Psychosocial perspectives in the treatment of pediatric chronic pain (original) (raw)
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Chronic pain in children and adolescents
Paediatric nursing, 2006
Chronic pain is a widespread and significant clinical problem. It can result in major negative short- and long-term physical and emotional effects in multiple domains of children's and their families' lives as Pain Associated Disability Syndrome. Assessment of chronic pain is challenging but it is an essential clinical task. Management requires a multidimensional response focussing on the whole patient. Specialist pain management units and programmes use cognitive behavioural methods and promote adaptive coping and focus on the child re-engaging with normal activities. While chronic pain is not well understood, there is emerging evidence that young people and their parents can recover from chronic disability, dependency and distress, and return to a normal life.
Current Pain and Headache Reports, 2018
Purpose of Review In the context of new efforts to formulate more comprehensive diagnostic and treatment processes for chronic pain conditions, this review aims to provide an overview of some of the most salient developments in the diagnosis and clinical treatment of pediatric chronic pain and to delineate the current and future role of clinical pediatric psychologists in these efforts. Recent Findings The acceptance and promotion of the multidisciplinary approach to pediatric pain management has had an especially significant impact on the field of pediatric psychology. Though chronic pain was historically conceptualized as a biomedical problem, psychology is increasingly viewed as a routine, integral, and component part of treatment. With this evolving biopsychosocial paradigm, pediatric psychology is poised to help shape the development of this field, contributing to emerging conceptual and diagnostic frameworks via consultation, research, clinical care, and education. Summary This review discusses the role of pediatric psychologists as collaborators in emerging diagnostic and assessment frameworks, leaders in pain-related research, drivers of clinical care, and educators for providers, patients, and the lay public. With increased opportunities to enhance the conceptualization and treatment of pediatric pain, pediatric psychologists have an important role to play in reducing the prevalence and persistence of pediatric pain.
Advances in pediatrics, 2010
P ediatric chronic pain has been an increasingly significant problem over the last 5 years. It is estimated to occur in 15% to 30% of school-age children [1]. Pain is not only a significant emotional stressor for the family unit but also an expensive one. Lost work from parental absences to care for the child as well as increasing costs of health care use are significant. There is increasing evidence that the development of chronic pain in childhood may lead to chronic pain as an adult. The behavioral consequences of school absences, changed peer relationships, effects on social activities, and effects on family interactions affect the child, his siblings, and his future. It is important to recognize that in the pediatric population, nonorganic factors may be as important as organic factors in maintaining pain and that both need to be addressed. Because all pain involves neurosensory changes and may involve altered pain processing, the use of ‘‘organic’’ or ‘‘medical’’ versus ‘‘nono...
Chronic and recurrent benign pain complaints are common among children and adolescents. Although many young persons with chronic pain adapt well, a small, but significant, proportion experience marked functional deficits. Pain can produce life disruptions, e.g. impeding activities and maturation, and interferes with family functioning. Conventional medically-based approaches have been inadequate in addressing chronic pain and its sequelae. Instead, effective management requires an interdisciplinary approach involving paediatricians and mental health practitioners working collaboratively to treat psychiatric comorbidities, enhance the pa-tientÕs functional adaptation, restore the child or adolescentÕs maturational and social capabilities and reduce family disruptions.
Psychological theories and models in pediatric pain
Th e purpose of this chapter is to review existing biopsychosocial models of paediatric pain and to examine common key factors across diff erent theoretical conceptualizations. Critical gaps in the empirical and theoretical literature are elucidated. In particular, lack of specifi c attention to developmental factors in biological, behavioural, and social functioning and the need for models that examine gaps in diff erent types of pain responding (e.g. immediate acute pain response, acute pain responding in the context of chronic pain) are highlighted. Moreover, the need for comprehensive, conceptual models, representative of current knowledge, that readily generate specifi c hypotheses confi rmable by experimentation are also discussed as ways of moving the fi eld of paediatric pain forward, both conceptually and pragmatically.
Family and parent influences on pediatric chronic pain: A developmental perspective
American Psychologist, 2014
Pain that recurs or persists is unfortunately a common experience for children. One of the unique considerations in pediatric chronic pain management is the bidirectional influences of children's pain experiences and parental and family factors. In this review we present a developmental perspective on understanding pediatric chronic pain and disability, highlighting factors relevant from infancy to adolescence, and family and parent influences. Preliminary evidence indicates that developmental processes are influenced and may also shape the pediatric pain experience. Parent emotions, behaviors, and health also play a role in children's pain experiences, where overly protective parent behaviors, increased distress, and history of chronic pain are important parent-level influences. Research on familylevel influences has revealed that families of children with chronic pain have poorer family functioning (e.g., more conflict, less cohesion) than families of healthy children. Several important gaps exist in this research, such as in understanding basic developmental processes in children with chronic pain and how they influence children's perception of and responses to pain. Also, there is a lack of longitudinal data on family relationships and individual adjustment to allow for understanding of whether changes occur in parenting over the course of the child's chronic pain experience. Although parent interventions have been successfully incorporated into many cognitive-behavioral treatments for children with chronic pain conditions, little guidance exists for adapting intervention strategies to be developmentally appropriate. Additional research is needed to examine whether parent interventions are effective at different developmental stages and the best way to incorporate developmental goals into treatment.
Pain, 2000
The ultimate objective of our epidemiological research is to complete a longitudinal population-based study to document the prevalence and impact of acute, recurrent, and chronic pain in children and adolescents. As the ®rst phase of our epidemiological research, we developed a comprehensive screening instrument for identifying children with acute, recurrent, and chronic pain, the Pain Experience Interview. We designed this interview to provide information about the lifetime and point prevalence of various pains, and also to provide information about the intensity, affect, duration, and frequency of children's pain. The primary objective of this study was to validate the Pain Experience Interview using the discriminant validation procedure of group differences. The secondary objectives of our study were to obtain descriptive data on children's acute, recurrent, and chronic pain experiences and to conduct exploratory analyses on age-and gender-related differences in children's pain experiences. We interviewed 187 children from ®ve different health groups (arthritis, cancer, enuresis, recurrent headaches, and healthy) to provide distinct subsets of children with respect to their acute, recurrent, and chronic pain experience, and from four different age groups (5±7, 8±10, 11±13, and 14±16 years) to provide distinct subgroups with respect to children's developmental level. To test the interview we determined a priori several study predictions about children's pain experiences. These included four predictions about the common response patterns that we would expect to observe for all children based on our understanding of acute pain caused by trauma/ disease, and six predictions about the distinct response patterns that we would expect to observe based on the known differences among children in their experiences of headache, acute treatment-related pain, recurrent pain, and chronic pain. All study predictions were con®rmed, demonstrating that the Pain Experience Interview is a valid screening instrument for differentiating children with different types of pain problems. The interview can provide estimates for the lifetime and point prevalence of various pains in children, and data on the intensity, affect, duration, and frequency of their pain experiences. q 2000 Published by Elsevier Science B.V. on behalf of the International Association for the Study of Pain.
Journal of Pediatric Psychology, 2017
Objective Psychological intervention is widely recognized as an integral part of the recovery process from pediatric chronic pain, but service acquisition is often limited by resource barriers. The aim of this study was to assess the feasibility, acceptability, and satisfaction of a brief, structured, skills-based, group intervention designed expressly to address gaps in service delivery. Exploratory outcomes were also assessed. Method Adolescents with chronic pain (n ¼ 102; ages 10-17 years) and their mothers (n ¼ 105) completed self-report questionnaires at baseline, 1-week, 1-month, and 3-month posttreatment. Results This study demonstrated feasibility, and overall high acceptability and satisfaction among adolescents and parents. Exploratory analyses within this nonrandomized design suggest that adolescents demonstrate improvement in functionality (p ¼ .0012), depression symptoms (p < .0001), and pain catastrophizing (p < .0001) by 1-month posttreatment and continued making gains over time. Parents made significant changes in parenting practices (p-values < .01) and in their beliefs about their adolescent's ability to manage pain (p < .001) by 1-week posttreatment and continued making gains over time. Conclusions This brief intervention is both feasible and acceptable. Although small effect sizes were found for all outcome measures, parents and adolescents made significant gains postintervention. In the absence of a direct comparison group, we cannot determine if these improvements are exclusively attributable to the intervention. Future research will be needed to understand the degree to which this brief intervention may effectively enhance the attainment of evidence-based psychoeducation and cognitive behavioral skills that are known to foster adaptive parent and adolescent responses to chronic pain.