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 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.

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 School Anxiety in Children and Adolescents with Chronic Pain

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
K. E. Jastrowski Mano
Keyword(s):  
Chronic Pain ◽  
Functional Impairment ◽  
Measurement Methods ◽  
Evidence Based ◽  
Single Source ◽  
Pediatric Pain ◽  
School Anxiety ◽  
Pediatric Chronic Pain ◽  
Novel Approaches ◽  
Gathering Data

Anxiety is highly prevalent in pediatric chronic pain. This comorbidity has been explained by the presence of shared mechanisms underlying the development and maintenance of chronic pain and anxiety. Accumulating evidence demonstrates that school is a significant source of anxiety among youth with chronic pain and that anxiety contributes to school-related functional impairment in this population. This article reviews the cooccurrence of pediatric chronic pain and anxiety, identifies unique sources of heightened school anxiety among youth with chronic pain, and describes current approaches for assessing anxiety in pediatric pain settings. Highlighted by this review is the absence of a comprehensive evidence-based approach for assessing school anxiety in pediatric chronic pain. Given the psychometric limitations inherent to gathering data from a single source, recommendations for advancing measurement methods are provided. Novel approaches may be needed to shed more light on the way in which school anxiety is experienced in pediatric chronic pain.

scholarly journals Leveraging VR/AR to combat chronic pain in youth: Position paper from the Interdisciplinary Network on Virtual and Augmented (AR/VR) Technologies for Pain (INOVATE-Pain) Management (Preprint)

2020 ◽  
Author(s):  
Deirdre Elizabeth Logan ◽  
Laura Edith Simons ◽  
Thomas Caruso ◽  
Jeffry I Gold ◽  
Anya Griffin ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Best Practices ◽  
Digital Health ◽  
Clinical Care ◽  
Design Evaluation ◽  
Pediatric Pain ◽  
Research And Practice ◽  
Pediatric Chronic Pain ◽  
Chronic Pain Conditions ◽  
Interdisciplinary Network

UNSTRUCTURED Background: Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions, but in this young field there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. Methods: The INOVATE-Pain consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. Results and Conclusions: Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR/AR clinical care, highlighted key opportunities and challenges facing the field, and established a consensus on best methodological practices to adopt in future efforts to advance the research and practice of VR/AR in pediatric pain. The consortium also identified important next steps to undertake to continue to advance the work in this promising new area of digital health pain interventions.

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.

Recognizing the Psychiatric Burden of Anxiety and Depression in Children With Headache, Chest Pain, and Abdominal Pain

2020 ◽  
pp. 160-175
Author(s):  
Susan T. Tran ◽  
Ana B. Goya Arce ◽  
Anjana Jagpal
Keyword(s):  
Chronic Pain ◽  
Functional Disability ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Pediatric Pain ◽  
Treatment Of Depression ◽  
Pediatric Chest ◽  
Psychiatric Conditions ◽  
Headache Pain

Anxiety and depression are particularly common in pediatric chest, abdominal, and headache pain. Shared genetic factors, biological processes, and neurochemical mechanisms may underlie these comorbidities. Chronic pain in children and adolescents is associated with substantial functional disability, and impairments are especially notable when youths have comorbid anxiety or depression. Thus, early detection and treatment of comorbid psychiatric conditions in youths with chronic pain is imperative. Screening for anxiety and depression in pediatric pain is made difficult by the number of overlapping symptoms between pain and psychiatric conditions. Research on the treatment of chronic pain and comorbid depression or anxiety has advanced, but larger trials with follow-up data are needed to improve confidence in effectiveness. Implications for considering developmental and familial factors in the screening and treatment of depression and anxiety in youths with chronic pain are discussed.

Applied Biofeedback in Pediatric Pain

Biofeedback ◽  
2014 ◽  
Vol 42 (3) ◽  
pp. 96-102 ◽  
Author(s):  
Ethan Benore ◽  
Gerard A. Banez ◽  
Tyson Sawchuk ◽  
Jeffrey Bolek
Keyword(s):  
Chronic Pain ◽  
Interdisciplinary Team ◽  
Lessons Learned ◽  
Use Case ◽  
Pediatric Pain ◽  
Case Examples ◽  
Interprofessional Care ◽  
Pediatric Chronic Pain ◽  
Key Issues ◽  
Further Development

Biofeedback is an effective tool for treating pediatric pain. As biofeedback professionals, we often work within an interdisciplinary team for complicated cases of pain. This interprofessional care of pediatric chronic pain presents both advantages and potential hurdles to the biofeedback clinician. In this article, we detail two current biofeedback services affiliated with interprofessional pediatric pain management. We then use case examples to demonstrate key issues in interprofessional care. We conclude with opportunities for further development of interprofessional care involving biofeedback and lessons learned from our practice that may be beneficial to others in the field.

scholarly journals Treatment Expectations for CAM Interventions in Pediatric Chronic Pain Patients and their Parents

2005 ◽  
Vol 2 (4) ◽  
pp. 521-527 ◽  
Author(s):  
Jennie C. I. Tsao ◽  
Marcia Meldrum ◽  
Brenda Bursch ◽  
Margaret C. Jacob ◽  
Su C. Kim ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Treatment Adherence ◽  
Conventional Medicine ◽  
Pediatric Pain ◽  
Treatment Expectations ◽  
Child Treatment ◽  
Pediatric Chronic Pain ◽  
Chronic Pain Patients ◽  
Expected Benefits ◽  
Pain Patients

Patient expectations regarding complementary and alternative medicine (CAM) interventions have important implications for treatment adherence, attrition and clinical outcome. Little is known, however, about parent and child treatment expectations regarding CAM approaches for pediatric chronic pain problems. The present study examined ratings of the expected benefits of CAM (i.e. hypnosis, massage, acupuncture, yoga and relaxation) and conventional medicine (i.e. medications, surgery) interventions in 45 children (32 girls; mean age = 13.8 years ± 2.5) and parents (39 mothers) presenting for treatment at a specialty clinic for chronic pediatric pain. Among children, medications and relaxation were expected to be significantly more helpful than the remaining approaches (P< 0.01). However, children expected the three lowest rated interventions, acupuncture, surgery and hypnosis, to be of equal benefit. Results among parents were similar to those found in children but there were fewer significant differences between ratings of the various interventions. Only surgery was expected by parents to be significantly less helpful than the other approaches (P< 0.01). When parent and child perceptions were compared, parents expected hypnosis, acupuncture and yoga, to be more beneficial than did children, whereas children expected surgery to be more helpful than did parents (P< 0.01). Overall, children expected the benefits of CAM to be fairly low with parents' expectations only somewhat more positive. The current findings suggest that educational efforts directed at enhancing treatment expectations regarding CAM, particularly among children with chronic pain, are warranted.

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