Editorial

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Open AccessEditorial

Advancing the Field of Pain Medicine—Special Issue on Pediatric Pain Management

by Keri R. Hainsworth and Kristen E. Jastrowski Mano

Children 2021, 8(3), 197; https://doi.org/10.3390/children8030197 - 06 Mar 2021

Viewed by 1363

Abstract

Pediatric pain management has made great strides over the past 50 years [...] Full article

(This article belongs to the Special Issue Pediatric Pain Management)

Research

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22 pages, 3289 KiB

Open AccessArticle

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

by Kendra N. Krietsch, Dean W. Beebe, Christopher King, Kendra J. Homan and Sara E. Williams

Children 2021, 8(1), 42; https://doi.org/10.3390/children8010042 - 12 Jan 2021

Cited by 4 | Viewed by 1776

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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11 pages, 368 KiB

Open AccessArticle

The Relationship between Stressors and Pain-Related Clinical Outcomes in Pediatric Chronic Pain Patients

by Anjana Jagpal, Keri Hainsworth, Ratka Galijot, Katherine S. Salamon, Kim Anderson Khan and Susan T. Tran

Children 2021, 8(1), 21; https://doi.org/10.3390/children8010021 - 04 Jan 2021

Cited by 4 | Viewed by 2054

Abstract

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 [...] Read more.

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 (M_age = 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. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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15 pages, 811 KiB

Open AccessArticle

Functional Disability in Adolescents with Chronic Pain: Comparing an Interdisciplinary Exposure Program to Usual Care

by Carolien Dekker, Mariëlle Goossens, Bjorn Winkens, Silvia Remerie, Caroline Bastiaenen and Jeanine Verbunt

Children 2020, 7(12), 288; https://doi.org/10.3390/children7120288 - 11 Dec 2020

Cited by 8 | Viewed by 2343

Abstract

(1) Background: Chronic musculoskeletal pain (CMP) in adolescents can negatively affect physical, psychological, and social functioning, resulting in functional disability. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of an outpatient rehabilitation program based on graded exposure in vivo (EP) compared [...] Read more.

(1) Background: Chronic musculoskeletal pain (CMP) in adolescents can negatively affect physical, psychological, and social functioning, resulting in functional disability. This randomized controlled trial (RCT) aimed to evaluate the effectiveness of an outpatient rehabilitation program based on graded exposure in vivo (EP) compared with care as usual (CAU: interdisciplinary outpatient rehabilitation care). Both EP and CAU aim to improve functional ability in adolescents with CMP. (2) Methods: Pragmatic multicenter RCT with 12-month follow-up. Adolescents (12–21 years) with CMP were invited to participate. Primary outcome: functional disability; secondary outcomes: perceived harmfulness; pain catastrophizing; pain intensity. Data analysis: intention-to-treat linear mixed model. (3) Results: Sixty adolescents (mean 16 years) were randomized; data for 53 were analyzed. Adolescents in EP showed relevant and significant decreases in functional disability (estimated mean difference at least −8.81, p ≤ 0.01) compared with CAU at all times. Significant differences in favor of EP were found for perceived harmfulness at all times (p ≤ 0.002), for pain catastrophizing at 2 months (p = 0.039) and for pain intensity at 4 and 10 months (p ≤ 0.028). (4) Conclusion: EP leads to a significant and clinically relevant decrease in functional disability compared with usual care. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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16 pages, 542 KiB

Open AccessArticle

Somatosensory Testing in Pediatric Patients with Chronic Pain: An Exploration of Clinical Utility

by Anna Kersch, Panchalee Perera, Melanie Mercado, Andrew Gorrie, David Sainsbury, Tara McGrath, Phillip Aouad, Sara Sarraf, Tiina Jaaniste and David Champion

Children 2020, 7(12), 275; https://doi.org/10.3390/children7120275 - 05 Dec 2020

Cited by 7 | Viewed by 2728

Abstract

We aimed to evaluate the utility of clinical somatosensory testing (SST), an office adaptation of laboratory quantitative sensory testing, in a biopsychosocial assessment of a pediatric chronic somatic pain sample (N = 98, 65 females, 7–18 years). Stimulus–response tests were applied at pain [...] Read more.

We aimed to evaluate the utility of clinical somatosensory testing (SST), an office adaptation of laboratory quantitative sensory testing, in a biopsychosocial assessment of a pediatric chronic somatic pain sample (N = 98, 65 females, 7–18 years). Stimulus–response tests were applied at pain regions and intra-subject control sites to cutaneous stimuli (simple and dynamic touch, punctate pressure and cool) and deep pressure stimuli (using a handheld pressure algometer, and, in a subset, manually inflated cuff). Validated psychological, pain-related and functional measures were administered. Cutaneous allodynia, usually regional, was elicited by at least one stimulus in 81% of cases, most frequently by punctate pressure. Central sensitization, using a composite measure of deep pressure pain threshold and temporal summation of pain, was implied in the majority (59.2%) and associated with worse sleep impairment and psychological functioning. In regression analyses, depressive symptoms were the only significant predictor of pain intensity. Functional interference was statistically predicted by deep pressure pain threshold and depressive symptoms. Manually inflated cuff algometry had comparable sensitivity to handheld pressure algometry for deep pressure pain threshold but not temporal summation of pain. SST complemented standard biopsychosocial assessment of pediatric chronic pain; use of SST may facilitate the understanding of disordered neurobiology. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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12 pages, 418 KiB

Open AccessArticle

Executive Functioning in Adolescents with Chronic Musculoskeletal Pain

by Kristen E. Jastrowski Mano, Emily A. Beckmann, Lauren M. Fussner and Susmita Kashikar-Zuck

Children 2020, 7(12), 273; https://doi.org/10.3390/children7120273 - 04 Dec 2020

Cited by 5 | Viewed by 2445

Abstract

Adolescents with chronic pain often suffer significant impairment in physical, emotional, and social domains. Surprisingly little is known about executive functioning (EF) in youth with chronic pain or how EF deficits may contribute to functional impairment. Study participants included 60 adolescents between the [...] Read more.

Adolescents with chronic pain often suffer significant impairment in physical, emotional, and social domains. Surprisingly little is known about executive functioning (EF) in youth with chronic pain or how EF deficits may contribute to functional impairment. Study participants included 60 adolescents between the ages of 12 and 17 years (M = 14.57). Thirty participants with chronic musculoskeletal pain and 30 age- and gender-matched healthy controls were recruited from a large Midwestern children’s hospital in the United States. Participants completed the Behavior Rating Inventory of Executive Functioning (BRIEF-2) as well as multiple measures of functional impairment across key domains: school, social, emotional (anxiety, depression), and physical. Adolescents with chronic musculoskeletal pain reported significantly greater EF impairment compared to healthy age- and gender-matched peers. Clinically elevated risk levels of impairment were reported across all aspects of EF, with many adolescents in the chronic pain group scoring above the clinical risk cut off for working memory (52%), inhibition (45%), and cognitive flexibility (38%). EF was also significantly related to functional impairment across all domains. Findings suggest that EF may have an impact across several critical domains of functioning for youth with chronic pain. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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14 pages, 248 KiB

Open AccessArticle

Risk and Resilience Factors Impacting Treatment Compliance and Functional Impairment among Adolescents Participating in an Outpatient Interdisciplinary Pediatric Chronic Pain Management Program

by Richa Aggarwal Dutta and Katherine S. Salamon

Children 2020, 7(11), 247; https://doi.org/10.3390/children7110247 - 22 Nov 2020

Cited by 4 | Viewed by 1854

Abstract

Recurrent pain is a common experience in childhood and adolescence and can result in significant disability in youth, including poor quality of life, school absences, and reduced social activities. Evidence has linked adolescent risk and resilience factors with treatment outcomes. However, less research [...] Read more.

Recurrent pain is a common experience in childhood and adolescence and can result in significant disability in youth, including poor quality of life, school absences, and reduced social activities. Evidence has linked adolescent risk and resilience factors with treatment outcomes. However, less research has focused on examining risk and resilience factors that may influence or predict adolescents’ compliance to treatment within an interdisciplinary pediatric chronic pain management program. Participants included 64 adolescents (M = 15.00 ± 1.69 years); 85.9% female, 84.4% Caucasian who presented to an initial evaluation in an interdisciplinary pediatric pain management program with their caregiver. Youth completed a series of questionnaires at the initial evaluation targeting pain acceptance, self-efficacy, pain catastrophizing, parental responses, pain intensity, and functional disability. Treatment compliance was measured at 3 and 6 months post-intake. Findings indicated that higher levels of adolescent-reported self-efficacy predict decreased treatment session attendance, whereas lower levels of acceptance and parental encouragement/monitoring of symptoms predict increased treatment compliance overall. Several adolescent-reported risk factors were associated with increased functional impairment among this sample. Results highlight the unique importance of risk and resilience factors within the developmental context of adolescence, while also emphasizing the need for further investigation of other relevant influences towards treatment compliance and functional impairment. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

12 pages, 551 KiB

Open AccessArticle

The Intergenerational Transmission of Chronic Pain from Parents to Survivors of Childhood Cancer

by Michaela Patton, Mehak Stokoe, Caitlin Forbes, Chidera Nwaroh, Melanie Noel, Kathleen Reynolds and Fiona Schulte

Children 2020, 7(11), 246; https://doi.org/10.3390/children7110246 - 21 Nov 2020

Cited by 1 | Viewed by 2597

Abstract

Background: Among youth with chronic non-cancer pain, 50% have parents with chronic pain. These youth report significantly more pain interference and posttraumatic stress symptoms (PTSS), and worse health-related quality of life (HRQL) than youth whose parents do not have chronic pain. Additionally, parent [...] Read more.

Background: Among youth with chronic non-cancer pain, 50% have parents with chronic pain. These youth report significantly more pain interference and posttraumatic stress symptoms (PTSS), and worse health-related quality of life (HRQL) than youth whose parents do not have chronic pain. Additionally, parent chronic pain is linked to increased child anxiety and depressive symptoms. Survivors of childhood cancer (SCCs) are at risk of pain and negative psychosocial outcomes and therefore may be especially vulnerable if their parents have chronic pain. Thus, the aims of the current study were to (1) identify rates of chronic pain among parents of SCCs, (2) test group differences in psychological symptoms in parents with chronic pain versus without, and (3) test group differences in pain interference, HRQL, anxiety, depression, and PTSS in SCCs with parents with chronic pain versus without. Methods: 122 SCCs (Mean age = 15.8, SD = 4.8, 45.7% male, Mean age at diagnosis = 5.9, SD = 4.7) and their parents were recruited from across Canada to complete online questionnaires. Parents were asked if they have had pain for at least three consecutive months and completed the brief symptom inventory (BSI) as a measure of psychological symptomatology. Survivors completed the pain questionnaire, patient reported outcomes measurement information system (PROMIS)—pain interference, anxiety, and depression measures, child posttraumatic stress scale, posttraumatic stress disorder checklist for the Diagnostic and Statistical Manual of Mental Disorders, and the pediatric quality of life inventory. Results: Forty-three (39%) parents of SCCs reported having chronic pain. Of the 29 survivors who had chronic pain, 14 (48%) also had parents with chronic pain. Parents with chronic pain reported significantly higher scores on the BSI than parents without chronic pain, F(1, 116) = 5.07, p = 0.026. SCCs with parents with versus without chronic pain reported significantly higher PTSS F(1, 105) = 10.53, p = 0.002 and depressive symptoms F(1, 102) = 6.68, p = 0.011. No significant differences were found across the other variables tested. Conclusions: Findings suggest that survivors’ parents’ own pain is prevalent and is related to survivors’ increased depressive symptoms and PTSS, but not anxiety, pain interference, or HRQL. Future research should explore whether parents may benefit from psychological intervention after their child has been diagnosed with cancer and how this could improve outcomes for their child. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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10 pages, 812 KiB

Open AccessArticle

Child Pain Intensity and Parental Attitudes toward Complementary and Alternative Medicine Predict Post-Tonsillectomy Analgesic Use

by Jaclyn Lee, Katherine Delaney, Molly Napier, Elizabeth Card, Brittany Lipscomb, Jay Werkhaven, Amy S. Whigham, Andrew D. Franklin, Stephen Bruehl and Amanda L. Stone

Children 2020, 7(11), 236; https://doi.org/10.3390/children7110236 - 19 Nov 2020

Cited by 4 | Viewed by 2087

Abstract

Parental attitudes regarding pain interventions and perceptions of their child’s pain intensity likely influence the decision to administer postoperative analgesics. Our study examined the impact of daily fluctuations in child pain intensity and parental attitudes regarding complementary and alternative medicine (CAM) on analgesic [...] Read more.

Parental attitudes regarding pain interventions and perceptions of their child’s pain intensity likely influence the decision to administer postoperative analgesics. Our study examined the impact of daily fluctuations in child pain intensity and parental attitudes regarding complementary and alternative medicine (CAM) on analgesic administration following pediatric tonsillectomy. Parents of children undergoing tonsillectomy (n = 33) completed a survey assessing CAM attitudes and a 7-day postoperative electronic daily diary to record their child’s daily pain intensity and analgesic medications (acetaminophen, ibuprofen, or oxycodone). Generalized linear mixed models with Poisson distributions evaluated the effects of within-person (child’s daily pain intensity) and between-person (average postoperative pain, parental CAM attitudes) components on the number of medication doses administered. Higher daily pain intensity was associated with more oxycodone doses administered on a given day, but not acetaminophen or ibuprofen. Positive parental CAM attitudes were associated with less oxycodone use, beyond the variations accounted for by the child’s daily pain intensity and average postoperative pain. Both parental CAM attitudes and their child’s daily pain intensity were independently associated with parental decisions to administer opioids following tonsillectomy. Understanding factors influencing individual variability in analgesic use could help optimize children’s postoperative pain management. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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Review

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12 pages, 947 KiB

Open AccessReview

Advancing the Measurement of Executive Functioning in Pediatric Chronic Pain

by Emily A. Beckmann and Kristen E. Jastrowski Mano

Children 2021, 8(8), 630; https://doi.org/10.3390/children8080630 - 24 Jul 2021

Cited by 6 | Viewed by 1760

Abstract

Youth with chronic pain often report executive functioning difficulties, many of which have been linked to poor treatment adherence and health-related quality of life in adults with chronic pain, as well as in other pediatric chronic health populations. Despite the extensive implications for [...] Read more.

Youth with chronic pain often report executive functioning difficulties, many of which have been linked to poor treatment adherence and health-related quality of life in adults with chronic pain, as well as in other pediatric chronic health populations. Despite the extensive implications for functional impairment, executive functioning remains understudied in pediatric chronic pain. Measurement approaches have lacked clear theoretical guidance, resulting in only some domains of executive functioning being investigated. To date, the methods used to measure executive functioning have been inconsistent, ranging from self-report measures of everyday executive functioning in home and school contexts to standardized neuropsychological tests. We argue for enhanced measure validation efforts and increased clarity in the approaches chosen to measure executive functioning in pediatric chronic pain to better guide research efforts in this area, thus yielding clearer clinical implications. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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26 pages, 375 KiB

Open AccessFeature PaperReview

Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders

by Robert Blake Windsor, Michael Sierra, Megan Zappitelli and Maria McDaniel

Children 2020, 7(12), 268; https://doi.org/10.3390/children7120268 - 02 Dec 2020

Cited by 6 | Viewed by 5033

Abstract

Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing [...] Read more.

Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

12 pages, 245 KiB

Open AccessReview

Bringing It All Together: A Review of the Challenges in Measuring Children’s Satisfaction as a Key Component of Acute Pain Management

by Joseph W. Hodapp, Samina Ali and Amy L. Drendel

Children 2020, 7(11), 243; https://doi.org/10.3390/children7110243 - 20 Nov 2020

Cited by 2 | Viewed by 1951

Abstract

In 2008, the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT) published a consensus statement that recognized the dearth of research surrounding the topic of children’s satisfaction with acute pain management. This review of published literature will summarize what [...] Read more.

In 2008, the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT) published a consensus statement that recognized the dearth of research surrounding the topic of children’s satisfaction with acute pain management. This review of published literature will summarize what is known about the topic of children’s satisfaction with pain management, identify current gaps in the knowledge, and provide direction for future research in this critical area. Including children in the decision-making process as soon as they are developmentally able is a concept that is the fundamental basis for seeking assent and more active roles within healthcare decisions for children. It is the responsibility of adults to provide them with increasing opportunities for self-evaluation and more independent management of their healthcare, encouraging the development of children into adults. As clinicians and researchers, it is our prerogative to support the maturation of children by building effective methods to communicate their satisfaction with acute pain treatment and healthcare. Children’s satisfaction with acute pain management is not well studied and further research is needed for the development of inclusive, developmentally appropriate measures of satisfaction for our pediatric patients. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

14 pages, 1390 KiB

Open AccessReview

Talking to Children and Families about Chronic Pain: The Importance of Pain Education—An Introduction for Pediatricians and Other Health Care Providers

by Helen Koechlin, Cosima Locher and Alice Prchal

Children 2020, 7(10), 179; https://doi.org/10.3390/children7100179 - 12 Oct 2020

Cited by 18 | Viewed by 6536

Abstract

Chronic pain in children and adolescents is a common and debilitating health problem. This narrative review will give a brief overview on what pediatric chronic pain is and what treatment options there are for children and adolescents. The specific emphasis will be on [...] Read more.

Chronic pain in children and adolescents is a common and debilitating health problem. This narrative review will give a brief overview on what pediatric chronic pain is and what treatment options there are for children and adolescents. The specific emphasis will be on pediatric chronic pain education and communication: this narrative review aims to show how important a good patient–health care provider relationship is—it builds the foundation for successful communication—and how this relationship can be established. In addition, we will present five steps that health care providers can perform to explain pediatric chronic pain to patients and their parents and what to keep in mind in their clinical routine. Our review is intended for pediatricians and other health care providers who treat pediatric patients with chronic pain but might feel uncertain on how to best communicate with them. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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17 pages, 454 KiB

Open AccessFeature PaperReview

Pain Symptomatology and Management in Pediatric Ehlers–Danlos Syndrome: A Review

by Estée C. H. Feldman, Daniel P. Hivick, P. Maxwell Slepian, Susan T. Tran, Pradeep Chopra and Rachel Neff Greenley

Children 2020, 7(9), 146; https://doi.org/10.3390/children7090146 - 21 Sep 2020

Cited by 12 | Viewed by 6541

Abstract

Ehlers–Danlos syndromes (EDS) are a group of connective tissue disorders that manifest with hyperextensibility of joints and skin, and general tissue fragility. While not a major criterion for clinical diagnosis, pain is a frequently endorsed symptom across subtypes of EDS. As such, the [...] Read more.

Ehlers–Danlos syndromes (EDS) are a group of connective tissue disorders that manifest with hyperextensibility of joints and skin, and general tissue fragility. While not a major criterion for clinical diagnosis, pain is a frequently endorsed symptom across subtypes of EDS. As such, the present review aims to summarize research to date on pain characteristics and management, and the relationship between such pain symptomatology and quality of life in pediatric EDS. Characteristics of pain, including theorized etiology, relative intensity and extent of pain are described, as well as descriptions of frequently endorsed pain sites (musculoskeletal, and non-musculoskeletal). Interventions related to the management of musculoskeletal (e.g., pharmaceutical intervention, physical therapy) and non-musculoskeletal pain (e.g., pharmaceutical and psychological interventions) are discussed, highlighting the need for additional research related to pediatric pain management in the context of hypermobility syndromes. In addition, the relationship between pain in pediatric EDS and quality of life is described. Finally, limitations of literature to date are described and recommendations for future lines of research are outlined. Full article

(This article belongs to the Special Issue Pediatric Pain Management)

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