Central Sensitization in Chronic Pain and Eating Disorders: A Potential Shared Pathogenesis.

Although less recognized than other disruptions in functioning, individuals with chronic pain frequently display disturbances in eating associated with pain, changes in appetite, medication side effects, and prescribed elimination diets. Not only may changes in nutritional status and weight increase the risk for the development of an eating disorder, there is evidence that individuals with chronic pain and those with eating disorders share similar vulnerabilities that place them at risk for both conditions, as well as their comorbidity. This review will describe the temperamental, behavioral, and neurobiological risk factors linking chronic pain and eating disorders. We propose that these risk factors may reflect central sensitization, a condition of over-activation of the central nervous system that increases sensitivity to internal and external conditions. To manage high levels of sensitivity, individuals may develop unique patterns of behavioral avoidance, pain behaviors and/or restrictive eating. Using the framework of central sensitization, this review will discuss relevant assessment and intervention strategies to address sensitivity in eating disorders and chronic pain.

Postural Orthostatic Tachycardia Syndrome and Disordered Eating: Clarifying the Overlap.

OBJECTIVE: Postural orthostatic tachycardia syndrome (POTS) is estimated to occur in up to 1% of adolescents, with symptoms of dizziness, fatigue, and pain impacting daily functioning. However, many risk factors and symptoms for POTS overlap with those of youth with disordered eating, and adolescents with POTS may be at increased risk for developing eating disorders. Therefore, the present study sought to better understand this overlap. We hypothesized that patients with POTS would have higher than expected rates of weight change, restrictive eating patterns, and food sensitivities. METHODS: We conducted a retrospective chart review of 96 adolescents and young adults diagnosed with POTS who were participating in a 3-week intensive interdisciplinary pain rehabilitation program. We conducted descriptive and correlational statistical analyses on data from self-report measures, biomarkers of nutritional status, and abstracted information about eating and weight concerns from medical notes. RESULTS: Nearly 3 quarters of participants described engaging in restrictive eating, and more than half of them described experiencing weight loss. They also endorsed experiencing food allergies, celiac disease, and eating disorder at higher rates than would be expected in the general population. One-fifth of the sample had experienced invasive interventions to correct for nutritional imbalances, such as having a feeding tube. CONCLUSION: Weight and eating are clear areas of risk for patients with orthostatic intolerance. It is essential that treatment team members thoroughly screen for eating disturbances and make recommendations that support regular and balanced eating habits.

Pain Assessment Methods and Interventions Used by Pediatric Psychologists: A Survey by the Pain Special Interest Group of the Society of Pediatric Psychology.

Although many valid pain-related assessment instruments and interventions exist, little is known about which are actually utilized in practice and the factors that contribute to pediatric psychologist's decisions about their use. The aim of this survey study was to present a summary of current clinical practice among pediatric psychologists in the area of pediatric pain and to identify the needs and possible resources that would enable practitioners to better implement evidence-based assessments and interventions. To accomplish this aim, the Pain Special Interest Group of the Society of Pediatric Psychology (SPP) constructed an online survey that was sent electronically to current members of the SPP list serve. Results indicated the majority of participants are guided by a theoretical model and are using evidence-based assessments and interventions, although they are not always familiar with the literature supporting their use. Providers noted evidence-based pain intervention is facilitated by assessment tools, intervention resources, and appreciation of pain interventions by multidisciplinary team members. Barriers are both logistical (clinic space and time constraints) and knowledge-based (lack of familiarity with assessments/interventions). Thus, while pediatric psychologists are progressing towards better translation of research to practice, continued educational efforts and communication among practitioners about available resources are warranted.