scholarly journals Best-Evidence for the Rehabilitation of Chronic Pain Part 1: Pediatric Pain

2019 ◽  
Vol 8 (9) ◽  
pp. 1267 ◽  
Author(s):  
Lauren E. Harrison ◽  
Joshua W. Pate ◽  
Patricia A. Richardson ◽  
Kelly Ickmans ◽  
Rikard K. Wicksell ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Middle Childhood ◽  
Functional Disability ◽  
Multidisciplinary Treatment ◽  
Current Data ◽  
Future Research ◽  
Childhood And Adolescence ◽  
Pediatric Pain ◽  
Persistent Problem ◽  
Biopsychosocial Model Of Pain

Chronic pain is a prevalent and persistent problem in middle childhood and adolescence. The biopsychosocial model of pain, which accounts for the complex interplay of the biological, psychological, social, and environmental factors that contribute to and maintain pain symptoms and related disability has guided our understanding and treatment of pediatric pain. Consequently, many interventions for chronic pain are within the realm of rehabilitation, based on the premise that behavior has a broad and central role in pain management. These treatments are typically delivered by one or more providers in medicine, nursing, psychology, physical therapy, and/or occupational therapy. Current data suggest that multidisciplinary treatment is important, with intensive interdisciplinary pain rehabilitation (IIPT) being effective at reducing disability for patients with high levels of functional disability. The following review describes the current state of the art of rehabilitation approaches to treat persistent pain in children and adolescents. Several emerging areas of interventions are also highlighted to guide future research and clinical practice.

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.

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.

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 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.

Challenges and Opportunities for Neuroimaging in Young Patients with Traumatic Brain Injury: a Coordinated Effort towards Advancing Discovery from the ENIGMA Pediatric Moderate/Severe TBI Group

2019 ◽  
Author(s):  
Emily L. Dennis ◽  
Karen Caeyenberghs ◽  
Robert F. Asarnow ◽  
Talin Babikian ◽  
Brenda Bartnik-Olson ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Young Patients ◽  
Future Research ◽  
Childhood And Adolescence ◽  
Developmental Issues ◽  
Challenges And Opportunities ◽  
Severe Tbi ◽  
Advance Research

Traumatic brain injury (TBI) is a major cause of death and disability in children in both developed and developing nations. Children and adolescents suffer from TBI at a higher rate than the general population; however, research in this population lags behind research in adults. This may be due, in part, to the smaller number of investigators engaged in research with this population and may also be related to changes in safety laws and clinical practice that have altered length of hospital stays, treatment, and access to this population. Specific developmental issues also warrant attention in studies of children, and the ever-changing context of childhood and adolescence may require larger sample sizes than are commonly available to adequately address remaining questions related to TBI. The ENIGMA (Enhancing NeuroImaging Genetics through Meta-Analysis) Pediatric Moderate-Severe TBI (msTBI) group aims to advance research in this area through global collaborative meta-analysis. In this paper we discuss important challenges in pediatric TBI research and opportunities that we believe the ENIGMA Pediatric msTBI group can provide to address them. We conclude with recommendations for future research in this field of study.

An Updated Review on COVID-19

2020 ◽  
Vol 20 ◽  
Author(s):  
Mahmoud Ahmed Ebada ◽  
Ahmed Wadaa Allah ◽  
Eshak Bahbah ◽  
Ahmed Negida
Keyword(s):  
Screening Tool ◽  
Distress Syndrome ◽  
Reproduction Number ◽  
Case Fatality ◽  
Current Data ◽  
Future Research ◽  
Rt Pcr ◽  
Viral Structure ◽  
Discharge Criteria ◽  
Serology Testing

: Coronavirus Disease (COVID-19) pandemic has affected more than seven million individuals in 213 countries worldwide with a basic reproduction number ranging from 1.5 to 3.5 and an estimated case fatality rate ranging from 2% to 7%. A substantial proportion of COVID-19 patients are asymptomatic; however, symptomatic cases might present with fever, cough, and dyspnoea or severe symptoms up to acute respiratory distress syndrome. Currently, RNA RT-PCR is the screening tool, while bilateral chest CT is the confirmatory clinical diagnostic test. Several drugs have been repurposed to treat COVID-19, including chloroquine or hydroxychloroquine with or without azithromycin, lopinavir/ritonavir combination, remdesivir, favipiravir, tocilizumab, and EIDD-1931. Recently, Remdesivir gained FDA emergency approval based on promising early findings from the interim analysis of 1063 patients. The recently developed serology testing for SARSCoV-2 antibodies opened the door to evaluate the actual burden of the disease and to determine the rate of the population who have been previously infected (or developed immunity). This review article summarizes current data on the COVID-19 pandemic starting from the early outbreak, viral structure and origin, pathogenesis, diagnosis, treatment, discharge criteria, and future research.

Harm Avoidance and Mobility During Middle Childhood and Adolescence among Hadza Foragers

Human Nature ◽  
2021 ◽  
Author(s):  
Alyssa N. Crittenden ◽  
Alan Farahani ◽  
Kristen N. Herlosky ◽  
Trevor R. Pollom ◽  
Ibrahim A. Mabulla ◽  
...  
Keyword(s):  
Middle Childhood ◽  
Harm Avoidance ◽  
Childhood And Adolescence

scholarly journals Evaluating the Relationship Between Initial Injury, Referral to A Pain Clinic, and Medical Retirement from the Army: A Retrospective Analysis

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 502-505
Author(s):  
Justin J Stewart ◽  
Diane Flynn ◽  
Alana D Steffen ◽  
Dale Langford ◽  
Honor McQuinn ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Retrospective Analysis ◽  
Extended Period ◽  
Pain Clinic ◽  
Outcome Variable ◽  
Future Research ◽  
Curvilinear Relationship ◽  
The Impact ◽  
Pain Care ◽  
The Relationship

ABSTRACT Introduction Soldiers are expected to deploy worldwide and must be medically ready in order to accomplish their mission. Soldiers unable to deploy for an extended period of time because of chronic pain or other conditions undergo an evaluation for medical retirement. A retrospective analysis of existing longitudinal data from an Interdisciplinary Pain Management Center (IPMC) was used to evaluate the temporal relationship between the time of initial duty restriction and referral for comprehensive pain care to being evaluated for medical retirement. Methods Patients were adults (&gt;18 years old) and were cared for in an IPMC at least once between May 1, 2014 and February 28, 2018. A total of 1,764 patients were included in the final analysis. Logistic regression was used to evaluate the impact of duration between date of first duty restriction documentation and IPMC referral to the outcome variable of establishment of a permanent 3 (P3) profile. Results The duration between date of first duty restriction and IPMC referral showed a curvilinear relationship to probability of a P3 profile. According to our model, a longer duration before referral is associated with an increased probability of a subsequent P3 profile with the highest probability peaking at 19 months. The probability of P3 declines gradually for those who were referred later. Discussion This is the first time the relationship between time of initial duty restriction, referral to an IPMC, and subsequent P3 or higher profile has been tested. Future research is needed to examine medical conditions listed on the profile to see how they might contribute to the cause of referral to the IPMC. Conclusion A longer duration between initial duty restriction and referral to IPMC was associated with higher odds of subsequent P3 status for up to 19 months. Referral to an IPMC for comprehensive pain care early in the course of chronic pain conditions may reduce the likelihood of P3 profile and eventual medical retirement of soldiers.

scholarly journals Health Inequalities in Children and Adolescents: A Scoping Review of the Mediating and Moderating Effects of Family Characteristics

2021 ◽  
Vol 18 (15) ◽  
pp. 7739
Author(s):  
Miriam Blume ◽  
Petra Rattay ◽  
Stephanie Hoffmann ◽  
Jacob Spallek ◽  
Lydia Sander ◽  
...  
Keyword(s):  
Mental Health ◽  
Children And Adolescents ◽  
Health Inequalities ◽  
Scoping Review ◽  
The United States ◽  
Family Characteristics ◽  
Future Research ◽  
Childhood And Adolescence ◽  
Moderating Effects ◽  
Scoping Reviews

This scoping review systematically mapped evidence of the mediating and moderating effects of family characteristics on health inequalities in school-aged children and adolescents (6–18 years) in countries with developed economies in Europe and North America. We conducted a systematic scoping review following the PRISMA extension for Scoping Reviews recommendations. We searched the PubMed, PsycINFO and Scopus databases. Two reviewers independently screened titles, abstracts and full texts. Evidence was synthesized narratively. Of the 12,403 records initially identified, 50 articles were included in the synthesis. The included studies were conducted in the United States (n = 27), Europe (n = 18), Canada (n = 3), or in multiple countries combined (n = 2). We found that mental health was the most frequently assessed health outcome. The included studies reported that different family characteristics mediated or moderated health inequalities. Parental mental health, parenting practices, and parent-child-relationships were most frequently examined, and were found to be important mediating or moderating factors. In addition, family conflict and distress were relevant family characteristics. Future research should integrate additional health outcomes besides mental health, and attempt to integrate the complexity of families. The family characteristics identified in this review represent potential starting points for reducing health inequalities in childhood and adolescence.

scholarly journals Correction to: Harm Avoidance and Mobility During Middle Childhood and Adolescence among Hadza Foragers

Human Nature ◽  
2021 ◽  
Author(s):  
Alyssa N. Crittenden ◽  
Alan Farahani ◽  
Kristen N. Herlosky ◽  
Trevor R. Pollom ◽  
Ibrahim A. Mabulla ◽  
...  
Keyword(s):  
Middle Childhood ◽  
Harm Avoidance ◽  
Childhood And Adolescence
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