1
|
Linkiewich D, Dib KC, Forgeron PA, Dick BD, McMurtry CM. Roadmap to the 'Chronic Pain GPS for Adolescents' Intervention: Content and Design Considerations for a Group Peer Support Intervention. Clin J Pain 2024; 40:288-298. [PMID: 38303597 DOI: 10.1097/ajp.0000000000001201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES A biopsychosocial approach to understanding and treating pain is crucial; however, there are limited socially targeted interventions for adolescents with chronic pain (ACP). Peer support interventions implemented with other populations are associated with positive outcomes. ACPs perceive peer support to have high potential value. This study explored the preferences of ACP regarding the content and design of a group peer support intervention. METHODS Fourteen ACP (M age : 15.21 y; 9 females; 3 males, 1 nonbinary, and 1 gender questioning) completed a virtual interview and survey. Interviews were analyzed using inductive qualitative content analysis, and surveys were analyzed using descriptive statistics. RESULTS Adolescents described how they want to both talk and do activities together within a fun and casual environment with a facilitator present-ideally, someone with lived experience of chronic pain. Preferences were for a medium-sized group intervention that was in-person, at a consistent time on a weekday after school, and semi-structured. Barriers to attending and engaging in the potential group peer intervention were also discussed. DISCUSSION ACPs desire a facilitated socially focused intervention that provides them with the opportunity to spend time with other ACPs. A group peer support environment where ACPs can provide and receive peer support through sharing their experiences with others who understand them as well as engage in activities was described. The findings from this study provide insights for the development of a group peer support intervention.
Collapse
Affiliation(s)
| | | | | | - Bruce D Dick
- Department of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph
- Department of Anesthesia, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Donovan E, Green V, Feldman G, Tachdjian R, Curry C, Rice C, Zeltzer LK. The acceptability of Songs of Love for youth living with chronic pain. Int J Adolesc Med Health 2024; 36:161-168. [PMID: 38332697 DOI: 10.1515/ijamh-2023-0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVES Music is helpful to young people in healthcare contexts, but less is known about the acceptability of music-based interventions for youth living at home with chronic pain who may be struggling to attend school and participate in social activities. The Songs of Love (SOL) foundation is a national nonprofit organization that creates free, personalized, original songs for youth facing health challenges. The aims of this study were (1) to assess acceptability of SOL from the perspective of youth with chronic pain receiving a song and singer-songwriters who created the songs, and (2) to explore the role of music more generally in the lives of young people living with pain. METHODS Twenty-three people participated. Fifteen youth (mean age 16.8) were interviewed and received a song, and six singer-songwriters were interviewed about creating the songs. (Two additional people participated in pilot interviews.) Acceptability was assessed by (1) proportion of youth who participated in a second interview about their song and (2) results of reflexive thematic analysis (RTA) to determine acceptability. Themes addressing the role of music in the lives of youth with pain were also explored using RTA. RESULTS The program was acceptable as 12 of 15 youth (80 %) participated in second interviews and themes met the definition of acceptability. Three themes addressing the role of music in the lives of youth living with pain were identified. CONCLUSIONS This is the first report of the acceptability and experience of SOL and contributes to research on the benefits of music for pain management.
Collapse
Affiliation(s)
| | - Vanya Green
- Creative Healing for Youth in Pain, Los Angeles, CA, USA
| | - Greg Feldman
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Raffi Tachdjian
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Children's Music Fund, Los Angeles, CA, USA
| | - Caitlin Curry
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Charlotte Rice
- Department of Psychology, Simmons University, Boston, MA, USA
| | - Lonnie K Zeltzer
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Creative Healing for Youth in Pain, Los Angeles, CA, USA
| |
Collapse
|
3
|
Boggero IA, Sangalli L, Brasch L, King CD. Social health in young women with chronic pain. Pain Rep 2024; 9:e1146. [PMID: 38505830 PMCID: PMC10950150 DOI: 10.1097/pr9.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Chronic pain may negatively affect social functioning, but no study to date has examined the specific social impact of different chronic pain conditions in young women, and whether living with multiple chronic overlapping pain conditions (COPCs) differently influences social domains. Objectives This study aimed to assess social functioning (social isolation, hostility, informational support satisfaction, social roles, emotional support, friendships, and family relationships) among young women with chronic pain compared with pain-free controls and to test whether the number of COPCs influenced the extent of social burden. Methods Participants aged 18 to 30 years with a physician-confirmed diagnoses of migraine, fibromyalgia, or temporomandibular disorder (TMD) and pain-free controls were invited to participate from across the United States. After confirming eligibility, participants completed a 1-hour REDCap online questionnaire assessing social functioning. Results One hundred four participants (mean age 24.54 ± 3.35 years) were included (n = 26 with TMD, n = 25 with fibromyalgia, n = 25 with migraine, and n = 28 controls). All 3 chronic pain groups combined reported worse functioning than controls on friendship (P = 0.038), social isolation (P = 0.002), and social roles (P < 0.001). There were no differences on social variables between the 3 chronic pain groups (all P's > 0.05). Compared with those with 3 COPCs, participants with 1 condition reported better family relationships (P = 0.024). Conclusions Experience of chronic pain-regardless of the specific pain condition-may negatively affect some areas of social functioning in young women.
Collapse
Affiliation(s)
- Ian A. Boggero
- Division of Orofacial Pain, Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, KY, USA
- Department of Psychology, College of Arts and Science, University of Kentucky, Lexington, KY, USA
- Department of Anesthesiology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Linda Sangalli
- College of Dental Medicine—Illinois, Midwestern University, Downers Grove, IL, USA
| | - Lauryn Brasch
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Christopher D. King
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Pediatric Pain Research Center (PPRC), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
4
|
Jordan A, Parchment A, Gauntlett-Gilbert J, Jones A, Donaghy B, Wainwright E, Connell H, Walden J, Moore DJ. Understanding the impacts of chronic pain on autistic adolescents and effective pain management: a reflexive thematic analysis adolescent-maternal dyadic study. J Pediatr Psychol 2024; 49:185-194. [PMID: 38324735 PMCID: PMC10954305 DOI: 10.1093/jpepsy/jsae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/19/2023] [Accepted: 01/04/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE Sensory elements are core features in chronic pain and autism, yet knowledge of the pain experience in autistic adolescents is limited. Little is known regarding how autistic adolescents experience chronic pain, manage their pain and perceive psychological treatment for their chronic pain. METHODS Ten autistic adolescents (6 female, 3 male, and 1 self-identified as agender) with chronic pain and their mothers (n = 10) participated in semistructured interviews concerning their perceptions of living with chronic pain. Participants were recruited from U.K. pain management services. According to preference, interviews were conducted individually (n = 10) or dyadically (n = 10 participants across 5 dyads). Data were analyzed using inductive reflexive thematic analysis. RESULTS Two themes were generated. Theme 1, "overstimulated and striving for control" described how adolescents' experience of heightened sensitivity enhanced adolescents' levels of anxiety and subsequent pain, illustrating a reciprocal relationship between anxiety, pain, and sensory elements. Theme 2, "not everyone fits the mold" captured how autistic adolescents positioned themselves as distinct from others due to the unique nature of being autistic and living with pain. This sense of difference negatively impacted adolescents' ability to engage with and benefit from the standard treatment for chronic pain. CONCLUSIONS Findings suggest that autistic adolescents living with pain experience pain and face barriers to effective pain treatment. Our results identify the need for educational resources to facilitate clinicians to better understand the experience of autistic adolescents living with pain. In turn, such understanding may improve treatment and outcomes in this population.
Collapse
Affiliation(s)
- Abbie Jordan
- Department of Psychology, University of Bath, Bath, United Kingdom
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amelia Parchment
- NIHR Applied Research Collaboration Greater Manchester, University of Manchester, Manchester, United Kingdom
| | - Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal United Hospitals Bath, Bath, United Kingdom
- Centre for Health and Clinical Research, University of the West of England, Bristol, United Kingdom
| | - Abigail Jones
- Department of Psychology, University of Bath, Bath, United Kingdom
- Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Bethany Donaghy
- Research Centre for Brain & Behaviour, Liverpool John Moores University, Liverpool, United Kingdom
| | - Elaine Wainwright
- Centre for Pain Research, University of Bath, Bath, United Kingdom
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Hannah Connell
- Bath Centre for Pain Services, Royal United Hospitals Bath, Bath, United Kingdom
| | - Joseline Walden
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - David J Moore
- Research Centre for Brain & Behaviour, Liverpool John Moores University, Liverpool, United Kingdom
| |
Collapse
|
5
|
Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
Collapse
Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
6
|
Lee S, Tomlinson R, Lumley MN, Bax KC, Ashok D, McMurtry CM. Positive Schemas, Coping, and Quality of Life in Pediatric Recurrent Abdominal Pain. J Clin Psychol Med Settings 2024; 31:37-47. [PMID: 36952113 DOI: 10.1007/s10880-023-09952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/24/2023]
Abstract
Pediatric recurrent abdominal pain is commonly associated with negative impacts on quality of life (QOL). Positive schemas (core beliefs about the self with subthemes of self-efficacy, optimism, trust, success, and worthiness) are a resilience factor that has not yet been examined within a pediatric recurrent pain context. This cross-sectional study examined (a) associations between positive schemas, pain coping, and youth QOL, and (b) exploratory analyses to investigate whether specific positive schema subthemes predicted QOL outcomes in youth with recurrent abdominal pain. Participants were 98 youth with recurrent abdominal pain (i.e., pain related to a disorder of gut-brain interaction [DGBI] or organic cause) who completed measures on positive schemas, QOL, and pain coping. Age and diagnostic status were controlled for in analyses. Positive schemas were significantly positively correlated with emotional, social, school, and overall QOL, as well as with approach and problem-focused avoidant coping, and significantly negatively correlated with emotion-focused coping. Worthiness was the strongest and only significant predictor of youth social functioning. Positive schemas may be an important cognitive resilience factor to consider within interventions for pediatric recurrent pain.
Collapse
Affiliation(s)
- Soeun Lee
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada.
| | - Rachel Tomlinson
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Margaret N Lumley
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
| | - Kevin C Bax
- Department of Paediatrics, Western University, London, ON, Canada
| | - Dhandapani Ashok
- Department of Paediatrics, Western University, London, ON, Canada
| | - C Meghan McMurtry
- Pediatric Pain, Health, and Communication Lab, Department of Psychology, University of Guelph, Guelph, ON, N1G 2W1, Canada
- Department of Paediatrics, Western University, London, ON, Canada
- Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| |
Collapse
|
7
|
Parsons RD, McParland JL, Halligan SL, Goubert L, Noel M, Jordan A. Looking on the bright side: The relationships between flourishing and pain-related outcomes among adolescents living with chronic pain. J Health Psychol 2023:13591053231214099. [PMID: 38102737 DOI: 10.1177/13591053231214099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
A deficits-based approach to adolescent chronic pain currently dominates the literature, to the exclusion of positive approaches, such as flourishing. Addressing this knowledge gap, this study examined the relationships between flourishing and pain-related outcomes in adolescent chronic pain. Seventy-nine adolescents aged 11-24 years were asked to complete self-report measures of three domains of flourishing and four pain-related outcomes. Correlation coefficients and four hierarchical linear regression analyses were conducted, controlling for age and gender. Flourishing mental health was associated with, and significantly contributed to explaining, anxiety and depressive symptoms, and social and family functioning impairment. Benefit finding and posttraumatic growth were each associated with social and family functioning impairment, while posttraumatic growth was also associated with anxiety and depressive symptoms. Additionally, benefit finding significantly contributed to explaining pain intensity. Study findings underscore the importance of assessing the relationships between flourishing and pain-related outcomes in adolescents with chronic pain.
Collapse
|
8
|
Sangalli L, Alessandri-Bonetti A, Kapos FP, Boggero IA. Occupations associated with treatment seeking and biopsychosocial functioning at a tertiary orofacial pain clinic: A cross-sectional study. J Am Dent Assoc 2023:S0002-8177(23)00622-0. [PMID: 37988046 DOI: 10.1016/j.adaj.2023.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The aim of this study was to describe whether certain occupations were over- or underrepresented and to compare biopsychosocial functioning by types of occupation and employment status among adults seeking orofacial pain (OFP) treatment. METHODS The authors extracted self-reported employment status, occupation, and biopsychosocial functioning from initial appointment records of 444 treatment-seeking adults at a university-affiliated OFP clinic. The authors categorized occupations in major and minor occupational groups according to the 2018 Standard Occupational Classification. The authors compared proportions between their sample and the corresponding state level, using a ratio and 95% CI (1.00 = equal representation in sample vs state, < 1.00 = underrepresentation, > 1.00 = overrepresentation). RESULTS Among major occupational categories, health care practitioners and technical occupations were the most common in the study sample (22.4%) and the second most overrepresented (ratio, 3.20; 95% CI, 2.59 to 3.97) after the arts, design, entertainment, sports, and media occupations (ratio, 3.95; 95% CI, 2.15 to 7.26). Among minor occupational categories, teachers and instructors were the most common in the study sample (11.2%) and the most overrepresented (ratio, 90.71; 95% CI, 65.67 to 125.30), followed by managers (ratio, 43.87; 95% CI, 29.61 to 64.99) and photographers (ratio, 40.89; 95% CI, 10.23 to 163.4). No differences were observed in biopsychosocial functioning between major occupational categories. However, those not working due to health reasons or disability had worse biopsychosocial functioning (insomnia, anxiety and depression, life satisfaction, sleep health, pain intensity, pain-related interference; all P < .034) than those who were employed. CONCLUSIONS Several occupations are strongly over- and underrepresented among adults seeking OFP treatment. Differences were not explained by biopsychosocial functioning. PRACTICAL IMPLICATIONS Future research should attempt to identify and address the underlying mechanisms of association between occupation and seeking care for OFP.
Collapse
|
9
|
Parkinson A, Mullan B, Bebbington K, Davis E, Treadgold C, Finlay-Jones A. Wellbeing and distress in young people with chronic conditions: how do positive psychology variables relate to mental health outcomes? Health Psychol Behav Med 2023; 11:2274539. [PMID: 37941791 PMCID: PMC10629415 DOI: 10.1080/21642850.2023.2274539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 10/17/2023] [Indexed: 11/10/2023] Open
Abstract
Objective The aim of this study was to determine the unique and shared contributions of various positive psychology constructs (gratitude, optimism, hope, self-compassion, self-efficacy, and emotion regulation) to wellbeing and distress outcomes in young people living with a diverse range of chronic health conditions. Methods and Measures 169 Australians (84.0% female, mean age = 21.2) who reported living with a chronic physical condition completed a cross-sectional survey assessing wellbeing, distress, and each positive psychology variable. Two multiple regressions were used to determine the unique and shared contributions of the positive psychology variables to wellbeing and distress outcomes. Results When considered alongside symptom severity, the variables explained 53.4% and 38.1% of variance in distress and wellbeing, respectively. Only optimism and self-efficacy accounted for unique and significant variance in the model predicting wellbeing, accounting for 6.1% and 4.6% of unique variance, respectively. For the distress model, optimism, self-compassion, and emotion regulation each accounted for significant variance. When considered alongside other variables, hope and gratitude did not contribute to either model. Conclusion Findings suggest that individual positive psychology variables differentially contribute to wellbeing and distress outcomes in young people with chronic conditions. Optimism appears to account for unique variance in both outcomes, suggesting it may be a parsimonious target to promote complete mental health in this population.
Collapse
Affiliation(s)
- Asha Parkinson
- Telethon Kids Institute, Nedlands, Australia
- enAble Institute, School of Population Health, Curtin University, Bentley, Australia
| | - Barbara Mullan
- enAble Institute, School of Population Health, Curtin University, Bentley, Australia
- WACPRU, School of Population Health, Curtin University, Bentley, Australia
| | - Keely Bebbington
- Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Australia
| | - Elizabeth Davis
- Children’s Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Department of Endocrinology and Diabetes, Perth Children’s Hospital, Perth, Australia
- Division of Paediatrics, Medical School, The University of Western Australia, Perth, Australia
| | - Claire Treadgold
- Starlight Children’s Foundation, Naremburn, NSW, USA
- Discipline of Paediatrics & Child Health, UNSW, Medicine & Health, University of New South Wales, Sydney, NSW, USA
| | | |
Collapse
|
10
|
Boileau NR, Thompson-Phillips KA, Goodin BR, Lynch-Milder MK, Evans CT, Adetayo T, Rudolph AF, Stoll ML, Weiser P, Fobian AD, Gowey MA, Wakefield EO. Pain-Related Stigma and Its Associations With Clinical and Experimental Pain Severity in Youth With Chronic Musculoskeletal Pain Conditions. J Pediatr Psychol 2023; 48:842-851. [PMID: 37500594 PMCID: PMC10588972 DOI: 10.1093/jpepsy/jsad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE Many children with chronic musculoskeletal pain conditions experience stigma which can have negative downstream consequences. This study compares ratings of clinical pain (current pain intensity and pain interference), experimental pain (temporal summation, cold water tolerance, and cold pain intensity), and pain-related stigma among three groups of youth with rheumatic conditions. The relations among ratings of pain-related stigma and pain variables were explored. METHODS Eighty-eight youth aged 8-17 years with a diagnosis of juvenile idiopathic arthritis (JIA = 32), juvenile fibromyalgia (JFM = 31), or non-specific chronic pain (NSCP = 25) completed measures of clinical pain ratings (average 7-day pain intensity, day of assessment pain (DoA), and pain interference), experimental pain (cold pain tolerance, cold pain intensity, and temporal summation of mechanical pain), and pain-related stigma. Data analysis compared pain-related stigma and pain ratings across the three groups and examined the relations among pain-related stigma and pain ratings. RESULTS Youth with JFM reported higher ratings of clinical pain and pain-related stigma than their counterparts with NSCP or JIA. However, there were no differences in experimental pain. Pain-related stigma was associated with greater ratings of pain interference, particularly for those with JIA and NSCP. Pain-related stigma was also associated with greater average daily pain intensity but not DoA. CONCLUSION Youth with medically unexplained pain report greater stigma and worse pain than their peers; thus, robust assessment of pain in this population is necessary. Future work should longitudinally explore the impact of pain-related stigma on pain outcomes and treatment responses.
Collapse
Affiliation(s)
| | | | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, USA
- Department of Anesthesiology, Washington University in St. Louis, USA
| | | | - Corinne T Evans
- Department of Psychology, University of Alabama at Birmingham, USA
| | - Tolulope Adetayo
- Department of Psychology, University of Alabama at Birmingham, USA
| | | | - Matthew L Stoll
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Alabama at Birmingham, USA
| | - Peter Weiser
- Department of Pediatrics, Division of Pediatric Rheumatology, University of Alabama at Birmingham, USA
| | - Aaron D Fobian
- Department of Psychiatry & Behavioral Neurobiology, University of Alabama at Birmingham, USA
| | - Marissa A Gowey
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, & Nutrition, University of Alabama at Birmingham, USA
| | - Emily O Wakefield
- Division of Pain and Palliative Medicine, Connecticut Children’s Medical Center, USA
- Division of Pediatric Psychology, Connecticut Children’s Medical Center, USA
- Department of Pediatrics, University of Connecticut School of Medicine, USA
| |
Collapse
|
11
|
Bateman S, Caes L, Eccleston C, Noel M, Jordan A. Co-occurring chronic pain and primary psychological disorders in adolescents: A scoping review. PAEDIATRIC & NEONATAL PAIN 2023; 5:57-65. [PMID: 37744281 PMCID: PMC10514777 DOI: 10.1002/pne2.12107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/21/2023] [Accepted: 04/25/2023] [Indexed: 09/26/2023]
Abstract
Long-term health conditions, whether mental or physical, often co-occur in adolescents. For instance, adolescents with chronic pain may experience co-occurring primary psychological disorders. In this scoping review, we determine the influence of co-occurring chronic pain and primary psychological disorders on adolescents' functioning. A systematic search of six databases was conducted to identify articles if they were: (1) peer-reviewed; (2) reported original findings; (3) included participants aged 11-19 years, who experienced chronic pain (i.e., pain lasting 3 months or more) and had a co-occurring diagnosis of a primary psychological disorder; and (4) assessed functioning. Searches returned 9864 articles after the removal of duplicates. A two-phase abstract and full-text screening process identified two eligible articles which compared emotional functioning (n = 1) and social functioning (n = 2) between groups of adolescents with co-occurring chronic pain and primary psychological disorders with adolescents only reporting chronic pain. Overall findings revealed no differences in social functioning, but adolescents with co-occurring chronic pain and a primary psychological disorder (depression and anxiety) reported worse emotional functioning compared with adolescents with chronic pain alone. This review confirms the limited research on the co-occurrence of primary psychological disorders and chronic pain in adolescents by only identifying two eligible articles exploring the co-occurrence of chronic pain with depression, anxiety, and/or attentional disorders.
Collapse
Affiliation(s)
- Sharon Bateman
- Department of PsychologyUniversity of BathBathUK
- Centre for Pain ResearchUniversity of BathBathUK
| | - Line Caes
- Division of Psychology, Faculty of Natural SciencesUniversity of StirlingStirlingUK
| | | | - Melanie Noel
- Department of PsychologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Abbie Jordan
- Department of PsychologyUniversity of BathBathUK
- Centre for Pain ResearchUniversity of BathBathUK
| |
Collapse
|
12
|
Corser J, Caes L, Bateman S, Noel M, Jordan A. 'A whirlwind of everything': The lived experience of adolescents with co-occurring chronic pain and mental health symptoms. Eur J Pain 2023; 27:981-994. [PMID: 37211969 DOI: 10.1002/ejp.2140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Co-occurring chronic pain and mental health issues are prevalent in adolescents, costly to society and can lead to increased risk of complications throughout the lifespan. While research has largely examined paediatric chronic pain and mental health in isolation, little is known about the unique challenges faced by adolescents who experience these co-occurring symptoms. This idiographic study examined the lived experience of adolescents with co-occurring chronic pain and mental health symptoms to identify salient issues for this population. METHODS Semi-structured telephone interviews were conducted with seven adolescents (11-19 years) self-reporting diagnoses of both pain and mental health issues for a duration of 3 months or longer. Participants were recruited from UK-based schools, pain clinics and charities. Interview transcripts were analysed using interpretative phenomenological analysis. RESULTS Analyses generated two themes 'a whirlwind of everything' and 'putting up fronts', which describe how the experience of co-occurring chronic pain and mental health symptoms typically disrupted adolescents' ability to regulate their physical, psychological and social wellbeing and identity. Adolescents described their symptom experience as like an internal storm over which they had no control. Such experiences required adolescents to embrace a variety of symptom management strategies, with adolescents reporting deliberate efforts to minimize their symptoms to external individuals. CONCLUSION Co-occurring pain and mental health symptoms may be experienced in similar ways to individually experienced pain or mental health symptoms, but together, the experience may be both more difficult to manage and more socially isolating. SIGNIFICANCE Adolescents with co-occurring chronic pain and mental health symptoms describe the experience as if there was a storm inside of them disrupting their sense of physical, emotional and social wellbeing. This inner chaos interferes with their self-identity and relationships with others. Challenges articulating their experiences, and negative encounters associated with their symptoms, further impact feelings of isolation and difficulties accessing support.
Collapse
Affiliation(s)
- Jenny Corser
- Department of Psychology, University of Bath, Bath, UK
| | - Line Caes
- Division of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
| |
Collapse
|
13
|
Choate ES, Neville AJ, Simons LE. Commentary: Peer Support Needs of Adolescents With Chronic Pain. J Pediatr Psychol 2023; 48:664-665. [PMID: 37155915 PMCID: PMC10895410 DOI: 10.1093/jpepsy/jsad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023] Open
Affiliation(s)
- Ellison S Choate
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, USA
| | - Alexandra J Neville
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, USA
| |
Collapse
|
14
|
Jordan A, Williams M, Jones A, Noel M, Neville A, Clinch J, Pincus T, Gauntlett-Gilbert J, Leake H. Pediatrician Explanations of Pediatric Pain in Clinical Settings: A Delicate Craft. THE JOURNAL OF PAIN 2023; 24:1396-1405. [PMID: 36893876 DOI: 10.1016/j.jpain.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/26/2023] [Accepted: 03/04/2023] [Indexed: 03/11/2023]
Abstract
Explaining chronic pain to children and families can be challenging, particularly in the absence of an obvious physiologically identifiable cause for the child's pain. In addition to medical intervention, children and families may expect clinicians to provide clarity around the cause of pain. Such explanations are often provided by clinicians who have not received formal pain training. This qualitative study sought to explore the following question: What do pediatricians consider to be important when providing pain explanations to children and their parents? Using semistructured interview methods, 16 UK pediatricians were interviewed regarding their perceptions of explaining chronic pain to children and families in clinical settings. Data were analyzed using inductive reflexive thematic analysis. Analyses generated 3 themes: 1) timing of the explanation, 2) casting a wider net, and 3) tailoring of the narrative. Study findings demonstrated the need for pediatricians to skilfully interpret where children and families are in their pain journey and deliver an appropriate and adaptable explanation relating to individual needs. Analyses identified the importance of providing a pain explanation that could be repeated and understood by others outside the consultation room, to enable children and families to accept the explanation. PERSPECTIVE: Study findings identify the importance of language in addition to familial and broader factors that may influence the provision and adoption of chronic pain explanations provided by pediatricians to children and families. Improving pain explanation provision may influence treatment engagement for children and their parents, subsequently impacting pain related outcomes.
Collapse
Affiliation(s)
- Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK; Centre for Pain Research, University of Bath, Bath, UK.
| | | | - Abigail Jones
- Department of Psychology, University of Bath, Bath, UK; Centre for Pain Research, University of Bath, Bath, UK
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada; Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Alexandra Neville
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Jacqueline Clinch
- Bristol Medical School, University of Bristol, UK; Bristol Royal Children's Hospital, University of Bristol, Bristol, UK; Bath Centre for Pain Services, Royal United Hospitals Bath, Bath, UK
| | - Tamar Pincus
- Department of Psychology, Royal Holloway, University of London, UK
| | - Jeremy Gauntlett-Gilbert
- Bath Centre for Pain Services, Royal United Hospitals Bath, Bath, UK; Centre for Health and Clinical Research, University of the West of England Bristol, Bristol, UK
| | - Hayley Leake
- IIMPACT in Health, University of South Australia, Adelaide, Australia
| |
Collapse
|
15
|
Nimbley E, Caes L, Noel M, Jordan A. Distress and Resilience Narratives within Pain Memories of Adolescents and Young Adults with Complex Regional Pain Syndrome: A Multi-Method Study. THE JOURNAL OF PAIN 2023; 24:1275-1287. [PMID: 36868487 DOI: 10.1016/j.jpain.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
A comprehensive understanding of pain memories requires consideration of risk and resilience factors across biopsychosocial domains. Previous research has typically focused on pain-related outcomes, largely ignoring the nature and context of pain memories. Using a multiple-method approach, this study explores the content and context of pain memories in adolescents and young adults with complex regional pain syndrome (CRPS). Recruited via social media and pain-related organizations, participants completed an autobiographical pain memory task. Two-step cluster analysis was conducted on the pain memory narratives of adolescents and young adults with CRPS (n=50) using a modified version of the Pain Narrative Coding Scheme. Narrative profiles generated from the cluster analysis subsequently guided a deductive thematic analysis. Cluster analysis identified two narrative profiles of Distress and Resilience, with the role of coping and positive affect emerging as important profile predictors across pain memories. Subsequent deductive thematic analysis, utilizing Distress and Resilience codes, demonstrated the complex interplay between affect, social, and coping domains. Findings highlight the importance of applying a biopsychosocial framework to pain memory research, accounting for both risk and resilience perspectives and encourage the use of multiple method approaches to improve understanding of autobiographic pain memories. Clinical implications of reframing and recontextualizing pain memories and narratives are discussed, and the importance of exploring the origins of pain and possible application to developing resilience-based, preventative interventions is highlighted. PERSPECTIVE: Using multiple methods, this paper presents a comprehensive account of pain memories in adolescents and young adults with CRPS. Study findings promote the importance of adopting a biopsychosocial approach to examining both risk and resilience factors in understanding autobiographical pain memories in the context of pediatric pain.
Collapse
Affiliation(s)
- Emy Nimbley
- Department of Psychology and Centre for Pain Research, University of Bath, UK; School of Health in Social Sciences, University of Edinburgh, UK
| | - Line Caes
- Division of Natural Sciences, University of Stirling, UK
| | - Melanie Noel
- Department of Psychology, University of Calgary; Alberta Children's Hospital Research Institute; Hotchkiss Brain Institute, Canada
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, UK; Department of Psychology, University of Bath, UK..
| |
Collapse
|
16
|
Parsons RD, McParland JL, Halligan SL, Goubert L, Jordan A. Glass half full: A diary and interview qualitative investigation of flourishing among adolescents living with chronic pain. Eur J Pain 2023. [PMID: 37128852 DOI: 10.1002/ejp.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/17/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Counter to paediatric pain literature that typically highlights the deleterious impacts associated with adolescent chronic pain, evidence suggests that some adolescents flourish in their experience of pain. This study sought to explore how adolescents experience, understand and perceive flourishing while living with chronic pain. METHODS Twenty-four adolescents aged 11-24 years were recruited via clinical and online settings. All adolescents were asked to complete daily diary entries, with a subset of 10 participants asked to complete follow-up interviews. RESULTS Inductive reflexive thematic analysis generated two themes: 'Appreciating the moment' and 'Becoming a better version of myself'. Themes addressed how self and other comparisons facilitated a renewed appreciation for achievements and pleasures in life due to living with chronic pain. Adolescents further demonstrated a perception of continued personal and social growth in their experience of chronic pain, including increased emotional maturity, resilience, positivity, kindness and improved communication skills. CONCLUSIONS We conclude that adolescents can experience positive changes in functioning and flourish in some domains of life despite, or resulting from, chronic pain. Further research with an exclusive focus on flourishing is needed to build on this work and address this important gap in knowledge. SIGNIFICANCE We present evidence that adolescents can flourish when living with chronic pain. Such knowledge may inform the development of positive psychological treatment strategies that are focused on reinforcing adolescents' existing strengths, to expand on current treatment options for adolescents living with chronic pain.
Collapse
Affiliation(s)
- Ryan D Parsons
- Department of Psychology, University of Bath, Bath, UK
- Centre for Pain Research, University of Bath, Bath, UK
| | | | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
- Centre for Pain Research, University of Bath, Bath, UK
| |
Collapse
|
17
|
Nahman-Averbuch H, Li R, Boerner KE, Lewis C, Garwood S, Palermo TM, Jordan A. Alterations in pain during adolescence and puberty. Trends Neurosci 2023; 46:307-317. [PMID: 36842946 DOI: 10.1016/j.tins.2023.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/26/2023]
Abstract
During adolescence and puberty, alterations in pain, both experimental and clinical, are observed. In addition, adolescents undergo extensive biopsychosocial changes as they transition from childhood to adulthood. However, a better understanding of how the biopsychosocial changes during adolescence impact pain is needed to improve pain management and develop targeted pain interventions for adolescents. This review synthesizes the literature on alterations in pain during adolescence in humans, describes the potential biopsychosocial factors impacting pain during adolescence, and suggests future research directions to advance the understanding of the impact of adolescent development on pain.
Collapse
Affiliation(s)
- Hadas Nahman-Averbuch
- Washington University Pain Center and Division of Clinical and Translational Research, Department of Anesthesiology, Washington University in St Louis School of Medicine, St. Louis, MO, USA.
| | - Rui Li
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Christopher Lewis
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA; Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah Garwood
- Transgender Center at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, United Kingdom
| |
Collapse
|
18
|
Farrant B, Denny S, Vroegop P, Fenaughty J, Clark TC. Prevalence, severity and impact of chronic pain among a representative cross-sectional study of New Zealand high school students. J Paediatr Child Health 2023; 59:144-152. [PMID: 36334005 PMCID: PMC10100059 DOI: 10.1111/jpc.16263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
AIM To report the prevalence of self-reported chronic pain and severity among young people in New Zealand and explore the relationships between pain and mental health, substance use, socialisation and school engagement. METHODS Prevalence of self-reported chronic pain frequency and severity are reported from an anonymous, representative cross-sectional self-administered health and well-being questionnaire by students aged 12-18 years in New Zealand. Multivariable models exploring chronic pain and mental health, substance use, socialisation and school engagement are reported controlling for age, sex, ethnicity, socio-economic status, disability and history of sexual abuse. RESULTS Overall, 22.8% (95% confidence interval (CI) 21.2-24.5) of young people reported chronic pain for 6 months or more, with 3.2% (95% CI 3.1-4.5) reporting severe pain weekly or more often. Females and rural adolescents were more likely to report chronic and severe pain. Asian youth reported less pain than other ethnic groups. Increased severity of pain was associated more with poorer daily functioning and socialising than with frequency of pain. Severe pain occurring weekly or more often was more common among students who had a disability (2.3% 95% CI 1.8-2.7 vs. 9.8%, 95% CI 7.2-12.5) or a history of sexual abuse (2.4% 95% 1.9-2.9 vs. 8.5%, 95% CI 6.3-10.5). Those reporting chronic pain had higher proportions of self-reported significant depressive symptoms, lower well-being, lower school engagement and lower access to health care, particularly for those reporting higher levels of intensity and frequency of pain. CONCLUSIONS Chronic pain is common in adolescent populations, and has a significant association with decreased daily functioning, socialising, school engagement and mental well-being. Adolescents with chronic pain report significant unmet health-care needs.
Collapse
Affiliation(s)
- Bridget Farrant
- Department of Paediatrics, Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand.,Kidz First Centre for Youth Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - Simon Denny
- Department of Paediatrics, Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand.,Mater Young Adult Health Centre, Brisbane, Queensland, Australia
| | - Paul Vroegop
- Department of Psychological Medicine, Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand.,Chronic Pain Service, Counties Manukau District Health Board, Auckland, New Zealand
| | - John Fenaughty
- School of Counselling, Human Services and Social Work, Faculty of Education and Social Work, University of Auckland, Auckland, New Zealand
| | - Terryann C Clark
- School of Nursing, Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand
| |
Collapse
|
19
|
Parsons RD, McParland JL, Halligan SL, Goubert L, Jordan A. Flourishing among adolescents living with chronic pain and their parents: A scoping review. PAEDIATRIC & NEONATAL PAIN 2022; 4:158-168. [PMID: 36618512 PMCID: PMC9798043 DOI: 10.1002/pne2.12088] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/30/2022] [Accepted: 09/22/2022] [Indexed: 12/31/2022]
Abstract
Evidence exists regarding the impact of flourishing in individuals living with chronic pain, but there are currently no reviews which collate the literature on flourishing in adolescents living with chronic pain and their parents. Therefore, the aim of this scoping review was to map and review the current literature, to document how flourishing is defined and understood in the literature, and to identify gaps in the field. Six databases were searched (Web of Science, Medline, Embase, APA PsycNet and the Cochrane Central Register of Controlled Trials). In addition, a limited gray literature search was conducted. The resulting data were collated and reported in relation to the review questions, by examining the included papers to search for the presence of flourishing. Database searches resulted in 7326 papers after duplicate removal, with eight remaining papers being assessed for full-text eligibility. Following full-text screening, a final four papers were included in the review. Within the papers, flourishing was defined in relation to commonalities of benefit finding, enhanced maturity and growth, and social support. Gaps in the literature and directions for future research are considered. This review suggests that there is a dearth of knowledge and research regarding flourishing among adolescents living with chronic pain and their parents, despite aspects of flourishing identified in limited literature. This warrants further investigation.
Collapse
Affiliation(s)
- Ryan D. Parsons
- Department of PsychologyUniversity of BathBathUK,Centre for Pain ResearchUniversity of BathBathUK
| | | | - Sarah L. Halligan
- Department of PsychologyUniversity of BathBathUK,Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Liesbet Goubert
- Department of Experimental‐Clinical and Health PsychologyGhent UniversityGhentBelgium
| | - Abbie Jordan
- Department of PsychologyUniversity of BathBathUK,Centre for Pain ResearchUniversity of BathBathUK
| |
Collapse
|
20
|
Weitzman ER, Wisk LE, Minegishi M, Cox R, Lunstead J, Brogna M, Levy S. Effects of a Patient-Centered Intervention to Reduce Alcohol Use Among Youth With Chronic Medical Conditions. J Adolesc Health 2022; 71:S24-S33. [PMID: 36122966 DOI: 10.1016/j.jadohealth.2021.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/13/2021] [Accepted: 10/15/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Alcohol poses unique risks for youth with chronic medical conditions (YCMC) yet many drink. Preventive interventions targeting YCMC are scarce. METHODS YCMC with type 1 diabetes, juvenile idiopathic arthritis, systemic lupus erythematosus, or inflammatory bowel disease were recruited and randomized to trial the effects of a self-administered condition-tailored psychoeducational intervention on frequency in days of past 3-month alcohol use, alcohol-related risk perceptions, and knowledge. Changes in outcomes over time were measured and compared by treatment arm using multivariate mixed effects models. RESULTS Among N = 418 participants (average age 16.0 years, 52.2% female, 84.7% white, 90.7% non-Hispanic), 24.2% reported past-year alcohol use at baseline. Alcohol-related knowledge increased overall and was greater for the intervention group (adjusted improvement in knowledge score +7.70, 95% confidence interval [CI] 2.92-12.48). By 6-month follow-up, the percentage of youth reporting any alcohol use is risky/dangerous increased among intervention arm participants from 41.5% to 45.4% at baseline and decreased from 38.9% to 37.4% among controls (adjusted intervention effect odds ratio 1.79, 95% confidence interval 1.02-3.13). Overall, frequency of drinking increased over time from 3.72 to 4.52 days on average, with no differences by treatment group. Among female drinkers, the predicted mean frequency of drinking days declined in the intervention group (4.11-3.33) and increased among controls (2.82-4.55) (adjusted intervention effect rate ratio .50, 95% confidence interval .25-.99). CONCLUSIONS Exposure to a chronic illness-tailored psychoeducational intervention targeting alcohol use increased knowledge and perceived risk and, among females, reduced alcohol use. Promising results merit future work to optimize the model for both males and females.
Collapse
Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - Lauren E Wisk
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Division of General Internal Medicine and Health Services Research, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Machiko Minegishi
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Rachele Cox
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Julie Lunstead
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Melissa Brogna
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| | - Sharon Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts; Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Boston, Massachusetts
| |
Collapse
|
21
|
Donovan E, Tanson K, Martin SR, Weston G, Griffin A, Zeltzer LK. The acceptability of photovoice as a method for incorporating resilience-enhancing factors into pediatric pain research. PLoS One 2022; 17:e0272504. [PMID: 36054195 PMCID: PMC9439202 DOI: 10.1371/journal.pone.0272504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Recurrent or chronic pain affects 11–38% of children and adolescents. Pediatric pain research typically focuses on risk factors, such as anxiety and parent functional disability, but resilience-building, protective factors also play an important role in the pain experience. New methods to incorporate resilience-enhancing factors into pain research are needed. Photovoice is a highly participatory research method, where participants take photos to address a common question, caption their photos, and discuss the meaning of the photos in a group. The main objective of this study was to determine whether photovoice is an acceptable method to young people living with chronic pain for identifying and sharing sources of joy. Another objective was to explore sources of joy. Sixteen adolescents and young adults participated, which involved meeting in a group to discuss the goal of the study, taking photographs of self-identified sources of joy over a two-week period, and meeting as a group again to discuss the photographs and participate in a focus group about the experience. Results suggest that photovoice is an acceptable method, as all participants took photographs and attended both meetings, and three themes from the focus group data suggested the participants considered photovoice to be appropriate: 1.) Relief associated with meeting peers, 2.) Potential to benefit young people living with pain, and 3.) Potential to raise awareness. Three themes emerged from the discussion of the photographs to describe sources of joy: 1.) Gratitude for everyday pleasures and accomplishments, 2.) Support from pets, and 3.) Journey of acceptance. Results add to the strengths-based literature on pediatric pain by identifying an acceptable method that could be further explored for use as an intervention to enhance protective factors such as positive affect, gratitude, and social support and to compare the experiences of different populations of youth living with pain.
Collapse
Affiliation(s)
- Elizabeth Donovan
- Department of Psychology, Simmons University, Boston, Massachusetts, United States of America
- * E-mail:
| | - Katherina Tanson
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
- Charles R. Drew University of Medicine and Science, Los Angeles, California, United States of America
| | - Sarah R. Martin
- Department of Anesthesiology & Perioperative Care, University of California Irvine School of Medicine, Orange, California, United States of America
| | - Georgia Weston
- Creative Healing for Youth in Pain, Los Angeles, California, United States of America
| | - Anya Griffin
- Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Lonnie K. Zeltzer
- Creative Healing for Youth in Pain, Los Angeles, California, United States of America
- Departments of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
22
|
Jones A, Caes L, Eccleston C, Noel M, Gauntlett‐Gilbert J, Jordan A. The sands of time: Adolescents' temporal perceptions of peer relationships and autonomy in the context of living with chronic pain. PAEDIATRIC AND NEONATAL PAIN 2022; 4:110-124. [PMID: 36188159 PMCID: PMC9485819 DOI: 10.1002/pne2.12071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/02/2021] [Accepted: 01/10/2022] [Indexed: 12/30/2022]
Abstract
The incidence of chronic and recurrent pain increases in adolescence. Prevalence of adolescent chronic pain is estimated to be 11%‐44%, with approximately 5% adolescents experiencing moderate‐to‐severe chronic pain. Adolescents with chronic pain also report unwanted changes in emotional, social, and developmental functioning. Very little is known about how adolescents with chronic pain make sense of their development, the role of pain in that development, and how such developmental trajectories progress over time. A multi‐methods qualitative study was designed to explore how adolescents make sense of their experience of chronic pain in the context of development. Nine adolescents (8 girls) aged 12‐22 years old (Mean = 15.7, SD = 2.8) were recruited from a UK national pain service. Adolescents completed an interview on entering the service, and a follow‐up interview 12 months later. They also completed monthly diaries in this 12‐month period. Data comprised 18 interviews and 60 diary entries, which were analyzed using inductive reflexive thematic analysis. Analyses generated one overarching theme entitled “tug of war: push and pull,” demonstrating developmental tension related to pain, and the cumulative impact these had over time. This overarching theme comprised two subthemes which capture these tensions across the developmental domains of peer relationships and autonomy. The first subtheme, “the shifting sands of peer relationships,” explores the ever‐changing closeness between self and peers. The second subtheme referred to “restricted choices” and how pain limited the participants' autonomy but that this, over time could push development forward. These results extend previous cross‐sectional research on the developmental consequences of chronic pain, showing the dynamic fluctuations and alterations to developmental trajectories over time.
Collapse
Affiliation(s)
- Abigail Jones
- Department of Psychology University of Bath Bath UK
- Centre for Pain Research University of Bath Bath UK
| | - Line Caes
- Division of Psychology Faculty of Natural Sciences University of Stirling Stirling UK
| | - Christopher Eccleston
- Centre for Pain Research University of Bath Bath UK
- Department of Health University of Bath Bath UK
| | - Melanie Noel
- Department of Psychology Alberta Children's Hospital Research Institute Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
| | - Jeremy Gauntlett‐Gilbert
- Bath Centre for Pain Services Royal United Hospitals Bath UK
- Centre for Health and Clinical Research University of the West of England Bristol UK
| | - Abbie Jordan
- Department of Psychology University of Bath Bath UK
- Centre for Pain Research University of Bath Bath UK
| |
Collapse
|
23
|
Neville A, Lund T, Soltani S, Jordan A, Stinson J, Killackey T, Birnie KA, Noel M. Pediatric Chronic Pain in the Midst of the COVID-19 Pandemic: Lived Experiences of Youth and Parents. THE JOURNAL OF PAIN 2022; 23:841-851. [PMID: 34915200 PMCID: PMC8710941 DOI: 10.1016/j.jpain.2021.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/16/2021] [Accepted: 11/18/2021] [Indexed: 01/23/2023]
Abstract
During the coronavirus 2019 (COVID-19) pandemic youth with chronic pain have experienced additional barriers to accessing treatment and managing their pain. This study explored the experiences of youth with chronic pain and their parents during the COVID-19 pandemic. Individual semi-structured interviews were conducted with 20 youth with chronic pain (aged 13-20 years) and one of their parents, recruited from a tertiary level pediatric chronic pain program. Interviews occurred between the months of June to August 2020 and enabled participants to describe their experiences of the COVID-19 pandemic according to their own unique perspectives. Transcripts were analyzed using inductive reflexive thematic analysis. Four themes were generated and labelled: "temporality, mental health, and pain," "coping with pain during a global pandemic," "impact on care," and "re-appraisal in the context of development and pandemic life." Across these themes, youth and parents described their unique challenges of living with pain as they adapted to changing circumstances of the COVID-19 pandemic. Notably, youth experienced increased difficulties managing their mental health and pain, which were intricately connected and related to social isolation, temporality, and uncertainty exacerbated by the COVID-19 pandemic. Restrictions due to the COVID-19 pandemic impacted youth's access to care and their abilities to engage in coping strategies to manage their pain. The COVID-19 pandemic was also perceived to have interrupted youth's development and growing autonomy, prompting youth to re-appraise their current circumstances and imagined futures. PERSPECTIVE: This manuscript provides an in-depth understanding of the impact of the COVID-19 pandemic on youth with chronic pain and their parents. Youth and their parents perceived the COVID-19 pandemic to have impacted youth's mental health, pain, socio-emotional development, and access to care.
Collapse
Affiliation(s)
- Alexandra Neville
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
| | - Tatiana Lund
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Sabine Soltani
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Abbie Jordan
- Department of Psychology and Centre for Pain Research, University of Bath, Bath, UK
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Research Institute Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Research Institute Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Department of Anesthesiology, Perioperative and Pain Medicine, and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada; Hotchkiss Brain Institute, Calgary, Canada
| |
Collapse
|
24
|
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] [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
|