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

Validation of the pediatric version of the Graded Chronic Pain Scale Revised in school-aged children and adolescents

ABSTRACT

The Graded Chronic Pain Scale (GCPS) was originally developed to grade the severity of chronic pain conditions in adults. A revised version of this instrument (ie, GCPS-R) has been developed for use with adults to account for advances in pain metrics and new operational definitions of chronic pain and high-impact chronic pain. The purpose of the current study was to adapt the GCPS-R for use with pediatric samples (P-GCPS-R) and evaluate the adapted measure's concurrent validity. One thousand five hundred sixty-four school-aged children and adolescents (55% girls; 8-18 years) completed the P-GCPS-R and provided responses to measures of physical health, anxiety and depressive symptoms, maladaptive pain coping strategies, and activity limitations. Results showed that 14% of participants had chronic pain, of which 37% (5% of the whole sample) had mild chronic pain, 45% (6% of the whole sample) bothersome chronic pain, and 18% (3% of the whole sample) high-impact chronic pain. Participants without chronic pain and those with mild chronic pain showed no significant between-group differences in any of the study measures. Participants with bothersome chronic pain and high-impact chronic pain reported worse physical health, more anxiety and depressive symptoms, pain catastrophizing, and activity limitations than those with mild chronic pain. Participants with high-impact chronic pain reported more activity limitations than those with bothersome chronic pain. The findings support the concurrent validity of the P-GCPS-R for use with pediatric samples.

“I had already tried that before going to the doctor” – exploring adolescents’ with knee pain perspectives on ‘wait and see’ as a management strategy in primary care; a study with brief semi-structured qualitative interviews

Objectives

The aim of this study was to examine how the “wait-and-see” recommendation affects adolescents’ understanding of their illness and symptoms and their care-seeking behavior.

Methods

This study included brief qualitative, semi-structured online interviews. Adolescents (age 10–19 years) with long-term knee pain, who had been recommended “wait-and-see” by their general practitioner (GP), were recruited via previous studies and social media. Two researchers conducted brief semi-structured interviews through Microsoft Teams. An interview guide with open questions was created prior to the interviews and updated as new questions emerged. The extracted data was transcribed and analyzed via a reflexive thematic approach in NVivo.

Results

Eight adolescents (mean age 17.8) with longstanding or recurrent knee pain (mean duration 3.5 years) were included. The analysis identified four main themes: (1) The perception of wait and see over time, (2) The GP’s acknowledgement and consideration, (3) experienced limitation from knee pain and (4) the importance of getting a diagnosis. The perception of “wait-and-see” approach changed from positive to negative when adolescents received the recommendation multiple times. Adolescents experienced frustration with their situation and a lack of consideration from their GP made them cautious about seeking additional care. Knee pain significantly limited the adolescents’ physical-and social activities. Receiving a diagnosis was important and helped adolescents dealing with their pain.

Conclusions

The connotation of wait-and-see changed from positive to negative for adolescents when receiving the recommendation multiple times. The participants felt getting a clinical diagnosis was a relief. Furthermore, the lack of consideration and acknowledgement from the GP plays an essential role in the adolescent’s understanding of their knee pain.

Implications

Recommending adolescents to “wait-and-see” multiple times in relation to their knee problems can lead adolescents experience frustration and a lack of consideration from their GP. It would be advisable for GPs to provide adolescents with a diagnosis as it can facilitate them in dealing with their pain and to use simple language when explaining adolescents their condition to improve communication.