sick Children, Department of Pediatrics, 555 University Avenue, Toronto ON M5G 1X8, Canada
| | - Elizabeth C Chalom
- Saint Barnabas Medical Center, Department of Pediatrics, 94 Old Shore Hills Road, Livingston NJ 07039, USA
| | - Peter Chira
- Indiana University School of Medicine, Department of Pediatrics, 705 Riley Hospital Drive, Indianapolis IN 46202, USA
| | - Michael Rapoff
- University of Kansas Medical Center, Department of Pediatrics, 3901 Rainbow Boulevard, Kansas City KS 66160, USA
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Young people making sense of pain: Cognitive appraisal, function, and pain in 8-16 year old children. Eur J Pain 2012; 13:751-9. [DOI: 10.1016/j.ejpain.2008.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 07/07/2008] [Accepted: 07/27/2008] [Indexed: 11/21/2022]
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40
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Huguet A, McGrath PJ, Pardos J. Development and Preliminary Testing of a Scale to Assess Pain-Related Fear in Children and Adolescents. THE JOURNAL OF PAIN 2011; 12:840-8. [DOI: 10.1016/j.jpain.2011.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 12/29/2010] [Accepted: 01/19/2011] [Indexed: 11/16/2022]
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Vergouw D, Heymans MW, de Vet HCW, van der Windt DAWM, van der Horst HE. Prediction of persistent shoulder pain in general practice: comparing clinical consensus from a Delphi procedure with a statistical scoring system. BMC FAMILY PRACTICE 2011; 12:63. [PMID: 21718463 PMCID: PMC3141514 DOI: 10.1186/1471-2296-12-63] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 06/30/2011] [Indexed: 11/24/2022]
Abstract
Background In prognostic research, prediction rules are generally statistically derived. However the composition and performance of these statistical models may strongly depend on the characteristics of the derivation sample. The purpose of this study was to establish consensus among clinicians and experts on key predictors for persistent shoulder pain three months after initial consultation in primary care and assess the predictive performance of a model based on clinical expertise compared to a statistically derived model. Methods A Delphi poll involving 3 rounds of data collection was used to reach consensus among health care professionals involved in the assessment and management of shoulder pain. Results Predictors selected by the expert panel were: symptom duration, pain catastrophizing, symptom history, fear-avoidance beliefs, coexisting neck pain, severity of shoulder disability, multisite pain, age, shoulder pain intensity and illness perceptions. When tested in a sample of 587 primary care patients consulting with shoulder pain the predictive performance of the two prognostic models based on clinical expertise were lower compared to that of a statistically derived model (Area Under the Curve, AUC, expert-based dichotomous predictors 0.656, expert-based continuous predictors 0.679 vs. 0.702 statistical model). Conclusions The three models were different in terms of composition, but all confirmed the prognostic importance of symptom duration, baseline level of shoulder disability and multisite pain. External validation in other populations of shoulder pain patients should confirm whether statistically derived models indeed perform better compared to models based on clinical expertise.
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Affiliation(s)
- David Vergouw
- Institute for Research in Extramural Medicine, VU University Medical Center Amsterdam, The Netherlands.
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42
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Tooyserkani MA, Besharat MA, Koochi S. The Moderating Role of Positive and Negative Affects on the Relationship Between Alexithymia and Experience of Pain in Chronic Pain Patients. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.sbspro.2011.10.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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Tremblay I, Sullivan MJL. Attachment and pain outcomes in adolescents: the mediating role of pain catastrophizing and anxiety. THE JOURNAL OF PAIN 2009; 11:160-71. [PMID: 19853522 DOI: 10.1016/j.jpain.2009.06.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2008] [Revised: 06/22/2009] [Accepted: 06/30/2009] [Indexed: 11/17/2022]
Abstract
UNLABELLED This study examined the relations between attachment styles and pain severity/depression in adolescents. Analyses examined whether anxiety and the 3 dimensions of pain catastrophizing mediated the associations between attachment styles, pain severity and depression. A total of 382 high-school students completed questionnaires assessing attachment styles, catastrophizing, depression, anxiety and, for those who reported pain during the last month, pain severity. Results revealed that secure attachment was associated with lower levels of pain severity, depression, pain catastrophizing and anxiety. Preoccupied and fearful attachment styles were associated with heightened pain severity, depression, pain catastrophizing and anxiety. Dismissing attachment style was only associated with high levels of depression and anxiety. Regression analyses revealed that anxiety and the helplessness dimension of pain catastrophizing mediated the relations between secure, preoccupied and fearful attachment styles and pain severity. Moreover, anxiety and the rumination dimension of pain catastrophizing mediated the relation between secure, preoccupied and fearful attachment styles and depression. These findings suggest that anxiety, pain catastrophizing and attachment styles are related processes but nevertheless make independent contributions to the prediction of pain severity and depression. In addition, these findings suggest that attachment styles and cognitive-affective factors might increase the risk of problematic outcomes in adolescents with pain conditions. Theoretical and clinical implications of these results are discussed. PERSPECTIVE The results of this study revealed that anxiety and the helplessness dimension of pain catastrophizing mediated the relation between attachment and pain severity whereas anxiety and rumination mediated the relation between attachment and depression. Attachment style and cognitive-affective factors might increase vulnerability for problematic pain outcomes in adolescents.
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Affiliation(s)
- Isabelle Tremblay
- Department of Psychology University of Montreal, Montreal, Quebec, Canada
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Hechler T, Dobe M, Zernikow B. Commentary: A worldwide call for multimodal inpatient treatment for children and adolescents suffering from chronic pain and pain-related disability. J Pediatr Psychol 2009; 35:138-40. [PMID: 19684118 DOI: 10.1093/jpepsy/jsp066] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Tanja Hechler
- Vodafone Foundation Institute and Chair of Children's Pain Therapy and Palliative Care, Children's and Adolescents' Hospital Datteln/Witten/Herdecke University, Dr.-Friedrich-Steiner-Str. 5, 45711 Datteln, Germany.
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Cebrián J, Sánchez P. [Pediatric complex regional pain syndrome affecting an upper limb: 7 cases and a brief review of the literature]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:163-169. [PMID: 19408782 DOI: 10.1016/s0034-9356(09)70358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To review the clinical, psychiatric, and social characteristics of complex regional pain syndrome in children and adolescents treated in the last 4 years at our pediatric pain clinic. MATERIAL AND METHODS We analyzed the specialty of the initial treating physician, age, sex, initial diagnosis, pain intensity, degree of disability, fear of movement, clinical stage, history of trauma, time between onset and diagnosis, psychiatric illness, family support and behavior, chronic pain in near relatives, school grades and attendance, treatment given at the pediatric pain clinic, recurrences, and course of disease. RESULTS The cases of 7 patients (4 female, 3 male) between the ages of 8 and 15 years were analyzed. Four had been referred by the child psychiatry department. The initial diagnosis was erroneous in all but 1 case. Pain intensity and associated disability were severe in 5 patients and 4 expressed intense fear of moving the limb. Five patients had initial stage I disease, 5 had a history of trauma, and 5 had been previously treated by immobilization of the limb and prescription of nonsteroidal anti-inflammatory drugs. The time between onset and diagnosis ranged from 2 to 18 months (mean [SD], 6.4 [3.5] months). In most cases psychiatric disease and concomitant social disability were present. Treatment prescribed at the pediatric pain clinic consisted of a combination of oral medication, psychologic and psychiatric counseling, and intensive physiotherapy for all but 2 children, who required regional nerve blocks. CONCLUSION The clinical course was satisfactory for all but 1 patient, who developed severe disability. Complex regional pain syndrome affecting an upper limb is uncommon in children but not rare.
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Affiliation(s)
- J Cebrián
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Infantil, Hospital General Universitario Gregorio Marañón, Madrid.
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Wicksell RK, Melin L, Lekander M, Olsson GL. Evaluating the effectiveness of exposure and acceptance strategies to improve functioning and quality of life in longstanding pediatric pain – A randomized controlled trial. Pain 2009; 141:248-257. [DOI: 10.1016/j.pain.2008.11.006] [Citation(s) in RCA: 218] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 10/31/2008] [Accepted: 11/10/2008] [Indexed: 10/21/2022]
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