Prevalence and associated psychosocial and health factors of chronic pain in adolescents: differences by sex and age

Abstract

Background

Chronic pain is a common issue in adolescents. Prevalence of pain and associated factors present differently in sex and age subgroups, however, the interaction of sex and age combined has not been thoroughly assessed. This study aimed to identify psychosocial and health factors associated with chronic pain in younger and older adolescent girls and boys.

Methods

Students from 5 schools in grades 5‐10 self‐completed a pain survey. Participants were 2280 adolescents (52% female) aged 10‐18 years (M=12.95, SD=1.84). Data were analyzed using multivariate logistic regression models.

Results

Chronic pain was present in 33% of participants. The risk of chronic pain increased by 29% in girls, compared to 16% in boys, per year of age (p=.039). Overall, depression (OR=2.05, p<.001), anxiety (OR=1.51, p<.001), lower school satisfaction (OR=1.41, p=.034) and sleep issues (OR=2.34, p<.001) were associated with chronic pain. Stratified analyses identified unique significant associations between chronic pain and psychosocial factors. In boys aged 10‐13 years, higher socioeconomic status (OR=1.76, p=.024) and poorer school performance (OR=1.60, p=.027) were uniquely important; in girls aged 10‐13 years, lower school satisfaction (OR=2.92, p=.003) was associated with pain, and in older girls aged 14‐18 years, anxiety (OR=1.74, p=.009) was significantly associated with pain. When these differences were assessed statistically, only lower school satisfaction had significant differences between subgroups (p=.049).

Conclusions

Many psychosocial and health factors are similarly important, with few differences, for chronic pain in girls and boys at different stages of adolescence.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/39uBDDC
via IFTTT

Von Frey testing revisited – provision of an online algorithm for improved accuracy of 50% thresholds

Abstract

Background

In the pain field, it is essential to quantify nociceptive responses. The response to the application of von Frey filaments to the skin measures tactile sensitivity and is a surrogate marker of allodynia in states of peripheral and/or central sensitization. The method is widely used across species within the pain field. However, uncertainties appear to exist regarding the appropriate method for analysing obtained data. Therefore, there is a need for refinement of the calculations for transformation of raw data to quantifiable data.

Methods

Here, we briefly review the fundamentals behind von Frey testing using the standard up‐down method and the associated statistics and show how different parameters of the statistical equation influence the calculated 50% threshold results. We discuss how to obtain the most accurate estimations in a given experimental setting.

Results

To enhance accuracy and reproducibility across laboratories, we present an easy to use algorithm that calculates 50% thresholds based on the exact filaments and their interval using math beyond the traditional methods. This tool is available to the everyday user of von Frey filaments and allows the insertion of all imaginable ranges of filaments and is thus applicable to data derived in any species.

Conclusion

We advocate for the use of this algorithm in order to minimise inaccuracies and to improve internal and external reproducibility.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2F8LtNv
via IFTTT

Author’s reply to Sharvill

Sharvill raises valid concerns about women accessing early pregnancy care.12 The National Institute for Health and Care Excellence recommends that all women presenting with pain or bleeding in early...

from Latest headlines from BMJ https://ift.tt/2Qc77GO
via IFTTT

Evolution in acute pain assessment and treatment in the pediatric emergency department of a tertiary health care center

Abstract

Background

Pediatric pain remains one of the most misunderstood, under‐diagnosed and under‐treated medical problems in children.

Aim

To investigate the accuracy of acute pain assessment and management in the Pediatric Emergency Department in Lithuanian University of Health Sciences Hospital.

Methods

We performed a retrospective record analysis before (the year 2017) and after (the year 2018) pediatric pain training course was conducted. In total, 1000 randomly selected outpatient records were analyzed. We divided all patients into two groups: group A records from 2017, group B – from 2018. Patients were further divided into trauma and non‐trauma and subdivided into 4 different age groups. We collected patient age, the origin of pain, pain characteristics, pain score, and medication.

Results

We compared 500 children in each group. Group A and B consisted of 154 (30.8%) and 116 (23.2%) trauma patients respectively. The pain was scored less in group A (420 children (84%)) compared to group B (94.4% of all 500 patients, p<0.001). In all age groups, the pain was assessed more often, and pain medication was prescribed more often in group B compared to group A (p <0.001). There was a tendency to assess pain more often in group A non‐trauma patients (p=0.054). However, pain relief in trauma patients was less adequate compared to non‐trauma.

Conclusion

Our research showed improvement in pain evaluation and treatment after systemic and local changes in PED. In group B, pain was evaluated more frequently, and patients received pain medication more often than in group A. Teenagers are still less likely to receive analgesics than toddlers. Tendency remains to give fewer painkillers to trauma patients compared to non‐trauma children.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2Qdpo6A
via IFTTT

Learning to fear pain after observing another’s pain: An experimental study in schoolchildren

Abstract

Background

Children of individuals with chronic pain have an increased vulnerability to experience pain problems, possibly through observation of pain in their parents. As pain‐related fear (PRF) is a critical factor in the development and maintenance of chronic pain, the current experimental study examined the acquisition of PRF through observational learning and subsequent extinction after first‐hand experience of the feared stimulus.

Methods

Healthy children (8–16 years) observed either their mother or a stranger performing two cold pressor tasks (CPT) filled with coloured water. In a differential conditioning procedure, one colour (CS+) was combined with genuine painful facial expressions and the other colour (CS‐) with neutral facial expressions. Following this observation phase, children performed both CPTs (10°C) themselves.

Results

Children expected the CS + to be more painful than the CS‐ and they reported being more afraid and hesitant to immerse in the CS + compared to the CS‐. Moreover, this fear was reflected in children's level of arousal in anticipation of CPT performance. This learned association extinguished after performing both CPTs. Effects were not moderated by whether the child observed their mother or a stranger, by the child's pain catastrophizing, trait PRF or trait anxiety. Remarkably, learning effects increased when the child perceived a larger difference between the model's painful and neutral facial expressions.

Conclusions

This study provides evidence for observational learning of PRF and subsequent extinction in schoolchildren. This acquisition of PRF by observing parental pain may contribute to vulnerabilities in children of parents with chronic pain.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/2MHQvon
via IFTTT

Biopsychosocial Influences on Shoulder Pain: Analyzing the Temporal Ordering of Post-Operative Recovery

Shoulder surgery has become a primary intervention for treating persistent shoulder pain, with the number of procedures now exceeding 500,000 annually.26 However, many patients who undergo shoulder surgery experience persistent post-operative pain.3,35 For musculoskeletal pain conditions, current research initiatives aim to identify phenotypical characteristics that predict variability in treatment outcomes.4,12 Our team used exercised-induced shoulder pain to identify an interaction between psychological distress (pain catastrophizing) and genetics (catechol-O-methyltransferase (COMT) enzyme activity) that predicted elevated pain and disability.

from The Journal of Pain https://ift.tt/367ayV1
via IFTTT

Quality of Chronic Pain Interventional Treatment guidelines from Pain Societies: Assessment with the AGREE II instrument

Abstract

Background and Objective

Procedures to relieve pain are performed frequently but there are concerns about patient selection, appropriate image‐guidance, frequency, and training for physicians. Patients, healthcare providers, policymakers, and licensing bodies seek evidence‐based recommendations to use these interventions judiciously. In this review we appraised the methodological quality of recent clinical practice guidelines (CPGs) for interventional pain procedures.

Database and Data Treatment

A systematic search of the medical literature was performed. Three trained appraisers independently evaluated the methodological quality of the CPGs using a validated instrument, the Appraisal of Guidelines in Research and Evaluation II (AGREE‐II). Six domains were considered: 1) score and purpose; 2) stakeholder involvement; 3) rigour of development; 4) clarity of presentation; 5) applicability; and 6) editorial independence. A total of 23 items were scored. CPGs were deemed “high quality” if a mean scaled score above 60% for rigour of development and for two other domains was obtained.

Results

Mean scaled domain quality scores ranged from 61.72% to 69.99%. Despite being based on modest levels of evidence, two of the four included CPGs were considered to be of high methodological quality. The AGREE II scores across the four guidelines exhibited good inter‐rater reliability. None of the guidelines involved key stakeholders such as patients, other healthcare providers, and payers.

Conclusions

All four CPGs were limited by a weak execution of the guideline development process. There is a need to develop methodologically‐sound evidence‐based guidelines for use of interventional pain procedures using a rigorous process that involves all relevant stakeholders.

from Wiley: European Journal of Pain: Table of Contents https://ift.tt/39lTigv
via IFTTT