The interplay of pain-related self-efficacy and fear on functional outcomes among youth with headache

Hallmarks of primary headache: part 1 - migraine

BACKGROUND AND AIM

Migraine is a common disabling conditions which, globally, affects 15.2% of the population. It is the second cause of health loss in terms of years lived with disability, the first among women. Despite being so common, it is poorly recognised and too often undertreated. Specialty centres and neurologists with specific expertise on headache disorders have the knowledge to provide specific care: however, those who do not regularly treat patients with migraine will benefit from a synopsis on the most relevant and updated information about this condition. This paper presents a comprehensive view on the hallmarks of migraine, from genetics and diagnostic markers, up to treatments and societal impact, and reports the elements that identify migraine specific features.

MAIN RESULTS

The most relevant hallmark of migraine is that it has common and individual features together. Besides the known clinical manifestations, migraine presentation is heterogeneous with regard to frequency of attacks, presence of aura, response to therapy, associated comorbidities or other symptoms, which likely reflect migraine heterogeneous genetic and molecular basis. The amount of therapies for acute and for prophylactic treatment is really wide, and one of the difficulties is with finding the best treatment for the single patient. In addition to this, patients carry out different daily life activities, and might show lifestyle habits which are not entirely adequate to manage migraine day by day. Education will be more and more important as a strategy of brain health promotion, because this will enable reducing the amount of subjects needing specialty care, thus leaving it to those who require it in reason of refractory condition or presence of comorbidities.

CONCLUSIONS

Recognizing the hallmarks of migraine and the features of single patients enables prescribing specific pharmacological and non-pharmacological treatments. Medical research on headaches today particularly suffers from the syndrome of single-disease approach, but it is important to have a cross-sectional and joint vision with other close specialties, in order to treat our patients with a comprehensive approach that a heterogeneous condition like migraine requires.

Relationship between Self-Efficacy and Headache Impact, Anxiety, and Physical Activity Levels in Patients with Chronic Tension-Type Headache: An Observational Study

Background

Chronic tension-type headache is the primary headache with the highest prevalence. The present study is aimed at analyzing the associations between patient self-efficacy and headache impact with pain characteristics, kinesiophobia, anxiety sensitivity, and physical activity levels in subjects with chronic tension-type headache.

Materials and Methods

An observational descriptive study was carried out. A total sample of 42 participants was recruited at university environment with diagnosis of tension-type headache. Headache characteristics (frequency, intensity, and duration), physical activity levels, pain related-self-efficacy, kinesiophobia, anxiety sensitivity, and headache impact were measured.

Results

The HIT-6 (61.05 ± 6.38) score showed significant moderate positive correlations with the ASI-3 score (17.64 ± 16.22; r = 0.47) and moderate negative correlations with the self-efficacy in the domains of pain management (31.9 ± 10.28; r = -0.43) and coping with symptoms (53.81 ± 14.19; r = -0.47). ASI-3 score had a negative large correlation with self-efficacy in the domains of pain management (r = -0.59), physical function (53.36 ± 7.99; r = -0.55), and coping with symptoms (r = -0.68). Physical activity levels showed positive moderate correlations with the self-efficacy in the domain of physical function (r = 0.41). Linear regression models determined that the self-efficacy and anxiety sensitivity with showed a significant relationship with the HIT-6 score (R 2 = 0.262; p = 0.008) and with the ASI-3 score (R 2 = 0.565; p < 0.001). In addition, no correlations were found between pain intensity, duration or frecuency with psychosocial factors, or headache impact.

Conclusions

The present study showed that patients with chronic tension-type headache had a great negative impact on daily tasks and physical activity levels, which were associated with higher anxiety levels and lower self-efficacy.

Microtemporal Relationships in the Fear Avoidance Model: An Ecological Momentary Assessment Study

OBJECTIVES

Current literature in pediatric pain evaluates the Fear-Avoidance Model pathways at the trait (or macrotemporal) level, but it is unknown if these pathways also occur at the state (or microtemporal) level. Identifying microtemporal processes can improve our understanding of how the relationships within the Fear-Avoidance constructs vary when specific Fear-Avoidance variables wax and wane. We hypothesized that changes in FAM constructs would be associated with changes in the next variable in the sequence on a microtemporal level, including: (1) higher pain when there is more pain related fear, (2) higher pain-related fear when there is more avoidance, and (3) higher avoidance when there is more reported disability.

METHODS

71 pediatric patients with chronic abdominal pain (M=13.34 y, SD=2.67 y) reported pain severity, pain-related fear, and avoidance via ecological momentary assessments over 14 days.

RESULTS

Our results indicated significant microtemporal relationships between Fear-Avoidance constructs for pain predicting pain related fear, pain-related fear predicting avoidance, and avoidance predicting disability.

DISCUSSION

The current study suggests that the ways in which the FAM is related to various aspects of pain functioning differs on a state-level, which adds new clinical and research opportunities.

Brazilian version of headache management self-efficacy scale

Background Headache-management self-efficacy has been associated with pain severity and headache-related disability. Objective The aim of this study was to test the cross-cultural adaptation and psychometric properties of a Brazilian version of the Headache Management Self-Efficacy Scale (HMSE) in a sample of patients coming from three tertiary headache centers in Brazil. Methods 137 migraine outpatients completed the Headache Management Self-Efficacy Scale (HMSE) and measures of psychopathological symptoms, pain catastrophizing, depression, anxiety, quality of life and headache-related disability. Results HMSE-10 showed good reliability (α = 0.84) and adequate corrected item-total correlation, ranging from 0.46 to 0.64. HMSE-10 was positively correlated with 6 of 8 domains of overall health status and negatively correlated with psychopathological symptoms, depression, anxiety, pain catastrophizing, headache-related disability, headache frequency and headache intensity. The difference between the means of the episodic and chronic headache patients had a magnitude of moderate effect in all the study measures, being headache-related disability the largest one found (d = 0.68). Along with headache intensity and depression, Efficacy Scale beliefs were predictors of headache-related disability. Conclusions The Brazilian short version of Headache Management Self-Efficacy Scale (HMSE-10) was revealed as a valid and reliable measure of headache-specific Efficacy Scale beliefs.

Associations between pain, self-efficacy, sleep duration, and symptoms of depression in adolescents: a cross-sectional survey

Background

Although pain has been identified as an important public health problem among adolescents, few studies have investigated possible protective and risk factors for pain. The main aim of the present study was to investigate associations between prevalence of daily pain, self-efficacy, sleep duration, and symptoms of depression in a representative sample of Norwegian adolescents.

Methods

A comprehensive cross-sectional survey was completed by 12,867 junior high school students and high school students (response rate: 90%) aged 14–19 years. Logistic regression models were adjusted for age, gender, and parental educational level.

Results

We found a high prevalence of daily pain among adolescents, especially among girls (19%) compared with boys (7%). Short sleep duration was associated with increased odds ratios (ORs) of pain in the shoulders/neck (OR 1.3; 95% CI 1.3–2.0) and stomach (1.7; 1.2–2.4). Symptoms of depression were associated with increased ORs for all measured types of daily pain, including head (3.7; 3.0–4.6), shoulders/neck (3.9; 3.1–4.8), joints/muscles (4.3; 3.3–5.6), and stomach (5.5; 4.1–7.4). By contrast, self-efficacy was not associated with any form of daily pain.

Conclusion

Given the burden of pain, high incidence of pain problems, and strong association between pain and depression and, to some degree, short sleep duration, co-occurring symptoms may be an important area for research in the public health field. The results highlight the importance of early identification and prevention. Longitudinal studies are needed to understand better pain problems and their underlying mechanisms with the aim of developing targeted interventions.

Health-related quality of life in youth with abdominal pain: An examination of optimism and pain self-efficacy

OBJECTIVES

Abdominal pain adversely impacts children with functional gastrointestinal disorders (FGIDs) or organic gastrointestinal disorders (OGIDs); findings are inconsistent regarding diagnosis and health-related quality of life (HRQoL). This study utilizes a positive psychology framework to understand the experience of youth with abdominal pain (i.e., do positive psychological factors, such as optimism and pain self-efficacy, relate to higher HRQoL?). Consistent with a protective factor model of resilience, in which personal assets may serve as buffers between risk factors and negative outcomes, optimism and pain self-efficacy were examined as they relate to HRQoL in youth with abdominal pain. Specifically, exploratory moderational analyses examined a) if optimism and pain self-efficacy moderate the relation between pain and HRQoL, and b) whether diagnostic status moderated the relation between optimism/pain self-efficacy and HRQoL.

METHODS

In a cross-sectional, observational study, youth (n = 98; M_age = 13, SD = 3) experiencing abdominal pain related to FGIDs or OGIDs and one of their parents participated. Measures included pain intensity, optimism, pain self-efficacy, and HRQoL. Analyses controlled for diagnosis, age, and gender.

RESULTS

Higher pain and age related to lower HRQoL. Higher levels of optimism and pain self-efficacy associated with HRQoL beyond demographics. Optimism and pain self-efficacy did not moderate the relation between pain and HRQoL. Diagnostic status did not moderate the relation between optimism or pain self-efficacy and HRQoL.

DISCUSSION

Our results suggest positive relations between positive psychological factors (optimism, pain self-efficacy) and HRQoL in youth with abdominal pain. Such factors could be further examined in intervention studies.

Resilience and vulnerability in adolescents with primary headaches: A cross-sectional population-based study

BACKGROUND

A scarcity of studies on the role of resilience resources (RRs) and vulnerability risk (VR) in children and adolescents with primary headache hampers the development of a risk-resilience model for pediatric headaches.

OBJECTIVE

To examine the extent to which headache frequency and diagnosis are associated with RRs and VR and explore possible predictors of low RRs and high VR in a cross-sectional population-based study in adolescents.

METHODS

This is a cross-sectional population study conducted in a small city in Brazil (Delfinópolis). Consents and analyzable data were obtained from 339/378 adolescents (89.7%). RRs and VR were assessed using the validated Brazilian version of the Resiliency Scales for Children and Adolescents, completed by the adolescents. Parents filled a structured questionnaire assessing sociodemographic and headache characteristics, as well as the Brazilian-validated version of the Strengths and Difficulties Questionnaire added to the impact supplement to evaluate the adolescent's psychosocial adjustment skills. Teachers completed a structured questionnaire about the students' school performance.

RESULTS

A higher frequency of headache was associated with lower RRs (F_3,335  = 2.99, p = 0.031) and higher VR (F_3,335  = 4.05, p = 0.007). Headache diagnosis did not significantly influence the risk of having lower RRs or higher VR. In the exploratory analyses, females (OR 3.07; 95% CI: 1.16-9.3) and individuals with psychosocial adjustment problems (OR 7.5; 95% CI: 2.51-22.4) were predictors of low RRs, and prenatal exposure to tobacco (OR 5.6; 95% CI: 1.57-20.9) was a predictor of high VR in adolescents with primary headache.

CONCLUSIONS

The risk of low RRs and high VR was associated with a higher headache frequency, but not with headache diagnosis. These findings may contribute to the development of a risk-resilience model of headaches in the pediatric population and help identify novel targets and develop effective resources for successful interventions.

Risk and Resilience Factors Impacting Treatment Compliance and Functional Impairment among Adolescents Participating in an Outpatient Interdisciplinary Pediatric Chronic Pain Management Program

Recurrent pain is a common experience in childhood and adolescence and can result in significant disability in youth, including poor quality of life, school absences, and reduced social activities. Evidence has linked adolescent risk and resilience factors with treatment outcomes. However, less research has focused on examining risk and resilience factors that may influence or predict adolescents’ compliance to treatment within an interdisciplinary pediatric chronic pain management program. Participants included 64 adolescents (M = 15.00 ± 1.69 years); 85.9% female, 84.4% Caucasian who presented to an initial evaluation in an interdisciplinary pediatric pain management program with their caregiver. Youth completed a series of questionnaires at the initial evaluation targeting pain acceptance, self-efficacy, pain catastrophizing, parental responses, pain intensity, and functional disability. Treatment compliance was measured at 3 and 6 months post-intake. Findings indicated that higher levels of adolescent-reported self-efficacy predict decreased treatment session attendance, whereas lower levels of acceptance and parental encouragement/monitoring of symptoms predict increased treatment compliance overall. Several adolescent-reported risk factors were associated with increased functional impairment among this sample. Results highlight the unique importance of risk and resilience factors within the developmental context of adolescence, while also emphasizing the need for further investigation of other relevant influences towards treatment compliance and functional impairment.

European Portuguese version of the Child Self-Efficacy Scale: A contribution to cultural adaptation, validity and reliability testing in adolescents with chronic musculoskeletal pain

BACKGROUND

Pain Self-efficacy is an important resilience mechanism in adolescents with chronic musculoskeletal pain. The Child Self-Efficacy Scale (CSES) was developed to assess self-efficacy related to functioning despite pain.

OBJECTIVES

This study aimed to cross-culturally adapt the CSES into European Portuguese and to assess its validity and reliability in a sample of adolescents with chronic musculoskeletal pain.

METHODS

The original version of the CSES was translated and pilot tested in line with international guideless. Then, the European Portuguese version was filled in by 1730 adolescents, who also completed the following instruments: Nordic Musculoskeletal Questionnaire; Numeric Pain Rating Scale; Pain Catastrophizing Scale; Depression, Anxiety and Stress Scale; Tampa Scale of Kinesiophobia, and Basic Scale on Insomnia Complaints and Quality of Sleep. Sixty-three of these adolescents, with at least one painful body site, completed the questionnaire twice to assess test-retest reliability and measurement error. Internal consistency was obtained, and hypothesis testing and factor analysis were used to assess validity.

RESULTS

Cronbach's alpha ranged from 0.89 to 0.92, ICC was 0.83 (95%CI: 0.71; 0.89), the SEM and MDD were 2.49 and 6.9, respectively. Fair and moderate to good correlations were found between CSES and catastrophizing (r_s from 0.45 to 0.48), depression, anxiety and stress (r_s from 0.35 to 0.38), fear of movement (r_s from 0.38 to 0.49) and sleep (r_s from 0.20 to 0.29). The factor analysis resulted in 1-factor model.

CONCLUSION

The European Portuguese version of the CSES appears to be valid and reliable in adolescents with chronic musculoskeletal pain.

Development, preliminary validation and reliability testing of SEDA - Self-Efficacy in Daily Activities for children with pain

BACKGROUND

Self-efficacy can affect a child's ability to perform important activities, infuse him/her with a sense of control and is likely an integral target for successful treatment in pediatric pain rehabilitation. Modern physical therapy treatment includes behavioral aspects and valid measures of self-efficacy are important for both research and clinical practice. In this study, the aim was to develop and perform preliminary testing of a self-efficacy scale for children and adolescents with pain.

METHODS

Children and adolescents participated, along with researchers and healthcare staff, in developing the Self-Efficacy in Daily Activities (SEDA) measure. A total of 109 children and adolescents seeking physical therapy treatment for pain lasting longer than 3 months responded to the SEDA. Pain and pain-related disability were assessed using the Functional Disability Inventory (FDI). Exploratory analyzes for testing validity and reliability - principal component analyses (PCA), intraclass correlation coefficients (ICCs) and bivariate correlations - were performed.

RESULTS

The PCA revealed a 16-item SEDA and a three-component scale. The components represented self-efficacy for physical activities, self-efficacy for personal care and self-efficacy for daily exertion. Validity correlation analyses showed moderate association between SEDA and FDI, -0.72 (p < .01), and low correlation with pain intensity, -0.29 (p = .03).

CONCLUSIONS

The 16-item SEDA has satisfactory psychometric properties in children moderately affected by long-term pain. Further validation of the SEDA in other populations and confirmatory analyses are warranted.

The Impact of Sleep on Disability and School Functioning: Results From a Tertiary Pediatric Headache Center

Pediatric headache patients often experience significant sleep disturbance, which may be a risk factor for poor physical, academic, and emotional functioning, including increased anxiety/fear. The current retrospective cohort study of a clinical sample of youth with persistent headache aimed to examine the impact of sleep on functional outcomes and to explore pain-related fear as a mediator of the association between sleep problems and functioning. A total of 109 youth (aged 7-17 years) with persistent headache presenting to a tertiary pediatric headache center (and their parents) completed measures of sleep problems, fear of pain, functional disability, and school functioning at the time of an initial evaluation and 6 months later. After controlling for age and headache frequency and severity, linear regression analyses indicated that increased sleep problems at baseline were associated with increased functional disability and poorer school functioning at baseline (β = 0.28, P = .01; β = -0.42, P < .001, respectively). Poor sleep at baseline was associated with poorer school functioning (but not functional disability) at follow-up (β = -0.25, P = .02). Mediation models demonstrated an indirect mediating effect of pain-related fear on the association between baseline sleep problems and follow-up functional disability (β = 0.06, 95% confidence interval 0.01, 0.15) and between baseline sleep problems and follow-up school functioning (β = -0.06, 95% confidence interval -0.13, -0.004). Sleep disturbance in youth with headache may be a risk factor for poor functional outcomes, both concurrently and over time, and may be explained partially through pain-related fear. Given the frequency with which pediatric headache patients experience co-occurring sleep problems, sleep should be thoroughly assessed and considered as a potential early treatment target.

Health-related quality of life in adolescents with persistent pain and the mediating role of self-efficacy: a cross-sectional study

Background

Persistent pain has a high prevalence among adolescents. Pain has been shown to reduce all aspects of the adolescent’s health-related quality of life (HRQOL). In adult patients with pain, self-efficacy has been shown to mediate the relationship between pain intensity, disability and depression. However, little is known about whether self-efficacy acts as a mediating variable in the relationship between persistent pain and HRQOL sub-scale scores in a school-based population of adolescents.

Objectives

To describe the experience of pain, HRQOL and self-efficacy, and to explore the association between pain intensity, general self-efficacy and HRQOL in adolescents with persistent pain by testing self-efficacy as a possible mediator.

Methods

The study participants were 78 adolescents with persistent pain, aged 16–19 years, who were recruited from five high schools in southern Norway. All participants completed an electronic survey consisting of the Lubeck Pain Questionnaire, which included a visual analogue scale (VAS) measuring pain intensity, the General Self-Efficacy Scale (GSE) and the KIDSCREEN-52 Questionnaire measuring HRQOL. Statistical analyses were conducted using the PROCESS macro for SPSS developed by Andrew Hayes.

Results

All participants reported pain in multiple locations, of which the head was most common (88.5%). Mean (SD) pain intensity score of the participants was 5.4 (1.8). The study sample had poor HRQOL, with mean (SD) scores for several sub-scales ranging from 45.2 (21.0) to 91.0 (13.3) on a 0–100 scale. The associations between pain intensity and the HRQOL sub-scales of physical well-being, psychological well-being, mood, self-perception, autonomy and school environment were mediated by self-efficacy. The highest degree of mediation and, thus, the largest indirect effect was estimated for the HRQOL sub-scale physical well-being (67.2%).

Conclusions

This school-based sample of adolescents with persistent pain had impaired HRQOL. Up to 67% of the reduction in the HRQOL sub-scale scores for physical well-being, psychological well-being, mood, self-perception, autonomy and school environment could be explained by the mediating variable self-efficacy. Thus, future pain-management interventions that aim to increase HRQOL in school-based populations of adolescents with persistent pain should consider promoting self-efficacy and providing more targeted interventions.

Trial registration

ClinicalTrials.gov ID NCT03551977.

Mindfulness and self-efficacy in pain perception, stress and academic performance. The influence of mindfulness on cognitive processes

Purpose

This study seeks to understand the mediating effects of mindfulness on self-efficacy, academic performance and ability to cope with pain. It further examines the effect of mindfulness on the capacity to cope with pain-induced stress. Whilst there are physiological changes which occur due to mindfulness, it is still not clearly understood how the mechanisms behind mindfulness work or whether the role of self-efficacy is an agent of mindfulness which may impact on performance and stress coping.

Participants and methods

A three-part study (n=92) was conducted to test the relationship between mindfulness, self-efficacy and well-being factors, alongside academic performance in university students. Part one involved data collection one month prior to an experiment where trait scores for all factors were used to check pain and well-being behaviors. Part two consisted of participant randomization into three intervention groups (control, sham, mindfulness) and then an exposure to a fear induction task followed by cognitive tasks. The third part consisted of investigating the effect of a short mindfulness intervention on self-efficacy, pain and well-being in students.

Results

The results indicate that self-efficacy had a positive effect on well-being factors (study 1 & 3) and in the experiment (study 2).

Conclusion

Self-efficacy influenced pain intensity and pain unpleasantness and significantly predicted academic performance. Mindfulness had mixed results in how it influenced self-efficacy. While it influenced well-being and lowered stress (study 1 & 2) in the long term, the mindfulness intervention significantly decreased self-efficacy.

Physical therapists' experiences of learning and delivering a complex behavioral medicine intervention to adolescents with pain

The objective was to study physical therapists' (PTs') experiences of learning and delivering a complex intervention, a tailored behavioral medicine treatment (BMT) targeting adolescents with pain in primary care.Method: An explorative study with qualitative approach, using content analysis. Three primary care PTs delivering the treatments in a randomized controlled study were interviewed regarding their views on the BMT.Results: The participating PTs considered learning about and delivering the BMT as challenging but rewarding. The biopsychosocial approach, tailoring of the treatment and dialogues with parents were identified as key aspects of the BMT program. The process of formulating a functional behavioral analysis was perceived as strenuous. The supervision of the PTs throughout the study was regarded as crucial and necessary for learning about and providing tailored BMT.Conclusion: Learning about and delivering BMT targeting adolescents with persistent pain is fruitful but laborious and demanding according to three PTs experienced with treatment of pediatric pain in primary care. Extensive education and long periods of supervision seem to be crucial for success and safe delivery according to protocol.

Fall Prevention Self-Management Among Older Adults: A Systematic Review

CONTEXT

Adequate self-management could minimize the impact of falls in older adults. The efficacy of fall prevention self-management interventions has been widely studied, yet little is known about why some older adults engage in fall prevention self-management actions and behaviors, whereas others do not. Through a systematic review of fall prevention self-management studies, this study identified characteristics and the personal, social, and environmental factors of older adults who engage in self-management actions and behaviors.

EVIDENCE ACQUISITION

Medical and nursing literature related to fall prevention self-management was searched in PubMed, Embase, and CINAHL (1997-2017), and relevant publications were selected by three researchers to assess whether the papers included subject characteristics and their fall prevention self-management actions and behaviors. GRADE (Grading of Recommendations, Assessment, Development and Evaluations) was used by the researchers to assess the quality of the included studies and to determine the significance of the extracted characteristics.

EVIDENCE SYNTHESIS

Searching literature through 2017, a total of 972 papers were identified, and 28 papers remained after removing those that did not meet inclusion criteria. Nine papers that addressed subject characteristics in relation to the study outcomes were included in a sub-analysis. The authors identified the following characteristics of older adults who participated in fall prevention self-management actions and behaviors: younger males, not living alone and with self-reported good health, having greater fear of falling and high fall prevention self-efficacy, and possessing high motivation for engagement with self-management activities.

CONCLUSIONS

The systematic literature review revealed the personal characteristics of older adults who engage in fall prevention self-management actions and behaviors.

Psychosocial and Demographic Characteristics of Children and Adolescents With Headache Presenting for Treatment in a Headache Infusion Center

BACKGROUND

Approximately 10% of pediatric patients have recurrent headaches, with migraine being the most common headache type. If untreated, migraine may progress to status migrainosus, a debilitating condition of prolonged duration, high pain severity, and significant disability. There is high variability in the treatment of status migrainosus including medications used and treatment setting, which may occur in the emergency room, as an inpatient admission, or, less often, in an outpatient infusion center. The paucity of research on the treatment of status migrainosus is a limitation to treatment effectiveness.

OBJECTIVE

The objective of the study was twofold. First, we sought to examine the demographic characteristics of children and adolescents accessing our outpatient infusion center for prolonged headache. Second, we sought to determine whether any demographic or psychosocial differences exist between patients who access infusion therapy compared to patients who do not access infusion therapy for their headaches.

METHODS

We conducted a retrospective chart review of all patients between the ages of 6 and 19 years who were treated in our outpatient headache infusion center. A subset of these patients completed a behavioral health evaluation (treatment group) and they were compared to a control group of similar age (birthdate within 6 months) and gender to patients not seeking infusion treatment. Variables of interest included patient demographics, headache type and characteristics, and scores on the Pediatric Quality of Life Inventory (PedsQL), Functional Disability Inventory (FDI), Pediatric Pain Coping Inventory (PPCI), and the Behavior Assessment System for Children - Second Edition (BASC-2).

RESULTS

A total of 284 patients were included in the study (n = 227 receiving infusion treatment and n = 57 controls). Patients were primarily female (224/286; 78.9%), Caucasian (254/286; 90.1%), and had a mean age of 15 years. Findings suggest a promising difference in the PPCI Distraction subscale, χ² (1) = 3.7, P = .054, with a mean rank score of 61.90 for the treatment group and 50.21 for the control group. Additionally, a statistically significant difference was noted on the Social Support subscale, χ² (1) = 10.6, P = .001, with a mean rank score of 65.92 for the treatment group and 46.26 for the control group. Results also indicated a statistically significant difference in disability scores, χ² (1) = 10.0, P = .002, with a mean rank FDI score of 66.83 for the treatment group and 47.34 for the control group. Patients in the infusion group also reported lower quality of life on the PedsQL Total score (F[1, 109] = 5.0, P = .028; partial η²  = 0.044), and on the Physical (F[1, 109] = 7.9, P = .006; partial η²  = 0.069) and School (F[1, 109] = 4.6, P = .035; partial η²  = 0.041) subscales. No significant differences were found on the BASC-2. Parent reported data also revealed a significantly higher level of disability among patients seeking infusion treatment compared to the non-infusion group χ² (1) = 11.7, P = .001. However, there were no significant differences on the PedsQL, PPCI, or BASC-2.

CONCLUSIONS

Our findings support the disabling nature of migraine among children and adolescents, with higher levels of disability and lower quality of life reported in the group of patients utilizing infusion treatment. Developing concrete treatment plans and goals combined with bio-behavioral therapy are necessary to reduce functional disability and increase quality of life among these patients. Awareness of this patient group's pain-related coping strategies may help health care providers tailor treatment recommendations and develop or refine cognitive-behavioral headache treatment techniques.

Chronic tension-type headache and coping strategies in adolescents: A qualitative interview study

OBJECTIVE

Headache is the most common cause of chronic pain in children and adolescents and may influence on several of the life's arenas such as high absence from school and inability to maintain leisure time activities. Adolescents with chronic headache also report co-morbidities such as anxiety, depression, insomnia, and reduced quality of life. This study aimed to explore which strategies adolescents use to cope with chronic tension-type headache in everyday life.

METHODS

A qualitative design with semistructured individual interviews was used. A strategic sample of 17 adolescents aged 14-19 with tension-type headache participated in the study. The interviews were audiotaped and transcribed verbatim. Transcripts were analysed using systematic text condensation.

RESULTS

To deal with the headache in everyday life, the adolescence expressed that it is important to have a good structure during the day, especially regarding regular meals and enough sleep. Sufficient rest and relaxation were also highlighted as crucial. Some of the adolescence had tried different therapies to help ease the pain but with varying effect. All of the adolescents had used or were using pain relievers, but they were ambivalent to the benefits. Low-intensity physical activity was perceived as beneficial and gave increased overall well-being. Such activity also gave release and distraction from the headache.

CONCLUSION

The adolescents used both problem-focused active strategies and emotion-focused passive strategies to deal with their headache in daily life. Through exploration and awareness of the types of behaviour that worked and did not work, they had arrived at strategies that helped them cope with their headache and its consequences.

Engagement in online pain self-management improves pain in adults on medication-assisted behavioral treatment for opioid use disorders

INTRODUCTION

Persistent pain has been recognized as an important motivator that can lead individuals to misuse opioids. New approaches are needed to test pain treatments that can improve outcomes for people with persistent pain in medication-assisted behavioral treatment for opioid use disorder. This study piloted an online pain self-management program to explore acceptability and treatment effects.

METHODS

A sample of 60 adults diagnosed with chronic non-cancer pain and receiving medication-assisted behavioral treatment at one of two clinics were randomized into either treatment group with access to an online pain management program or waitlist attention control. Participants received online surveys via email at baseline and post-treatment at week 8.

RESULTS

The majority of participants (n = 44; 73%) reported that their first use of opioids was in response to a painful event. Those who engaged in the online program had significantly lower pain interference, pain severity, opioid misuse measures, and depressive symptoms after eight weeks while pain self-efficacy was increased.

CONCLUSION

Our results suggest the online pain self-management program content may be helpful for managing physical and emotional symptoms experienced by individuals with co-occurring pain and opioid use disorders. To improve online engagement, more support is necessary to assist with technology access and completion of online activities.

The ‘work of childhood’: understanding school functioning in youth with chronic pain

School is often cited as the ‘work of childhood’ and serves as an important site for child and adolescent development. Frequent school absences in children and adolescents with chronic pain are well documented; however, variables that may explain school impairment are not understood. The potential consequences of school impairment are extensive, as these children and adolescents are at great risk for achieving poor grades and sometimes require full-time homebound instruction. This, in turn, can have adverse effects on occupational and social functioning well into adulthood. The present review provides a summary of selected studies that have investigated why children and adolescents with chronic pain may experience disruptions in school functioning. A conceptual model of school functioning is presented to summarize factors accumulated to date and to guide future investigations.

Photographs of Daily Activities-Youth English: validating a targeted assessment of worry and anticipated pain

PHODA is an electronic measure that individualizes and guides treatment for individuals with chronic pain. Implicit in its design is recognition that pain-related fear is a driving force that impedes treatment progress. With this tool, patients visually rate their expectations about the harmful consequences of specific movements. This study aimed to (1) develop and validate PHODA-Youth English (PHODA-YE) and (2) evaluate the potential impact of PHODA-YE assessment on treatment outcomes. Participants were 195 youth, age 8 to 20 years, who presented to an outpatient pain clinic for evaluation (n = 99), or enrolled at the Pediatric Pain Rehabilitation Center (PPRC) intensive program (PPRC; n = 96). All patients completed the PHODA-YE along with measures of emotional functioning and disability. Patients in the PPRC completed the measure at both admission and discharge. After eliminating infrequently endorsed and poorly loading items, factor analytic procedures yielded a 4-subscale, 50-item measure with strong internal consistency (from 0.92 to 0.97 across subscales). Fear, avoidance, and functional disability were strongly associated with PHODA-YE scores, supporting construct validity. Within the PPRC sample, PHODA-YE was sensitive to changes over time in relation to functional improvements. Across the PPRC sample, patients found it helpful to complete the PHODA and target feared activities. Altogether, the PHODA-YE is a valid and concrete assessment tool that rapidly identifies specific activities and movements that elicit fearful responses from patients.

How Accurate Appraisal of Behavioral Costs and Benefits Guides Adaptive Pain Coping

Coping with pain is a complex phenomenon encompassing a variety of behavioral responses and a large network of underlying neural circuits. Whether pain coping is adaptive or maladaptive depends on the type of pain (e.g., escapable or inescapable), personal factors (e.g., individual experiences with coping strategies in the past), and situational circumstances. Keeping these factors in mind, costs and benefits of different strategies have to be appraised and will guide behavioral decisions in the face of pain. In this review we present pain coping as an unconscious decision-making process during which accurately evaluated costs and benefits lead to adaptive pain coping behavior. We emphasize the importance of passive coping as an adaptive strategy when dealing with ongoing pain and thus go beyond the common view of passivity as a default state of helplessness. In combination with passive pain coping, we highlight the role of the reward system in reestablishing affective homeostasis and discuss existing evidence on a behavioral and neural level. We further present neural circuits involved in the decision-making process of pain coping when circumstances are ambiguous and, therefore, costs and benefits are difficult to anticipate. Finally, we address the wider implications of this topic by discussing its relevance for chronic pain patients.

Goal Pursuit in Youth with Chronic Pain

Children and adolescents frequently experience chronic pain that can disrupt their usual activities and lead to poor physical and emotional functioning. The fear avoidance model of pain with an emphasis on the maladaptive behaviors that lead to activity avoidance has guided research and clinical practice. However, this model does not take into consideration variability in responses to pain, in particular the active pursuit of goals despite pain. This review aims to introduce a novel conceptualization of children's activity engagement versus avoidance using the framework of goal pursuit. We propose a new model of Goal Pursuit in Pediatric Chronic Pain, which proposes that the child's experience of pain is modified by child factors (e.g., goal salience, motivation/energy, pain-related anxiety/fear, and self-efficacy) and parent factors (e.g., parent expectations for pain, protectiveness behaviors, and parent anxiety), which lead to specific goal pursuit behaviors. Goal pursuit is framed as engagement or avoidance of valued goals when in pain. Next, we recommend that research in youth with chronic pain should be reframed to account for the pursuit of valued goals within the context of pain and suggest directions for future research.

Supporting Teens with Chronic Pain to Obtain High School Credits: Chronic Pain 35 in Alberta

Chronic pain is a significant problem in children and teens, and adolescents with chronic pain often struggle to attend school on a regular basis. We present in this article a novel program we developed that integrates attendance at a group cognitive-behavioural chronic pain self-management program with earning high school credits. We collaborated with Alberta Education in the development of this course, Chronic Pain 35. Adolescents who choose to enroll are invited to demonstrate their scientific knowledge related to pain, understanding of and engagement with treatment homework, and demonstrate their creativity by completing a project, which demonstrates at least one concept. Integrating Chronic Pain 35 into an adolescent’s academic achievements is a creative strategy that facilitates the engagement of adolescents in learning and adopting pain coping techniques. It also helps teens to advocate for themselves in the school environment and improve their parents’ and teachers’ understanding of adolescent chronic pain. This is one of the first successful collaborations between a pediatric health program and provincial education leaders, aimed at integrating learning and obtaining school credit for learning about and engaging in health self-management for teens. The authors hope this paper serves as an effective reference model for any future collaborating programs aimed at supporting teens with chronic pain to obtain high school credits.

Fear of pain in children and adolescents with neuropathic pain and complex regional pain syndrome

A significant proportion of children and adolescents with chronic pain endorse elevated pain-related fear. Pain-related fear is associated with high levels of disability, depressive symptoms, and school impairment. Because of faulty nerve signaling, individuals with neuropathic pain and complex regional pain syndrome may be more prone to develop pain-related fear as they avoid use of and neglect the affected body area(s), resulting in exacerbated symptoms, muscle atrophy, maintenance of pain signaling, and ongoing pain-related disability. Not surprisingly, effective treatments for elevated pain-related fears involve exposure to previously avoided activities to downregulate incorrect pain signaling. In the context of intensive interdisciplinary pain treatment of youth with neuropathic pain, decreasing pain-related fear is associated with improved physical and psychological functioning, whereas high initial pain-related fear is a risk factor for less treatment responsiveness. An innovative approach to targeting pain-related fear and evidence of a neural response to treatment involving decoupling of the amygdala with key fear circuits in youth with complex regional pain syndrome suggest breakthroughs in our ability to ameliorate these issues.

Pediatric Pain Beliefs Questionnaire: Psychometric Properties of the Short Form

Cognitive appraisals inform and shape individuals' pain experiences. As researchers examine mechanisms of cognitive-behavioral interventions for chronic pain, psychometrically sound measures based in cognitive theory are needed to directly assess pain beliefs. The Pain Beliefs Questionnaire (PBQ), a 32-item self-report measure informed by coping and appraisal theory, was designed to assess children's pain threat appraisals, problem-focused pain coping efficacy, and emotion-focused pain coping efficacy. The present study aimed to: 1) create a short form of the PBQ, and 2) evaluate the psychometric properties of the reduced measure in a large database of pediatric patients with functional abdominal pain (n = 871). Item reduction analyses identified an 18-item short form of the PBQ (PBQ-SF) that exhibited psychometric properties similar to the original measure. All 3 subscales of the PBQ-SF exhibited strong internal consistency (α levels ranged from .79 to .80) and adequate test-retest reliability at 2 weeks. Evidence for construct validity was provided by examining patterns of partial correlations for each subscale. The PBQ-SF represents a valid and reliable measure for evaluating children's pain beliefs. Future studies should investigate the treatment sensitivity of the PBQ-SF to evaluate its appropriateness for use in clinical trials.

PERSPECTIVE

This article presents the psychometric properties of a reduced 18-item version of a measure used to assess children's pain beliefs in a large sample of children with functional abdominal pain. This measure could help identify processes and individual differences underlying children's responses to psychological treatments for chronic pain.

Fall-Related Psychological Concerns and Anxiety among Community-Dwelling Older Adults: Systematic Review and Meta-Analysis

Fear of falling and other fall-related psychological concerns (FRPCs), such as falls-efficacy and balance confidence, are highly prevalent among community-dwelling older adults. Anxiety and FRPCs have frequently, but inconsistently, been found to be associated in the literature. The purpose of this study is to clarify those inconsistencies with a systematic review and meta-analysis and to evaluate if the strength of this relationship varies based on the different FRPC constructs used (e.g., fear of falling, falls-efficacy or balance confidence). A systematic review was conducted through multiple databases (e.g., MEDLINE, PsycINFO) to include all articles published before June 10th 2015 that measured anxiety and FRPCs in community-dwelling older adults. Active researchers in the field were also contacted in an effort to include unpublished studies. The systematic review led to the inclusion of twenty relevant articles (n = 4738). A random-effect meta-analysis revealed that the mean effect size for fear of falling and anxiety is r = 0.32 (95% CI: 0.22-0.40), Z = 6.49, p < 0.001 and the mean effect size for falls-efficacy or balance confidence and anxiety is r = 0.31 (95% CI: 0.23-0.40), Z = 6.72, p < 0.001. A Q-test for heterogeneity revealed that the two effect sizes are not significantly different (Q(19) = 0.13, p = n.s.). This study is the first meta-analysis on the relationship between anxiety and FRPCs among community-dwelling older adults. It demonstrates the importance of considering anxiety when treating older adults with FRPCs.

The European Portuguese adaptation of the Fear of Pain Questionnaire

In Portugal, it is estimated that chronic pain affects 36.7% of the population, constituting a multifactorial phenomenon with great impact at individual, family, community, and social levels. In the fear-avoidance model of pain, one of the most consistent consensual in the literature, the fear arises as one of the variables that can contribute to the development and maintenance of this condition. Thus, instruments for evaluating the fear of pain, as Fear of Pain Questionnaire (FPQ-III), may be useful in the conceptualization of the subjective experience of pain. Accordingly, this paper aims to describe the adaptation of FPQ-III for the European Portuguese. A total of 1094 participants (795 women; mean age=25.16, SD=7.72) completed the web based questionnaire. The results pointed to a different factor solution found in the first study of the original scale (five factors: minor pain, severe pain, medical pain, injection pain, and afflicted pain), good internal consistency (.75-.85) and good correlations (between .30 and .59) between subscales and (between .68 and .85) for the total score and subscales. Given the need to meet the various dimensions of subjective experience of pain, the Fear of Pain Questionnaire is assumed as a useful tool, in combination with other, may contribute to the evaluation and intervention procedures progressively more comprehensive and adjusted to the challenges raised with the issue of chronic pain.

The European Portuguese adaptation of the Fear of Pain Questionnaire

In Portugal, it is estimated that chronic pain affects 36.7% of the population, constituting a multifactorial phenomenon with great impact on individual, family, community, and social levels. In the fear-avoidance model of pain, one of the most consistent consensus in the literature, the fear arises as one of the variables that can contribute to the development and maintenance of this condition. Thus, instruments for evaluating the fear of pain, as Fear of Pain Questionnaire (FPQ-III), may be useful in the conceptualization of the subjective experience of pain. Accordingly, this paper aims to describe the adaptation of FPQ-III to the European Portuguese idiom. A total of 1,094 participants (795 female; mean age=25.16, SD=7.72 years old) completed the web based questionnaire. The results point to a different factor model found in the first study of the original scale (five factors: minor pain, severe pain, medical pain, injection pain, and afflicted pain), good internal consistency (0.75 to 0.85) and good correlations (between 0.30 and 0.59) between subscales and (between 0.68 e 0.85) for the total score and subscales. Given the need to meet the various dimensions of the subjective experience of pain, the Fear of Pain Questionnaire is assumed as a useful tool that, in combination with other tools, may contribute to the evaluation and intervention procedures progressively more comprehensive and adjusted to the challenges raised with the issue of chronic pain.

Topical Review: Resilience Resources and Mechanisms in Pediatric Chronic Pain

OBJECTIVE

To apply resilience theory and the extant literature to propose a resilience-risk model for pediatric chronic pain and provide an agenda for research and clinical practice in pediatric chronic pain resilience. 

METHOD

Literature review to develop a resilience-risk model for pediatric chronic pain.

RESULTS

The chronic pain literature has identified unique individual and social/environmental resilience resources and pain-related resilience mechanisms that promote pain adaptation. These data support our ecological resilience-risk model for pediatric chronic pain, and the model highlights novel directions for clinical and research efforts for youth with chronic pain.

CONCLUSIONS

The examination of pediatric chronic pain from a strengths-based approach might lead to novel clinical avenues to empower youth to positively adapt and live beyond their pain.

Risk and Resilience in Pediatric Chronic Pain: Exploring the Protective Role of Optimism

OBJECTIVE

Fear of pain and pain catastrophizing are prominent risk factors for pediatric chronic pain-related maladjustment. Although resilience has largely been ignored in the pediatric pain literature, prior research suggests that optimism might benefit youth and can be learned. We applied an adult chronic pain risk-resilience model to examine the interplay of risk factors and optimism on functioning outcomes in youth with chronic pain.

METHOD

Participants included 58 children and adolescents (8-17 years) attending a chronic pain clinic and their parents. Participants completed measures of fear of pain, pain catastrophizing, optimism, disability, and quality of life.

RESULTS

Consistent with the literature, pain intensity, fear of pain, and catastrophizing predicted functioning. Optimism was a unique predictor of quality of life, and optimism contributed to better functioning by minimizing pain-related fear and catastrophizing.

CONCLUSIONS

Optimism might be protective and offset the negative influence of fear of pain and catastrophizing on pain-related functioning.

"Pain Can't Stop Me": Examining Pain Self-Efficacy and Acceptance as Resilience Processes Among Youth With Chronic Headache

OBJECTIVE

To examine pain self-efficacy and pain acceptance in relation to functioning in pediatric patients with chronic headache.

METHODS

Participants were 209 youth aged 8-17 years who presented for a multidisciplinary pediatric headache clinic evaluation. They completed measures of pain self-efficacy and pain acceptance and a standard battery of clinical measures including indicators of emotional functioning.

RESULTS

Pain self-efficacy and acceptance were associated with less disability, better school functioning, and fewer depressive symptoms. While taking into account several demographic and pain-related variables, pain self-efficacy had a greater association with less functional disability, while pain acceptance had a greater association with less depressive symptoms and better school functioning.

CONCLUSIONS

These findings indicate that both resilience processes can serve to positively interact with functioning and symptoms of depression. Ultimately, this study suggests that higher levels of pain self-efficacy and pain acceptance in an individual experiencing pain are associated with more positive outcomes.