A clinically significant change in functional disability for adolescents with fibromyalgia comprised an approximate 8-point reduction in disability scores and a reduction in disability grade after ...cognitive-behavioral treatment (CBT).
The primary objective of this study was to estimate a clinically significant and quantifiable change in functional disability to identify treatment responders in a clinical trial of cognitive-behavioral therapy (CBT) for youth with juvenile fibromyalgia (JFM). The second objective was to examine whether baseline functional disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children’s Depression Inventory), coping self-efficacy (Pain Coping Questionnaire), and parental pain history predicted treatment response in disability at 6-month follow-up. Participants were 100 adolescents (11–18years of age) with JFM enrolled in a recently published clinical trial comparing CBT to a fibromyalgia education (FE) intervention. Patients were identified as achieving a clinically significant change in disability (ie, were considered treatment responders) if they achieved both a reliable magnitude of change (estimated as a ⩾7.8-point reduction on the FDI) using the Reliable Change Index, and a reduction in FDI disability grade based on established clinical reference points. Using this rigorous standard, 40% of patients who received CBT (20 of 50) were identified as treatment responders, compared to 28% who received FE (14 of 50). For CBT, patients with greater initial disability and higher coping efficacy were significantly more likely to achieve a clinically significant improvement in functioning. Pain intensity, depressive symptoms, and parent pain history did not significantly predict treatment response. Estimating clinically significant change for outcome measures in behavioral trials sets a high bar but is a potentially valuable approach to improve the quality of clinical trials, to enhance interpretability of treatment effects, and to challenge researchers to develop more potent and tailored interventions.
Abstract Purpose Juvenile-onset fibromyalgia (JFM) affects physical, social, and emotional functioning. Little is known about how social support and social interactions are impacted in the transition ...to young adulthood for patients diagnosed with JFM. Methods Young adults (Mage = 21.6) diagnosed with JFM during adolescence (N = 94) and matched healthy controls (N = 33) completed measures of social network size and diversity, perceived social support, physical functioning, and depressive symptoms as part of a cross-sectional survey study. Results No difference in social network diversity was found, although JFM patients reported fewer total people within their social networks. JFM patients reported poorer emotional and tangible support and fewer positive social interactions than healthy controls. After controlling for condition and pain intensity, the level of perceived social support was a significant predictor of physical functioning and depressive symptoms, whereas social network size also contributed uniquely to physical functioning. Conclusions Given the developmental importance of social support in adolescence and young adulthood, interventions should include methods of improving social support into fibromyalgia management.
This study examined whether increasing the demand for central cognitive processing involved in a distraction task, by involving the child in ongoing, effortful interaction with the distraction ...stimulus, would increase children's tolerance for cold pressor pain.
Seventy-nine children ages 6-15 years underwent a baseline cold pressor trial followed by two cold pressor trials in which they received interactive distraction (i.e., used voice commands to play a videogame) or passive distraction (in which they merely watched the output from the same videogame segment) in counterbalanced order. Both distraction conditions were presented via a virtual reality-type helmet.
As expected, children demonstrated significant improvement in pain tolerance during distraction relative to baseline. Children showed the greatest improvement during the interactive distraction task.
The effects of distraction on children's cold pressor pain tolerance are significantly enhanced when the distraction task also includes greater demands for central cognitive processing.
OBJECTIVE:To describe chronic pain—pain that is present most days per month over the past 3 months—in youth with sickle cell disease (SCD). This study characterized differences in functional ...outcomes, psychosocial characteristics, and health care utilization for youth with SCD across 3 groups based on pain frequencychronic pain, episodic pain, and no SCD pain in the past month.
MATERIALS AND METHODS:Children and adolescents (aged 8 to 18 y) with SCD and their parents (n=100) completed measures of functional disability, health-related quality of life, depressive symptoms, pain catastrophizing, pain beliefs, and health care utilization during an outpatient comprehensive sickle cell clinic appointment. On the basis of pain frequency and duration, patients were categorized as follows(1) chronic (≥3 d of pain per week in the past month lasting ≥3 mo; range, 12 to 31 d/mo), (2) episodic (<3 d of pain per week for the past month; range, 1 to 10 d/mo), and (3) no SCD pain in the past month.
RESULTS:Consistent with other pediatric chronic pain conditions, youth characterized as having chronic sickle pain (n=40) reported significantly greater functional disability, depressive symptoms, and inpatient admissions for pain relative to patients characterized with having episodic SCD pain (n=40) or no SCD pain (n=20). The chronic and episodic pain groups had comparable levels of pain intensity, pain catastrophizing, and quality of life.
DISCUSSION:Specific definitions and criteria for chronic sickle pain in youth are needed. Identifying risk and protective factors related to the transition from acute to chronic pain is important to facilitate improved psychosocial functioning.
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Introduction: Chronic pain related to pediatric sickle cell disease (SCD) contributes to high healthcare use and poor quality of life. Factors that contribute to the transition from acute to ...chronic pain in SCD remain largely unknown. Thus, chronic SCD pain remains a challenging problem that is difficult to manage due to the complex interaction of biological, psychological, and social determinants that contribute to its onset and maintenance. Common sequelae of chronic SCD pain in children and adolescents include functional impairment, frequent school absences, elevated depressive symptoms, and high levels of anxiety or catastrophic thinking. Early identification of youth who are at risk of developing chronic SCD pain is needed to help prevent the onset and exacerbation of chronic pain. This study aimed to identify youth at increased risk for chronic SCD pain and its sequelae through the integration of a brief psychosocial pain screening tool. Children and adolescents with SCD identified as “high risk” on the pain screening tool were expected to demonstrate a psychosocial profile consistent with chronic SCD pain, including increased pain frequency and duration, high levels of functional impairment, elevated anxiety and depressive symptoms, and reduced quality of life.
Methods: Children and adolescents with SCD presenting to a pediatric SCD clinic completed the Pediatric Pain Screening Tool, a brief 9-item self-report questionnaire developed for rapid identification of risk in youth with pain complaints. Youth also completed a battery of surveys about their pain characteristics (pain frequency and duration), pain burden (SCD Pain Burden Interview for Youth), functional impairment (PROMIS Pain Interference), anxiety (Pain Catastrophizing Scale-Child; Fear of Pain Questionnaire), depressive symptoms (Children's Depression Inventory -2), and quality of life (Pediatric Quality of Life-SCD Module).
Results: Youth (n=45) were on average 13.5 years old (SD = 4.4), 89% Black or African American, 80% HbSS, 85.5% prescribed hydroxyurea, and 16.7% receiving chronic transfusions. Youth were classified into Low (n=15, 33.3%), Medium (n=15, 33.3%), and High (n=15, 33.3%) risk groups based on pain screening. Risk groups did not significantly differ by age, race, hemoglobin type, or treatment with hydroxyurea or chronic transfusions. Multivariate Analysis of Variance (MANOVA) showed significant risk group differences on pain characteristics, pain burden, functional impairment, anxiety and depressive symptoms, and quality of life (Wilks' λ = 0.13, F16, 54 = 6.02, p < .001). Post-hoc univariate tests revealed that youth in the High Risk group had significantly higher pain frequency (M=15.2 days/month, SD= 2.2) and duration (over 1 year) compared to the Low (M=1.8, SD= 2.3; duration 1.2 months) and Medium (M=7.6, SD= 2.3; duration 2.5 months) Risk groups. The High Risk group also had significantly higher pain burden, functional impairment, catastrophic thinking, depressive symptoms, and poorer quality of health compared to the Low and Medium Risk groups. The High Risk group had significantly higher levels of fear of pain relative to the Low Risk group, but there was no significant difference in fear of pain between the Medium and High Risk groups.
Conclusions: Brief psychosocial pain screening may be a helpful tool to support the early identification of youth at risk for chronic SCD pain. Youth classified as High Risk based on pain screening demonstrated a psychosocial profile consistent with other pediatric chronic pain conditions. Additionally, the High Risk group reported high pain frequency and duration that is consistent with the primary diagnostic criteria for chronic SCD pain (i.e., ≥15 days of pain per month, lasting ≥ 6 months). Further validation with a larger sample of children and adolescents with SCD is needed to support the utility of the Pediatric Pain Screening Tool in identifying youth at risk of transitioning from acute to chronic pain.
Supported by NCATS Award UL1TR000454. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
No relevant conflicts of interest to declare.
Background
This study aimed to evaluate the preliminary validation and application of a pain screening tool to identify biopsychosocial risk factors for chronic pain in pediatric sickle cell disease ...(SCD) and classify youth with SCD into prognostic risk groups.
Method
Youth presenting to a pediatric SCD clinic completed the Pediatric Pain Screening Tool (PPST), a brief 9‐item self‐report questionnaire developed for rapid identification of risk in youth with pain complaints. Youth also completed a battery of standardized patient‐reported outcomes, including pain characteristics, pain burden, functional disability, pain interference, depressive symptoms, pain catastrophizing, and fear of pain. Healthcare utilization was extracted from medical chart review.
Results
Seventy‐three 8‐ to 18‐year‐olds (94% Black, 57% female) with SCD participated. The PPST demonstrated discriminant validity that ranged from fair to excellent (area under the curves (AUC) = 0.74–0.93, P values < 0.001) for identifying significant pain frequency, disability, pain interference, and psychosocial distress. Receiver operating characteristic curve analyses indicated that previously established cutoff scores were appropriate for the SCD sample. Participants were classified into low‐risk (28.8%), medium‐risk (38.4%), and high‐risk (32.9%) groups, with significant group differences across measures, F(18, 116) = 6.67, P < 0.001. The high‐risk group reported significantly higher pain intensity, pain frequency, pain burden, functional disability, pain interference, and depressive symptoms relative to both low‐risk and medium‐risk groups (P values < 0.005).
Conclusions
The high‐risk group demonstrated a pain and psychosocial profile consistent with chronic SCD pain. The PPST may be useful for efficiently identifying youth with chronic SCD pain or those at risk of poor outcomes.
Youth living with chronic sickle cell disease (SCD) pain are at risk for psychosocial distress and high levels of pain catastrophizing that contribute to functional impairment. This study aimed to ...identify the unique long-term impact of pain catastrophizing on pain impairment among youth with SCD. Youth with chronic SCD pain (
N
= 63, 10–18 years old, 58.3% female, 95.1% Black or African American) were recruited within comprehensive SCD clinics and completed a battery of measures at baseline and 4-months follow-up. A linear hierarchical regression examined baseline demographic and clinical characteristics (child SCD genotype, age, and average pain intensity), psychosocial functioning (anxiety, depression), and pain catastrophizing as predictors of pain interference at 4-months follow-up. Pain catastrophizing was the only unique predictor of pain interference at 4-months follow-up. Among youth with chronic SCD pain, pain catastrophizing warrants greater consideration as an important predictor that influences pain management and overall functioning.
Youth with sickle cell disease (SCD) and chronic pain, defined in this study as pain on most days for 3 months, experience variability in daily pain and physical and psychosocial functioning. This ...study aimed to (1) empirically derive chronic pain subgroups based on pain characteristics among youth with chronic SCD pain; and (2) investigate derived subgroups for differences in sociodemographics, clinical characteristics, and psychosocial and functional outcomes.
Youth with chronic SCD pain (n=62, Mage =13.9, SD=2.5, 10 to 18 y; 58% female, 60% HbSS) completed a battery of questionnaires. Clinical characteristics (eg, medications, treatments) and health care utilization were abstracted from electronic medical records. Hierarchical cluster analysis informed the number of clusters at the patient level. k-means cluster analysis used multidimensional pain assessment to identify and assign patients to clusters.
Cluster 1 (n=35; Moderate Frequency, Moderate Pain) demonstrated significantly lower worst pain intensity, number of pain days per month, number of body sites affected by pain, and pain quality ratings. Cluster 2 (n=27; Almost Daily, High Pain) reported high ratings of worst pain intensity, almost daily to daily pain, greater number of body sites affected by pain, and higher ratings of pain quality (all P 's <0.05). There were no differences between subgroups by sociodemographics, clinical characteristics, or health care utilization. The Almost Daily, High Pain subgroup reported significantly higher pain interference, depressive symptoms, and pain catastrophizing than the Moderate Frequency, Moderate Pain subgroup.
Identifying chronic SCD pain subgroups may inform tailored assessment and intervention to mitigate poor pain and functional outcomes.
Pain catastrophizing is poorly understood in children and adolescents with sickle cell disease (SCD) and their parents. The objectives of this study were twofold: 1) to evaluate the interplay between ...parent and child pain catastrophizing and its effect on disability among youth with SCD, and 2) to evaluate whether child pain catastrophizing served as a mechanism that explained the relation between pain and functional disability within the context of varying levels of parent pain catastrophizing. One hundred youth (8-18 years old) with SCD and parents completed measures of pain characteristics (pain frequency and intensity), catastrophizing (Pain Catastrophizing Scale), and the outcome of functional disability (Functional Disability Inventory) in a cross-sectional study. Youth with low levels of catastrophizing showed high levels of disability in the presence of high levels of parent catastrophizing. Additionally, child pain catastrophizing was a significant mechanism that partially explained the effect of higher pain frequency and pain intensity on greater levels of disability, but only at low levels of parent pain catastrophizing. High levels of parent catastrophizing and incongruence between child and parent catastrophizing contributes to poorer functional outcomes in youth with SCD.
Youth with SCD and parents with high levels of catastrophic thinking about child pain or incongruent levels of catastrophizing are at increased risk for greater child disability. Clinicians treating youth with SCD should focus on targeting worried thinking about pain in patients and parents to facilitate improved function.
Racial/ethnic disparities in childhood cancer survival persist despite advances in cancer biology and treatment. Survival rates are consistently lower among non-Hispanic Black and Hispanic children ...as compared with non-Hispanic White children across a range of hematologic cancers and solid tumors. We provide a framework for considering complex systems and social determinants of health in research examining the drivers of racial/ethnic disparities in childhood cancer survival, given that pediatric patients' interactions with the healthcare system are filtered through their caregiver, family, and societal structure. Dismantling the multi-level (patient, family, healthcare system, and structural) barriers into modifiable drivers is critical to developing policies and interventions toward equitable health outcomes. This commentary highlights areas at the family, healthcare system, and society levels that merit closer examination and proposes actions and interventions to support improvements across these levels. See recently published article in the November issue of CEBP, Racial/Ethnic Disparities in Childhood Cancer Survival in the United States p. 2010.
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