Pain Beliefs Predict Pain Intensity and Pain Status in Children: Usefulness of the Pediatric Version of the Survey of Pain Attitudes

The interplay between pain and disease activity: personal models of pain beliefs and emotional representations in children and young people with juvenile idiopathic arthritis in a UK nationwide prospective inception cohort

OBJECTIVES

Juvenile idiopathic arthritis (JIA) is a group of childhood-onset inflammatory rheumatic conditions characterized by pain as one of the most common and distressing symptoms. This cross-sectional study aimed to investigate whether relationships between reported pain and disease activity in JIA affected beliefs about pain, known as "personal models."

METHODS

187 out of a possible 363 participants with JIA who completed questionnaires about function and pain perception were recruited through the Childhood Arthritis Prospective Study (CAPS). A pre-selected pain score threshold and validated disease activity score cut-offs were used to assign the participants into four groups: low pain/low disease, low pain/high disease, high pain/low disease, and high pain/high disease. Multivariable linear regressions examined associations between the groups and their "personal models."

RESULTS

Compared to participants with low pain/low disease, those with high pain/high disease and those with high pain/low disease were more likely to sense greater threat, have more negative emotional representations, and perceive less control over their pain. Participants with low pain/high disease had similar pain beliefs compared to those with low pain/low disease.

CONCLUSION

This is the first study to compare "personal models" of pain in JIA. Children and young people who experience high pain severity regardless of disease activity perceived high pain threat, low controllability, and negative emotional representations. This highlights the importance of considering and addressing personal models of pain at diagnosis, especially those who present high levels of pain.

Professional education about pain in children and adolescents and current treatment practices among healthcare professionals working in Lebanon: a survey study

BACKGROUND

Professional education has been suggested to be a key barrier in the implementation and availability of treatment programs for children and adolescents with pain. The purpose of this study was to improve our understanding of the pain education of healthcare professionals working with children and adolescents with pain in Lebanon, and the current assessment and treatment practices that are used with them in Lebanon.

METHODS

A group of 120 experienced healthcare professionals participated. Participants had to respond to an online survey with 47 questions about pain education and organizational characteristics of their pain treatment programs.

RESULTS

The results of the study mainly showed that most participants (80%) reported having not received any type of related formal training. Treatment of children and adolescents with chronic pain was mostly based on medical procedures. A third of participants (34%) reported to be, at least, dissatisfied with the treatment provided in Lebanon to children and adolescents with pain.

CONCLUSIONS

The findings can now be used to improve pain education to healthcare professionals and the care given to children and adolescents with pain in Lebanon.

CLINICAL TRIAL NUMBER

Not applicable.

Perceived Stress, Perceived Social Support, and Global Health in Adults with Chronic Pain

BACKGROUND

Chronic pain is a common problem in adults that can have a significant impact on individuals' quality of life and on society. The complex pain experience emerges from a dynamic combination of biological, psychological, and social factors. Previous research has shown that social support has positive effects on health-related outcomes through two mechanisms: direct-effects and stress-buffering effects. The aim of this study was to investigate the role that perceived stress, perceived social support, and their interaction play as predictors of global physical health and global mental health in adults with chronic pain.

METHOD

One hundred sixty-five adults with chronic pain completed measures of pain, perceived stress, perceived social support, global physical health, and global mental health.

RESULTS

Perceived stress but not perceived social support made a significant and independent contribution to the prediction of global physical health; both perceived stress and perceived social support made independent contributions to the prediction of global mental health. The perceived stress × perceived social support interaction did not make a significant contribution to the prediction of either criterion variable. The results suggested that perceived stress has an impact on both global physical and mental health, whereas perceived social support associated mostly with global mental health. In addition, perceived social support does not appear to moderate the impact of stress on global physical and mental health.

CONCLUSION

The findings are more consistent with a direct-effects model than a stress-buffering model of social support.

Exploring Adolescents' Understanding, Experiences and Beliefs About Pain: A Qualitative Study

BACKGROUND

Pain is prevalent across the lifespan and contributes to significant societal and economic burdens. The public often holds misconceptions about pain and pain management. Despite this, there are no well-resourced public health initiatives delivering information about pain and pain management to the public. Adolescence is an opportune time to educate the public about pain. Health interventions designed for adolescents should reflect their understanding, beliefs and experiences; however, no studies explore this in non-clinical populations of adolescents. We aimed to explore adolescents' understanding, experiences and beliefs about pain to inform the development of a school-based pain education module.

METHODS

We conducted semi-structured interviews with 25 adolescents in grades 7-10 (ages 11-16) attending Australian secondary schools. Interviews were conducted on video-conferencing software, audio-recorded, transcribed verbatim and analysed using Framework Analysis.

RESULTS

We generated three themes: (i) physical and psychological pain are distinct, (ii) psychological and contextual factors influence how someone feels or reacts to physical pain and (iii) physical pain matters if it impacts participation in meaningful activities.

CONCLUSIONS

Adolescents' understanding and beliefs about pain do not always align with current scientific understanding of pain. School-based pain education programmes should target these areas of misalignment. Addressing adolescents' misconceptions about pain through pain education could also create a more supportive school environment for adolescents experiencing pain. Interactive approaches to learning, such as discussions that encourage adolescents to reflect on their experiences of pain, could be a promising avenue for pain education.

PATIENT OR PUBLIC CONTRIBUTION

Two co-authors are part of the study population and contributed to the study design and analysis. Their input ensured the interview guide was appropriate for the target population and provided an adolescent perspective on the findings. They were remunerated for their time in accordance with consumer involvement guidelines.

Pain Characteristics and Symptom Management in Children with Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorder

AIMS

This study aims to investigate pediatric hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorder (HSD) pain features and management strategies.

METHODS

This is a mixed-methods, cross-sectional study design using patient-reported outcomes in 21 children diagnosed with hEDS/HSD. Children who reported bothersome pain were interviewed for pain features. The Child Activity Limitation Interview-21, the Brief Pain Inventory pain interference items, and the Functional Disability Inventory were used to investigate pain interference. To evaluate psychological symptoms regarding pain, the pediatric version of the Survey of Pain Attitude and the child version of the Pain Catastrophizing Scale were used.

RESULTS

Nineteen children had bothersome pain and of them, eight children reported constant pain. The most frequently reported regions of pain were at the ankle (mild pain) and the back (moderate-to-severe pain). Children reported mild-to-moderate pain interference and believed medications were beneficial for their pain management. Nineteen children sought treatment and of those 16 children used to exercise and acetaminophen and 13 visited physicians as a means of treatment. Parents were overall satisfied with their child's treatment (13 out of 19).

CONCLUSIONS

Sufficient awareness of pain-related symptoms and understanding of the treatment strategies in early childhood is needed to prevent deleterious consequences in adulthood.

Selection and reporting of outcome measures used in long-term follow-up studies of children and adolescents with chronic pain: A scoping review

The aim of this review was to determine the range of outcomes reported in long-term follow-up studies of children and adolescents with chronic pain. Using a scoping review methodology, a systematic search for studies reporting outcomes in children and adolescents with chronic pain over a ≥12 month period was undertaken. Studies were eligible for inclusion if they included children and adolescents (≤18 years old on study enrolment) with chronic pain, and outcomes were followed up for ≥12 months. Overall, 42 studies investigating more than 24,132 children were included in the review. Studies assessed a total of 187 unique outcome measures within the broader measures of pain (38 studies; 90%), function (33 studies; 79%) and other (21 studies; 50%). Unidimensional assessments of the severity or presence of pain and global assessments of function were the most commonly reported outcome measures. The number of study follow-up points ranged from 1 to 5, with mode duration of follow-up 12 months post intervention (25 studies; 60%; range 1-13 years). Overall, we identified a wide range of reported outcome measures in studies of children with chronic pain. Beyond assessments of pain intensity and global function, there is little consistency, and reporting of developmental outcome measures is poor. Further long-term outcome research in this population is needed.

Does Religiosity/Spirituality Play a Role in Function, Pain-Related Beliefs, and Coping in Patients with Chronic Pain? A Systematic Review

This systematic review examined the extent to which measures of religiosity/spirituality (R/S): (1) are associated with pain, function, pain-related beliefs (beliefs), coping responses, and catastrophizing in people with chronic pain; and (2) moderate the association between beliefs, coping and catastrophizing, and pain and function. Experimental and observational studies examining at least one of these research questions in adults with chronic pain were eligible. Two reviewers independently performed eligibility screening, data extraction, and quality assessment. Twenty studies were included. Most studies focused on the association between R/S and pain or function. When significant associations emerged, those between R/S and psychological function were weak to strong and positive; those between religious/spiritual well-being and pain and physical dysfunction were negative, but weak. Few studies examined the associations between R/S and beliefs/coping/catastrophizing; none examined the moderation role of R/S. The findings suggest that R/S is associated with pain and psychological function in people with chronic pain, and that viewing oneself as being "spiritual," regardless of religion, may contribute to positive psychological adjustment. More research is needed to determine the reliability of this finding. PROSPERO registry CRD42018088803.

Children's Beliefs about Pain: An Exploratory Analysis

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.

Development of the Conceptualization of Pain Questionnaire: A Measure to Study How Children Conceptualize Pain

(1) Background: Research has shown that thoughts about pain are important for the management of chronic pain in children. In order to monitor changes in thoughts about pain over time and evaluate the efficacy of treatments, we need valid and reliable measures. The aims of this study were to develop a questionnaire to assess a child’s concept of pain and to evaluate its psychometric properties; (2) Methods: This is a cross-sectional, two-phase, mixed-method study. A total of 324 individuals aged 8 to 17 years old responded to the newly created questionnaire. The Conceptualization of Pain Questionnaire (COPAQ) was calibrated using the Rasch model. The chi-square test was used for the fit statistics. Underfit and overfit of the model were determined and a descriptive analysis of infit and outfit was conducted to identify who responded erratically. Internal consistency was measured using the Person Separation Index (PSI); (3) Results: Fit to the Rasch model was good. Suitable targeting indicated which items were simple to answer; Person Fit identified 9.56% children who responded erratically; PSI = 0.814; (4) Conclusions: The findings suggest that COPAQ is a measure of a child’s concept of pain that is easy to administer and respond to. It has a good fit and a good internal consistency.

Video-based Pain Education in Schools: A Study With Adolescents

OBJECTIVE

School-based educational programs have shown positive changes in health-related behaviors among adolescents. The aim of this study was to analyze the changes in pain-related knowledge among adolescents and in the use of positive responses to their peers' pain behaviors after watching a brief educational video.

METHODS

One hundred and thirty-five adolescents (mean age=13.27; SD=1.17) participated and provided demographic and pain-related information. They also responded to a pain-related knowledge questionnaire before (T1), after (T2), and 1 month after (T3) watching a brief pain educational video, and to a modified version of the Inventory of Parent/Caregiver Responses to the Children's Pain Experience at T1 and at T3.

RESULTS

There was a significant increase in pain knowledge for all participants between T1 and T2 (η2p=0.73) and between T1 and T3 (η2p=0.62). An increase in responses considered to be positive to peers' pain behaviors (ie, the promotion of well-behaviors and coping responses) 1 month after watching the educational video was also found. Interestingly, these results were not associated with the chronic pain status of the participant.

DISCUSSION

The findings showed that a brief and inexpensive educational video-based intervention in schools helps to increase pain-related knowledge and change responses to students with chronic pain. This has the potential to prevent chronic pain and related disability among students, and decrease bullying-like behaviors toward students with chronic pain.

The Role of Spirituality in Pain, Function, and Coping in Individuals with Chronic Pain

OBJECTIVE

Chronic pain is a multidimensional experience associated with psychosocial (e.g., pain-related beliefs and pain coping responses) and spiritual factors. Spirituality is a universal aspect of the human experience that has been hypothesized to impact pain experience via its effects on pain, physical/psychological function, resilience and pain-related beliefs, and pain coping responses. However, research evaluating the associations between measures of spirituality and measures of pain and function in individuals with chronic pain is limited. This study seeks to address this limitation.

METHODS

Participants were 62 Portuguese adults with chronic musculoskeletal pain. Participants completed measures of spirituality, pain intensity, physical and psychological function, and pain coping responses.

RESULTS

Spirituality as hope and a positive perspective toward life was positively and moderately associated with better psychological function and coping responses of ignoring pain sensations and coping self-statements. Spirituality as a search for meaning and sense of purpose was positively and moderately associated with the coping response of task persistence.

CONCLUSIONS

These findings suggest the possibility that spirituality may be a useful resource for facilitating psychological adjustment, potentially promoting the use of some adaptive pain coping responses.

The management of pediatric chronic pain in Spain: a web-based survey study

OBJECTIVE

To improve understanding of current practices in the treatment of children and adolescents with chronic pain in Spain.

METHODS

A web-based survey was conducted with a representative sample of healthcare professionals (i.e. general practitioners [GP] and pediatricians [P]) in Spain. The survey included 23 questions on the pain education and training they had been given, and on organizational issues and current practices in the assessment and management of children and adolescents with chronic pain in their current work.

RESULTS

The survey was completed by 191 professionals (75 GP and 116 P) with wide experience (mean number of years = 21; SD = 8) in the management of children and adolescents with chronic pain. Half of the participants reported that they had not been given any specific education or training on pediatric chronic pain management during their studies, and 80% acknowledged important gaps in their training. Although the majority assessed pain when attending children with chronic pain (80%), and almost all (96%) believed that protocols to guide the management of chronic pain in young people were necessary, only a third reported that they usually use a specific protocol. Less than 25% were part of a multidisciplinary team addressing the needs of children and adolescents with chronic pain.

CONCLUSIONS

This survey has identified considerable limitations in the management of children and adolescents with chronic pain in Spain. This information can now be used by policy makers to improve the care given to children and adolescents suffering from chronic pain and their families.

Pain Diagnosis, Pain Coping, and Function in Individuals with Chronic Musculoskeletal Pain

Purpose

Research supports a role for coping responses in adjustment to chronic pain. However, it is likely that some coping responses play a larger role in adjustment to pain for some individuals than others. The identification of the factors that moderate the association between coping responses and pain-related outcomes has important clinical implications. This study sought to determine if musculoskeletal pain diagnosis moderates the associations between eight pain-coping responses and both pain and function.

Patients and Methods

A non-probabilistic sample of 323 persons with different chronic musculoskeletal pain conditions completed measures of pain intensity, physical function, psychological function, and pain-coping responses.

Results

With only one exception, the frequency of use of pain-coping responses was not associated with pain diagnosis. Statistically significant moderation effects of pain diagnosis on the association between coping and pain outcomes were found for two coping responses: 1) support seeking when predicting pain intensity, and 2) resting when predicting both physical and psychological function.

Conclusion

The findings indicate that coping responses tend to play a similar role in patients' pain and function across different musculoskeletal pain conditions, with some important exceptions. If the findings are found to replicate in other samples, they would have important implications for determining when psychosocial pain treatments might (and when they might not) need to be adapted for specific diagnostic groups.

The Portuguese 35-item Survey of Pain Attitudes applied to Portuguese women with Endometriosis

Background and aims Endometriosis is a gynecologic recurring persistent condition affecting from 8% to 15% of premenopausal women worldwide. About 80% of women with endometriosis have at least one form of chronic pain - a multidimensional experience influenced by a number of psychosocial factors, including pain-related beliefs. The Survey of Pain Attitudes is the most commonly used measure of pain-related beliefs. This study aims to evaluate the psychometric properties of a Portuguese version of a brief version of the SOPA (the SOPA-35) in a sample of Portuguese women with Endometriosis. Methods A sample of 199 Portuguese women with Endometriosis provided demographic and pain history information, and completed a Portuguese version of the SOPA-35 and measures of pain intensity, disability, and psychological function. Analyses were performed to evaluate the factor structure of the Portuguese SOPA-35 items as well as the internal consistency, composite reliability, convergent validity, and concurrent validity of the scale scores. Results Confirmatory factor analysis supported a six-factor solution for a 19-item version of the Portuguese version of the Survey of Pain Attitudes (SOPA-19-P). The six scales evidenced marginal to good reliability (Cronbach's alphas: between 0.60 and 0.84; composite reliability: between 0.61 and 0.84). Four scales evidenced acceptable to good convergent validity (AVE: between 0.51 and 0.63). The findings also supported the concurrent validity of the SOPA-19-P. Conclusions The results support the use of the Portuguese SOPA-19-P for research and clinical purposes with Portuguese women in chronic pain due to endometriosis. Future research is warranted to further develop a European Portuguese version of SOPA. Implications The findings provide psychometric information about the SOPA-19-P. The results are helpful to researchers wishing to study the role of pain-related beliefs and their association with adjustment and treatment outcomes in women with chronic pain due to endometriosis.

Support for the Spanish version of the CPAQ-8 as a measure of chronic pain acceptance

AIM AND OBJECTIVE

To provide evidence regarding the psychometric properties of the Spanish eight-item version of the Chronic Pain Acceptance Questionnaire (CPAQ-8).

METHOD

Three hundred adults with chronic pain completed measures of pain acceptance, committed action, fear of movement, anxiety, depression, and health-related quality of life. A confirmatory factor analysis (CFA) of the CPAQ-8 was performed. Reliability and validity were also evaluated.

RESULTS

The CFA confirmed a two-factor structure. The CPAQ-8 Total and subscale scores showed acceptable-to-good internal consistency. Furthermore, the Total and the Activity Engagement scale scores showed moderate associations with Committed Action scores, supporting construct validity. Both the Total and the two subscale scores showed good criterion validity.

CONCLUSION

The findings provide further support for the reliability and validity of the Spanish version of the CPAQ-8 Total and subscale scores.

Are attitudes about pain related to coping strategies used by adolescents in the community?

Background and aims To better understand the associations between pain beliefs and pain coping strategies in a sample of community adolescents. Methods Four hundred and thirty-four adolescents were asked to complete measures of physical function, pain-related beliefs and use of pain coping strategies. A series of three hierarchical regression analyses were performed. Results Approach coping strategies demonstrated significant and positive associations with beliefs about the importance of solicitousness responding and control over pain. Problem-focused avoidance coping strategies evidenced a negative association with the belief of being disabled by pain, and a positive association with the importance of exercise. Emotion-focused avoidance coping strategies showed significant and positive associations with beliefs about being disabled by pain and that emotions affect pain, and negative associations with beliefs about control over pain and the appropriateness of pain medications. Conclusions The findings provide important new information regarding the potential role that beliefs could play as predictors of pain coping in adolescents living in the community. Prospective studies are needed to evaluate the possible causal role that beliefs play in decisions to use what pain coping strategy and under what circumstances. Implications The role that pain beliefs and coping strategies play in the adjustment to pain in adolescents in the community has both similarities to and differences with the role that these factors play in adolescent clinical populations. This information can guide the development of community-based treatment programs for adolescents with pain.

Spouse and Patient Beliefs and Perceptions About Chronic Pain: Effects on Couple Interactions and Patient Pain Behavior

Patient beliefs and perceptions about the causes and meaning of their chronic pain are related to their psychosocial functioning. Beliefs and perceptions about chronic pain held by spouses may also be related to patient functioning. We used a laboratory procedure to evaluate whether spouse beliefs about and perceptions of chronic pain were related to spouse negative responses toward patients with chronic low back pain during a conflictual discussion and to their attributions about patient pain behavior during a subsequent pain-induction task. Patients (n = 71) and their spouses (n = 71) participated in a 10-minute discussion followed by the patient undergoing a 10-minute structured pain behavior task. Findings were that a) spouse perceptions that patient's pain was a mystery were significantly related to greater patient perceived spouse critical/invalidating responses toward the patient during the discussion; and b) spouse perceptions that patient's pain was a mystery were related to internal and negative attributions spouses made while observing patients display pain behaviors during the structured pain behavior task. Inasmuch as both spouse critical/invalidating speech toward patients and negative attributions regarding the cause of patient behavior are related to poor patient functioning, spouse uncertainty about the source and potential legitimacy of their partner's pain may play crucial roles in affecting patient well-being. PERSPECTIVE: Spouse beliefs about and perceptions of patient chronic pain were related to spouse behavior toward patients during a discussion and to attributions explaining patient pain during physical activity. If spouse confusion and doubt about patient pain is related to negative behavior and attributions, then modifying these perceptions may be a fundamental intervention target.

Do Commonly Used Measures of Pain Intensity Only Reflect Pain Intensity in Youths With Bothersome Pain and a Physical Disability?

The objective of this cross-sectional study was to evaluate the extent to which non-pain intensity factors influence the ratings of pain intensity on two commonly used measures: the Wong-Baker Faces pain rating scale (FACES) and the Verbal Rating Scale (VRS) in a sample of youths with physical disabilities and bothersome pain. Study participants came from a convenience sample of 115 youths (age: X ¯ = 14.4 years; SD = 3.3), who participated in a survey on the impact of pain in young people with a physical disability. They were administered measures of pain intensity, pain catastrophizing, depressive symptoms, pain interference, and pain control beliefs. Zero-order correlation analyses were used to examine the associations among the pain intensity scores, while regression analyses were used to test the influence of the non-pain intensity factors on the pain intensity scores. Although pain intensity scores from all scales were significantly associated with one another, the correlations were moderate. Regression analyses showed that the FACES and VRS also reflect pain interference, in addition to pain intensity. The fact that the FACES and VRS ratings reflect more than pain intensity should be considered when selecting a pain measure. The results of this study also provide information to help interpret results after treatment.

Construct Validity and Internal Consistency of the Catalan Version of the Pain Self-Efficacy Questionnaire in Young People With Chronic Pain

The purpose of this study was to evaluate the construct validity and reliability of the Catalan version of the Pain Self-Efficacy Questionnaire (PSEQ) in a sample of young people with chronic pain. Two hundred twenty-seven young people with chronic pain (age range = 12–24 years, mean age = 17.87 years, SD = 3.08 years) participated in this study. The findings support a one-factor structure of the PSEQ, and the scale demonstrated excellent internal consistency reliability in our sample. In addition, convergent validity was supported by a loading of average variance extracted (AVE) greater than .50, and discriminant validity was supported by the finding that self-efficacy and pain-related anxiety AVEs were greater than the shared variance between both constructs. Further support for the measure’s construct validity was shown by (1) significant and positive associations between PSEQ scores and adaptive coping strategies and (2) negative and significant associations between PSEQ scores and maladaptive coping strategies and catastrophizing thoughts. The results of this study indicate that the Catalan version of the PSEQ is reliable and valid when used to assess pain self-efficacy beliefs in young people with chronic pain.

Pain Beliefs and Quality of Life in Young People With Disabilities and Bothersome Pain

OBJECTIVES

Pain beliefs have been hypothesized to play an important role in pediatric pain. However, research examining the associations between pain-related beliefs and measures of function in youths with disabilities is limited.

METHODS

In total, 84 youths (mean age, 14.26 y; SD, 3.27) with physical disabilities who indicated they also had bothersome pain were interviewed and asked to rate their average pain intensity in the past week and to complete measures of pain-related beliefs and health-related quality of life.

RESULTS

A number of pain beliefs were associated with different physical and psychosocial function domains, although different beliefs appeared to play different roles, depending on the function domain examined. Across all of the health-related quality-of-life domains studied, a belief that pain is influenced by one's emotions was associated with lower levels of function. No differences were found in pain beliefs related to age. In addition, a small difference in pain beliefs was found for sex; specifically, girls were more likely than boys to endorse the belief that pain is influenced by emotions.

DISCUSSION

The findings provide new information regarding the role that pain beliefs have in predicting function and have important clinical implications regarding how youth with physical disabilities and pain might be most effectively treated.

Agreement between child self-reported and parent-reported scores for chronic pain secondary to specific pediatric diseases

BACKGROUND

Parental report on a child's secondary chronic pain is commonly requested by anesthesiologists when the child cannot directly provide information. Daily pain intensity is reported as highest, average and lowest. However, it is unclear whether the parents' score is a valid indicator of the child's pain experience.

METHODS

Nineteen children (aged 6-18years) with secondary chronic pain attending our anesthesiologist-run pediatric pain unit participated in this study. Identification of highest, average and lowest pain intensity levels were requested during initial screening interviews with the child and parents. Pain intensity was scored on a 0-10 numerical rating scale. Agreement was examined using: (i) intraclass correlation coefficient (ICC), and (ii) the Bland-Altman method.

RESULTS

The ICC's between the children and the parents' pain intensity reports were: 0.92 for the highest, 0.68 for the average, and 0.50 for the lowest pain intensity domains. The limits of agreement set at 95% between child and parental reports were respectively +2.19 to -2.07, +3.17 to -3.88 and +5.15 to -5.50 for the highest, average and lowest pain domains.

CONCLUSIONS

For the highest pain intensity domain, agreement between parents and children was excellent. If replicated this preliminary finding would suggest the highest pain intensity is the easiest domain for reporting pain intensity when a child cannot directly express him or herself.

Pain extent and function in youth with physical disabilities

Background

The aim of this study was to increase our understanding of the role that spatial qualities of pain (location and extent) play in functioning, among youths with disabilities and chronic pain.

Methods

One-hundred and fifteen youths (mean age 14.4 years; SD ±3.3 years) with physical disabilities and chronic pain were interviewed and were asked to provide information about pain locations and their average pain intensity in the past week, and to complete measures of pain interference, psychological function and disability. Most of the participants in this sample were males (56%), Caucasian (68%), and had a cerebral palsy (34%) or muscular dystrophy (25%) problem. Most participants did not report high levels of disability ( X¯=12.7, SD ±9.5, range 0–60) or global pain intensity ( X¯=3.2, SD ±2.4, range 0–10).

Results

Pain at more than one body site was experienced by 91% of participants. There were positive associations between pain extent with pain interference (r = 0.30) and disability (r = 0.30), and a negative association with psychological function (r = –0.38), over and above average pain intensity. Additionally, pain intensity in the back (as opposed to other locations) was associated with more pain interference (r = 0.29), whereas pain intensity in the shoulders was associated with less psychological function (r = –0.18), and pain intensity in the bottom or hips was associated with more disability (r = 0.29).

Conclusion

The findings support the need to take into account pain extent in the assessment and treatment of youths with physical disabilities and chronic pain, call our attention about the need to identify potential risk factors of pain extent, and develop and evaluate the benefits of treatments that could reduce pain extent and target pain at specific sites.

Psychological Neuromodulatory Treatments for Young People with Chronic Pain

The treatment of young people with chronic pain is a complex endeavor. Many of these youth do not obtain adequate relief from available interventions. Psychological neuromodulatory treatments have been shown to have potential benefit for adults with chronic pain. Here, we review and summarize the available information about the efficacy of three promising psychological neuromodulatory treatments-neurofeedback, meditation and hypnosis-when provided to young people with chronic pain. A total of 16 articles were identified and reviewed. The findings from these studies show that hypnotic treatments are effective in reducing pain intensity for a variety of pediatric chronic pain problems, although research suggests variability in outcomes as a function of the specific pain problem treated. There are too few studies evaluating the efficacy of neurofeedback or meditation training in young people with chronic pain to draw firm conclusions regarding their efficacy. However, preliminary data indicate that these treatments could potentially have positive effects on a variety of outcomes (e.g., pain intensity, frequency of pain episodes, physical and psychological function), at least in the short term. Clinical trials are needed to evaluate the effects of neurofeedback and meditation training, and research is needed to identify the moderators of treatment benefits as well as better understand the mechanisms underlying the efficacy of all three of these treatments. The findings from such research could enhance overall treatment efficacy by: (1) providing an empirical basis for better patient-treatment matching; and (2) identifying specific mechanisms that could be targeted with treatment.

Pediatric Pain Beliefs Questionnaire: Psychometric Properties of the Short Form

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

PERSPECTIVE

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

Effects of a Cognitive Behavioral Therapy Intervention Trial to Improve Disease Outcomes in Children with Inflammatory Bowel Disease

BACKGROUND

Studies testing the efficacy of behavioral interventions to modify psychosocial sequelae of inflammatory bowel disease in children are limited. This report presents outcomes through a 6-month follow-up from a large randomized controlled trial testing the efficacy of a cognitive behavioral intervention for children with inflammatory bowel disease and their parents.

METHODS

One hundred eighty-five children aged 8 to 17 years with a diagnosis of Crohn's disease or ulcerative colitis and their parents were randomized to one of two 3-session conditions: (1) a social learning and cognitive behavioral therapy condition or (2) an education support condition designed to control for time and attention.

RESULTS

There was a significant overall treatment effect for school absences due to Crohn's disease or ulcerative colitis (P < 0.05) at 6 months after treatment. There was also a significant overall effect after treatment for child-reported quality of life (P < 0.05), parent-reported increases in adaptive child coping (P < 0.001), and reductions in parents' maladaptive responses to children's symptoms (P < 0.05). Finally, exploratory analyses indicated that for children with a higher level of flares (2 or more) prebaseline, those in social learning and cognitive behavioral therapy condition experienced a greater reduction in flares after treatment.

CONCLUSIONS

This trial suggests that a brief cognitive behavioral intervention for children with inflammatory bowel disease and their parents can result in improved child functioning and quality of life, and for some children may decrease disease activity.

The Survey of Pain Attitudes: A revised version of its pediatric form

BACKGROUND AND AIMS

Valid and reliable measures of patients' pain beliefs are needed by clinicians and researchers to better understand the efficacy and mechanisms of pain treatments. The objective of this work was to address this need by further developing the pediatric version of the Survey of Pain Attitudes (Peds-SOPA), one of the most commonly used measures of pain beliefs.

METHODS

A convenience sample of three hundred and seven adolescents (mean age= 14.35; SD=1.62; 59% girls) participated in the study. They rated the intensity of their worst pain experienced in the 3 months prior to the assessment and completed both the Functional Disability Inventory and a revised version of a pediatric version of the Survey of Pain Attitudes (Peds-SOPA-R).

RESULTS

Factor analyses confirmed a seven-factor solution of the questionnaire, and the revised version demonstrated improvements in the internal consistency of several of the scales (values ranged between adequate and good: 0.71-0.87), except for the Medical Cure scale which showed an internal consistency value of 0.65. The results support the validity of the Peds-SOPA-R scale scores by showing, as predicted, positive relationships between beliefs thought to be maladaptive (e.g., the belief that one is unable to function because of pain) and pain intensity and disability, and negative relationships with beliefs thought to be adaptive (e.g., the belief that exercise is beneficial for pain management) and these criterion variables.

CONCLUSIONS

These findings will be helpful to researchers who wish to study the role that pain beliefs play in adjustment to pain in youth.

IMPLICATIONS

The results provide critical psychometric information about a revised version of one of the most used questionnaires to assess pain beliefs. The evidence presented will be helpful to researchers who want to study the role that pain beliefs play in adjustment to chronic pain in young people.

Pain-related attitudes and functioning in elderly primary care patients

This study examined the associations between specific pain-related beliefs and both mental health and pain interference in elderly patients with chronic pain. A total of 139 patients completed validated questionnaires assessing pain domains (i.e., intensity, duration and location), psychological functioning, pain interference and demographic variables. Pain-related beliefs were related with poorer mental health (Disability = -.27; Harm = -.23; Solicitude = -.24; Control = .18; Emotion = -.29) and greater interference in daily activities (Disability =.41; Harm =.13; Solicitude =.29; Control = -.31). Our findings are consistent with a biopsychosocial model of chronic pain which goes beyond physical variables in an attempt to understand and promote patients' adjustment to chronic pain problems.