Understanding Adolescents' Experiences With Menstrual Pain to Inform the User-Centered Design of a Mindfulness-Based App: Mixed Methods Investigation Study.

BACKGROUND: Digital interventions are increasingly popular for the provision of nonpharmacological pain interventions, but few exist for adolescents with menstrual pain. User-centered design involves incorporating users across phases of digital health intervention design, development, and implementation and leads to improved user engagement and outcomes. A needs assessment is the first step of this approach. OBJECTIVE: The goal of this study was to conduct a needs assessment to understand menstrual pain management needs and preferences and mindfulness experiences, preferences, and knowledge of adolescents with menstrual pain to inform the future development of an app for managing menstrual pain. METHODS: We used an explanatory sequential mixed method design that included a survey followed by focus groups. Adolescents aged 13-17 years completed a survey (n=111) and participated in focus groups (n=16). Data were analyzed using descriptive statistics and thematic content analysis and synthesized to provide specific recommendations based on adolescent responses. RESULTS: Adolescents (n=111) who completed the survey reported a moderate understanding of mindfulness and menstrual pain. Over three-quarters (n=87, 78%) of participants practiced some form of mindfulness and 87% (n=97) of survey participants used nonpharmacological pain management strategies. Teens had a moderate perception that mindfulness could help their menstrual pain (mean 4.51/10, SD 2.45, with higher scores suggesting more interest). Themes were generated related to mindfulness experiences, menstrual pain knowledge and experiences, and app functionality. These themes underscored adolescents' need for continued support and flexible access to mindfulness activities; their awareness of multiple influences to pain, with potential for further education in this area; and the need for menstrual pain-specific content, along with content relevant to typical day-to-day experiences of adolescents. CONCLUSIONS: Adolescents with menstrual pain have an interest in using a mindfulness app for pain but have unique needs that need to be addressed to ensure app engagement and relevance for this population. Concrete recommendations for future app development are provided.

Initiatives Targeting Health Care Professionals: A Systematic Review of Knowledge Translation Pain Assessment and Management Studies Focusing on Older Adults.

OBJECTIVES: Pain is often undertreated in older adult populations due to factors, such as insufficient continuing education and health care resources. Initiatives to increase knowledge about pain assessment and management are crucial for the incorporation of research evidence into practice. Knowledge translation (KT) studies on pain management for older adults and relevant knowledge users have been conducted; however, the wide variety of KT program formats and outcomes underscores a need to evaluate and systematically report on the relevant literature. MATERIALS AND METHODS: Using a systematic review methodology, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycInfo, and Web of Science databases were searched from inception to June 2023. Pain-related KT programs targeted towards older adults, their informal caregivers, and health care professionals were examined. Initiatives focusing on health care professionals are the focus of this review. Initiatives focusing on older adults are reported in a companion article. RESULTS: From an initial 21,669 search results, 172 studies met our inclusion criteria. These studies varied widely in focus and delivery format but the majority were associated with significant risk of bias. In this report, we are focusing on 124 studies targeting health care professionals; 48 studies involving initiatives targeting older adults are reported in a companion article. Moreover, most programs were classified as knowledge mobilization studies without an implementation component. Across all studies, knowledge user satisfaction with the initiative and the suitability of the material presented were most commonly assessed. Patient outcomes, however, were underemphasized in the literature. CONCLUSION: Patient and clinical outcomes must be a focus of future research to fully conceptualize the success of KT programs for older adult individuals. Without implementation plans, disseminated knowledge does not tend to translate effectively into practice.

Initiatives Targeting Patients: A Systematic Review of Knowledge Translation Pain Assessment and Management Studies Focusing on Older Adults.

OBJECTIVES: Older adults frequently experience persistent pain but are often unaware of self-management and other strategies that can help improve their condition. In a related article, we reported on pain assessment and management knowledge translation initiatives related to older adults that were targeting health professionals. In this paper, we report on initiatives targeting older adults. MATERIALS AND METHODS: Using systematic review methodology, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycInfo, and Web of Science databases were searched from inception to June 2023. Pain-related knowledge translation programs targeted towards older adults, their informal caregivers, and health care professionals were examined. RESULTS: From an initial 21,669 search results, 172 studies met our inclusion criteria. Of these studies, 49 targeted older adults. These studies varied widely in focus and delivery format, but the majority were associated with a significant risk of bias. Older adults with musculoskeletal pain were the primary recipients of education. Most programs were classified as knowledge mobilization initiatives. The remainder were considered self-management programs. Knowledge users were satisfied with the suitability of the information presented, and patient outcomes were a primary concern across all studies. Behavioral changes and pain management outcomes, however, were underemphasized in the literature. CONCLUSION: Knowledge acquisition outcomes are overrepresented in the current literature compared with behavioral outcomes changes. Nonetheless, older adults report benefitting from the guidance provided in self-management programs when applying knowledge to practice. Future research is needed to better understand the facilitators and barriers to pain management changes in this population.

"You're Not Alone": How Adolescents Share Dysmenorrhea Experiences Through Vlogs.

Many adolescents experience severe pain during menstruation, yet their attempts to receive medical attention to alleviate or manage this pain are often met with dismissal or disbelief. In light of these barriers to care, many adolescents turn to social media to share their experiences with menstruation and pain, as well as hear from other members of their community. In this study, we investigated how adolescents present their experiences with menstruation in vlogs (or "video blogs"). Using critical qualitative methods and a four-column analysis structure, we transcribed and thematically analyzed the audio and video content of 17 YouTube vlogs wherein adolescents described their experiences with menstrual pain. We found that stylistically, the vloggers modulated between a polished documentary style and an intimate storytime style of video production. We additionally found that vloggers spoke about their menstrual pain experiences from three perspectives: as a Patient managing and diagnosing physical symptoms, as a Self considering how the pain affects their life and ambitions, and as a Teacher educating their audience. Considering both the visual and audio data, we discuss how healthcare providers can use these findings to inform their approach to discussing menstrual pain with adolescents. We further discuss possible future directions for research into health story sharing on social media.

Dysmenorrhea and psychological wellbeing among females with attention deficit hyperactivity disorder.

Although rarely examined together, ADHD, emotional regulation (ER), and dysmenorrhea may be associated, which could create additive burdens on psychological well-being (PWB). Clinicians working with ADHD populations may need to take these challenges into consideration to maximize treatment outcomes. This study investigated the relationships among ADHD, dysmenorrhea, ER, and PWB within a sample of 266 adult females with a self-reported ADHD diagnosis. ADHD symptom severity was positively correlated with dysmenorrhea severity, but ER skills were not a significant moderator of this relationship. ADHD symptom severity was negatively correlated with PWB; however, this relationship was not moderated by dysmenorrhea severity nor ER ability. Overall, a positive association between ADHD symptom severity and dysmenorrhea severity was found in our sample. Further research is needed to understand the nature of this association, as well as factors that may contribute to PWB among individuals with these comorbid conditions.

Is all validation equal? Evaluating sensory- and emotion-focused validation in the context of experimentally induced pain.

Validation has been examined in experimental and clinical settings, but examination of whether specific content of validation responses affect pain-related outcomes has not been considered. We examined the impact of sensory- or emotion-focused validation following a pain task. Participants (N = 140) were randomly assigned to one of three validation conditions (i.e. sensory, emotional, or neutral) and completed the cold pressor task (CPT). Participants provided self-report ratings of pain and affective-related variables. Subsequently, a researcher validated emotional, sensory, or no aspects of participants' experience. The CPT was repeated, as were the self-report ratings. No significant differences were observed across conditions in pain or affective outcomes. All conditions reported an increase in pain intensity and pain unpleasantness across CPT trials. These findings suggest validation content may not impact pain outcomes during painful experiences. Future directions to understanding the nuances of validation across interactions and settings are discussed.

Smartphone apps for menstrual pain and symptom management: A scoping review.

The past decade marks a surge in the development of mobile apps used to digitally track and monitor aspects of personal health, including menstruation. Despite a plethora of menstruation-related apps, pain and symptom management content available in apps has not been systematically examined. The objective of this study was to evaluate app characteristics, overall quality (i.e., engagement, functionality, design aesthetics, and information), nature and quality of pain and symptom tracking features, and availability and quality of pain-related intervention content. A scoping review of apps targeting facets of the menstrual experience was conducted by searching the Apple App Store. After removal of duplicates and screening, 119 apps targeting menstrual experiences were retained. Pain and menstrual symptoms tracking were available in 64 % of apps. Checkboxes or dichotomous (present/absent) reporting was the most common method of tracking symptoms and was available in 75 % of apps. Only a small subset (n = 13) of apps allowed for charting/graphing of pain symptoms across cycles. Fourteen percent of apps included healthcare professionals or researchers in their development and one app reported use of end-users. Overall app quality measured through the Mobile App Rating Scale (MARS) was found to be acceptable; however, the apps ability to impact pain and symptom management (e.g., impact on knowledge, awareness, behaviour change, etc.) was rated as low. Only 10 % of apps (n = 12) had interventions designed to manage pain. The findings suggest that despite pain and symptom management content being present in apps, this content is largely not evidence-based in nature. More research is needed to understand how pain and symptom management content can be integrated into apps to improve user experiences.

Comorbid pain experiences in young women with dysmenorrhea.

The association among dysmenorrhea, chronic pain, and conditions classified as central sensitivity syndromes (CSS) is largely unknown. We investigated the co-occurrence of dysmenorrhea with chronic pain and other CSS (e.g., fibromyalgia, migraines); and, whether severity of menstrual symptoms was associated with severity of chronic pain and of somatic symptoms. Women from a mid-sized Canadian university women (N = 248, Mage = 21.52) completed measures of menstrual pain severity, chronic pain severity, somatic symptoms severity, and the presence of comorbid CSS. Pearson's correlations assessed the relationship between severity of dysmenorrhea, chronic pain, and somatic symptoms. MANOVA procedures assessed the interaction between dysmenorrhea and chronic pain and χ2 analyses were used to test the frequency of CSS among women with dysmenorrhea. Higher ratings of menstrual symptom severity were associated with increased chronic pain severity (r =.66, p <.001), and somatic symptom severity (r =.66, p <.001). Women with dysmenorrhea were not more likely to experience chronic pain, but were more likely to report a CSS, χ2 (1) = 5.12, p <.05. Dysmenorrhea symptoms may extend beyond the menstrual phase and be associated with more severe symptoms among women with comorbid pain and somatic concerns.