1
|
Rogers AH, Smit T, Bakhshaie J, Zvolensky MJ. Momentary Emotion Regulation Strategies and Pain Experience Among Adults With Chronic Pain: An Ecological Momentary Assessment Study. Clin J Pain 2024; 40:269-277. [PMID: 38345471 PMCID: PMC11015978 DOI: 10.1097/ajp.0000000000001206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/30/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES The intention of this study was to characterize the real-time momentary relationship between emotion regulation strategies and the pain experience (ie intensity, interference, and negative affect) among adults with chronic pain. Chronic pain is a significant public health concern. Psychological treatments are effective for treating chronic pain, but long-term follow-up studies are limited, and treatment effect sizes are small. Identifying modifiable treatment targets, such as emotion regulation (ER), is critical to improve interventions. ER (ie, cognitive and attentional strategies to modulate or maintain emotional experience) has been linked to psychopathology and pain experience in adults. Yet, the existing work is limited and has largely focused on the relationship between emotional experience, not ER, and pain. MATERIALS AND METHODS The current study utilized ecological momentary assessment 53 adults with chronic pain. Participants completed ecological momentary assessments of pain experience and ER strategies 5 times a day for 7 days. Associations by specific strategy type were also examined, highlighting the importance of worry, experiential avoidance, rumination, and expressive suppression in pain experience. RESULTS Results of the current study provide evidence for the association between within-person maladaptive ER strategies and pain intensity ( b = 2.11, SE = 0.37, P < 0.001), pain interference ( b = 1.25, SE = 0.40, P = 0.002), and pain-related negative affect ( b = 2.20, SE = 0.41, P < 0.001). (77.4% females; M age = 27.10 y, SD = 5.16 y). DISCUSSION Given that ER is readily targeted in psychological treatments for chronic pain, the results from the current study provide initial evidence to target these ER strategies in treatment.
Collapse
Affiliation(s)
- Andrew H Rogers
- Department of Psychology
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, WA
| | | | - Jafar Bakhshaie
- Department of Psychiatry, Center for Health Outcomes and Interdisciplinary Research
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Michael J Zvolensky
- Department of Psychology
- HEALTH Institute, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
2
|
van der Meulen M, Rischer KM, González Roldán AM, Terrasa JL, Montoya P, Anton F. Age-related differences in functional connectivity associated with pain modulation. Neurobiol Aging 2024; 140:1-11. [PMID: 38691941 DOI: 10.1016/j.neurobiolaging.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
Growing evidence suggests that aging is associated with impaired endogenous pain modulation, and that this likely underlies the increased transition from acute to chronic pain in older individuals. Resting-state functional connectivity (rsFC) offers a valuable tool to examine the neural mechanisms behind these age-related changes in pain modulation. RsFC studies generally observe decreased within-network connectivity due to aging, but its relevance for pain modulation remains unknown. We compared rsFC within a set of brain regions involved in pain modulation between young and older adults and explored the relationship with the efficacy of distraction from pain. This revealed several age-related increases and decreases in connectivity strength. Importantly, we found a significant association between lower pain relief and decreased strength of three connections in older adults, namely between the periaqueductal gray and right insula, between the anterior cingulate cortex (ACC) and right insula, and between the ACC and left amygdala. These findings suggest that the functional integrity of the pain control system is critical for effective pain modulation, and that its function is compromised by aging.
Collapse
Affiliation(s)
- Marian van der Meulen
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg.
| | - Katharina M Rischer
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg
| | - Ana María González Roldán
- Cognitive and Affective Neuroscience and Clinical Psychology, University of the Balearic Islands, Palma, Spain
| | - Juan Lorenzo Terrasa
- Cognitive and Affective Neuroscience and Clinical Psychology, University of the Balearic Islands, Palma, Spain
| | - Pedro Montoya
- Cognitive and Affective Neuroscience and Clinical Psychology, University of the Balearic Islands, Palma, Spain
| | - Fernand Anton
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg
| |
Collapse
|
3
|
Huang X, Jia N, Zhang Y, Hao Y, Xiao F, Sun C, Cui X, Wang F. Effect of cognitive-behavior therapy for children with functional abdominal pain: a meta-analysis. BMC Gastroenterol 2024; 24:62. [PMID: 38310252 PMCID: PMC10838415 DOI: 10.1186/s12876-024-03120-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/01/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Cognitive-Behavior Therapy (CBT) is the validated non-pharmacological treatment for chronic pain in pediatric patients. While some suggested CBT were comparable to the usual care in reducing children's functional abdominal pain. This meta-analysis was designed to systematically review the literature for RCTs that investigated the efficacy of CBT in children with functional abdominal pain (FAP). METHODS PubMed, Embase, and the Cochrane library were searched for papers published up to October 2022. Studies applying different CBT delivery methods (in-person, web-based, phone-based) were included in this meta-analysis to evaluate the comprehensive effectiveness of CBT compared with usual care. Weighted and standardized mean difference with the 95% confidence intervals were used for the synthesis of the results. Primary outcome was the decrease of functional disability inventory (FDI) and the secondary outcomes were the decrease of severity in pain intensity, depression, anxiety, gastrointestinal symptoms, and improvement in physical quality of life (QoL). RESULTS A total of 10 RCTs with 1187 children were included in the final analysis. The results showed that CBT resulted in better effect in reducing functional disability inventory (SMD=-2.282, 95%CI: -4.537 to -0.027, P = 0.047), pain intensity (SMD=-0.594, 95%CI: -1.147 to -0.040, P = 0.036), and improving QoL (SMD = 14.097, 95%CI: 0.901 to 27.292, P = 0.036) compared with the control groups. Comparable effects were observed in the severity of depression (SMD=-0.493, 95%CI: -1.594 to 0.608, P = 0.380), anxiety (SMD=-0.062, 95%CI: -0.640 to 0.517, P = 0.835), and gastrointestinal symptoms (SMD=-1.096 95%CI: -2.243 to 0.050, P = 0.061) between CBT and usual treatment. CONCLUSIONS We observed the differences in post-treatment FAP and pain intensity for children receiving CBT compared with children receiving treatment as usual. CBT in the setting of FAP demonstrates promising developments and highlights the need for future research.
Collapse
Affiliation(s)
- Xiaolan Huang
- Experiment center, Capital Institute of Pediatrics, Beijing, China
| | - Nan Jia
- Experiment center, Capital Institute of Pediatrics, Beijing, China
| | - Yan Zhang
- Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, 100000, China
| | - Yanyan Hao
- Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, 100000, China
| | - Fei Xiao
- Experiment center, Capital Institute of Pediatrics, Beijing, China
| | - Chunrong Sun
- Experiment center, Capital Institute of Pediatrics, Beijing, China
| | - Xiaodai Cui
- Experiment center, Capital Institute of Pediatrics, Beijing, China
| | - Fei Wang
- Affiliated Children's Hospital of Capital Institute of Pediatrics, Beijing, 100000, China.
| |
Collapse
|
4
|
Santucci NR, Beigarten AJ, Khalid F, El-Chammas KI, Graham K, Sahay R, Fei L, Rich K, Mellon M. Percutaneous Electrical Nerve Field Stimulation in Children and Adolescents With Functional Dyspepsia-Integrating a Behavioral Intervention. Neuromodulation 2024; 27:372-381. [PMID: 37589640 PMCID: PMC10869640 DOI: 10.1016/j.neurom.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/25/2023] [Accepted: 07/05/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVES Functional dyspepsia (FD) includes postprandial distress and epigastric pain syndrome. Percutaneous electrical nerve field stimulation (PENFS) in addition to behavioral interventions (BI) has shown benefits in children with functional abdominal pain but not specifically in FD. We aimed to assess the efficacy of PENFS for treating FD and compare the outcomes with those who received the combination of PENFS + BI. MATERIALS AND METHODS Charts of patients with FD who completed four weeks of PENFS were evaluated. A subset of patients received concurrent BI. Demographic data, medical history, and symptoms were documented. Outcomes at different time points included subjective symptom responses and validated questionnaires collected clinically (Abdominal Pain Index [API], Nausea Severity Scale [NSS], Functional Disability Inventory [FDI], Pittsburgh Sleep Quality Index [PSQI], Children's Somatic Symptoms Inventory [CSSI], Patient-Reported Outcomes Measurement Information Systems [PROMIS] Pediatric Anxiety and Depression scales). RESULT Of 84 patients, 61% received PENFS + BI, and 39% received PENFS alone. In the entire cohort, API (p < 0.0001), NSS (p = 0.001), FDI (p = 0.001), CSSI (p < 0.0001), PSQI (p = 0.01), PROMIS anxiety (p = 0.02), and depression (p = 0.01) scores improved from baseline to three weeks and at three months. Subjective responses showed nausea improvement (p = 0.01) and a trend for improvement in abdominal pain (p = 0.07) at week three. Abdominal pain subjectively improved at week three and three months (p = 0.003 and 0.02, respectively), nausea at week three and three months (p = 0.01 and 0.04, respectively), and a trend for improvement in sleep disturbances at week three and three months (p = 0.08 and p = 0.07, respectively) in the PENFS + BI group vs PENFS alone. CONCLUSION Abdominal pain, nausea, functioning, somatization, sleep disturbances, anxiety, and depression improved at three weeks and three months after PENFS in pediatric FD. Subjective pain and nausea improvement were greater in the PENFS + BI group than in the group with PENFS alone, suggesting an additive effect of psychologic therapy.
Collapse
Affiliation(s)
- Neha R Santucci
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Alan J Beigarten
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Fatima Khalid
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Khalil I El-Chammas
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Kahleb Graham
- Gastroenterology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Pediatrics, University of Cincinnati, Cincinnati, OH, USA
| | - Rashmi Sahay
- Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lin Fei
- Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kristin Rich
- Pediatrics, University of Cincinnati, Cincinnati, OH, USA; Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael Mellon
- Pediatrics, University of Cincinnati, Cincinnati, OH, USA; Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
5
|
Lamparyk K, Stellway J, Turnage C, Murphy TB, Echere J, Levy RL. Evolution of Parent-Targeted Interventions for Pain-Predominant Disorders of Gut-Brain Interactions: Research and Clinical Practice Considerations. Clin Pract Pediatr Psychol 2023; 11:423-434. [PMID: 38433851 PMCID: PMC10907008 DOI: 10.1037/cpp0000496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Objective Abdominal pain-related Disorders of Gut-Brain Interaction (DGBIs) in children are best understood from a biopsychosocial model, including particular attention to the child's environment. Interventions have begun to increasingly target parents as important agents of change in this population. The purpose of this manuscript is to summarize the evolution of parent-targeted interventions for pediatric pain-related DGBIs and provide recommendations for application of the model to clinical practice. Methods A topical review of literature regarding parent-targeted interventions and related factors in the treatment of pediatric pain-related DGBIs was conducted, followed by a discussion of these findings to clinical practice settings. Results A growing body of research has supported parent-targeted interventions in the treatment of pediatric pain-related disorders of gut-brain interactions (DGBI), although translation of these findings to practice settings is complicated by numerous factors. Strategies for obtaining physician buy-in and parental engagement are discussed, as are potential logistical considerations of multiple caregivers, child age, and billing considerations. Conclusions There is a promising and growing evidence-base for parent-targeted interventions for pain-related DGBIs, which have not yet been widely adopted into clinical practice recommendations. Engaging all stake-holders and attending to the nuances of this approach are recommended to successfully apply parent-targeted interventions into clinical practice settings.
Collapse
Affiliation(s)
| | - Jacklyn Stellway
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University
| | - Cathleen Turnage
- Department of Pediatrics, Institute on Development and Disability, Oregon Health & Science University
| | | | | | | |
Collapse
|
6
|
Yuming T, Jiani S, Hefeng C, Ying Z, Weiyan Y, Duowu Z. The Clinical Characteristics and Related Factors of Centrally Mediated Abdominal Pain Syndrome. Clin Transl Gastroenterol 2023; 14:e00624. [PMID: 37467381 PMCID: PMC10684177 DOI: 10.14309/ctg.0000000000000624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION The aim of this study was to explore the clinical characteristics and related factors of centrally mediated abdominal pain syndrome (CAPS). METHODS Our study included 73 patients with CAPS and 132 age-matched and gender-matched healthy controls. The general information of the participants was collected, and the questionnaires were completed including the 7-item Generalized Anxiety Disorder Scale, 9-item Patient Health Questionnaire, Hamilton Anxiety Scale, Hamilton Depression Scale Pittsburgh Sleep Quality Index, Visual Analog Scale, and Short-Form 36. Univariate and forward stepwise regression analyses were performed to explore the influencing factors of CAPS. RESULTS Nonexercise (adjusted odds ration [AOR] 4.53; confidence interval [CI] 1.602-12.809), mild-to-moderate depression (AOR 7.931; CI 3.236-19.438), married status (AOR 3.656; CI 1.317-10.418), and drinking coffee (AOR 0.199; CI 0.051-0.775) were found to be related with centrally mediated abdominal syndrome. The Hamilton Anxiety Scale score (7-13) was significantly related to moderate-to-severe abdominal pain (AOR 7.043; CI 1.319-37.593). Higher Hamilton Depression Scale score was related to lower mental component scale score (β = -0.726, P < 0.01) and physical component scale score (β = -0.706, P < 0.01). DISCUSSION Depression, married status, and nonexercise were the independent risk factors of CAPS. Conversely, coffee intake was an independent protective factor of CAPS. Anxiety was related to the severity of abdominal pain, while depression was related to low health-related quality of life.
Collapse
Affiliation(s)
- Tang Yuming
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Song Jiani
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Chen Hefeng
- Department of Pharmacy, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Zhu Ying
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Yao Weiyan
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Zou Duowu
- Department of Gastroenterology, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| |
Collapse
|
7
|
Abstract
BACKGROUND Chronic pain conditions impose significant burdens worldwide. Pharmacological treatments like opioids have limitations. Non-invasive non-pharmacological therapies (NINPT) encompass diverse interventions including physical, psychological, complementary and alternative approaches, and other innovative techniques that provide analgesic options for chronic pain without medications. MAIN BODY This review elucidates the mechanisms of major NINPT modalities and synthesizes evidence for their clinical potential across chronic pain populations. NINPT leverages peripheral, spinal, and supraspinal mechanisms to restore normal pain processing and limit central sensitization. However, heterogeneity in treatment protocols and individual responses warrants optimization through precision medicine approaches. CONCLUSION Future adoption of NINPT requires addressing limitations in standardization and accessibility as well as synergistic combination with emerging therapies. Overall, this review highlights the promise of NINPT as a valuable complementary option ready for integration into contemporary pain medicine paradigms to improve patient care and outcomes.
Collapse
Affiliation(s)
- Yu Shi
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical University, Guangzhou, 510282, China.
| |
Collapse
|
8
|
Chen JY, Chen SN, Lee CH, Huang YJ. A systematic review and meta-analysis of randomized control trials: efficacy of cognitive behavioral therapies for the management of functional and recurrent abdominal pain disorders in children and adolescents. Cogn Behav Ther 2023; 52:438-459. [PMID: 37102319 DOI: 10.1080/16506073.2023.2200562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 03/30/2023] [Indexed: 04/28/2023]
Abstract
Cognitive behavioral therapy (CBT) is effective for pain relief in children and adolescents with functional abdominal pain disorders (FAPDs). However, few studies have focused on the FAPDs specifically and the medium-term or long-term results of CBT. In this meta-analysis, we investigated the efficacy of CBT in pediatric FAPDs and unclassified chronic or recurrent abdominal pain (CAP and RAP, respectively). We searched the PubMed, Embase, and Cochrane Library databases for related randomized controlled trials until August 2021. Eventually, 10 trials with 872 participants were included. The methodological quality of the studies was assessed, and data on two primary and four secondary outcomes of interest were extracted. We used the standardized mean difference (SMD) to measure the same outcome, and precisions of effect sizes were reported as 95% confidence intervals (CIs). We found that CBT had significantly positive effects on reducing pain intensity immediately (SMD: -0.54 [CI: -0.9, -0.19], p = 0.003), 3 months after the intervention (SMD: -0.55; [CI: -1.01, -0.1], p = 0.02) and 12 months after the intervention (SMD: -0.32; [CI: -0.56, -0.08], p = 0.008). CBT also reduced the severity of gastrointestinal symptoms, depression, and solicitousness, improved the quality of life and decreased the total social cost. Future studies should consider uniform interventions in the control group and comparing different CBT delivery methods.
Collapse
Affiliation(s)
- Jia-Yi Chen
- Department of Education Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sheng-Ni Chen
- Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Che-Hsiung Lee
- Department of Plastic and Reconstructive Surgery, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Yu-Jui Huang
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan
| |
Collapse
|
9
|
Joslin R, Donovan‐Hall M, Roberts L. "You just want someone to help": Outcomes that matter to parents when their child is treated for chronic pain. Paediatr Neonatal Pain 2023; 5:38-48. [PMID: 37283953 PMCID: PMC10240402 DOI: 10.1002/pne2.12098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/05/2022] [Accepted: 02/09/2023] [Indexed: 06/08/2023]
Abstract
In children's chronic pain services, healthcare decisions involve a three-way interaction between the child, their parent or guardian, and the health professional. Parents have unique needs, and it is unknown how they visualize their child's recovery and which outcomes they perceive to be an indication of their child's progress. This qualitative study explored the outcomes parents considered important, when their child was undergoing treatment for chronic pain. A purposive sample of twenty-one parents of children receiving treatment for chronic musculoskeletal pain, completed a one-off semi-structured interview that involved drawing a timeline of their child's treatment. The interview and timeline content were analyzed using thematic analysis. Four themes are evident at different points of the child's treatment course. The "perfect storm" that described their child's pain starting, "fighting in the dark" was a stage when parents focused on finding a service or health professional that could solve their child's pain. The third stage, "drawing a line under it," changed the outcomes parents considered important, parents changed how they approached their child's pain and worked alongside professionals, focusing on their child's happiness and engagement with life. They watched their child make positive change and moved toward the final theme "free." The outcomes parents considered important changed over their child's treatment course. The shift described by parents during treatment appeared pivotal to the recovery of young people, demonstrating the importance of the role of parents within chronic pain treatment.
Collapse
Affiliation(s)
- Rhiannon Joslin
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
- Women's and Children's DepartmentUniversity Hospitals Sussex, St. Richards HospitalChichesterUK
| | | | - Lisa Roberts
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
- Therapy Services DepartmentUniversity Hospital Southampton NHS Foundation TrustSouthamptonUK
| |
Collapse
|
10
|
Johnston JD, Schatz J, Bills SE, Frye BG, Carrara GC. Preschool Pain Management Program for Young Children with Sickle Cell Disease: A Pre-Post Feasibility Study. J Pediatr Psychol 2023; 48:330-340. [PMID: 36694913 DOI: 10.1093/jpepsy/jsac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Vaso-occlusive pain crises in sickle cell disease (SCD) often begin in early childhood. We developed an online pain management intervention to teach caregivers of preschool-aged children with SCD behavioral pain management strategies. The feasibility study goals were to examine response to recruitment, barriers to participation, engagement, acceptability and perceived usefulness of the intervention, and suitability of outcome measures. METHODS Caregivers of children aged 2.0-5.9 years with access to text messaging and a device to access online videos were recruited from a Southeastern outpatient hematology clinic for a 12-week intervention consisting of pain management videos. Videos taught caregivers behavioral pain management strategies and adaptive responses to pain. Workbook activities helped tailor strategies to their child. Caregivers completed process measures as well as baseline and follow-up measures of pain catastrophizing (Pain Catastrophizing Scale-Parent Report) and responses to their child's pain (Adult Response to Children's Symptoms). RESULTS Fifty percent (10 of 20) of eligible parents enrolled. Caregivers partially completed (N = 6), completed (N = 3), or did not engage (N = 1) in the intervention. Caregivers who engaged in the program reported implementing the pain management strategies. The intervention was rated as high quality, relevant, and useful. Measures of pain catastrophizing and responses to their child's pain appeared sensitive to change. CONCLUSIONS The intervention to promote adaptive coping to pain was acceptable and feasible for caregivers though we found barriers to delivering the intervention to parents. Evaluation of a modified version of the program is indicated to assess implementation issues and effectiveness.
Collapse
Affiliation(s)
| | - Jeffrey Schatz
- Department of Psychology, University of South Carolina, USA
| | - Sarah E Bills
- Department of Psychology, University of South Carolina, USA
| | | | | |
Collapse
|
11
|
Lalouni M, Bujacz A, Bonnert M, Jensen KB, Rosengren A, Hedman-Lagerlöf E, Serlachius E, Olén O, Ljótsson B. Parental responses and catastrophizing in online cognitive behavioral therapy for pediatric functional abdominal pain: A mediation analysis of a randomized controlled trial. Front Pain Res (Lausanne) 2022; 3:962037. [PMID: 36262179 PMCID: PMC9574038 DOI: 10.3389/fpain.2022.962037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To test if decreased parental protective behaviors, monitoring behaviors, and parental catastrophizing mediate relief of gastrointestinal symptoms in children 8-12 years with functional abdominal pain disorders (FAPDs). The study uses secondary data analyses of a randomized controlled trial in which exposure-based online cognitive behavioral therapy (ICBT) was found superior to treatment as usual in decreasing gastrointestinal symptoms. Methods The ICBT included 10 weekly modules for children and 10 weekly modules for parents. Treatment as usual consisted of any medication, dietary adjustments, and healthcare visits that the participants engaged in during 10 weeks. All measures were self-assessed online by parents. Biweekly assessments of the Adult Responses to Children's Symptoms (ARCS), Protect and Monitor subscales, and the Pain Catastrophizing Scale, parental version (PCS-P) were included in univariate and multivariate growth models to test their mediating effect on the child's gastrointestinal symptoms assessed with the Pediatric Quality of Life Gastrointestinal Symptoms Scale (PedsQL). Results A total of 90 dyads of children with FAPDs and their parents were included in the study, of which 46 were randomized to ICBT and 44 to treatment as usual. The PCS-P was found to mediate change in the PedsQL ab = 0.639 (95% CI 0.020-2.331), while the ARCS Monitor ab = 0.472 (95% CI -1.002 to 2.547), and Protect ab = -0.151 (95% CI -1.455 to 0.674) were not mediators of change. Conclusions To target parental catastrophizing in ICBT for pediatric FAPDs is potentially important to reduce abdominal symptoms in children.
Collapse
Affiliation(s)
- Maria Lalouni
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Correspondence: Maria Lalouni
| | - Aleksandra Bujacz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden,Department of Leadership and Command / Control, The Swedish Defense University, Stockholm, Sweden
| | - Marianne Bonnert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet / Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Karin B. Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rosengren
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet / Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Ola Olén
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Department of Paediatric Gastroenterology and Nutrition, Sachs’ Children’s Hospital, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden,Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet / Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| |
Collapse
|
12
|
Rexwinkel R, Vlieger AM, Saps M, Tabbers MM, Benninga MA. A therapeutic guide on pediatric irritable bowel syndrome and functional abdominal pain-not otherwise specified. Eur J Pediatr 2022; 181:2603-2617. [PMID: 35460383 PMCID: PMC9192445 DOI: 10.1007/s00431-022-04459-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
Disorders of the gut-brain interaction negatively impact quality of life and carry a substantial socioeconomic burden. Irritable bowel syndrome (IBS) and functional abdominal pain-not otherwise specified (FAP-NOS) are common functional abdominal pain disorders in childhood. The pathophysiology is not fully understood, and high-quality intervention trials and international guidelines are missing. Therefore, the management of these disorders remains challenging. This review aims to provide an up-to-date overview of therapeutic possibilities for pediatric IBS or FAP-NOS and recommends management strategies. To prevent unnecessary referrals and extensive costs, it is fundamental to make a positive diagnosis of IBS or FAP-NOS in children with chronic abdominal pain with only minimal investigations. A tailor-made approach for each patient, based on the accompanying physical and psychological symptoms, is proposed to date. CONCLUSION Shared decision-making including non-pharmacological and pharmacological interventions should be considered and discussed with the family. WHAT IS KNOWN • Irritable bowel syndrome and functional abdominal pain-not otherwise specified are common in childhood. • Although the number of treatment options has grown recently, managing these disorders can be challenging and unsatisfactory, and no evidence-based international management guidelines are available. WHAT IS NEW • We suggest using a stepwise individualized approach to management, where after first-line management, both non-pharmacological and pharmacological interventions should be discussed.
Collapse
Affiliation(s)
- Robyn Rexwinkel
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands.
| | - Arine M Vlieger
- Department of Pediatrics, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Miguel Saps
- Department of Pediatric Gastroenterology, University of Miami, Miami, FL, USA
| | - Merit M Tabbers
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, Pediatric Gastroenterology, University of Amsterdam, Room C2-312, PO Box 22700, 1100 DD, Amsterdam, Netherlands
| |
Collapse
|
13
|
Gordon M, Sinopoulou V, Tabbers M, Rexwinkel R, de Bruijn C, Dovey T, Gasparetto M, Vanker H, Benninga M. Psychosocial Interventions for the Treatment of Functional Abdominal Pain Disorders in Children: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:560-568. [PMID: 35404394 PMCID: PMC9002716 DOI: 10.1001/jamapediatrics.2022.0313] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Functional abdominal pain disorders (FAPDs) can severely affect the life of children and their families, with symptoms carrying into adulthood. Management of FADP symptoms is also a financial and time burden to clinicians and health care systems. OBJECTIVE To systematically review various randomized clinical trials (RCTs) on the outcomes of cognitive behavioral therapy (CBT), educational support, yoga, hypnotherapy, gut-directed hypnotherapy, guided imagery, and relaxation in the management of FAPDs. DATA SOURCES PubMed, MEDLINE, Embase, PsycINFO, and Cochrane Library. STUDY SELECTION All RCTs that compared psychosocial interventions with any control or no intervention, for children aged 4 to 18 years with FAPDs. DATA EXTRACTION AND SYNTHESIS Pairs of the authors independently extracted data of all included studies, using a predesigned data extraction sheet. One author acted as arbitrator. Risk of bias was assessed using the Cochrane risk of bias tool, and certainty of the evidence for all primary outcomes was analyzed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. MAIN OUTCOMES AND MEASURES Primary outcomes were treatment success, pain frequency, pain intensity, and withdrawal owing to adverse events. Dichotomous outcomes were expressed as risk ratio (RR) with corresponding 95% CIs. Continuous outcomes were expressed as mean difference (MD) or standardized MD with 95% CI. RESULTS A total of 33 RCTs with 2657 children (median [range] age, 12 [7-17] years; 1726 girls [67.3%]) were included. Twelve studies compared CBT with no intervention, 5 studies compared CBT with educational support, 3 studiescompared yoga with no intervention, 2 studies compared hypnotherapy with no intervention, 2 studies compared gut-directed hypnotherapy with hypnotherapy, and 2 studies compared guided imagery with relaxation. Seven studies evaluated other unique comparisons (eg, visceral osteopathy vs normal osteopathy). Per the GRADE framework, owing to risk of bias, there was moderate certainty in evidence that CBT was associated with higher treatment success numbers (n = 324 children; RR, 2.37; 95% CI 1.30-4.34; number needed to treat [NNT] = 5), lower pain frequency (n = 446 children; RR, -0.36; 95% CI, -0.63 to -0.09), and lower pain intensity (n = 332 children; RR, -0.58; 95% CI, -0.83 to -0.32) than no intervention. Owing to high imprecision, there was low certainty in evidence that there was no difference between CBT and educational support for pain intensity (n = 127 children; MD, -0.36; 95% CI, -0.87 to 0.15). Owing to risk of bias and imprecision, there was low certainty in evidence that hypnotherapy resulted in higher treatment success compared with no intervention (n = 91 children; RR, 2.86; 95% CI, 1.19-6.83; NNT = 5). Owing to risk of bias and imprecision, there was low certainty in evidence that yoga had similar treatment success to no intervention (n = 99 children; RR, 1.09; 95% CI, 0.58-2.08). CONCLUSIONS AND RELEVANCE Results of this systematic review and meta-analysis suggest that CBT and hypnotherapy may be considered as a treatment for FAPDs in childhood. Future RCTs should address quality issues to enhance the overall certainty of the results, and studies should consider targeting these interventions toward patients who are more likely to respond.
Collapse
Affiliation(s)
- Morris Gordon
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
| | | | - Merit Tabbers
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Robyn Rexwinkel
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Clara de Bruijn
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Terence Dovey
- Department of Life Sciences, Brunel University London, London, United Kingdom
| | - Marco Gasparetto
- Department of Pediatric Gastroenterology, The Royal London Children’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Marc Benninga
- Department of Pediatric Gastroenterology, Emma Children’s Hospital/Amsterdam University Medical Centers, Amsterdam, the Netherlands
| |
Collapse
|
14
|
Kalomiris AE, Ely SL, Love SC, Mara CA, Cunningham NR. Child-Focused Cognitive Behavioral Therapy for Pediatric Abdominal Pain Disorders Reduces Caregiver Anxiety in Randomized Clinical Trial. J Pain 2022; 23:810-821. [PMID: 34902549 PMCID: PMC9086118 DOI: 10.1016/j.jpain.2021.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
Pediatric functional abdominal pain disorders (FAPD) are associated with elevated anxiety in youth and their caregivers, both contributing to an adverse impact on functioning in youth with FAPD. While a CBT approach (ie, Aim to Decrease Anxiety and Pain Treatment [ADAPT]) is known to improve health outcomes for youth, it is unknown if child-focused treatment improves caregiver anxiety. This secondary analysis of a larger randomized clinical trial examined if child-focused CBT (ADAPT) for pain and anxiety also impacts caregiver anxiety and explored the relation between caregiver anxiety and child symptoms (ie, pain, disability, anxiety) after treatment. A total of 79 caregiver-child dyads were randomized to ADAPT plus treatment as usual (TAU) or TAU only. Caregiver anxiety and child outcomes (pain, disability, anxiety) were assessed at baseline and approximately 8 weeks later. Caregivers of children who completed ADAPT+TAU demonstrated lower anxiety compared to those who only received TAU. Moreover, regardless of treatment assignment, caregivers with greater anxiety had children who reported more pain and anxiety, but not functional disability at post-assessment. Results suggest a brief, child-focused intervention targeting pain and anxiety may also improve caregiver anxiety. As such, suggestions to improve future treatments are offered. PERSPECTIVE: Caregiver anxiety symptoms diminished after their child with functional abdominal pain completed a course of child-focused CBT targeting pain and anxiety. Further, caregiver anxiety was related to child-reported symptoms (pain and anxiety) after treatment. Therefore, improved caregiver mental health via a child-focused CBT may also improve pediatric outcomes.
Collapse
Affiliation(s)
- Anne E Kalomiris
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Samantha L Ely
- Department of Family Medicine, Michigan State University, Grand Rapids, Michigan
| | - Sarah C Love
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Constance A Mara
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | |
Collapse
|
15
|
Cordeiro Santos ML, da Silva Júnior RT, de Brito BB, França da Silva FA, Santos Marques H, Lima de Souza Gonçalves V, Costa dos Santos T, Ladeia Cirne C, Silva NOE, Oliveira MV, de Melo FF. Non-pharmacological management of pediatric functional abdominal pain disorders: Current evidence and future perspectives. World J Clin Pediatr 2022; 11:105-119. [PMID: 35433299 PMCID: PMC8985495 DOI: 10.5409/wjcp.v11.i2.105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/19/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
Functional abdominal pain disorders (FAPDs) are an important and prevalent cause of functional gastrointestinal disorders among children, encompassing the diagnoses of functional dyspepsia, irritable bowel syndrome, abdominal migraine, and the one not previously present in Rome III, functional abdominal pain not otherwise specified. In the absence of sufficiently effective and safe pharmacological treatments for this public problem, non-pharmacological therapies emerge as a viable means of treating these patients, avoiding not only possible side effects, but also unnecessary prescription, since many of the pharmacological treatments prescribed do not have good efficacy when compared to placebo. Thus, the present study provides a review of current and relevant evidence on non-pharmacological management of FAPDs, covering the most commonly indicated treatments, from cognitive behavioral therapy to meditation, acupuncture, yoga, massage, spinal manipulation, moxibustion, and physical activities. In addition, this article also analyzes the quality of publications in the area, assessing whether it is possible to state if non-pharmacological therapies are viable, safe, and sufficiently well-based for an appropriate and effective prescription of these treatments. Finally, it is possible to observe an increase not only in the number of publications on the non-pharmacological treatments for FAPDs in recent years, but also an increase in the quality of these publications. Finally, the sample selection of satisfactory age groups in these studies enables the formulation of specific guidelines for this age group, thus avoiding the need for adaptation of prescriptions initially made for adults, but for children use.
Collapse
Affiliation(s)
- Maria Luísa Cordeiro Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Breno Bittencourt de Brito
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | | - Hanna Santos Marques
- Campus Vitória da Conquista, Universidade Estadual do Sudoeste da Bahia, Vitória da Conquista 45083-900, Bahia, Brazil
| | | | - Talita Costa dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Carolina Ladeia Cirne
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Natália Oliveira e Silva
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Márcio Vasconcelos Oliveira
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | - Fabrício Freire de Melo
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| |
Collapse
|
16
|
Calvano C, Warschburger P. Treatment for Pediatric Functional Abdominal Pain: An Initial Examination of Reciprocal Associations Between Pain, Functional Impairment, and Parental Distress. J Pediatr Psychol 2022; 47:483-496. [PMID: 35237811 DOI: 10.1093/jpepsy/jsac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE While cross-sectional studies underline that child and parent factors in pediatric chronic pain are reciprocally related, so far, little is known on their prospective relationship, especially in treatment contexts. This study aims to analyze directions of influence between child and parental outcomes using data from an intervention study. METHODS The sample covered 109 families with children aged 7-13 years diagnosed with functional abdominal pain (FAP). Child outcomes included pain and impairment, and parental outcomes covered caregiver-specific distress including both parental personal time burden (i.e., less time available for personal needs) and emotional burden due to child's pain (i.e., increased worries). Cross-lagged panel analyses examined the directions of the relations between child and parental outcomes across time (pretreatment T1, post-treatment T2, and 3-month follow-up and 12-month follow-up T3/T4). RESULTS First, a significant improvement over time in all measures was observed. Cross-lagged effects were found for less parental personal time burden at T2, predicting both less pain (β = -0.254, p = .004) and less impairment (β = -0.150, p = .039) at T3. Higher baseline pain was predictive for higher parental emotional burden after treatment (β = -0.130, p = .049) and, reversely, for less emotional burden at 12-month follow-up (β = 0.261, p = .004). CONCLUSIONS Addressing parental personal time burden in FAP treatment might possibly support the improvement on the child level. Replication of results in larger samples is warranted to gain more insight into the directions of influence and, in that way, to optimize treatment for pediatric FAP.
Collapse
Affiliation(s)
- Claudia Calvano
- University of Potsdam, Department Psychology, Counseling Psychology, Germany.,Freie Universität Berlin, Department of Education and Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Germany
| | - Petra Warschburger
- University of Potsdam, Department Psychology, Counseling Psychology, Germany
| |
Collapse
|
17
|
MARTINS GP, SANDY NS, ALVARENGA LR, LOMAZI EA, BELLOMO-BRANDÃO MA. FUNCTIONAL ABDOMINAL PAIN IS THE MAIN ETIOLOGY AMONG CHILDREN REFERRED TO TERTIARY CARE LEVEL FOR CHRONIC ABDOMINAL PAIN. Arq Gastroenterol 2022; 59:97-101. [DOI: 10.1590/s0004-2803.202200001-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022]
Abstract
ABSTRACT Background Chronic abdominal pain (CAP) carries a significant burden of disease. The last edition of the Rome Criteria (Rome IV) allows the diagnosis of functional gastrointestinal disorders (FGIDs) according to symptoms-based criteria; however, patients continue to experience a delay in their diagnosis and to be submitted to different interventions before the establishment of a positive diagnosis. Objective We aimed to characterize etiology, clinical features, and interventions in a pediatric cohort of patients with CAP secondary to FGIDs, who were referred to our tertiary care university-affiliated hospital, in Brazil. Methods A retrospective descriptive study of children and adolescents (aged 20 years and younger) referred to our institution, from January/2013 to December/2018, for CAP, and who fulfilled criteria for FGIDs classified according to Rome IV criteria. Results Three hundred twenty-eight patients with CAP were screened, of which 67.9% (223 patients) fulfilled the criteria for FGIDs and were included in the study. Sixty percent were female, with a mean age of 8.3 years. At the time of referral, the mean duration of symptoms was 2.8 years. Length/height for age and weight for age mean z-scores were -0.08±1.87 and -0.38±1.62, respectively. Functional abdominal pain not otherwise specified was overall the most common diagnosis (70.4%). Before establishing the diagnosis of FGIDs, multiple pharmacological interventions were described, while after, the mainstay of therapy was education/reassurance and dietary interventions. Thirty-two percent of patients did not further require specialized follow-up. Conclusion Even at the tertiary care level, FGIDs were still the most common etiology of chronic abdominal pain, particularly functional abdominal pain not otherwise specified. Despite the relatively long duration of symptoms at referral, cessation of specialized care follow-up was possible in approximately a third of the cases.
Collapse
|
18
|
Sieberg CB, Karunakaran KD, Kussman B, Borsook D. Preventing Pediatric Chronic Postsurgical Pain: Time for Increased Rigor. Can J Pain 2022; 6:73-84. [PMID: 35528039 PMCID: PMC9067470 DOI: 10.1080/24740527.2021.2019576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic postsurgical pain (CPSP) results from a cascade of events in the peripheral and central nervous systems following surgery. Several clinical predictors, including the prior pain state, premorbid psychological state (e.g., anxiety, catastrophizing), intraoperative surgical load (establishment of peripheral and central sensitization), and acute postoperative pain management, may contribute to the patient’s risk of developing CPSP. However, research on the neurobiological and biobehavioral mechanisms contributing to pediatric CPSP and effective preemptive/treatment strategies are still lacking. Here we evaluate the perisurgical process by identifying key problems and propose potential solutions for the pre-, intra-, and postoperative pain states to both prevent and manage the transition of acute to chronic pain. We propose an eight-step process involving preemptive and preventative analgesia, behavioral interventions, and the use of biomarkers (brain-based, inflammatory, or genetic) to facilitate timely evaluation and treatment of premorbid psychological factors, ongoing surgical pain, and postoperative pain to provide an overall improved outcome. By achieving this, we can begin to establish personalized precision medicine for children and adolescents presenting to surgery and subsequent treatment selection.
Collapse
Affiliation(s)
- Christine B. Sieberg
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, MA USA
- Pain and Affective Neuroscience Center, Department of, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
- Department of Psychiatry, Harvard Medical School, Boston, MA USA
| | - Keerthana Deepti Karunakaran
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children’s Hospital, Boston, MA USA
- Pain and Affective Neuroscience Center, Department of, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, MA USA
| | - Barry Kussman
- Department of Anesthesiology, Critical Care, & Pain Medicine, Boston Children’s Hospital, Boston, MA USA
- Department of Anesthesiology, Harvard Medical School, Boston, MA USA
| | - David Borsook
- Department of Anesthesiology, Harvard Medical School, Boston, MA USA
- Department of Psychiatry and Radiology, Massachusetts General Hospital, Hospital, Harvard Medical School, Boston, USA
| |
Collapse
|
19
|
Layer P, Andresen V, Allescher H, Bischoff SC, Claßen M, Elsenbruch S, Freitag M, Frieling T, Gebhard M, Goebel-Stengel M, Häuser W, Holtmann G, Keller J, Kreis ME, Kruis W, Langhorst J, Jansen PL, Madisch A, Mönnikes H, Müller-Lissner S, Niesler B, Pehl C, Pohl D, Raithel M, Röhrig-Herzog G, Schemann M, Schmiedel S, Schwille-Kiuntke J, Storr M, Preiß JC, Andus T, Buderus S, Ehlert U, Engel M, Enninger A, Fischbach W, Gillessen A, Gschossmann J, Gundling F, Haag S, Helwig U, Hollerbach S, Karaus M, Katschinski M, Krammer H, Kuhlbusch-Zicklam R, Matthes H, Menge D, Miehlke S, Posovszky MC, Schaefert R, Schmidt-Choudhury A, Schwandner O, Schweinlin A, Seidl H, Stengel A, Tesarz J, van der Voort I, Voderholzer W, von Boyen G, von Schönfeld J, Wedel T. Update S3-Leitlinie Reizdarmsyndrom: Definition, Pathophysiologie, Diagnostik und Therapie. Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Neurogastroenterologie und Motilität (DGNM) – Juni 2021 – AWMF-Registriernummer: 021/016. Z Gastroenterol 2021; 59:1323-1415. [PMID: 34891206 DOI: 10.1055/a-1591-4794] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P Layer
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - V Andresen
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - H Allescher
- Zentrum für Innere Medizin, Gastroent., Hepatologie u. Stoffwechsel, Klinikum Garmisch-Partenkirchen, Garmisch-Partenkirchen, Deutschland
| | - S C Bischoff
- Institut für Ernährungsmedizin, Universität Hohenheim, Stuttgart, Deutschland
| | - M Claßen
- Klinik für Kinder- und Jugendmedizin, Klinikum Links der Weser, Bremen, Deutschland
| | - S Elsenbruch
- Klinik für Neurologie, Translational Pain Research Unit, Universitätsklinikum Essen, Essen, Deutschland.,Abteilung für Medizinische Psychologie und Medizinische Soziologie, Ruhr-Universität Bochum, Bochum, Deutschland
| | - M Freitag
- Abteilung Allgemeinmedizin Department für Versorgungsforschung, Universität Oldenburg, Oldenburg, Deutschland
| | - T Frieling
- Medizinische Klinik II, Helios Klinikum Krefeld, Krefeld, Deutschland
| | - M Gebhard
- Gemeinschaftspraxis Pathologie-Hamburg, Hamburg, Deutschland
| | - M Goebel-Stengel
- Innere Medizin II, Helios Klinik Rottweil, Rottweil, und Innere Medizin VI, Psychosomat. Medizin u. Psychotherapie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - W Häuser
- Innere Medizin I mit Schwerpunkt Gastroenterologie, Klinikum Saarbrücken, Saarbrücken, Deutschland
| | - G Holtmann
- Faculty of Medicine & Faculty of Health & Behavioural Sciences, Princess Alexandra Hospital, Brisbane, Australien
| | - J Keller
- Medizinische Klinik, Israelitisches Krankenhaus, Hamburg, Deutschland
| | - M E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | | | - J Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Deutschland
| | - P Lynen Jansen
- Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten, Berlin, Deutschland
| | - A Madisch
- Klinik für Gastroenterologie, interventionelle Endoskopie und Diabetologie, Klinikum Siloah, Klinikum Region Hannover, Hannover, Deutschland
| | - H Mönnikes
- Klinik für Innere Medizin, Martin-Luther-Krankenhaus, Berlin, Deutschland
| | | | - B Niesler
- Abteilung Molekulare Humangenetik Institut für Humangenetik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - C Pehl
- Medizinische Klinik, Krankenhaus Vilsbiburg, Vilsbiburg, Deutschland
| | - D Pohl
- Klinik für Gastroenterologie und Hepatologie, Universitätsspital Zürich, Zürich, Schweiz
| | - M Raithel
- Medizinische Klinik II m.S. Gastroenterologie und Onkologie, Waldkrankenhaus St. Marien, Erlangen, Deutschland
| | | | - M Schemann
- Lehrstuhl für Humanbiologie, TU München, Deutschland
| | - S Schmiedel
- I. Medizinische Klinik und Poliklinik Gastroenterologie, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - J Schwille-Kiuntke
- Abteilung für Psychosomatische Medizin und Psychotherapie, Medizinische Universitätsklinik Tübingen, Tübingen, Deutschland.,Institut für Arbeitsmedizin, Sozialmedizin und Versorgungsforschung, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - M Storr
- Zentrum für Endoskopie, Gesundheitszentrum Starnberger See, Starnberg, Deutschland
| | - J C Preiß
- Klinik für Innere Medizin - Gastroenterologie, Diabetologie und Hepatologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Abstract
Symptomatic celiac artery compression syndrome (CACS) or median arcuate ligament syndrome (MALS) is a controversial diagnosis that should be considered in patients with chronic abdominal pain of unknown etiology despite an extensive medical evaluation. Once suspected, patients should undergo mesenteric duplex ultrasound. Diagnosis is confirmed with elevated celiac artery velocities which normalize with deep inspiration followed by CT angiogram showing the typical "J-hook" conformation of the celiac artery. Patients should then undergo evaluation by a multi-disciplinary team to appropriately select and prepare patients for potential surgical treatment. Surgical options include release of the median arcuate ligament, with or without neurolysis of the celiac nerve plexus, and with or without concomitant revascularization procedures. Approaches can be open, laparoscopic, or robotic. Surgical treatment has an overall success rate of 70-80% with patients reporting improved abdominal pain and quality of life. Post-operatively, patients can have persistent or recurrent abdominal pain and should undergo re-evaluation for possible need for a revascularization procedure for stenosis of the celiac artery or celiac plexus block if the celiac artery flow is normalized. Additionally, some patients will have persistent pain consistent with functional gastrointestinal disorder (FGID) that will then require medical management. Psychiatric comorbidities have been identified as a predisposing factor that may predict poorer outcomes, and there are preliminary findings suggesting that patients with dysautonomia diagnoses may have worse outcomes as well.
Collapse
|
21
|
Walker LS, Stone AL, Han GT, Garber J, Bruehl S, Smith CA, Anderson J, Palermo TM. Internet-delivered cognitive behavioral therapy for youth with functional abdominal pain: a randomized clinical trial testing differential efficacy by patient subgroup. Pain 2021; 162:2945-2955. [PMID: 34793406 PMCID: PMC8602868 DOI: 10.1097/j.pain.0000000000002288] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/22/2021] [Indexed: 12/19/2022]
Abstract
ABSTRACT Inconsistent results of psychological treatments for pediatric functional abdominal pain (FAP) may be due to heterogeneity of patients' pain-related psychological characteristics. This randomized controlled trial tested whether statistically derived patient subgroups (high pain dysfunctional [HPD], high pain adaptive [HPA], and low pain adaptive [LPA]) moderated response to cognitive behavior therapy (CBT) for adolescents with FAP and their parents (n = 278 dyads; patients were 66% female, mean [SD] age was 14.62 [1.88] years, and parents were 95% female). Randomization to Internet-delivered CBT vs Internet-delivered pain education (EDU) was stratified by patient subgroup. Follow-up assessments of gastrointestinal (GI) symptoms (primary outcome), abdominal pain, and pain interference were at midtreatment, posttreatment, 6 months, and 12 months. Data were analysed using linear mixed effects models. Significant treatment × subgroup × time interaction effects showed that patient subgroup significantly moderated the effect of treatment on GI symptoms (t[853 = -2.93, P = 0.003) and abdominal pain (t(844) = -2.14, P = 0.03) across the treatment period. Among HPD youth, those in CBT had significantly greater GI symptom reduction than those in EDU through posttreatment. By contrast, among HPA and LPA youth, symptom improvement did not differ by treatment condition. Furthermore, among all patients assigned to CBT, HPD youth demonstrated significantly greater reductions in GI symptoms compared with HPA and LPA youth and greater reductions in abdominal pain compared with LPA youth. All subgroups maintained symptom reductions throughout the follow-up period. Results suggest that subgrouping FAP patients may inform treatment allocation and optimize treatment response.
Collapse
Affiliation(s)
- Lynn S. Walker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda L. Stone
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Gloria T. Han
- Child Study Center, Yale University School of Medicine, New Haven, CT
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Judy Garber
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Craig A. Smith
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN
| | - Julia Anderson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington
- Seattle Children’s Research Institute, Seattle, WA
| |
Collapse
|
22
|
Ruiz G, Marsac ML. Commentary: Intergenerational Associations in Pediatric Chronic Pain: Validity of an Adapted Unified Multifactorial Model of Parental Factors in Pediatric Chronic Pain. J Pediatr Psychol 2021; 47:132-134. [PMID: 34850071 DOI: 10.1093/jpepsy/jsab126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gemma Ruiz
- International Doctoral School, Faculty of Psychology, Universidad Nacional de Educación a Distancia, Spain
| | - Meghan L Marsac
- Department of Pediatrics, Kentucky Children's Hospital, USA.,College of Medicine, University of Kentucky, USA
| |
Collapse
|
23
|
van Tilburg MAL, Levy RL, Stoner S, Romano JM, Murphy TB, Abdullah B, Mancl L, Feld AD. Mediation of outcomes for cognitive behavioral therapy targeted to parents of children with Functional Abdominal Pain Disorders. J Psychosom Res 2021; 150:110618. [PMID: 34598050 PMCID: PMC8526395 DOI: 10.1016/j.jpsychores.2021.110618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE There is a large body of evidence for the efficacy of Cognitive Behavioral Therapy (CBT) in treating Functional Abdominal Pain Disorders (FAPD) in children. In most CBT interventions for FAPD, parents participate together with their children. However, only one study to date has examined targeting parents alone for treatment. The aim of the current study was to examine mediators of a parent-only CBT treatment incorporating social learning (SLCBT) for FAPD in children. METHODS We examined mediators of child outcomes in an existing randomized controlled trial (n = 316) of parent-only social learning CBT compared to an education condition. Hypothesized mediators (parental protectiveness, perceived threat of pain, catastrophizing) were assessed at 3 months post-treatment, and outcomes (parent ratings of disability, quality of life, school absences, and health care visits) were assessed at 6 months post-treatment. Mediation analyses were performed using Hayes' PROCESS macro. RESULTS Pain catastrophizing significantly mediated treatment effects for all outcomes (B ranged from -1.65 to 2.22). Reduction in pain threat was a significant mediator for all outcomes (B ranged from -1.84 to 3.13) except school absences and health care visits. Decrease in parental protectiveness mediated effects on disability and missed school (B ranged from -1.47 to 1.34). Mediation effects did not differ by in-person or remote delivery of SLCBT. CONCLUSION Changes in maladaptive parental thoughts and behaviors following parent-only SLCBT intervention appeared to mediate the effects of the intervention. Parental catastrophizing appears to be a particularly important target given that decreases in that variable mediated all outcomes.
Collapse
Affiliation(s)
- Miranda A L van Tilburg
- School of Pharmacy & Health Sciences, Campbell University, Buies Creek, NC, United States of America; School of Social Work, University of Washington, Seattle, WA, United States of America; Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, United States of America.
| | - Rona L Levy
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Susan Stoner
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, United States of America
| | - Joan M Romano
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States of America
| | - Tasha B Murphy
- School of Social Work, University of Washington, Seattle, WA, United States of America
| | - Bisher Abdullah
- CHI Franciscan, Prime Health Clinic, Tacoma, WA, United States of America
| | - Lloyd Mancl
- Oral Health Sciences, University of Washington, Seattle, WA, United States of America
| | - Andrew D Feld
- Division of Gastroenterology, Washington Permanente Medical Group, University of Washington, Seattle, WA, United States of America
| |
Collapse
|
24
|
Lee S, Dick BD, Jordan A, McMurtry CM. Psychological Interventions for Parents of Youth With Chronic Pain: A Scoping Review. Clin J Pain 2021; 37:825-844. [PMID: 34475341 DOI: 10.1097/ajp.0000000000000977] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/19/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Parents are integral to their youth's chronic pain experiences, and intervening with parents may improve parent and youth functioning. Existing systematic reviews are not specific to pain or do not systematically report critical aspects to facilitate implementation of parent interventions in diverse settings. Thus, this scoping review aimed to map published parent interventions for pediatric chronic pain to summarize the participant and intervention characteristics, treatment components, methods, outcomes, feasibility, and acceptability, as well as identify gaps for future research. METHODS Four databases were searched (PubMed, PsycINFO, CINAHL, and Google Scholar). Studies of any design reporting psychological interventions including parents of youth (0 to 18 y) with chronic pain were included. Data on study characteristics, treatment components, effectiveness, and feasibility/acceptability were extracted. RESULTS Fifty-four studies met inclusion criteria from 9312 unique titles. The majority were nonrandomized cognitive-behavioral therapy interventions delivered individually. The degree of parent participation ranged from 17% to 100%; the average enrollment rate was 68%. Reported parent and youth outcomes were variable; 26% of studies did not include any parent-related outcomes. DISCUSSION Parent interventions may be a helpful and feasible way to support parents and youth with chronic pain. There is variability across study characteristics, treatment content/aims, parent participation, and parent/youth outcomes.
Collapse
Affiliation(s)
- Soeun Lee
- Department of Psychology, University of Guelph, Guelph
| | - Bruce D Dick
- Department of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta
- Pediatric Chronic Pain Clinic, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Abbie Jordan
- Department of Psychology and Bath Centre for Pain Research, University of Bath, Bath, UK
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton
- Children's Health Research Institute and Department of Pediatrics, Schulich School of Medicine and Dentistry, London, ON
| |
Collapse
|
25
|
Stiles-Shields C, Osos S, Heilbrun A, Feldman ECH, Mak GZ, Skelly CL, Drossos T. Targeting Coping to Improve Surgical Outcomes in Pediatric Patients With Median Arcuate Ligament Syndrome: Feasibility Study. Front Psychol 2021; 12:695435. [PMID: 34744860 PMCID: PMC8569106 DOI: 10.3389/fpsyg.2021.695435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 10/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Median arcuate ligament syndrome (MALS) is a vascular compression syndrome leading to postprandial epigastric pain, nausea, and weight loss; it can be treated surgically. While most patients report improved quality of life following surgical intervention, 30% continue to experience chronic abdominal pain. Pre-surgical diagnoses of depression and/or anxiety have been found to significantly predict post-surgical: quality of life, highest experience of pain, anxiety, and parent- and self-reported coping strategies. As such, increasing the coping strategies of pediatric patients with MALS may impact their post-surgical outcomes. The purpose of the current study was to: (1) implement a pre-operative cognitive behavioral therapy protocol with a focus on psychoeducation and coping strategies; and (2) determine feasibility of a pre-surgical intervention for this population. Method: Children (<18 years of age) with a diagnosis of MALS who were eligible for surgical intervention were invited to participate in a 7-week in-person or video-based pre-surgical cognitive behavioral therapy intervention. Psychiatric comorbidities were assessed at baseline and post-surgery; patient-reported distress, pain interference and intensity, health-related quality of life, and health status were assessed at four time points (baseline, week 4, week 7, and post-surgery). Descriptive analyses were used to characterize the sample, assess feasibility outcomes (i.e., attrition rates), and explore symptom-based outcomes across time. Results: Twelve pediatric patients (M age = 15.2 ± 1.7; 91.7% female) and their parents (91.7% mothers) participated. Feasibility metrics based on protocol completion were exceeded for engagement at the stages of consent (68.4% vs. goal of ≥50%), treatment initiation (92.3% vs. 85%), and treatment completion (84.6% vs. 75%). Out of the 12 participants, nine (75%) met criteria for at least one comorbid psychiatric diagnosis at baseline and nine (75%) elected to undergo MALS surgery after completing the intervention. Conclusion: The intervention implementation was feasible, despite chronic pain symptoms experienced by the sample, a high prevalence of psychiatric diagnoses, and an international pandemic, suggesting that it would be beneficial to further evaluate the efficacy of the intervention. Future research should include stakeholder input in the design, deployment, and evaluation of a pilot efficacy trial of pre-surgical cognitive behavioral therapy for pediatric patients with MALS.
Collapse
Affiliation(s)
- Colleen Stiles-Shields
- Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Sylwia Osos
- Department of Psychiatry and Behavioral Sciences, The University of Chicago Medicine, Chicago, IL, United States
- College of Arts and Sciences, Roosevelt University, Chicago, IL, United States
| | | | - Estée C. H. Feldman
- Department of Psychiatry and Behavioral Sciences, The University of Chicago Medicine, Chicago, IL, United States
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Grace Zee Mak
- Section of Pediatric Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, United States
| | - Christopher L. Skelly
- Section of Vascular Surgery, Department of Surgery, The University of Chicago Medicine, Chicago, IL, United States
| | - Tina Drossos
- Department of Psychiatry and Behavioral Sciences, The University of Chicago Medicine, Chicago, IL, United States
| |
Collapse
|
26
|
Abstract
OBJECTIVE Functional gastrointestinal disorders (FGIDs) are common during childhood and adolescence. When a somatic diagnosis is excluded, the healthcare system often terminates contact with the patient. The aim of the present study was to learn more about children's and adolescents' experiences with, and reflections on, the causes of their abdominal pain and what could possibly help them. DESIGN The study has a qualitative design. Interviews with open questions were carried out by the first author. The conversations were audiotaped, transcribed and analysed by means of qualitative content analysis. SETTING Children and adolescents referred from general practitioners located in urban and rural regions in two municipals in Norway. In 2016 and 2019, we had interviewed these children's parents about their child's abdominal pain. In spring 2020, the children and adolescents were interviewed. PARTICIPANTS Twelve children and adolescents aged 10-18 years with FGIDs. RESULTS Eight of the children and adolescents had recovered from their abdominal pain, while four still had symptoms. They felt frustrated by not having a diagnosis and by the lack of available treatment. Some who had been absent from school for weeks to months felt isolated and depressed. Focusing on positive thoughts and activities was reported to improve the pain. The abdominal pain could be considered a manifestation of mental problems. CONCLUSIONS Thinking differently about the symptoms reduced the FGIDs for the children and adolescents. The treating physicians as well as parents and teachers need to help the child focus on changing the mindset of pain.
Collapse
Affiliation(s)
- Anne Brodwall
- Department of Child and Adolescent Psychiatry, Vestre Viken Trust, Baerum, Norway
| | - Mette Brekke
- General Practice Research Unit, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
27
|
Miller AK, Ely SL, Barber Garcia BN, Richardson P, Cunningham NR. Engagement during a Mixed In-Person and Remotely Delivered Psychological Intervention for Youth with Functional Abdominal Pain Disorders and Anxiety. Children 2021; 8:775. [PMID: 34572207 PMCID: PMC8466519 DOI: 10.3390/children8090775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/19/2021] [Accepted: 08/31/2021] [Indexed: 12/02/2022]
Abstract
Functional abdominal pain disorders (FAPD) are common disabling pain conditions frequently associated with co-occurring mental health problems such as anxiety. Psychological therapies such as cognitive behavioral therapy (CBT) have been shown to be effective. Therefore, it is important to understand participant engagement (i.e., use of intervention tools) to such approaches, and if engagement impacts treatment response. The Aim to Decrease Anxiety and Pain Treatment (ADAPT) is an effective psychological treatment approach using a blend of in-person sessions and interventionist phone support with self-paced web modules to manage pain and anxiety. The current study used a mixed-methods approach to investigate micro-level and macro-level participant engagement during the ADAPT program. In-person/phone session attendance was high (>95%) although scheduling adjustments were common (25.5%). Varied levels of engagement with web tools were observed. Thematic analysis also revealed variability in patterns of use. Additionally, while participants indicated they generally understood how to use certain skills (e.g., problem solving, detective thinking), and these skills were effective in managing symptoms during treatment, these activities were generally underutilized. Further, participant engagement did not predict response to the ADAPT intervention. These findings are important as the demand for accessible psychotherapeutic tools to manage pain and anxiety is likely to remain high.
Collapse
|
28
|
Short P, Burklow CS, Nylund CM, Susi A, Hisle-Gorman E. Impact of Parental Illness and Injury on Pediatric Disorders of Gut-Brain Interaction. J Pediatr 2021; 236:148-156.e3. [PMID: 33991543 DOI: 10.1016/j.jpeds.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/02/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the relationship between parental injury and illness and disorders of gut-brain interaction (DGBI) in children. STUDY DESIGN A self-controlled case series using data from the Military Health System Data Repository compared International Classification of Diseases, Ninth Revision-identified DGBI-related outpatient visits and prescriptions in 442 651 children aged 3-16 years in the 2 years before and the 2 years after the injury and/or illness of their military parent. Negative binomial regression was used to compare visit rates for constipation, fecal incontinence, abdominal pain, irritable bowel syndrome, and a composite of these before and after parental injury and/or illness. Logistic regression, clustered by child, compared the odds of stooling agent and antispasmodic prescription before and after parental injury and/or illness. RESULTS In the 2 years following parental injury and/or illness, children had increased visits for DGBIs (adjusted incidence rate ratio [aIRR] 1.09; 95% CI 1.07-1.10), constipation (aIRR 1.07; 95% CI 1.04-1.10), abdominal pain (aIRR 1.09; 95% CI 1.07-1.12), and irritable bowel syndrome (aIRR 1.37; 95% CI 1.19-1.58). Following parental injury and/or illness, the odds of stooling agent prescription decreased (aOR 0.95; 95% CI 0.93-0.97) and the odds of antispasmodic prescription increased (aOR 1.26; 95% CI 1.18-1.36). CONCLUSIONS Parental injury and/or illness is associated with increased healthcare use for DGBIs. Parental health should be considered by clinicians when assessing DGBIs, counseling patients, and formulating treatment plans.
Collapse
Affiliation(s)
- Patrick Short
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Carolyn Sullivan Burklow
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Cade M Nylund
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Apryl Susi
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Elizabeth Hisle-Gorman
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
29
|
Friesen C, Colombo JM, Deacy A, Schurman JV. An Update on the Assessment and Management of Pediatric Abdominal Pain. Pediatric Health Med Ther 2021; 12:373-393. [PMID: 34393542 PMCID: PMC8354769 DOI: 10.2147/phmt.s287719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Abstract
Chronic abdominal pain is very common in children and adolescent and results in high personal and social costs. Most youth with chronic abdominal pain fulfill criteria for a functional abdominal pain disorder (FAPD) as defined by Rome criteria. These are complex conditions with a wide array of biological, psychological, and social factors contributing to the experience of pain. The purpose of the current review is to provide an overview of the pathophysiology of FAPDs and an up-to-date summary of the literature related to FAPDs in children and adolescents, with additional focus on several areas (eg, diet and probiotics) where patients and families frequently have questions or implement self-directed care. We also provide an approach to the assessment and treatment of pediatric FAPDs focusing on the robust literature regarding psychological interventions and much sparser literature regarding medication treatment.
Collapse
Affiliation(s)
- Craig Friesen
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer M Colombo
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Amanda Deacy
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer V Schurman
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| |
Collapse
|
30
|
Warschburger P, Calvano C, Becker S, Ebinger F, Hudert C, Iven E, Posovszky C, Winter SM, Daubmann A, Ozga AK, Wegscheider K. Do Children With Functional Abdominal Pain Benefit More From a Pain-Specific Cognitive-Behavioral Intervention Than From an Unspecific Attention Control Intervention? Results of a Randomized Controlled Trial. Am J Gastroenterol 2021; 116:1322-35. [PMID: 33767111 DOI: 10.14309/ajg.0000000000001191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/22/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION We aimed to compare the efficacy of cognitive-behavioral therapy (CBT) among children with functional abdominal pain with an attention control (AC), hypothesizing the superiority of CBT group intervention regarding pain intensity (primary outcome), pain duration and frequency (further primary outcomes), functional disability, and quality of life and coping strategies (key secondary outcomes). METHODS We conducted a prospective, multicenter, randomized controlled efficacy trial (RCT) with 4 time points (before intervention, after intervention, 3-month follow-up, and 12-month follow-up). One hundred twenty-seven children aged 7-12 years were randomized to either the CBT (n = 63; 55.6% girls) or the AC (n = 64; 57.8% girls). RESULTS Primary endpoint analysis of the logarithmized area under the pain intensity curve showed no significant difference between groups (mean reduction = 49.04%, 95% confidence interval [CI] -19.98%-78.36%). Treatment success rates were comparable (adjusted odds ratio = 0.53, 95% CI 0.21-1.34, number needed to treat = 16). However, time trend analyses over the course of 1 year revealed a significantly greater reduction in pain intensity (40.9%, 95% CI 2.7%-64.1%) and pain duration (43.6%, 95% CI 6.2%-66.1%) in the CBT compared with the AC, but not in pain frequency per day (1.2, 95% CI -2.7 to 5.2). In the long term, children in the CBT benefitted slightly more than those in the AC with respect to functional disability, quality of life, and coping strategies. DISCUSSION Both interventions were effective, which underlines the role of time and attention for treatment efficacy. However, in the longer term, CBT yielded more favorable results.
Collapse
|
31
|
Ives LT, Stein K, Rivera-Cancel AM, Nicholas JK, Caldwell K, Datta N, Mauro C, Egger H, Puffer E, Zucker NL. Children's Beliefs about Pain: An Exploratory Analysis. Children (Basel) 2021; 8:452. [PMID: 34071866 DOI: 10.3390/children8060452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/21/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022]
Abstract
Functional abdominal pain (FAP) is one of the most common childhood medical complaints, associated with significant distress and impairment. Little is known about how children understand their pain. Do they attribute it to personal weakness? Do they perceive pain as having global impact, affecting a variety of activities? How do they cope with pain? We explored the pain beliefs of 5- to 9-year-old children with FAP using a novel Teddy Bear Interview task in which children answered questions about a Teddy bear's pain. Responses were analyzed quantitatively and qualitatively. Results indicate that the majority of young children with FAP are optimistic about pain outcomes. Children generated many types of coping strategies for Teddy's pain and adjusted their calibration of Teddy's pain tolerance dependent on the activity being performed. Early warning signs also emerged: a subset of children were pessimistic about Teddy's pain, and several children identified coping strategies that, while developmentally appropriate, could lead to excessive help seeking if not intervened upon (e.g., physician consultation and shot). The Teddy Bear Interview allows children to externalize their pain, making it a useful tool to access cognitive pain constructs in younger children. Thus, these findings highlight the importance of early intervention for childhood FAP.
Collapse
|
32
|
Reis F, Palermo TM, Acalantis L, Nogueira LC, Meziat-Filho N, Louw A, Ickmans K. "A journey to learn about pain": the development and validation of a comic book about pain neuroscience education for children. Braz J Phys Ther 2021; 26:100348. [PMID: 34001422 DOI: 10.1016/j.bjpt.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/15/2021] [Accepted: 04/06/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pain education resources for children using appropriate language and illustrations remain scarce. OBJECTIVES We aimed to summarize the development process and testing for face and content validity of a structured comic book about pain education for children. METHODS A first draft of a comic book was developed (Portuguese and English) based on pain education concepts. Experts in pediatric pain from different countries analyzed content, objectives, language, illustrations, layout, motivation, and cultural adjustment. A third draft developed in Portuguese considering experts' suggestions was presented to children and parents in Brazil. The total adequacy score was calculated from the sum of the scores obtained in each domain, divided by the maximum total score. Descriptive analysis is presented. RESULTS The expert panel was composed of 11 (64.7%) physical therapists, and 6 (35.3%) psychologists. The total adequacy score (0-100%) was 87.74%. The third draft version of the comic book was presented to 28 children and the final version was presented to 16 children with a mean age of 9.6 years. Children were totally satisfied (n=4; 26.7%) or satisfied (n=9; 56.2%) with the story of the comic book. The readability of the comic book was considered suitable for grades 4 to 6 educational level. CONCLUSION The comic book "A Journey to Learn about Pain" was validated for face and content validity by the expert panel and the Brazilian target population. This comic book is available in Portuguese and English and can be a potentially useful resource for children.
Collapse
Affiliation(s)
- Felipe Reis
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ); Pain in Motion research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel.
| | | | - Louise Acalantis
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ)
| | - Leandro Calazans Nogueira
- Physical Therapy Department of Instituto Federal do Rio de Janeiro (IFRJ); Postgraduate Program in Rehabilitation Sciences - Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | - Ney Meziat-Filho
- Postgraduate Program in Rehabilitation Sciences - Centro Universitário Augusto Motta (UNISUAM), Rio de Janeiro, Brazil
| | | | - Kelly Ickmans
- Pain in Motion research group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel; Research Foundation - Flanders (FWO), Brussels, Belgium
| |
Collapse
|
33
|
Riquelme I, Escobio-Prieto I, Oliva-Pascual-Vaca Á, Heredia-Rizo AM, Montoya P. Effect of Social Support in Pain Sensitivity in Children with Cerebral Palsy and Typically Developing Children. Int J Environ Res Public Health 2021; 18:ijerph18094661. [PMID: 33925690 PMCID: PMC8125433 DOI: 10.3390/ijerph18094661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/25/2021] [Indexed: 12/03/2022]
Abstract
Pain and abnormal somatosensory processing are important associated conditions in children and adolescents with cerebral palsy (CP). Perceived social support is highly relevant for pain perception and coping. Aim: The aim of the present study was to assess the influence of social support on pain sensitivity in children and adolescents with cerebral palsy and healthy peers. Design: Cross-sectional study. Methods: Pressure pain thresholds were assessed in 42 children and adolescents with CP and 190 healthy peers during three different conditions: alone, with their mother and with a stranger. Results: Children with CP reported lower pain sensitivity when they were with their mother than being alone or with a stranger, whereas healthy peers did not experience different pain sensitivity related to the social condition. Sex or clinical characteristics did not affect the relationship between pain perception and social support. Conclusion: The present study shows how children with CP are highly affected by social and contextual influences for regulating pain sensitivity. Solicitous parental support may enhance pain perception in children with CP. Further research on the topic is warranted in order to attain well-founded conclusions for clinical practice.
Collapse
Affiliation(s)
- Inmaculada Riquelme
- Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Carretera de Valldemossa km 7.5, 07122 Palma de Mallorca, Spain;
- Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma de Mallorca, Spain
- Correspondence: ; Tel.: +34-971-171-310; Fax: +34-971-172-309
| | - Isabel Escobio-Prieto
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (I.E.-P.); (Á.O.-P.-V.); (A.M.H.-R.)
| | - Ángel Oliva-Pascual-Vaca
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (I.E.-P.); (Á.O.-P.-V.); (A.M.H.-R.)
| | - Alberto Marcos Heredia-Rizo
- Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, 41009 Sevilla, Spain; (I.E.-P.); (Á.O.-P.-V.); (A.M.H.-R.)
| | - Pedro Montoya
- Institute of Health Sciences Research (IUNICS-IdISBa), University of Balearic Islands, Carretera de Valldemossa km 7.5, 07122 Palma de Mallorca, Spain;
| |
Collapse
|
34
|
Garr K, Odar Stough C, Origlio J. Family Functioning in Pediatric Functional Gastrointestinal Disorders: A Systematic Review. J Pediatr Psychol 2021; 46:485-500. [PMID: 33876231 DOI: 10.1093/jpepsy/jsab007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Children with some chronic health conditions experience family functioning difficulties. However, research examining family functioning in youth with functional gastrointestinal disorders (FGIDs) has produced mixed results. Therefore, the current review critically synthesized the literature on family functioning among youth with FGIDs. METHODS A systematic search using pediatric, family functioning, and FGID search terms was conducted in PubMed, PsycInfo, and ProQuest. Out of the 586 articles initially identified, 17 studies met inclusion criteria. Studies were included if they presented original research in English, assessed family functioning, and the study sample consisted of children (0-18 years) diagnosed with a FGID. Quality assessment ratings were conducted for each included study based on a previously developed scientific merit 3-point rating system. RESULTS The majority of studies (n = 13) examined family functioning between youth with FGIDs and comparison groups. The remaining studies explored associations between family functioning and study variables (e.g., child psychosocial functioning and sociodemographic factors) and examined family functioning clusters among children with FGIDs. In general, children with FGIDs demonstrated poorer family functioning compared to healthy counterparts. Findings also suggested that child psychosocial functioning, disease characteristics, and sociodemographic factors were related to family functioning among youth with FGIDs. The average quality of studies was moderate (M = 2.3). CONCLUSIONS Maintaining healthy family functioning appears to be challenging for some families of children with FGIDs. Future research should explore the directionality of the relationship between family functioning and child physical and psychosocial outcomes to advance the understanding and treatment of pediatric FGIDs.
Collapse
Affiliation(s)
- Katlyn Garr
- Department of Psychology, University of Cincinnati
| | | | | |
Collapse
|
35
|
Laird KT, Smith CA, Hollon SD, Walker LS. Validation of the Health-Related Felt Stigma and Concealment Questionnaire. J Pediatr Psychol 2021; 45:509-520. [PMID: 32388554 DOI: 10.1093/jpepsy/jsaa030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Stigma is associated with many health conditions, including chronic pain. Research on health-related stigma is limited by the lack of validated instruments that distinguish among various stigma-related constructs. We aimed to develop and validate such a measure for pediatric functional abdominal pain (FAP). Felt stigma (FS) was defined as comprising both perceived and internalized stigma. Stigma concealment (SC) was defined as efforts by stigmatized individuals to prevent others from learning of their condition. METHODS Using a theory-driven approach, we adapted items from existing self-report measures of stigma to construct the health-related FS and Concealment Questionnaire (FSC-Q). Patients with FAP (N = 179, ages 11-17) completed the preliminary FSC-Q and health-related measures hypothesized to be associated with stigma. Cognitive interviewing and exploratory factor analysis (EFA) informed the final version of the measure. RESULTS EFA identified a 2-factor model comprised of FS and SC. The FS and SC scales exhibited good internal consistency and construct validity. Consistent with study hypotheses, both factors were significantly associated with anxiety, depression, pain catastrophizing, pain threat, physical symptoms, and pain interference/disability. Higher FS was associated with higher mental healthcare utilization. The subset of participants meeting criteria for irritable bowel syndrome (IBS) reported higher FS and SC compared with those without IBS. CONCLUSION The FSC-Q may help advance research on health-related stigma in FAP and other chronic health conditions by allowing for assessment of distinct stigma-related constructs.
Collapse
Affiliation(s)
- Kelsey T Laird
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.,Department of Psychology and Human Development, Vanderbilt University
| | - Craig A Smith
- Department of Psychology and Human Development, Vanderbilt University
| | | | - Lynn S Walker
- Department of Psychology and Human Development, Vanderbilt University.,Department of Pediatrics, Vanderbilt University Medical Center
| |
Collapse
|
36
|
Freeman AJ, Maqbool A, Bellin MD, Goldschneider KR, Grover AS, Hartzell C, Piester TL, Szabo F, Kiernan BD, Khalaf R, Kumar R, Rios M, Husain SZ, Morinville VD, Abu-El-Haija M. Medical Management of Chronic Pancreatitis in Children: A Position Paper by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr 2021; 72:324-340. [PMID: 33230082 PMCID: PMC8054312 DOI: 10.1097/mpg.0000000000003001] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT This position paper summarizes the current understanding of the medical management of chronic pancreatitis (CP) in children in light of the existing medical literature, incorporating recent advances in understanding of nutrition, pain, lifestyle considerations, and sequelae of CP. This article complements and is intended to integrate with parallel position papers on endoscopic and surgical aspects of CP in children. Concepts and controversies related to pancreatic enzyme replacement therapy (PERT), the use of antioxidants and other CP medical therapies are also reviewed. Highlights include inclusion of tools for medical decision-making for PERT, CP-related diabetes, and multimodal pain management (including an analgesia ladder). Gaps in our understanding of CP in children and avenues for further investigations are also reviewed.
Collapse
Affiliation(s)
- A. Jay Freeman
- Department of Gastroenterology, Hepatology and Nutrition, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA
| | - Asim Maqbool
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Melena D. Bellin
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN
| | | | - Amit S. Grover
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Cheryl Hartzell
- Division of Pediatric Anesthesiology, Department of Anesthesiology, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Travis L. Piester
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Flora Szabo
- Division of Pediatric Gastroenterology and Nutrition, Children’s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA
| | - Bridget Dowd Kiernan
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Racha Khalaf
- Digestive Health Institute, Children’s Hospital Colorado, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO
| | - Rakesh Kumar
- Department of Gastroenterology, Hepatology and Nutrition, Promedica Toledo Children’s Hospital, Toledo, OH
| | - Mirta Rios
- Food and Nutrition Department, Nicklaus Children’s Hospital, Miami, FL
| | - Sohail Z. Husain
- Department of Pediatrics, Stanford University, and the Lucile Packard Children’s Hospital, Palo Alto, CA
| | - Veronique D. Morinville
- Division of Pediatric Gastroenterology and Nutrition, Montreal Children’s Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Maisam Abu-El-Haija
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
37
|
Lalouni M, Hesser H, Bonnert M, Hedman-Lagerlöf E, Serlachius E, Olén O, Ljótsson B. Breaking the vicious circle of fear and avoidance in children with abdominal pain: A mediation analysis. J Psychosom Res 2021; 140:110287. [PMID: 33227558 DOI: 10.1016/j.jpsychores.2020.110287] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Exposure-based cognitive behavioral therapy via internet (Internet-CBT) has been shown to reduce symptoms and increase quality of life for children with functional abdominal pain disorders (FAPDs), but the mechanisms of change are unknown. The objective was to examine whether a change in symptom-specific fear and avoidance, i.e., gastrointestinal-specific anxiety (GI-anxiety) and gastrointestinal-specific avoidance (GI-avoidance), mediated changes in parent-reported abdominal symptoms for children receiving Internet-CBT compared with children receiving treatment as usual. A further aim was to assess if baseline levels of the proposed mediators moderated the mediation. METHODS Weekly assessments of child-reported mediators and parent-reported outcome from 90 children aged 8-12 who were included in a randomized controlled trial were used in univariate and multivariate growth models to test the direct effect of treatment on outcome and the indirect effects via mediators and moderated mediation. RESULTS Treatment condition significantly predicted the slope of the mediators (a-path), in favor of Internet-CBT, and mediators were correlated with the outcome (b-path). The indirect effects of the mediators on the outcome (cross-product of the a and b-paths) were significantly different from zero for both GI-avoidance, ab = 1.43, 95%CI [0.42, 3.23]; and GI-anxiety ab = 1.58, 95%CI [0.43, 3.62]. Baseline levels of the proposed mediators moderated the size of the mediation. CONCLUSIONS GI-anxiety and GI-avoidance were mediators of change in Internet-CBT and high levels of the mediators at baseline were associated with larger mediated effects. Healthcare professionals should be aware of, and inform families about, the potential benefits of reducing symptom-specific fear and avoidance.
Collapse
Affiliation(s)
- Maria Lalouni
- Department of Medicine, Karolinska Institutet, Solna, Sweden; Stockholm Health Care Services, Stockholm County Council, Sweden; Department of Clinical Neuroscience, Neuro, Karolinska Institutet, Stockholm, Sweden.
| | - Hugo Hesser
- Department of Behavioral Sciences and Learning, Linköping University, Sweden; Center for Health and Medical Psychology, Örebro University, Sweden
| | - Marianne Bonnert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Sweden; Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Sweden
| | - Eva Serlachius
- Stockholm Health Care Services, Stockholm County Council, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Department of Medicine, Karolinska Institutet, Solna, Sweden; Department of Paediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Sweden
| |
Collapse
|
38
|
Abstract
INTRODUCTION Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. OBJECTIVES To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. METHODS This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable "Factsheet Pain in Children: Management" and reviews best evidence and practice. RESULTS Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind-body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. CONCLUSION Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
Collapse
Affiliation(s)
- Stefan J Friedrichsdorf
- Center of Pain Medicine, Palliative Care and Integrative Medicine, University of California at San Francisco (UCSF), Benioff Children's Hospitals in Oakland and San Francisco, Kalifornien, USA.
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgien
| |
Collapse
|
39
|
Thapar N, Benninga MA, Crowell MD, Di Lorenzo C, Mack I, Nurko S, Saps M, Shulman RJ, Szajewska H, van Tilburg MAL, Enck P. Paediatric functional abdominal pain disorders. Nat Rev Dis Primers 2020; 6:89. [PMID: 33154368 DOI: 10.1038/s41572-020-00222-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
Paediatric functional abdominal pain disorders, currently referred to as disorders of gut-brain interaction, comprise irritable bowel syndrome, functional dyspepsia, abdominal migraine and functional abdominal pain not otherwise specified, as defined by the Rome IV diagnostic criteria. Functional abdominal pain disorders are common disorders with a prevalence of 3-16% depending on country, age and sex. A greater understanding of aetiopathogenesis and pathophysiology is emerging and includes intestinal components (inflammation, motility and the microbiota), central factors (psychological aspects, sensitization and/or differences in connectivity or activity of certain brain regions) as well as extrinsic factors (infections). In particular, the timing of disruption of the microbiota-gut-brain axis seems to be important. Diagnosis is challenging but is primarily based on clinical symptoms and exclusion of other organic causes, with an emphasis on avoiding unnecessary invasive diagnostic procedures. The available pharmacological interventions are limited in children and, therefore, management has focused on combined approaches, including mind-targeted interventions (hypnotherapy and cognitive behavioural therapy), diet (probiotics) and percutaneous electrical nerve field stimulation. The evidence for their clinical efficacy, although limited, is favourable, with positive impacts on symptoms and overall quality of life. The coming decades hold promise for improved understanding and management of these enigmatic disorders.
Collapse
|
40
|
Reed B, Buzenski J, van Tilburg MAL. Implementing psychological therapies for gastrointestinal disorders in pediatrics. Expert Rev Gastroenterol Hepatol 2020; 14:1061-1067. [PMID: 32749161 PMCID: PMC7577923 DOI: 10.1080/17474124.2020.1806055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/03/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The brain-gut axis refers to complex and reciprocal interactions that impact symptom presentation and disease course within the GI tract. Psychological therapies included in the treatment of functional gastrointestinal disorders (FGIDs) as well as chronic gut disorders including inflammatory bowel disease (IBD) address environmental and psychological factors impacting patients' symptoms and overall functioning. AREAS COVERED Employing a biopsychosocial approach, this review focuses on the evidence for and implementation of psychological therapies across pediatric gastrointestinal disorders. EXPERT OPINION By developing a working knowledge of evidence-based psychological therapies applicable to pediatric gastrointestinal disorders, clinicians have the opportunity to comprehensively treat patients' symptoms and distress. Regular communication and coordination between pediatric gastroenterology clinicians and providers of psychological therapies offers the greatest likelihood for successfully implementing psychological therapies into treatment plans.
Collapse
Affiliation(s)
- Bonney Reed
- Department of Pediatrics, Division of Gastroenterology, Hepatology, & Nutrition, Emory+Children's Pediatric Institute , Atlanta, Georgia
| | - Jessica Buzenski
- Department of Pediatrics, Division of Gastroenterology, Hepatology, & Nutrition, Emory+Children's Pediatric Institute , Atlanta, Georgia
| | - Miranda A L van Tilburg
- College of Pharmacy & Health Sciences, Campbell University , Buies Creek, NC, USA
- School of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina , Chapel Hill, NC, USA
- School of Social Work, University of Washington , Seattle, WA, USA
| |
Collapse
|
41
|
Yacob D, Kroon Van Diest AM, Di Lorenzo C. Functional abdominal pain in adolescents: case-based management. Frontline Gastroenterol 2020; 12:629-635. [PMID: 34917320 PMCID: PMC8640410 DOI: 10.1136/flgastro-2020-101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/23/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023] Open
Abstract
Functional gastrointestinal disorders (FGIDs), including functional abdominal pain (FAP), account for a large portion of conditions seen by paediatric gastroenterologists. Despite the commonality of FGIDs, there remains significant stigma around these diagnoses among medical providers, patients and families. This is due to the absence of easily identifiable biological markers in FGIDs and the overlay with psychological and social factors contributing to symptom onset and maintenance. As such, the biopsychosocial model is essential in conceptualising, evaluating and treating FGIDs. The way in which medical providers explain FGIDs and the manner in which they collaborate with other specialists (eg, psychologists, dieticians, physical therapists, school nurses) is paramount to the patient and family acceptance of an FGID diagnosis and the success of subsequent treatment. The following review outlines paediatric FGIDs with a focus on FAP in adolescents, in particular within the context of the biopsychosocial approach to pathophysiology, diagnosis and treatment.
Collapse
Affiliation(s)
- Desale Yacob
- Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio, USA,Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Ashley M Kroon Van Diest
- Pediatrics, The Ohio State University, Columbus, Ohio, USA,Pediatric Psychology and Neuropsychology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Carlo Di Lorenzo
- Pediatric Gastroenterology, Hepatology and Nutrition, Nationwide Children’s Hospital, Columbus, Ohio, USA,Pediatrics, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
42
|
Abstract
Abdominal pain in childhood is extremely common and presents frequently to both primary and secondary care, with many children having recurrent pain which impacts on daily functioning. Despite this most children have no discernible underlying pathology. We discuss the underlying mechanism for functional abdominal pain (visceral hypersensitivity), the evidence base linking parental anxiety and patient symptoms, and how parents can be supported in managing their children's symptoms by addressing questions commonly asked by children and families. We look at the evidence for a one-stop rational approach to investigation including a coeliac screen, inflammatory markers and consideration of stool faecal calprotectin, in the absence of red flags. We evaluate commonly used treatments for functional abdominal pain, within a context of managing family expectations. Given the limitations in pharmacological treatment options, trials of probiotics, peppermint oil, mebeverine and (for short-term use only) hyoscine butylbromide may be appropriate. Psychological interventions including cognitive-behavioural therapy, distraction techniques and hypnotherapy have a better evidence base. There is also some evidence for other complementary therapies in children, including yoga and neurostimulation. Outcome is generally good providing there is child and family acceptance of the multiple factors implicated in the aetiology of the pain.
Collapse
Affiliation(s)
- Edward Thomas Andrews
- Department of Paediatrics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R Mark Beattie
- Department of Paediatric Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark P Tighe
- Department of Paediatrics, Poole Hospital NHS Trust, Poole, UK
| |
Collapse
|
43
|
Stone AL, Han GT, Bruehl S, Garber J, Smith CA, Anderson J, Palermo TM, Walker LS. Subgroups of Pediatric Patients With Functional Abdominal Pain: Replication, Parental Characteristics, and Health Service Use. Clin J Pain 2020; 36:897-906. [PMID: 32969866 DOI: 10.1097/AJP.0000000000000882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Prior work in a cohort of youth with functional abdominal pain (FAP) identified patient subgroups (High Pain Dysfunctional, High Pain Adaptive, Low Pain Adaptive) that predicted differences in the course of FAP from childhood into young adulthood. We aimed to replicate these subgroups in a new sample of adolescents with FAP using the original classification algorithm and to extend subgroup characteristics to include parental characteristics and health service use. METHODS Adolescents (n=278; ages 11 to 17 y, 66% females) presenting to a gastroenterology clinic for abdominal pain, and their parents (92% mothers) completed self-report measures; adolescents also completed a 7-day pain diary. RESULTS The replicated patient subgroups exhibited distress and impairment similar to subgroups in the original sample. Moreover, in novel findings, the High Pain Dysfunctional subgroup differed from other subgroups by the predominance of mother-daughter dyads jointly characterized by high levels of anxiety, depressive symptoms, pain behavior, and pain catastrophizing. The High Pain Dysfunctional subgroup used more health care services than Low Pain Adaptive but did not differ from High Pain Adaptive. DISCUSSION Findings replicate and extend the original FAP classification and suggest that the subgroups have unique patient and parent features that may reflect distinct illness mechanisms requiring different treatments.
Collapse
|
44
|
Murphy LK, van Diggelen TR, Levy RL, Palermo TM. Understanding the Psychosocial and Parenting Needs of Mothers with Irritable Bowel Syndrome with Young Children. Children (Basel) 2020; 7:E93. [PMID: 32784536 DOI: 10.3390/children7080093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022]
Abstract
Women of childbearing age experience the highest prevalence of irritable bowel syndrome (IBS), yet little is known about their psychosocial and parenting needs, which may influence their children’s experience of future gastrointestinal or pain-related conditions. The aims of this study were to conduct qualitative interviews to understand the psychosocial and parenting needs of mothers with IBS who have young school-age children, and to assess mothers’ potential interest in and acceptability of a preventive parenting intervention program. Ten mothers with IBS who have young (age 5–10), healthy children were interviewed. Interviews were coded with thematic analysis and three themes were identified: (1) Guilt about how IBS impacts children, (2) Worry that children will develop IBS, and (3) Already on high alert for children’s health. All mothers expressed interest in an Internet-based preventive intervention and identified tools and strategies they would want included. Results demonstrate that mothers experience guilt about how IBS has impacted their children in their daily lives, concern that they need to pay attention to children’s early signs and symptoms that could indicate gastrointestinal problems, and worry about children developing IBS in the future—suggesting that a preventive intervention may address important concerns for this population.
Collapse
|
45
|
Abstract
PURPOSE OF REVIEW Even with optimized medical management, pain remains an inevitable part of pediatric cancer care. The most effective interventions for nonpharmacologic pain management within pediatric psychology include parent skills training. This review specifically explored the role of parents in cancer-related pain management with the goal of defining a set of evidence-based skills that could translate to improved pediatric cancer pain management. RECENT FINDINGS Pain is now widely understood to be both a sensory and emotional experience. As a result, within pediatric non-cancer pain management there is increasing application of the biopsychosocial model for pain management, inclusive of evidence-based psychological intervention. This review, specifically focusing on the role of parent training in cancer-related pain management, finds few interventions that systematically included parents. There is a need for continued evidence-based innovation and knowledge dissemination in this area of care. This paper highlights a critical gap in translational science within pediatric cancer pain management, namely, that parents who have a child with cancer are not reliably gaining access to well-established, evidence-based psychological skills training that can help to mitigate pain and pain-related stress. Based on the literature, the authors provide recommendations for generating adaptable, evidence-informed interventions that support and empower parents to help their child with pain management through all phases of cancer treatment.
Collapse
Affiliation(s)
- Kristen Uhl
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, 02115, USA
| | - Maureen Burns
- Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, 02115, USA
| | - Amy Hale
- Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, 02115, USA
| | - Rachael Coakley
- Boston Children's Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Boston, MA, 02115, USA.
| |
Collapse
|
46
|
Harrison LE, Timmers I, Heathcote LC, Fisher E, Tanna V, Duarte Silva Bans T, Simons LE. Parent Responses to Their Child's Pain: Systematic Review and Meta-Analysis of Measures. J Pediatr Psychol 2020; 45:281-298. [DOI: 10.1093/jpepsy/jsaa005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
Parent responses can have a major impact on their child’s pain. The purpose of this systematic review is to (a) identify and describe measures assessing pain-related cognitive, affective, and behavioral responses in parents of children with chronic pain and (b) meta-analyze reported correlations between parent constructs and child outcomes (i.e., pain intensity, functional disability, and school functioning). Prospero protocol registration ID: CRD42019125496.
Methods
We conducted a systematic search of studies including a measure of parent/caregiver responses to their child’s chronic pain. Study characteristics and correlations between parent measures and child outcomes were extracted. Data were summarized and meta-analyzed.
Results
Seventy-nine met inclusion criteria using 18 different measures of cognitive/affective (n = 3), behavioral (n = 5), and multidimensional responses (n = 10). Measures were used a median of three times (range 1–48), predominantly completed by mothers (88%), and primarily in mixed pain samples. Psychometrics of measures were generally adequate. Meta-analyses were based on 42 papers across five measures. Results showed that each of the cognitive, affective, and behavioral parent constructs we examined was significantly associated with pain-related functional disability. A small number of measures assessing parent cognitions and affective functioning were associated with higher child pain intensity; however, the majority were not.
Conclusion
Findings demonstrate that there is a wealth of measures available, with adequate reliability overall but a lack of psychometrics on temporal stability. Synthesizing data across studies revealed small effects between parent responses and child functioning, and even smaller and/or absent effects on child pain intensity.
Collapse
Affiliation(s)
- Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine
| | - Inge Timmers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine
| | - Emma Fisher
- Department for Psychology, Centre for Pain Research, University of Bath
| | - Vivek Tanna
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine
| | - Tom Duarte Silva Bans
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine
| |
Collapse
|
47
|
Richardson PA, Birnie KA, Harrison LE, Rajagopalan A, Bhandari RP. Profiling Modifiable Psychosocial Factors Among Children With Chronic Pain: A Person-Centered Methodology. The Journal of Pain 2020; 21:467-76. [DOI: 10.1016/j.jpain.2019.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 12/15/2022]
|
48
|
Nieto R, Boixadós M, Ruiz G, Hernández E, Huguet A. Effects and Experiences of Families Following a Web-Based Psychosocial Intervention for Children with Functional Abdominal Pain and Their Parents: A Mixed-Methods Pilot Randomized Controlled Trial. J Pain Res 2020; 12:3395-3412. [PMID: 32099447 PMCID: PMC6997197 DOI: 10.2147/jpr.s221227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
Purpose To evaluate post-treatment efficacy of DARWeb (online psychosocial intervention for children with functional abdominal pain) using a randomized clinical trial design and combining quantitative and qualitative data. Patients and methods Twenty-five families with children with FAP in the experimental group (EG: accessed to DARWeb) and 36 in the control group (CG: wait-list) were compared. Children and parents completed measures of abdominal pain severity (primary outcome), quality of life, and satisfaction. Moreover, children completed measures of depression, functional disability, catastrophizing and coping strategies; parents completed measures about parental responses to their children's pain. Families also answered open questions and were interviewed. Results A higher percentage of children in the EG achieved a significant clinical change in abdominal pain severity from the parents' perspective (28% in the EG vs 8.33% in the CG). There was a significantly greater reduction in pain frequency in the EG compared to the CG (both from the children's and parents' perspectives) from mixed repeated-measures analyses of variance (there was not a significant interaction in total scores of pain severity). A higher percentage of children in the EG improved in quality of life and depression compared to the CG (results from mixed methods repeated-measures analyses of variances were not significant). However, there were no differences for disability, pain catastrophizing or the coping strategies assessed from the children's perspective; neither from the parents' assessment of quality of life. There were significant interactions for parents' solicitousness responses and promotion of well behaviors in the expected directions. Families were quite satisfied with the intervention, and the qualitative results confirmed an improvement in pain and having learned important coping strategies. Conclusion Our results support the efficacy of our intervention, but future studies are needed with different profiles of initial severity of the pain problem, longer follow-ups, and other conditions.
Collapse
Affiliation(s)
- Rubén Nieto
- eHealth Lab, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Mercè Boixadós
- PSiNET Research Group, Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Gemma Ruiz
- eHealth Lab, Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Eulàlia Hernández
- PSiNET Research Group, Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | | |
Collapse
|
49
|
O'Connell C, Shafran R, Bennett S. A systematic review of randomised controlled trials using psychological interventions for children and adolescents with medically unexplained symptoms: A focus on mental health outcomes. Clin Child Psychol Psychiatry 2020; 25:273-290. [PMID: 31232094 DOI: 10.1177/1359104519855415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Medically unexplained symptoms affect between 4% and 20% of children and adolescents; 30-60% of these children also experience mental health difficulties. Trials and reviews have focussed on physical gains in this population, often overlooking mental health outcomes. OBJECTIVES To use a systematic review methodology guided by the PRISMA checklist to (1) investigate the effectiveness of psychological interventions for mental health difficulties in children and adolescents with medically unexplained symptoms and (2) identify aspects of interventions associated with their success. METHODS Randomised controlled studies investigating the impact of psychological interventions on mental health in children and adolescents with medically unexplained symptoms were included. Systematic searches of PsycINFO, MEDLINE and CINAHL were undertaken from inception to January 2018. Studies were appraised using the quality appraisal checklist. A qualitative synthesis of studies was completed. RESULTS In all, 18 studies were identified. Interventions targeting parental responses to illness and family communication appeared to have the best outcomes. CONCLUSIONS Psychological interventions may be effective in improving mental health outcomes within this population; however, evidence for the efficacy of these interventions is limited due to a high risk of bias within the majority of reviewed studies. Future research using rigorous methodology and non-cognitive behavioural therapy interventions is recommended.
Collapse
Affiliation(s)
- Christine O'Connell
- Department of Applied Psychology, Canterbury Christ Church University, Kent, UK.,Kaleidoscope, London, UK
| | - Roz Shafran
- UCL Institute of Child Health, University College London, London, UK
| | - Sophie Bennett
- UCL Institute of Child Health, University College London, London, UK
| |
Collapse
|
50
|
Friedrichsdorf SJ, Goubert L. Pediatric pain treatment and prevention for hospitalized children. Pain Rep 2020; 5:e804. [PMID: 32072099 DOI: 10.1097/PR9.0000000000000804] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/23/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction: Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. Objectives: To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. Methods: This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable “Factsheet Pain in Children: Management” and reviews best evidence and practice. Results: Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind–body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. Conclusion: Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
Collapse
|