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Children
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Innovative Approaches to Treating and Preventing Pediatric Chronic Pain
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Innovative Approaches to Treating and Preventing Pediatric Chronic Pain

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Anesthesiology, Perioperative and Pain Medicine".

Deadline for manuscript submissions: closed (5 July 2023) | Viewed by 11825

Special Issue Editors

Dr. Mark A. Connelly

E-Mail Website
Guest Editor
Division of Developmental & Behavioral Health, University of Missouri-Kansas City School of Medicine and Children's Mercy Kansas City, Kansas City, MO 64108, USA
Interests: pediatric psychology; pain; migraine and headache; digital health; health psychology/behavioral medicine; nonpharmacological therapies; adjustment to chronic illness
Dr. William Robert Black

E-Mail Website
Guest Editor
Department of Pediatrics, The University of Kansas Medical Center, Kansas City, KS 66160, USA
Interests: pediatric psychology; pain; physical activity and exercise interventions

Special Issue Information

Dear Colleagues,

Chronic pain continues to be one of the most prevalent, disruptive, and costly problems experienced by children and adolescents worldwide. Although studies have shown that the symptoms and impact of chronic pain, on average, can improve with some treatment approaches (psychological, rehabilitative, integrative, and/or medical/pharmacological), treatment adherence and outcomes are highly variable, and known treatment effect sizes have remained small to moderate over time. Many young people struggling with chronic pain also never access formal treatment in current care models, and those that do often have complexities that do not easily fit into studied treatment protocols. To maximize effectiveness and accessibility, contemporary treatment of pediatric chronic pain requires creativity and innovation.

The aim of this Special Issue of Children is to communicate cutting-edge, novel, and transformative approaches to improving the efficacy and/or reach of pediatric chronic pain treatment.  We invite original research across the spectrum of pediatric chronic pain conditions, on all types of interventions, and from any stage of intervention development and testing (early stage and formative research methods through efficacy and implementation studies), assuming appropriate methodological rigor. Although prioritizing original research, conceptual papers and reviews will be considered if they inform novel pediatric chronic pain treatment elements that are likely to have an impact on improving impact or reach. 

Examples of invited work include, but are not limited to, studies that involve:

  • Modifying established chronic pain treatments in novel ways to reach new or underserved pediatric populations or to improve treatment adherence or effects;
  • Developing new treatment models and methods based on contemporary advances in understanding pediatric chronic pain mechanisms;
  • Evaluating treatments intended to prevent pain chronification and secondary chronic pain conditions in children and adolescents;
  • Innovative care models for improving pediatric chronic pain treatment access, adherence, and outcomes;
  • Precision/personalized and adaptive treatment approaches;
  • Digital therapeutics for chronic pain management.

Dr. Mark A. Connelly
Dr. William Robert Black
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pediatric chronic pain
  • children and adolescents
  • treatment
  • innovation

Published Papers (8 papers)

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Research

17 pages, 512 KiB  
Article
Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team
by Gloria T. Han, Holly S. Heavner, Thomas R. Rains, Alan H. Hoang and Amanda L. Stone
Children 2024, 11(3), 312; https://doi.org/10.3390/children11030312 - 06 Mar 2024
Viewed by 1166
Abstract
Though there is growing awareness of the overrepresentation of autistic patients in chronic pain clinics, potential adaptations for the assessment and treatment of chronic pain in this population have not yet been established. To address this gap, a retrospective review of electronic medical [...] Read more.
Though there is growing awareness of the overrepresentation of autistic patients in chronic pain clinics, potential adaptations for the assessment and treatment of chronic pain in this population have not yet been established. To address this gap, a retrospective review of electronic medical records and discussions by an interdisciplinary pain treatment team were summarized to inform potential biopsychosocial factors affecting the presentation, assessment, and treatment of chronic pain in autistic youth. Our sample included a record review of 95 patients receiving treatment in an interdisciplinary outpatient pediatric pain clinic. Results indicated that 9% (n = 9) of the patients presented to the clinic with a prior diagnosis of autism, but an additional 21% (n = 20) were identified as likely meeting criteria for autism based on the clinical assessment of the developmental history, behaviors observed during the clinical encounter(s), and expert clinical judgment, suggesting that the prevalence rate of autism may be closer to 30% in our outpatient pediatric pain clinic. Over half (52%) of the autistic youth presented to the clinic with widespread pain, 60% identified as female, and 6% identified as gender expansive or transgender. Qualitative insights revealed that most of the autistic patients had co-occurring sensory-processing challenges and difficulty in describing their pain, emotions, and somatic experiences and exhibited cognitive inflexibility and social challenges. We summarize our team’s clinical reflections on how autism-relevant biopsychosocial vulnerability factors may contribute to the experience of pain in autistic youth and propose treatment targets and adaptations for the assessment and treatment of pain in this population. Finally, we recommend the need for interventions focused on sensorimotor integration, especially for autistic youth, and describe how pain clinics may be particularly helpful for identifying and supporting autistic females, for whom the potential role of autism in pain experiences had not been considered until receiving treatment in our clinic. Full article
(This article belongs to the Special Issue Innovative Approaches to Treating and Preventing Pediatric Chronic Pain)
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14 pages, 246 KiB  
Article
Centering Patient and Clinician Voices in Developing Tools to Address Pain Related School Impairment: A Phase I Study of a Virtual Reality School Simulation for Children and Adolescents with Chronic Pain
by Deirdre E. Logan, Karina Khanna, Edin Randall, Shealyn O’Donnell, Talis Reks and Logan McLennan
Children 2023, 10(10), 1644; https://doi.org/10.3390/children10101644 - 01 Oct 2023
Viewed by 1038
Abstract
Building on growing evidence supporting virtual reality (VR) interventions for pain management, this study describes the process of developing vReal-School (vRS), a VR-based school simulation for children and adolescents with chronic pain and associated school impairment. Following guidelines for developing user-centered VR interventions, [...] Read more.
Building on growing evidence supporting virtual reality (VR) interventions for pain management, this study describes the process of developing vReal-School (vRS), a VR-based school simulation for children and adolescents with chronic pain and associated school impairment. Following guidelines for developing user-centered VR interventions, initial phases of intervention development focus on understanding and incorporating patient and clinician perspectives when designing this digital health tool. Phase I entailed focus groups with patients undergoing intensive interdisciplinary pain treatment (IIPT). A total of 19 participants across four focus groups shared their experiences related to dealing with pain at school and provided initial feedback on the concept of a VR-based school simulation. In phase II, we pilot-tested a vRS prototype and collected patient and clinician feedback via mixed method approaches. Phase I results highlight four themes related to pain in school, including physical/environmental challenges and solutions, academic challenges and solutions, peer interaction challenges and solutions, and teacher interaction challenges and solutions. These themes guided the development of our vRS prototype. Nine patients and eleven treating clinicians then engaged with the vRS prototype and provided feedback via semi-structured interviews and validated self-report measures. The results indicate high levels of patient engagement/immersion (mean total score of 17.0 on the Child Presence Measure). Qualitative feedback from both groups identified positive aspects of vRS, including finding the simulation realistic and easy to use and offering ways to address school functioning goals that are not otherwise feasible in the IIPT setting. Areas for improvement included integrating more physical movement as well as increasing the number of scenarios and the level of demands of the tasks available. Both patients and clinicians found vRS to be useful in the IIPT context and relevant to treatment goals. This user input will guide subsequent iterations of intervention development. Full article
(This article belongs to the Special Issue Innovative Approaches to Treating and Preventing Pediatric Chronic Pain)
14 pages, 668 KiB  
Article
Rapid Mobilization of an Evidence-Based Psychological Intervention for Pediatric Pain during COVID-19: The Development and Deployment of the Comfort Ability® Program Virtual Intervention (CAP-V)
by Amy E. Hale, Simona Bujoreanu, Timothy W. LaVigne and Rachael Coakley
Children 2023, 10(9), 1523; https://doi.org/10.3390/children10091523 - 08 Sep 2023
Cited by 1 | Viewed by 913
Abstract
Background: The gold standard of treatment for chronic pain is a multidisciplinary approach in which psychology plays a leading role, but many children and caregivers do not gain access to this treatment. The Comfort Ability® Program (CAP) developed a CBT-oriented group intervention [...] Read more.
Background: The gold standard of treatment for chronic pain is a multidisciplinary approach in which psychology plays a leading role, but many children and caregivers do not gain access to this treatment. The Comfort Ability® Program (CAP) developed a CBT-oriented group intervention for adolescents and caregivers designed expressly to address access to evidence-based psychological care for pediatric chronic pain. Before the COVID-19 disruption of in-person services, the CAP workshop had been disseminated to a network of 21 children’s hospitals across three countries. In March 2020, a virtual (telehealth) format was needed to ensure that children with chronic pain could continue to access this clinical service throughout the CAP Network. Methods: A model of knowledge mobilization was used to adapt the CAP workshop to a virtual format (CAP-V) and disseminate it to network sites. A pilot study assessing participant and clinician perceptions of acceptability, feasibility, and treatment satisfaction included baseline, post-sessions, and post-program questionnaires. Results: A knowledge mobilization framework informed the rapid development, refinement, and mobilization of CAP-V. Data from a pilot study demonstrated feasibility and high acceptability across participants and clinicians. Conclusions: A knowledge mobilizationframework provided a roadmap to successfully develop and deploy a virtual behavioral health intervention for adolescents with chronic pain and their caregivers during a worldwide pandemic. While CAP-V has demonstrated preliminary clinical feasibility and acceptability at the CAP hub, ongoing research is needed. Full article
(This article belongs to the Special Issue Innovative Approaches to Treating and Preventing Pediatric Chronic Pain)
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17 pages, 311 KiB  
Article
Baseline Factors Associated with Pain Intensity, Pain Catastrophizing, and Pain Interference in Intensive Interdisciplinary Pain Treatment for Youth
by Rob D. Long, Andrew Walker, Si Chen Pan, Jillian Vinall Miller, Laura Rayner, Joanne Vallely and Nivez Rasic
Children 2023, 10(7), 1229; https://doi.org/10.3390/children10071229 - 15 Jul 2023
Cited by 1 | Viewed by 1049
Abstract
Background: More could be known about baseline factors related to desirable Intensive Interdisciplinary Pain Treatment (IIPT) outcomes. This study examined how baseline characteristics (age, gender, child pain catastrophizing (PCS-C), pain interference, pain intensity, anxiety, depression, paediatric health-related quality of life (PedsQLTM), [...] Read more.
Background: More could be known about baseline factors related to desirable Intensive Interdisciplinary Pain Treatment (IIPT) outcomes. This study examined how baseline characteristics (age, gender, child pain catastrophizing (PCS-C), pain interference, pain intensity, anxiety, depression, paediatric health-related quality of life (PedsQLTM), and parent catastrophizing (PCS-P)) were associated with discharge and 3-month follow-up scores of PCS-C, pain intensity, and pain interference. Methods: PCS-C, pain intensity, and pain interference T-scores were acquired in 45 IIPT patients aged 12–18 at intake (baseline), discharge, and 3-month follow-up. Using available and imputed data, linear mixed models were developed to explore associations between PCS-C, pain intensity, and pain interference aggregated scores at discharge and follow-up with baseline demographics and a priori selected baseline measures of pain, depression, anxiety, and PCS-C/P. Results: PCS-C and pain interference scores decreased over time compared to baseline. Pain intensity did not change significantly. Baseline PCS-C, pain interference, anxiety, depression, and PedsQLTM were associated with discharge/follow-up PCS-C (available and imputed data) and pain interference scores (available data). Only baseline pain intensity was significantly associated with itself at discharge/follow-up. Conclusions: Participants who completed the IIPT program presented with reduced PCS-C and pain interference over time. Interventions that target pre-treatment anxiety and depression may optimize IIPT outcomes. Full article
(This article belongs to the Special Issue Innovative Approaches to Treating and Preventing Pediatric Chronic Pain)
15 pages, 1415 KiB  
Article
Diagnostics and Management of Pediatric Headache: An Exploratory Study among Dutch Physical Therapists
by Maria N. Bot, Hedwig A. van der Meer, Marloes Meurs de Vries, Ewald M. Bronkhorst, Stanimira I. Kalaykova and Nico H. J. Creugers
Children 2023, 10(7), 1135; https://doi.org/10.3390/children10071135 - 30 Jun 2023
Viewed by 1495
Abstract
Physiotherapists are often part of a multidisciplinary treatment plan for children with headaches. The literature on physical therapeutic diagnostics and management of headaches is often focused on adults. To gain insight, identify knowledge gaps, and increase the evidence needed for clinical physical therapeutic [...] Read more.
Physiotherapists are often part of a multidisciplinary treatment plan for children with headaches. The literature on physical therapeutic diagnostics and management of headaches is often focused on adults. To gain insight, identify knowledge gaps, and increase the evidence needed for clinical physical therapeutic practice with children with headaches, an exploratory method is warranted. The purpose of this study was to describe the views, beliefs, and experiences of physical therapists regarding diagnostics and treatment options for children with headaches. The method consisted of a survey and two peer consultation group meetings. A total of 195 individual surveys were returned and 31 out of 47 peer consultation groups participated. Most participants were specialized in pediatric physical therapy (93.3%). They use the 4P-factor model (predisposing, precipitating, perpetuating, and protective factors) as a guiding principle in the diagnostic and therapeutic process in children with headaches. This model helps to organize and to understand how a variety of factors interact in a biopsychosocial relationship. Pediatric physical therapists focus their treatments on factors interfering with movement and functional abilities of the child with headaches. Knowledge of how temporomandibular disfunction can relate to headaches is currently insufficient for pediatric physical therapists. Full article
(This article belongs to the Special Issue Innovative Approaches to Treating and Preventing Pediatric Chronic Pain)
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14 pages, 1735 KiB  
Article
Do Teachers Question the Reality of Pain in Their Students? A Survey Using the Concept of Pain Inventory-Proxy (COPI-Proxy)
by Rebecca Fechner, Melanie Noel, Arianne Verhagen, Erin Turbitt and Joshua W. Pate
Children 2023, 10(2), 370; https://doi.org/10.3390/children10020370 - 13 Feb 2023
Viewed by 1840
Abstract
An assessment of a teacher’s concept of their student’s pain could be useful to guide preventative and targeted school-based pain science education. We aimed to assess a teacher’s own concept of pain against their concept of their student’s pain and examine the psychometric [...] Read more.
An assessment of a teacher’s concept of their student’s pain could be useful to guide preventative and targeted school-based pain science education. We aimed to assess a teacher’s own concept of pain against their concept of their student’s pain and examine the psychometric properties of the tool. Teachers of 10–12-year-old children were invited to participate in an online survey via social media. We modified the Concept of Pain Inventory (COPI) by inserting a vignette (COPI-Proxy), and we included questions to explore teacher stigma. Overall, a sample of 233 teachers participated in the survey. The COPI-Proxy scores showed that teachers can conceptualize their student’s pain separately but are influenced by their own beliefs. Only 76% affirmed the pain in the vignette as real. Teachers used potentially stigmatizing language to describe pain in their survey responses. The COPI-Proxy had acceptable internal consistency (Cronbach’s alpha = 0.72) and moderate convergent validity with the COPI (r = 0.56). The results show the potential benefit of the COPI-Proxy for assessing someone’s concept of another’s pain, particularly for teachers who are important social influencers of children. Full article
(This article belongs to the Special Issue Innovative Approaches to Treating and Preventing Pediatric Chronic Pain)
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15 pages, 570 KiB  
Article
Acceptability and Tolerability of Extended Reality Relaxation Training with and without Wearable Neurofeedback in Pediatric Migraine
by Mark Connelly, Madeline Boorigie and Klanci McCabe
Children 2023, 10(2), 329; https://doi.org/10.3390/children10020329 - 09 Feb 2023
Cited by 2 | Viewed by 1485
Abstract
Objective. To determine the acceptability of using extended reality (XR) relaxation training as a preventive treatment for pediatric migraine. Methods. Youths aged 10–17 years old with migraine were recruited from a specialty headache clinic and completed baseline measures evaluating their vestibular symptoms and [...] Read more.
Objective. To determine the acceptability of using extended reality (XR) relaxation training as a preventive treatment for pediatric migraine. Methods. Youths aged 10–17 years old with migraine were recruited from a specialty headache clinic and completed baseline measures evaluating their vestibular symptoms and attitudes about technology. The patients were then instructed in three XR-based relaxation training conditions (fully immersive virtual reality with and without neurofeedback, and augmented reality with neurofeedback), in counterbalanced order, and completed acceptability and side effect questionnaires after each. The patients also took XR equipment home for one week to use for relaxation practice and again completed the measures about their experience. The acceptability and side effect data were compared against predetermined acceptable thresholds and were evaluated for their association with the participant characteristics. Results. The aggregate acceptability questionnaire scores exceeded our minimum threshold of 3.5/5, with the two fully immersive virtual reality conditions preferred over augmented reality for relaxation training (z = −3.02, p = 0.003, and z = −2.31, p = 0.02). The endorsed side effects were rated by all but one participant as mild, with vertigo being the most common. The acceptability ratings were not reliably associated with age, sex, typical hours per day of technology use, or technology attitudes, but were inversely related to the side effect scores. Conclusions. The preliminary data on acceptability and tolerability of immersive XR technology for relaxation training among youths with migraine supports further intervention development work. Full article
(This article belongs to the Special Issue Innovative Approaches to Treating and Preventing Pediatric Chronic Pain)
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11 pages, 253 KiB  
Article
The Feasibility and Acceptability of Resilience Coaching for Adolescent Chronic Musculoskeletal Pain: A Single-Arm Pilot Trial
by Sabrina Gmuca, Pamela F. Weiss, Mackenzie McGill, Rui Xiao, Michaela Ward, Maria Nelson, David D. Sherry, Peter F. Cronholm, Jeffrey S. Gerber, Tonya M. Palermo, Jami F. Young and Abby R. Rosenberg
Children 2022, 9(10), 1432; https://doi.org/10.3390/children9101432 - 21 Sep 2022
Cited by 3 | Viewed by 1743
Abstract
Promoting Resilience in Stress Management (PRISM) is a well-established resilience coaching program for youth with chronic illness. It is a one-on-one intervention targeting skills in stress management, goal-setting, cognitive reframing, and meaning-making. We aimed to (i) assess the feasibility and acceptability of PRISM [...] Read more.
Promoting Resilience in Stress Management (PRISM) is a well-established resilience coaching program for youth with chronic illness. It is a one-on-one intervention targeting skills in stress management, goal-setting, cognitive reframing, and meaning-making. We aimed to (i) assess the feasibility and acceptability of PRISM and (ii) explore PRISM’s impact on clinical outcomes among youth with chronic musculoskeletal pain (CMP). This was a single-arm pilot trial of PRISM for youth with CMP aged 12–17 years. Patients completed patient-reported outcome measures (PROs) pre- and post- intervention; patients and caregivers provided qualitative feedback. Twenty-seven patients were enrolled (63% enrollment rate); 82% percent were female. The patients’ median age was 16 years (IQR: 13–16). The intervention completion rate was 81% (n = 22). The mean satisfaction for PRISM overall was 4.3 (SD 0.9), while the mean acceptability of the intervention measure (AIM) was 4.4 (SD 0.89). Participants reported improved resilience (2.2 [SD 5.1]), functional disability (−3.5 [IQR: −6.0, 1.0]), and psychological distress (−1.0 [−5.0, 2.0]) from baseline to immediately post-treatment; pain intensity, pain catastrophizing, and global health were similar at both time points. Feedback was positive and suggested that a group component may be helpful. PRISM is feasible and acceptable among youth with CMP. Exploratory analyses suggest improvements in clinically relevant outcomes, warranting further investigation. Full article
(This article belongs to the Special Issue Innovative Approaches to Treating and Preventing Pediatric Chronic Pain)
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