scholarly journals Validation and Clinical Application of a Biopsychosocial Model of Pain Intensity and Functional Disability in Patients with a Pediatric Chronic Pain Condition Referred to a Subspecialty Clinic

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Thomas R. Vetter ◽  
Gerald McGwin ◽  
Cynthia L. Bridgewater ◽  
Avi Madan-Swain ◽  
Lee I. Ascherman
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Clinical Application ◽  
Functional Disability ◽  
Published Data ◽  
Pain Coping ◽  
Patient Anxiety ◽  
Pediatric Chronic Pain ◽  
Patient Pain ◽  
Anxiety Patient

Background. Pediatric chronic pain is considered to be a multidimensional construct that includes biological, psychological, and social components. Methods. The 99 enrolled study patients (mean age 13.2 years, 71% female, 81% Caucasian) and an accompanying parent completed a series of health-related questionnaires at the time of their initial appointment in a pediatric chronic pain medicine clinic. Results. Significant correlations (, ) were observed between pediatric chronic pain intensity and patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, and parent functional disability. Pediatric chronic pain intensity was significantly associated with patient anxiety (). Significant correlations (, ) were observed between pediatric functional disability and patient chronic pain intensity, patient anxiety, patient depression, patient pain coping, parent chronic pain intensity, parent functional disability, parent anxiety, parent depression, and parent stress. Pediatric functional disability was significantly associated with patient chronic pain intensity (), patient anxiety (), patient pain coping (), and parent functional disability (). Conclusions. These findings provide empirical support of a multidimensional Biobehavioral Model of Pediatric Pain. However, the practical clinical application of the present findings and much of the similar previously published data may be tenuous.

scholarly journals Patient Versus Parental Perceptions about Pain and Disability in Children and Adolescents with a Variety of Chronic Pain Conditions

2014 ◽  
Vol 19 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Thomas R Vetter ◽  
Cynthia L Bridgewater ◽  
Lee I Ascherman ◽  
Avi Madan-Swain ◽  
Gerald L McGwin
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Correlation Coefficient ◽  
Functional Disability ◽  
Pediatric Pain ◽  
Proxy Reports ◽  
Pediatric Chronic Pain ◽  
Self Reports ◽  
The Difference ◽  
Parent Proxy

BACKGROUND: Cross-informant variance is often observed in patient self-reports versus parent proxy reports of pediatric chronic pain and disability.OBJECTIVE: To assess the relationship and merit of the child versus parent perspective.METHODS: A total of 99 patients (eight to 17 years of age [mean 13.2 years]; 71% female, 81% Caucasian) and parents completed the Pediatric Pain Questionnaire and Functional Disability Inventory at their initial clinic visit. Patients’ and parents’ pain intensity and disability scores were analyzed using an intraclass correlation coefficient (ICC), Wilcoxon signed-rank test, Bland-Altman plot and Spearman’s correlation coefficient. The association between clinical/demographic variables and differences in patient/parent pain intensity and disability scores was assessed using multivariable regression.RESULTS: There was significant agreement between patients’ self-reports and parents’ proxy reports of their child’s pain intensity (ICC=0.52; P<0.001) and disability (ICC=0.57; P=0.004) at the individual level. There were no significant group differences in patient versus parent-proxy pain intensity scores (P=0.40) and disability scores (P=0.54). The difference between patient and parent-proxy pain intensity was associated with patients’ self-reported pain intensity (P<0.001). The difference between patient and parent-proxy disability was associated with patient’s self-reported pain disability (P<0.001). Bland-Altman plots revealed major inter-rater variation in the Pediatric Pain Questionnaire and Functional Disability Inventory across their score ranges. A significant relationship (r=0.38; P<0.001) was observed between patients’ self-reported pain intensity and disability.CONCLUSIONS: While equal merit should ideally be given to pediatric chronic pain patients’ self-reports and their parents’ proxy reports of pain intensity and disability, it would appear that, as needed, pediatric patients or parents can offer a clinically valid, single clinical perspective.

scholarly journals Biomarkers of Allostatic Load as Correlates of Impairment in Youth with Chronic Pain: An Initial Investigation

Children ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 709
Author(s):  
Sarah Nelson ◽  
Samantha Bento ◽  
Michelle Bosquet Enlow
Keyword(s):  
Risk Factors ◽  
Chronic Pain ◽  
Allostatic Load ◽  
Functional Disability ◽  
Pain Treatment ◽  
Pediatric Pain ◽  
Childhood Experiences ◽  
High Exposure ◽  
Pediatric Chronic Pain ◽  
Study Results

Pediatric chronic pain is common and responsible for significant healthcare burden. However, the mechanisms underlying the development and/or maintenance of pediatric chronic pain remain poorly understood. Allostatic load (AL), or wear and tear on the nervous system following significant or prolonged stress, has been proposed to play a role in the maintenance of chronic pain, but minimal research has examined this possibility. This gap in research is particularly notable given the high exposure to adverse childhood experiences (ACEs; abuse/neglect, etc.) and psychological stress in this population. Accordingly, the current study aimed to preliminarily examine the measurement of AL in a treatment-seeking pediatric pain population. Biomarkers were collected during an already scheduled new patient pain evaluation and included salivary cortisol, dehydroepiandrosterone (DHEA), and C-reactive protein, in addition to waist–hip ratio, body-mass index, and blood pressure. A total of 61 children and adolescents with chronic pain (Mage = 14.47 years; 88.5% female and white/Caucasian) completed study procedures and were included in analyses. Preliminary results indicated that a multifactorial AL composite is feasible to assess for in a tertiary pain treatment setting and that over 50% of youth with chronic pain were classified as high risk for AL (two or more risk factors). Further, it was found that individual AL risk factors were significantly associated with functional disability and that AL may moderate the association between psychosocial and functional outcomes. Given the pilot nature of this study, results should be used to inform future investigations with larger and more diverse pediatric pain samples.

scholarly journals Differential changes in functional disability and pain intensity over the course of psychological treatment for children with chronic pain

Pain ◽  
2014 ◽  
Vol 155 (10) ◽  
pp. 1955-1961 ◽  
Author(s):  
Anne M. Lynch-Jordan ◽  
Soumitri Sil ◽  
James Peugh ◽  
Natoshia Cunningham ◽  
Susmita Kashikar-Zuck ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Functional Disability ◽  
Psychological Treatment

scholarly journals Caregiver–Child Discrepancies in Reports of Child Emotional Symptoms in Pediatric Chronic Pain

2019 ◽  
Vol 45 (4) ◽  
pp. 359-369
Author(s):  
Sarah R Martin ◽  
Lonnie K Zeltzer ◽  
Laura C Seidman ◽  
Katherine E Allyn ◽  
Laura A Payne
Keyword(s):  
Chronic Pain ◽  
Depressive Symptoms ◽  
Functional Impairment ◽  
Internalizing Symptoms ◽  
Functional Disability ◽  
Child Anxiety ◽  
Depression Scale ◽  
Proxy Report ◽  
Proxy Reports ◽  
Pediatric Chronic Pain

Abstract Objective Pediatric chronic pain evaluation includes self-reports and/or caregiver proxy-reports across biopsychosocial domains. Limited data exist on the effects of caregiver–child discrepancies in pediatric pain assessment. In children with chronic pain, we examined associations among discrepancies in caregiver–child reports of child anxiety and depressive symptoms and child functional impairment. Methods Participants were 202 children (Mage=14.49 ± 2.38 years; 68.8% female) with chronic pain and their caregivers (95.5% female). Children and caregivers completed the Revised Child Anxiety and Depression Scale (RCADS) and RCADS-Parent, respectively. Children also completed the Functional Disability Inventory. Mean difference tests examined caregiver–child discrepancies. Moderation analyses examined whether associations between child self-reported anxiety and depressive symptoms and functional impairment varied as a function of caregiver proxy-report. Results Children reported more anxiety and depressive symptoms compared with their caregivers’ proxy-reports (Z = −4.83, p &lt; .001). Both informants’ reports of child anxiety and depressive symptoms were associated with child functional impairment (rs = .44, rs = .30, p &lt; .001). Caregiver proxy-report moderated associations between child-reported anxiety and depressive symptoms and functional impairment (B = −0.007, p = .003). When caregiver proxy-report was low, child self-reported anxiety and depressive symptoms were positively related to functional impairment (B = 0.28, SE = 0.07, 95% CI [0.15, 0.41], p &lt; .001). Conclusions Discrepant caregiver–child perceptions of child anxiety and depressive symptoms may be associated with functioning in children with chronic pain, especially when caregivers report less child internalizing symptoms. These findings highlight the need for further examination of the effects of caregiver–child discrepancies on pediatric chronic pain outcomes and may indicate targets for intervention.

The effectiveness of cognitive behavioural therapy for pain in childhood and adolescence: a meta-analytic review

2016 ◽  
Vol 33 (4) ◽  
pp. 251-264 ◽  
Author(s):  
A. Lonergan
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Cognitive Behavioural Therapy ◽  
Functional Disability ◽  
Behavioural Therapy ◽  
Medium Effect ◽  
Care Providers ◽  
Cognitive Behavioural ◽  
Analytic Review ◽  
Pain Duration

ObjectivesA variety of chronic painful conditions are present in the paediatric population. Patients with chronic pain often experience considerable scepticism and avoidance by health care providers. This meta-analytic review aimed to utilise well-designed studies, in examining the effectiveness of cognitive behavioural therapy (CBT) in the treatment of chronic pain in children and adolescents.MethodsNine randomized controlled trial studies examining CBT for chronic pain were reviewed. Outcome measures were child reported pain intensity, pain duration and functional disability.ResultsCBT had a large effect on pain intensity for recurrent abdominal pain (RAP), a small effect on headaches, and a medium effect on fibromyalgia. CBT had a medium effect on pain duration across pain types. CBT had a large effect on functional disability for RAP, a small effect on fibromyalgia and a moderate effect on headaches. Findings are limited by the small number of studies and varied control conditions.ConclusionsCBT may be effective in reducing child reported pain symptomology. Future studies using a larger sample and examining the differential impact of varied control conditions are needed.

scholarly journals Treatment of Pediatric Chronic Pain with Tramadol Hydrochloride: Siblings with Ehlers-Danlos Syndrome - Hypermobility Type

2004 ◽  
Vol 9 (4) ◽  
pp. 209-211 ◽  
Author(s):  
Stephen C Brown ◽  
Jennifer Stinson
Keyword(s):  
Physical Activity ◽  
Chronic Pain ◽  
Pain Intensity ◽  
Pediatric Patients ◽  
Previous Treatment ◽  
Tramadol Hydrochloride ◽  
Ehlers Danlos Syndrome ◽  
Pediatric Chronic Pain ◽  
Danlos Syndrome

OBJECTIVE:To evaluate the effectiveness of tramadol hydrochloride for the treatment of chronic pain refractory to previous treatment in two pediatric patients.METHODS:Tramadol hydrochloride was administered (50 mg/day to 150 mg/day) to two siblings with Ehlers-Danlos syndrome -- Hypermobility type refractory to previous pharmacological treatments, and changes in pain intensity and physical activity were assessed.RESULTS:Pain intensity decreased and physical activity improved within days of starting therapy. Positive results have been maintained for 30 months.CONCUSIONS:Tramadol hydrochloride was a safe and effective treatment for relieving chronic pain in two pediatric patients suffering from the hypermobility type of Ehlers-Danlos syndrome. No morbidity or side effects were noted during the 30-month follow-up.

Pediatric chronic pain, coping and health-related quality of life

2005 ◽  
Vol 6 (3) ◽  
pp. S72
Author(s):  
J. Gold ◽  
M. Carson ◽  
A. Griffin ◽  
A. Kant ◽  
M. Joseph
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Pain Coping ◽  
Health Related Quality ◽  
Pediatric Chronic Pain ◽  
Related Quality ◽  
Health Related

scholarly journals The Relationship between Stressors and Pain-Related Clinical Outcomes in Pediatric Chronic Pain Patients

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 21
Author(s):  
Anjana Jagpal ◽  
Keri Hainsworth ◽  
Ratka Galijot ◽  
Katherine S. Salamon ◽  
Kim Anderson Khan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Pain ◽  
Functional Disability ◽  
Future Research ◽  
Clinical Interviews ◽  
Pediatric Chronic Pain ◽  
Patient Reported ◽  
Poor Outcomes ◽  
The Relationship

Youth with chronic pain and youth who have experienced stressors are at risk for poor outcomes; however, little is known about the intersection of pain and stressors. This study aims to understand the prevalence of stressors among youth with chronic pain and the relationship between stressors and pain-related outcomes. Seven hundred and seventy youth with chronic pain aged 8–18 (Mage = 14.15 years, 70% female) reported pain characteristics, stressors, anxiety, disability, and quality of life. Most participants (82%) endorsed at least one stressor. A greater number of stressors was significantly related to greater anxiety and disability, and lower levels of quality of life. School stressors were significantly associated with functional disability; family, school, and peer stressors were significantly associated with anxiety and quality of life. Stressors are common in youth with chronic pain, and the presence of stressors is related to greater functional impairment. The results of this preliminary study using semi-structured clinical interviews suggest the importance of developing a validated measure that encompasses a wide variety of stressors for youth with pain. Future research on patient-reported stressors, relative intensity, and impact are needed.

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