A developmental perspective on the impact of chronic pain in late adolescence and early adulthood: implications for assessment and intervention

Rosenbloom, Brittany N.; Rabbitts, Jennifer A.; Palermo, Tonya M.

doi:10.1097/j.pain.0000000000000888

Cited by 54 publications

(45 citation statements)

References 54 publications

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“…Our study of surviving teenagers with bilateral CP from a total population cohort confirms that pain is a common experience for these young people at an age when they are striving for greater independence in the world, 27 and is associated with severity both of motor impairment (increasing GMFCS and non-ambulant) and of general ill health but not deformity, sex, SDQ score, intellectual disability, or maternal education (this is in line with previous cross-sectional studies). 3,4,6 It is important to note that some young people in all GMFCS levels experience regular moderate/severe pain.…”

Section: Discussionsupporting

confidence: 89%

Factors associated with pain in adolescents with bilateral cerebral palsy

Fairhurst

Shortland

Chandler

et al. 2018

Develop Med Child Neuro

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Aim We explored factors associated with pain and its severity in a population cohort of young people with bilateral cerebral palsy, comparing parent/carer and young people self‐reports. Method Of 278 survivors (mean age 16y 8mo, SD 1y 4mo, range 13y 8mo–19y 3mo) from the South Thames in the Study of Hips and Physical Experience cohort of 338 young people with bilateral cerebral palsy, 212 parents/carers and 153 young people completed questionnaires on the presence, severity, timing, site, associated factors, impact, and treatment of pain. Results Seventy per cent of parents/carers reported pain within 3 months, 59% the previous week, and 50% the previous day with 56% reporting ‘regularly experienced’. Of young people able to do so, 63% reported pain within 3 months, 50% the previous week, and 42% the previous day, with 48% reporting regular pain. There was strong agreement between the parent/carer and young people, reporting pain severity over the previous 3 months. Pain severity was associated with increased motor impairment and comorbidity, particularly constipation, spasticity, equipment use, and higher emotional score, but not sex, intellectual disability, speech, or maternal education. Multiple sites of musculoskeletal pain were reported in two‐thirds of individuals. Pain was associated with voluntary movement in individuals with less motor impairment and with being moved in those with severe motor impairment. Greater pain severity had a negative effect on both physical and psychological quality of life. Interpretation Increasing awareness of the comorbidities in cerebral palsy may aid effective treatment, reducing pain experienced by young people with cerebral palsy. What this study adds Regular moderate or severe pain is reported in young people with bilateral cerebral palsy (CP) in all Gross Motor Function Classification System levels. Pain is reported more frequently in young people who are non‐ambulant. General ill health is strongly associated with severity of pain after controlling for severity of CP, especially constipation. Pain occurs most often in ambulant young people during voluntary activity and in those who are non‐ambulant when being moved. There is strong agreement between parents/carers and young people about pain presence and severity.

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Section: Discussionsupporting

confidence: 89%

Factors associated with pain in adolescents with bilateral cerebral palsy

Fairhurst

Shortland

Chandler

et al. 2018

Develop Med Child Neuro

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“…They may have focused on independently managing pain and utilizing positive social support (i.e., with encouraging parental responses) rather than relying on psychological treatment. Nevertheless, research is also needed to better understand the role of other potentially relevant barriers for adolescents or families (e.g., stigma) in predicting treatment compliance [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Risk and Resilience Factors Impacting Treatment Compliance and Functional Impairment among Adolescents Participating in an Outpatient Interdisciplinary Pediatric Chronic Pain Management Program

Dutta

Salamon

2020

Children

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Recurrent pain is a common experience in childhood and adolescence and can result in significant disability in youth, including poor quality of life, school absences, and reduced social activities. Evidence has linked adolescent risk and resilience factors with treatment outcomes. However, less research has focused on examining risk and resilience factors that may influence or predict adolescents’ compliance to treatment within an interdisciplinary pediatric chronic pain management program. Participants included 64 adolescents (M = 15.00 ± 1.69 years); 85.9% female, 84.4% Caucasian who presented to an initial evaluation in an interdisciplinary pediatric pain management program with their caregiver. Youth completed a series of questionnaires at the initial evaluation targeting pain acceptance, self-efficacy, pain catastrophizing, parental responses, pain intensity, and functional disability. Treatment compliance was measured at 3 and 6 months post-intake. Findings indicated that higher levels of adolescent-reported self-efficacy predict decreased treatment session attendance, whereas lower levels of acceptance and parental encouragement/monitoring of symptoms predict increased treatment compliance overall. Several adolescent-reported risk factors were associated with increased functional impairment among this sample. Results highlight the unique importance of risk and resilience factors within the developmental context of adolescence, while also emphasizing the need for further investigation of other relevant influences towards treatment compliance and functional impairment.

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“…The opioid epidemic extends to the pediatric population, with evidence indicating that deaths from drug overdose in adolescents more than doubled from 1999 to 2007 and have continued to rise, with the majority of deaths due to opioid‐related drug overdoses . Most adolescents who abuse opioids began with a prescription opioid and many transitions that occur during adolescence, including neurobiological, behavioral, and psychological changes can leave adolescents vulnerable to both chronic pain and drug use . Thus, adolescents are a particularly at‐risk population in the context of the opioid epidemic.…”

Section: Problem 1: the Opioid Epidemicmentioning

confidence: 99%

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

Fortier

Yang

Phan

et al. 2019

Pediatric Blood & Cancer

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The opioid crisis in the United States has grown at an alarming rate. Children with cancer are at high risk for pain, and opioids are a first‐line treatment in this population. Accordingly, there is an urgent need to optimize pain management in children with cancer without contributing to the opioid crisis. This report details opportunities for this optimization, including clinical practice guidelines, comprehensive approaches to pain management, mobile health, and telemedicine. It is vital to balance appropriate use of analgesics with efforts to prevent misuse in order to reduce unnecessary suffering and minimize unintended harms.

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A developmental perspective on the impact of chronic pain in late adolescence and early adulthood: implications for assessment and intervention

Cited by 54 publications

References 54 publications

Factors associated with pain in adolescents with bilateral cerebral palsy

Factors associated with pain in adolescents with bilateral cerebral palsy

Risk and Resilience Factors Impacting Treatment Compliance and Functional Impairment among Adolescents Participating in an Outpatient Interdisciplinary Pediatric Chronic Pain Management Program

Children's cancer pain in a world of the opioid epidemic: Challenges and opportunities

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