Children With Chronic Pain: Response Trajectories After Intensive Pain Rehabilitation Treatment

Abstract

Deriving groups of individuals with differing treatment response trajectories stimulates new thinking regarding potential mechanisms that may be driving these outcomes.

Longitudinal Analysis of Patient‐Reported Outcomes From an Interdisciplinary Pediatric Pain Rehabilitation Program for Children With Chronic Migraine and Headache

“…In addition, it should be further considered whether a linear trend is the best method to interpret response to chronic pain rehabilitation. Simons and colleagues recently identified potentially different trajectories in response to chronic pain rehabilitation, such as early and late responders . Although our data supported a significant linear trend, as this research field develops, there may be compelling reasons to examine other response trajectories, as well as factors that predict the response.…”

“…Our study also provides initial data to support the hypothesized model that, for pediatric chronic pain, treatment should target independent functioning as a primary outcome, and patients should not anticipate a reduction in pain until at a later phase of rehabilitation. Interestingly, though not unexpected, pain level was significantly lower yet not eliminated over a 1‐year time period (Table , Figure ). The majority of our patients still reported pain from headache 1 year following rehabilitation.…”

Pain Stickiness in Complex Regional Pain Syndrome: A role for the Nucleus Accumbens

“…Our previous study based on a large group of patients (n = 253) suggested the predictive influence of several baseline characteristics (e.g. pain problem complexity, older adolescence age and cognitive-affective factors) [55]. However, results from this work showed that brain metric measures might have a better performance in the prediction of individual responsivity, especially when only limited prior information is available.…”

“…One of the observations in the latter reports was the ‘normalization’ of networks and gray matter changes when pretreatment vs. posttreament scans were evaluated. Despite observed changes in brain metrics and converging evidence of improved pain and functioning [26; 33; 56], not all patients respond to treatment with improvements in pain [55]. Despite emerging evidence of brain markers of the transition from acute to chronic pain [4; 25], there is no known data on baseline brain metrics that can distinguish pain responders and nonresponders who undergo pain treatment.…”

Subliminal (latent) processing of pain and its evolution to conscious awareness

“…The contribution of these states of decreasing the threshold for activation of pain awareness have not been explored. However, associated symptoms such as catastrophizing (Coronado et al, 2015; Quartana et al, 2009) or fear of pain (Simons et al, 2012, 2017) may predict later onset of pain. Some have argued that anxiety or chronic stress may exacerbate pain (Li et al, 2017) through alteration in specific nuclei (e.g., amygdala) via a process that induced neuronal sensitization due to decreased inhibition (Jiang et al, 2014).…”