Autonomy and competence satisfaction as resources for facing chronic pain disability in adolescence: a self-determination perspective.

This study aimed to test empirically the developmental goal pursuit model of paediatric chronic pain, which draws upon Self-Determination Theory for understanding risks and resources for living with chronic pain. This study examined the relationship between basic psychological need satisfaction (i.e. the satisfaction of the needs for autonomy, relatedness and competence) and the fear-avoidance model of pain in adolescents suffering from chronic pain. Hundred and twenty adolescents (mean age = 14.52, 71.6% female), receiving treatment through paediatric pain centres for chronic pain, were enrolled. Adolescents completed measures of basic psychological need satisfaction, fear and avoidance of pain, and pain-related functional impairment. Path analyses model indicated that higher levels of autonomy and competence satisfaction were associated with lower levels of functional disability, through the mediation of fear and avoidance of pain. Relatedness satisfaction was not significatively related to fear of pain, avoidance, and functional disability. The integration of Self-Determination Theory in the paediatric pain literature may further our understanding of potential resources for decreasing functional disability in children living with chronic pain.

[Pain and postoperative behavioural changes following adenoidectomy and ear tube placement in children]. / Douleur et troubles comportementaux après adénoïdectomie et pose d'aérateurs transtympaniques chez l'enfant.

OBJECTIVES: The purpose of this study was to evaluate postoperative pain in the hospital and at home as well as behavioural changes at home following outpatient adenoidectomy (VG) and ear tube (ATT) surgery. STUDY DESIGN: Prospective cohort study. PATIENTS AND METHODS: Sixty-four children (mean age 4.3+/-2.4 years): 28 VG, 16 (ATT), 20 dual surgeries (VG-ATT). Postoperative pain was evaluated (arrival in recovery room, departure from wake-up room, departure from hospital) using the Objective Pain Scale (OPS). Parents evaluated their child's pain at home over a period of seven days using a numeric pain scale. Behavioural changes were measured with the Post-Hospital Behaviour Questionnaire (PHBQ). RESULTS: At arrival in the recovery room, OPS=3.5 [0-6]. A statistically significant difference (p<0.05) was shown between the VG group (OPS=5 [2.25-7.75]), and the ATT (OPS=0 [0-5.5]) and VG-ATT (OPS=2 [0-5.75]) groups. OPS was 1.0 [0-2] when leaving the recovery room, and OPS was 0 [0-1] when leaving the hospital. Numeric pain scale scores recorded at home were extremely low. Postoperatively, 75% of parents at Day 1 and 40.6% at Day 7 reported at least one postoperative behavioural change. DISCUSSION: In all three groups, parents reported frequent postoperative behaviour changes despite adequate analgesia. CONCLUSION: The relatively high frequency of postoperative behaviour changes in this population demonstrates the need to systematically evaluate those changes in order to improve overall paediatric care.

[Anxiety and depression in children and adolescents with migraine: a review of the literature]. / Anxiété et dépression chez l'enfant et l'adolescent migraineux : revue de la littérature.

INTRODUCTION: The authors review the literature on anxiety and depression in children and adolescents who experience migraine headaches. For over a century, clinicians and researchers have noticed potential links between migraine and certain psychopathological traits. More recently, rigorous methodological studies have confirmed some of those links. For example, several reviews have shown a strong comorbidity in adults between migraine, major depression and certain anxiety disorders. As for children and adolescents, no recent work has thoroughly reviewed the literature specifically on the topic of migraine, anxiety, and depression. METHODS: For the purposes of this study, research published between January 1980 and January 2007 was examined. In order to be included in the review, studies had to specify the diagnostic criteria used to indicate migraine headaches and also use validated measures for anxiety and depression. Of the eleven remaining articles, ten used a control group matched for age and sex. Only three of the studies used a representative sample of the general population. Carrying out a meta-analysis was not possible due to the dearth of articles and the wide variety of methodologies applied. The studies included in this review do not provide conclusive findings for the comorbidity of migraine, anxiety and depression in children. RESULTS: The majority of the studies with clinical populations show slightly higher scores on at least one of the anxiety or depression scales in the migraine group as compared to the control group. However, in all eleven studies, the average score on the anxiety and depression scales obtained by children with migraine did not reach a pathological level, according to the norms established by the validated scales. Findings point to above average levels of anxiety or depression, rather than diagnosed psychopathologies. Therefore, certain authors use the term "sub-clinical." One study of a clinical population, paired dimensional assessment with tests and categorical assessment, using diagnostic interviews. In this particular study, children with highly predictive anxiety or depression scores were interviewed by a psychiatrist or psychologist, in order to confirm or deny a diagnosis. No categorical difference was found. Moreover, none of the three studies carried out in the general population revealed differences between the anxiety and depression scores in children with migraine as opposed to children in the control group. The difference in results from studies in the general population and clinical populations can most likely be explained by a recruitment bias. Studies conducted with clinical populations recruit subjects from specialised medical consultations for children and adolescents with migraine, who are probably not representative of the general population. These results contradict those found in the adult population. DISCUSSION: More studies are needed to better clarify the links between anxiety, depression, and migraine in children, adolescents and adults. To ensure the validity of future studies, the following remarks should be taken into account. The distinction between headache and migraine is not always clear, even when ICHD criteria are used. The children considered to have migraines often have a variety of diagnoses. Future studies should only use the ICHD 2nd edition criteria. Children suffering from migraine are almost always recruited from specialized headache centres in hospitals. This is a very specific population and probably not representative of children with migraine in the general population. In the future, researchers should do their best to avoid this recruitment bias. The questionnaires used in these studies often contain questions related to migraine symptoms such as headache, nausea, vomiting, etc. Several authors have therefore questioned the validity of results from these questionnaires with migraine patients. CONCLUSION: Questionnaires created specifically for a research project, or containing vague terminology, such as "psychosocial disorders", should never be used. Future studies should rely on assessment tools validated for the specific population.

Dodecyl propionate, attractant from rat pup preputial gland: Characterization and identification.

A chemical agent contained in the rat pup preputial gland was found to regulate anogenital licking, a behavioral pattern crucial to pup survival. Combined gas chromatography and mass spectrometric analysis led to identification of four components in addition to high molecular alkanes (waxes). Independent synthesis added to behavioral observations were used to quantify the dam's response to these components. Among them, dodecyl propionate (DP), a pheromone-like compound, appears to be the only one efficient enough to induce, in the dam, behavior patterns similar to those observed with crude lipidic extract from the preputial gland secretion. Various esters previously were predicted in the adult rat preputial gland. DP is the first ester identified from mammalian infant tissue. These results, in combination with previous findings, allow discussion of the DP pheromonal role.

[Treatment of carotid sinus syncope by demand electro-systolic cardiac pacing]. / Traitement des syncopes sino-carotidiennes par l'entrainement cardiaque électro-systolique "sentinelle"

The observations of 2 patients having carotid sinus syncopes treated by temporary (1 case), or definitive (1 case) endovenous demand cardiac pacing are correlated with 15 similar observations found in the literature. In all these patients, cardiac pacing is more effective than all the other treatments cutting off the hyperactive reflex. Indeed, carotid sinus hypersensibility seems to be good, though unusual indication of cardiac pacing.