Non-Pharmacologic Intensive Interdisciplinary Pain Treatment in Pediatrics: Impact on Symptoms, Daily Functioning, and the Family Unit.

Objectives: To assess non-pharmacologic treatment outcomes pertaining to health-related quality of life (HRQoL) in youth with chronic idiopathic pain and their families. Methods: We conducted a retrospective cohort study of 115 youth with chronic idiopathic pain enrolled in a non-pharmacologic, hospital-based intensive interdisciplinary pain treatment (IIPT) program. HRQoL measures for the patient (Pediatric Quality of Life Inventory [PedsQL] short form) and family unit (PedsQL Family Impact) were collected on admission and discharge as part of routine clinical care. Changes in PedsQL scores were calculated using the Wilcoxon signed-rank test. Multivariable linear regression was used to explore factors associated with patient-level HRQoL. Results: Both individuals and the family unit reported that their HRQoL improved in all domains by program completion. Improvements in pain and allodynia were present for program participants at the time of completion as well as at the 3-month follow-up, suggesting durability of these effects. Conclusions: A non-pharmacologic IIPT program is a compelling treatment for pediatric and adolescent chronic idiopathic pain, for both patients and the family unit. Patients participating in this program had positive treatment outcomes with significantly improved subjective and objective measures of physical, emotional, social, and cognitive function.

Predicting suicidal ideation in adolescents with chronic amplified pain: The roles of depression and pain duration.

The rates of suicidal ideation and completed suicide among adolescents have become increasingly alarming in recent years. Epidemiological studies indicate that a large portion of adolescents suffer from chronic pain, which research supports as a risk factor for suicidal ideation and behaviors. Further, psychological factors may account for the associations between chronic pain and suicidality. The current study sought to fill gaps in the literature on chronic pain and suicidality in adolescents, by examining whether depression mediates the links between various chronic amplified pain symptoms and suicidal ideation. Retrospective medical record reviews were conducted of 453 adolescents ages 11-17 (M = 14.34, SD = 1.83), who presented to a tertiary pain clinic and received a diagnosis of amplified pain. Prior to their initial appointment, participants completed measures assessing pain symptoms, disability, depression, and suicidality. We found pain duration was significantly related to suicidal ideation, however, this association was mediated by depressive symptoms. These results highlight the need for early screening and intervention for depressive symptoms among adolescents suffering from amplified pain. Clinical recommendations for mental health and medical providers are discussed. (PsycINFO Database Record

The Treatment of Juvenile Fibromyalgia with an Intensive Physical and Psychosocial Program.

OBJECTIVE: To assess the short-term and 1-year outcomes of children with fibromyalgia treated with intensive physical and occupational therapy (PT/OT) and psychotherapy. STUDY DESIGN: Children with fibromyalgia seen at a tertiary care hospital were treated with 5-6 hours of intensive PT/OT daily and at least 4 hours of psychosocial services weekly. All medications used for fibromyalgia were discontinued. Children underwent standardized testing, including a visual analog scale for pain; the Bruininks-Oseretsky Test of Motor Performance, Second Edition; the Bruce treadmill protocol; the Functional Disability Inventory; the Pain Stages of Change Questionnaire, adolescent version; and the Pediatric Quality of Life Inventory, Teen Report, at 3 time points: at program entry, at the end of the intensive program, and 1 year after the end of the program. RESULTS: Sixty-four children (median age, 16 years; 95% Caucasian; 94% female; median duration of symptoms, 21 months) were studied. The mean pain score decreased significantly from program entry to the end of the program (from 66 of 100 to 25 of 100; P = .001). At the 1-year follow-up, 33% reported no pain. All measures of function on the Bruininks-Oseretsky Test of Motor Performance, Second Edition improved significantly and remained at that level or continued to improve over the subsequent year. The mean Bruce treadmill protocol time first increased from 588 seconds to 801 seconds (P < .001) and then dropped to 750 seconds (P = .005), which is at the 90th percentile for age and sex. All Pain Stages of Change Questionnaire, adolescent version subset scores improved significantly initially and were stable or improved at 1 year, as did the Pediatric Quality of Life Inventory, Teen Report total score. CONCLUSION: Children with fibromyalgia can be successfully treated without medications with a very intensive PT/OT and psychotherapy program. They have significantly improved pain and function by subject report and objective measures of function.

Treatment expectations among adolescents with chronic musculoskeletal pain and their parents before an initial pain clinic evaluation.

OBJECTIVES: To understand expectations regarding treatment recommendations among treatment-seeking adolescents with chronic musculoskeletal pain and their parents. METHODS: A total of 102 adolescent-parent dyads were recruited at the time of initial contact with a multidisciplinary pain management clinic. Each participant completed reports of adolescent pain intensity and disability, biopsychosocial perspective of pain, and treatment expectations related to recommendations and feedback for a vignette description of an adolescent presenting at an initial multidisciplinary pain clinic evaluation. RESULTS: Descriptive findings for individual treatment expectations and adolescent-parent dyad agreement statistics were examined. Slight to fair levels of agreement occurred for 50% of the expectations assessed. The strongest shared expectations were for recommendations to return to school, pursue psychological counseling, and pursue PT/OT treatment. Stronger agreement occurred for items reflecting alternative, emotional, behavioral, and activity recommendations with weaker agreement for medical interventions (eg, medication and surgery). Correlations emerged between individual expectations and adolescent pain intensity, disability, with the greatest number of significant relationships found for adolescent and parent expectations and biopsychosocial perspectives of pain. DISCUSSION: Our results document that adolescents and parents show modest levels of agreement on expectations for treatment at the time of an initial pain clinic evaluation. This may relate to expectations being internal perspectives not clearly expressed within families; thus, the initial treatment consultation may provide an important opportunity to create and align appropriate expectations. Implications of our findings are considered with respect to education, treatment, and future research to understand factors that contribute to treatment adherence and outcomes.

Pain beliefs and readiness to change among adolescents with chronic musculoskeletal pain and their parents before an initial pain clinic evaluation.

OBJECTIVES: To understand relationships between pain-related beliefs and readiness to change among treatment-seeking adolescents with chronic musculoskeletal pain and their parents. METHODS: A total of 102 adolescent-parent dyads were recruited at the time of initial evaluation at a multidisciplinary pain management clinic. Dyads completed self-report measures to assess pain, catastrophizing, endorsement of a biopsychosocial perspective of pain, and readiness to change/motivation to adopt a self-management approach to pain coping. RESULTS: Agreement between adolescent-parent dyad reports of pain catastrophizing and readiness to change was found; however, adolescents were less likely to view pain as "affected by feelings and emotions" than parents. The hypothesis that greater pain catastrophizing would be correlated with less readiness to change was partially supported. Adolescent and parents who reported lower levels of endorsement of a biopsychosocial perspective were less willing to adopt a self-management approach to pain coping. Endorsement of a biopsychosocial perspective of pain aligned with readiness to change stages more consistently for parents. DISCUSSION: This study documents initial relationships among pain catastrophizing, biopsychosocial perspectives of pain, and readiness to engage in a self-management approach to pain coping for adolescents with chronic pain and their parents. Although agreement exists between dyads regarding catastrophizing and readiness to change, differences were noted in biopsychosocial perspective and dominant readiness to change stage before an initial pain clinic encounter. Findings are considered in terms of future research to advance knowledge regarding the role these factors may play in treatment adherence and outcomes.

Relationships among pain, protective parental responses, and disability for adolescents with chronic musculoskeletal pain: the mediating role of pain catastrophizing.

OBJECTIVES: Children learn to cope with pain within the context of the family and parental responses to pediatric pain can impact health outcomes. The aim of this study was to examine relationships among pain, protective parental responses to pain, functional disability, and pain catastrophizing for adolescents with chronic musculoskeletal pain syndromes. METHODS: Initial evaluation records for 138 adolescents with chronic musculoskeletal pain who consulted a pediatric multidisciplinary pain management clinic were examined. Measures were collected at the time of the initial evaluation and included adolescent self-reports of their own usual pain intensity, perceived parental responses to their pain, adolescent functional disability, and pain catastrophizing. RESULTS: Pain catastrophizing was significantly correlated with pain intensity, protective parental responses to pain, and functional disability. Multiple regression analyses further suggest that pain catastrophizing serves as a mediator of relationships between: (1) pain and disability and (2) protective parenting responses and disability. Evidence supporting a significant indirect effect for pain catastrophizing on disability was found within both models through bootstrap and Sobel analyses. DISCUSSION: Pain catastrophizing seems to play an important role in understanding relationships between pain, protective parental responses, and disability for adolescents with musculoskeletal pain. Our findings suggest that strategies that help modify adolescent catastrophic pain beliefs and parental responses to pain, may help improve adolescent functioning.

Relationship quality, trait similarity, and self-other agreement on personality ratings in college roommates.

Previous research has shown that the level of self-other agreement for personality trait ratings increases with the length of acquaintanceship between the target and the informant. These findings emerge exclusively from studies of well-acquainted pairs in natural relationships and relative strangers interacting in laboratory and classroom settings. The present study examines self-other correlations for trait ratings using the NEO Five Factor Inventory (NEO-FFI; Costa & McCrae, 1992) with 103 pairs of previously unacquainted female college roommates. Assessments were obtained at approximately 2 weeks and again at approximately 15 weeks subsequent to the roommates' initial introduction. Self-other correlations increased for all five NEO-FFI scores and agreement correlations for Conscientiousness were significantly higher than for Extraversion at both occasions. Differences in relationship quality did not moderate self-other agreement for any of the traits. However, better relationship quality was associated with higher other-ratings of Extraversion, Agreeableness, and Conscientiousness and lower other-ratings of Neuroticism after controlling for self-ratings on the same trait. Higher similarity in self-ratings of Neuroticism and Openness was associated with higher self-other agreement for these ratings, and similarity in Conscientiousness was associated with higher relationship quality. These results are considered in light of existing theories of differential trait observability and the effects of unique contexts on trait perception.