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 Leveraging Virtual Reality and Augmented Reality to Combat Chronic Pain in Youth: Position Paper From the Interdisciplinary Network on Virtual and Augmented Technologies for Pain Management

10.2196/25916 ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. e25916
Author(s):  
Deirdre E Logan ◽  
Laura E Simons ◽  
Thomas J Caruso ◽  
Jeffrey I Gold ◽  
Walter Greenleaf ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Virtual Reality ◽  
Pain Management ◽  
Augmented Reality ◽  
Digital Health ◽  
Clinical Care ◽  
Pediatric Chronic Pain ◽  
Widespread Access ◽  
Chronic Pain Conditions ◽  
Interdisciplinary Network

Background Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions. However, in this young field, there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. Objective The INOVATE-Pain (Interdisciplinary Network on Virtual and Augmented Technologies for Pain management) 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. Methods An interdisciplinary meeting of 16 academics, clinicians, industry partners, and philanthropy partners was held in January 2020. Results Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR and 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 and 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. Conclusions To realize the promise of this realm of innovation, key ingredients for success include productive partnerships among industry, academic, and clinical stakeholders; a uniform set of outcome domains and measures for standardized evaluation; and widespread access to the latest opportunities, tools, and resources. The INOVATE-Pain collaborative hopes to promote the creation, rigorous yet efficient evaluation, and dissemination of innovative VR-based interventions to reduce pain and improve quality of life for children.

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 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 Drugs for Chronic Pain in Children: A Commentary on Clinical Practice and the Absence of Evidence

2013 ◽  
Vol 18 (1) ◽  
pp. 47-50 ◽  
Author(s):  
Marie-Claude Grégoire ◽  
G Allen Finley
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Multidisciplinary Team ◽  
Clinical Care ◽  
Multimodal Approach ◽  
Research Directions ◽  
Best Management ◽  
Pediatric Chronic Pain ◽  
Absence Of Evidence

Pediatric chronic pain is widespread, under-recognized and undertreated. Best management usually involves a multimodal approach coordinated by a multidisciplinary team. The present commentary specifically discusses common pharmacological approaches to chronic pain in children, identifies gaps in knowledge and suggests several research directions that would benefit future clinical care.

scholarly journals Assessing Digital Health Implementation for a Pediatric Chronic Pain Intervention: Comparing the RE-AIM and BIT Frameworks Against Real-World Trial Data and Recommendations for Future Studies (Preprint)

2020 ◽  
Author(s):  
Rocio de la Vega ◽  
Lee Ritterband ◽  
Tonya M Palermo
Keyword(s):  
Chronic Pain ◽  
Real World ◽  
Digital Health ◽  
Controlled Trial ◽  
User Engagement ◽  
Maintenance Period ◽  
Treatment Implementation ◽  
Positive Attitudes ◽  
Pediatric Chronic Pain ◽  
Implementation Costs

BACKGROUND Digital health interventions have demonstrated efficacy for several conditions including for pediatric chronic pain. However, the process of making interventions available to end users in an efficient and sustained way is challenging and remains a new area of research. To advance this field, comprehensive frameworks have been created. OBJECTIVE The aim of this study is to compare the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Behavior Interventions using Technology (BIT) frameworks with data collected from the web-based management of adolescent pain (WebMAP Mobile; WMM) randomized controlled trial (RCT). METHODS We conducted a hybrid effectiveness-implementation cluster RCT with a stepped wedge design in which the intervention was sequentially implemented in 8 clinics, following a usual care period. Participants were 143 youths (mean age 14.5 years, SD 1.9; 117/143, 81.8% female) with chronic pain, from which 73 were randomized to receive the active intervention. Implementation outcomes were assessed using the RE-AIM and BIT frameworks. RESULTS According to the RE-AIM framework, the WMM showed excellent reach, recruiting a sample 19% larger than the size originally planned and consenting 79.0% (143/181) of eligible referred adolescents. Effectiveness was limited, with only global impression of change showing significantly greater improvements in the treatment group; however, greater treatment engagement was associated with greater reductions in pain and disability. Adoption was excellent (all the invited clinics participated and referred patients). Implementation was acceptable, showing good user engagement and moderate adherence and positive attitudes of providers. Costs were similar to planned, with a 7% increase in funds needed to make the WMM publicly available. Maintenance was evidenced by 56 new patients downloading the app during the maintenance period and by all clinics agreeing to continue making referrals and all, but one, making new referrals. According to the BIT, 82% (60/73) of adolescents considered the treatment acceptable. In terms of adoption, 93% (68/73) downloaded the app, and all of them used it after their first log-in. In terms of appropriateness at the user level, 2 participants were unable to download the app. Perceptions of the appearance, navigation, and theme were positive. Providers perceived the WMM as a good fit for their clinic, beneficial, helpful, and resource efficient. In terms of feasibility, no technical issues were reported. In terms of fidelity, 40% (29/73) completed the treatment. Implementation costs were 7% above the budget. With regard to penetration, 56 new users accessed the app during the maintenance period. In terms of sustainability, 88% (7/8) of clinics continued recommending the WMM after the end of the study. CONCLUSIONS For the first time, a real-world digital health intervention was used as a proof of concept to test all the domains in the RE-AIM and BIT frameworks, allowing for comparisons. INTERNATIONAL REGISTERED REPORT RR2-10.1016/j.cct.2018.10.003

scholarly journals Assessing Digital Health Implementation for a Pediatric Chronic Pain Intervention: Comparing the RE-AIM and BIT Frameworks Against Real-World Trial Data and Recommendations for Future Studies

10.2196/19898 ◽  
2020 ◽  
Vol 22 (9) ◽  
pp. e19898 ◽  
Author(s):  
Rocio de la Vega ◽  
Lee Ritterband ◽  
Tonya M Palermo
Keyword(s):  
Chronic Pain ◽  
Real World ◽  
Digital Health ◽  
Controlled Trial ◽  
User Engagement ◽  
Maintenance Period ◽  
Treatment Implementation ◽  
Positive Attitudes ◽  
Pediatric Chronic Pain ◽  
Implementation Costs

Background Digital health interventions have demonstrated efficacy for several conditions including for pediatric chronic pain. However, the process of making interventions available to end users in an efficient and sustained way is challenging and remains a new area of research. To advance this field, comprehensive frameworks have been created. Objective The aim of this study is to compare the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) and Behavior Interventions using Technology (BIT) frameworks with data collected from the web-based management of adolescent pain (WebMAP Mobile; WMM) randomized controlled trial (RCT). Methods We conducted a hybrid effectiveness-implementation cluster RCT with a stepped wedge design in which the intervention was sequentially implemented in 8 clinics, following a usual care period. Participants were 143 youths (mean age 14.5 years, SD 1.9; 117/143, 81.8% female) with chronic pain, from which 73 were randomized to receive the active intervention. Implementation outcomes were assessed using the RE-AIM and BIT frameworks. Results According to the RE-AIM framework, the WMM showed excellent reach, recruiting a sample 19% larger than the size originally planned and consenting 79.0% (143/181) of eligible referred adolescents. Effectiveness was limited, with only global impression of change showing significantly greater improvements in the treatment group; however, greater treatment engagement was associated with greater reductions in pain and disability. Adoption was excellent (all the invited clinics participated and referred patients). Implementation was acceptable, showing good user engagement and moderate adherence and positive attitudes of providers. Costs were similar to planned, with a 7% increase in funds needed to make the WMM publicly available. Maintenance was evidenced by 56 new patients downloading the app during the maintenance period and by all clinics agreeing to continue making referrals and all, but one, making new referrals. According to the BIT, 82% (60/73) of adolescents considered the treatment acceptable. In terms of adoption, 93% (68/73) downloaded the app, and all of them used it after their first log-in. In terms of appropriateness at the user level, 2 participants were unable to download the app. Perceptions of the appearance, navigation, and theme were positive. Providers perceived the WMM as a good fit for their clinic, beneficial, helpful, and resource efficient. In terms of feasibility, no technical issues were reported. In terms of fidelity, 40% (29/73) completed the treatment. Implementation costs were 7% above the budget. With regard to penetration, 56 new users accessed the app during the maintenance period. In terms of sustainability, 88% (7/8) of clinics continued recommending the WMM after the end of the study. Conclusions For the first time, a real-world digital health intervention was used as a proof of concept to test all the domains in the RE-AIM and BIT frameworks, allowing for comparisons. International Registered Report Identifier (IRRID) RR2-10.1016/j.cct.2018.10.003

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.

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 Placebos Are Part of the Solution, Not the Problem. An Exemplification of the Case of Antidepressants in Pediatric Chronic Pain Conditions

2020 ◽  
Vol 10 ◽  
Author(s):  
Cosima Locher ◽  
Jens Gaab ◽  
Charlotte Blease ◽  
Marc Inderbinen ◽  
Linda Kost ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Pediatric Chronic Pain ◽  
Chronic Pain Conditions
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