scholarly journals Sleep among Youth with Severely Disabling Chronic Pain: Before, during, and after Inpatient Intensive Interdisciplinary Pain Treatment

Children ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. 42
Author(s):  
Kendra N. Krietsch ◽  
Dean W. Beebe ◽  
Christopher King ◽  
Kendra J. Homan ◽  
Sara E. Williams
Keyword(s):  
Chronic Pain ◽  
Comparison Group ◽  
Pain Treatment ◽  
Environmental Control ◽  
Sleep Onset ◽  
Functional Independence ◽  
Poor Sleep ◽  
Final Sample ◽  
Interdisciplinary Pain Treatment ◽  
Wake Patterns

Poor sleep is commonly reported in pediatric chronic pain. There are signals that intensive interdisciplinary pain treatments (IIPT) may inadvertently improve objective sleep, but this claim cannot be substantiated without baseline sleep data prior to IIPT. This study followed the objective sleep/wake patterns (e.g., duration, quality, timing, consistency) of pediatric patients with severely functionally disabling chronic pain before, during, and after inpatient IIPT (the Functional Independence Restoration Program—“FIRST Program”), alongside a similarly-disabled chronic pain Comparison Group. The final sample included N = 10 FIRST Patients and N = 9 Comparison Group patients. At baseline, the whole sample showed healthy sleep duration (~9 h), average sleep efficiency <90%, late sleep onset and offset (mean = 11:56 p.m.–8:50 a.m.), and highly inconsistent sleep schedules night to night. During IIPT, FIRST Patients maintained healthy sleep durations, moved sleep schedules 2 h earlier, and decreased timing and duration variability by >60 min while the Comparison Group maintained similar sleep to baseline. At follow up (1–2 months later), FIRST Patients’ sleep schedules shifted later but were still less variable than at baseline. Results point to the malleability of sleep/wake patterns within treatment contexts with strict environmental control but suggest that these gains may be difficult for youth with chronic pain to maintain in the home environment.

scholarly journals Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Patricia A. Poulin ◽  
Jennifer Nelli ◽  
Steven Tremblay ◽  
Rebecca Small ◽  
Myka B. Caluyong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chronic Pain ◽  
Mental Health Problems ◽  
Pain Treatment ◽  
Care Center ◽  
Tertiary Care ◽  
Care Physician ◽  
Cross Sectional ◽  
Interdisciplinary Pain Treatment ◽  
Ed Visits

Background. Chronic pain (CP) accounts for 10–16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

scholarly journals Complementary Parent Components for Pediatric Pain Families: Innovations in Treatment

Children ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 4 ◽  
Author(s):  
Beth S. Russell ◽  
Jessica W. Guite ◽  
Kendra J. Homan ◽  
Rebecca M. Tepe ◽  
Sara E. Williams
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Control Sample ◽  
Intervention Development ◽  
Treatment Programs ◽  
Pediatric Pain ◽  
Parent Intervention ◽  
Pediatric Chronic Pain ◽  
Interdisciplinary Pain Treatment ◽  
Caregiver Needs

For families with a child with chronic pain, the home environment is the context in which adaptive or maladaptive illness behaviors are developed. Supporting families to effectively cope with their child’s chronic pain is a critical need. This work analyzes intervention approaches from emerging treatment programs to support families coping with pediatric pain that diverge from traditional treatment models by specifically targeting parents. Two novel parent intervention programs are presented that consider caregiver needs in both outpatient and inpatient pain treatment settings: Parents as Coping Coaches and Putting Parents FIRST. These programs are evaluated through comparing parental training components across different stages of treatment. Additionally, the efficacy of Putting Parents FIRST in promoting maintenance of children’s functional gains achieved in intensive interdisciplinary pain treatment is presented, and compared to previous results of the efficacy of Putting Parents FIRST. Specifically, outcomes of 36 children whose parents received the intervention in Putting Parents FIRST were compared to a matched control sample of children whose parents did not receive the parent intervention. Similar to the findings from Parents as Coping Coaches, results indicated that patients whose parents received the intervention maintained/improved program gains in disability, coping, and pain significantly more than patients whose parents did not receive the intervention. Implications for parent-focused intervention development efforts targeting parent and youth functioning in the context of pediatric chronic pain are considered.

Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain

PEDIATRICS ◽  
2015 ◽  
Vol 136 (1) ◽  
pp. 115-127 ◽  
Author(s):  
T. Hechler ◽  
M. Kanstrup ◽  
A. L. Holley ◽  
L. E. Simons ◽  
R. Wicksell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Pain Treatment ◽  
Interdisciplinary Pain Treatment

The Impact of Spatial Distribution of Pain on Long-Term Trajectories for Chronic Pain Outcomes After Intensive Interdisciplinary Pain Treatment

2020 ◽  
Vol 36 (3) ◽  
pp. 181-188 ◽  
Author(s):  
Sara E. Williams ◽  
Kendra J. Homan ◽  
Susan L. Crowley ◽  
David W. Pruitt ◽  
Andrew B. Collins ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Spatial Distribution ◽  
Pain Treatment ◽  
Interdisciplinary Pain Treatment ◽  
Pain Outcomes ◽  
The Impact

scholarly journals Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study (Preprint)

2020 ◽  
Author(s):  
Anya Griffin ◽  
Luke Wilson ◽  
Amanda B Feinstein ◽  
Adeline Bortz ◽  
Marissa S Heirich ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Development Process ◽  
Pain Treatment ◽  
Functional Limitations ◽  
Great Promise ◽  
Movement Data ◽  
Iterative Development ◽  
Interdisciplinary Pain Treatment

BACKGROUND In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. OBJECTIVE We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. METHODS We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. RESULTS This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (<i>P</i>&lt;.001), fear (<i>P</i>=.003), avoidance (<i>P</i>=.004), and functional limitations (<i>P</i>=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. CONCLUSIONS The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun.

scholarly journals Extent of sleep problems and relationship with severity of chronic pain using three validated sleep assessment tools

2021 ◽  
pp. 204946372110546
Author(s):  
Rachel Vaughan ◽  
Helen F Galley ◽  
Saravana Kanakarajan
Keyword(s):  
Chronic Pain ◽  
Sleep Quality ◽  
Assessment Tool ◽  
Sleep Problems ◽  
Sleep Onset ◽  
Assessment Tools ◽  
Poor Sleep ◽  
Pain Clinics ◽  
Sleep Assessment ◽  
Sleep Interference

Objective Chronic pain can impact on sleep, but the extent and nature of sleep problems in patients with chronic pain are incompletely clear. Several validated tools are available for sleep assessment but they each capture different aspects. We aimed to describe the extent of sleep issues in patients with chronic non-malignant pain using three different validated sleep assessment tools and to determine the relationship of sleep issues with pain severity recorded using the Brief Pain Inventory (BPI), a commonly used self-assessment tool in pain clinics. The BPI has a single question on the interference of pain on sleep and we also compared this with the validated sleep tools. Design Prospective, cross-sectional study. Setting Pain management clinic at a large teaching hospital in the United Kingdom. Subjects Adult patients (with chronic non-malignant pain of at least 3 months’ duration) attending clinic during a 2-month period. Methods Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Pain and Sleep Questionnaire-3 (PSQ-3) and the Verran Snyder-Halpern (VSH) sleep scale, plus the BPI. Duration and type of pain, current medications and demographic data were recorded. Results We recruited 51 patients and 82% had poor sleep quality as shown by PSQIscores above five. PSQI ( p = 0.0002), PSQ-3 ( p = 0.0032), VSH sleep efficiency ( p = 0.012), sleep disturbance ( p = 0.0014) and waking after sleep onset ( p = 0.0005) scores were associated with worse BPI pain scores. BPI sleep interference scores concurred broadly with the validated sleep tools. Median [range] sleep duration was 5.5 [3.0–10.0] hours and was also related to pain score ( p = 0.0032). Conclusion Chronic pain has a marked impact on sleep regardless of the assessment tool used. The sleep interference question in the BPI could be used routinely for initial identification of sleep problems in patients with chronic pain.

scholarly journals Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study

10.2196/22620 ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e22620
Author(s):  
Anya Griffin ◽  
Luke Wilson ◽  
Amanda B Feinstein ◽  
Adeline Bortz ◽  
Marissa S Heirich ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Development Process ◽  
Pain Treatment ◽  
Functional Limitations ◽  
Great Promise ◽  
Movement Data ◽  
Iterative Development ◽  
Interdisciplinary Pain Treatment

Background In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. Objective We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. Methods We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. Results This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (P<.001), fear (P=.003), avoidance (P=.004), and functional limitations (P=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. Conclusions The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun.

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