Alterations in pain during adolescence and puberty

Nahman‐Averbuch, Hadas; Li, Rui; Boerner, Katelynn E.; Garwood, S. Gray; Palermo, Tonya M.; Jordan, Abbie

doi:10.1016/j.tins.2023.01.006

Cited by 12 publications

(7 citation statements)

References 106 publications

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“…More specific to the perioperative time frame, existing research supports positive relationships between the expected degree of postoperative pain when assessed preoperatively and subsequent reported degree of pain in the postoperative period [ 21 ]. Additionally, emerging literature suggests direct impacts of sex steroid hormones on subjective pain perception in the peripubertal time period [ 22 , 23 ]. This is particularly relevant to this patient population given the age range of patients included in this study overlaps significantly with the age range of puberty in both adolescent females and males [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Sex related difference in postoperative pain and opioid use following posterior spinal fusion for adolescent idiopathic scoliosis

Collis,

Dry,

Chan

et al. 2024

Spine Deform

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Purpose This project aims to evaluate the relationship between biological sex and postoperative pain and in patients receiving posterior spinal fusion for adolescent idiopathic scoliosis. Methods This is a retrospective study of patients (n=137) aged 10-17 receiving posterior spinal fusion for adolescent idiopathic scoliosis between 01/2018 and 09/2022. Each patient received surgery by the same pediatric orthopedic surgeon with identical postoperative pain management regimen at a children’s hospital or a tertiary referral center with a pediatric spine program. Results There were no significant differences in any background characteristics between the male and female patients, including age, BMI, number of levels fused, preoperative degree of scoliosis, and length of surgery and anesthesia (p>0.05). There were no differences in amount given of any intraoperative medications, nor in amount of postoperative scheduled analgesics (p>0.05). Female patients demonstrated higher average pain scores on Visual Analogue Scale evaluations during the first 24 hours postoperatively (5.0 vs 3.6, p<0.0001), 24-48 hours postoperatively (4.9 vs 4.0, p=0.03), and at the first physical therapy evaluation (5.3 vs 3.8, p<0.001). These patients received significantly greater amounts of morphine milligram equivalents in the first 24 hours postoperatively (42.2 vs 31.5, p=0.01) and for the hospitalization in total (63.8 vs 51.3, p=0.048). There was no difference in hours until hospital discharge (44.3 vs 42.6, p=0.62) nor until first ambulation (20.1 vs 21.3, p=0.24) between the female and male patients. Conclusion The influence of biopsychosocial factors on postoperative pain in adolescents is complex. This study adds to the existing pool of literature suggesting differences in pain perception between adolescent female and male patients. Female patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis may benefit from increased preoperative counseling and more aggressive intra- and postoperative pain management regimens.

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Section: Discussionmentioning

confidence: 99%

Sex related difference in postoperative pain and opioid use following posterior spinal fusion for adolescent idiopathic scoliosis

Collis,

Dry,

Chan

et al. 2024

Spine Deform

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show abstract

“…This is particularly true in the adolescent population as FAPD [ 5 , 8 ] and anxiety [ 75 ] increases and can become more severe as children age and transition to adolescence. This is a period marked by pubertal and developmental changes that may alter changes in neural functioning associated with pain processing [ 76 ]. Therefore, additional investigation of the impact of pubertal status on pain processing following effective treatments will be important in future research.…”

Section: Discussionmentioning

confidence: 99%

Study protocol for a pilot clinical trial to understand neural mechanisms of response to a psychological treatment for pain and anxiety in pediatric functional abdominal pain disorders (FAPD)

Cunningham,

Adler,

Barber Garcia

et al. 2024

PLoS ONE

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Background Functional abdominal pain disorders (FAPD) are the most common chronic pain conditions of childhood and are made worse by co-occurring anxiety. Our research team found that the Aim to Decrease Pain and Anxiety Treatment (ADAPT), a six-session coping skills program using cognitive behavioral therapy strategies, was effective in improving pain-related symptoms and anxiety symptoms compared to standard care. In follow-up, this current randomized clinical trial (RCT) aims to test potential neural mechanisms underlying the effect of ADAPT. Specifically, this two-arm RCT will explore changes in amygdalar functional connectivity (primary outcome) following the ADAPT protocol during the water loading symptom provocation task (WL-SPT). Secondary (e.g., changes in regional cerebral blood flow via pulsed arterial spin labeling MRI) and exploratory (e.g., the association between the changes in functional connectivity and clinical symptoms) outcomes will also be investigated. Methods We will include patients ages 11 to 16 years presenting to outpatient pediatric gastroenterology care at a midwestern children’s hospital with a diagnosis of FAPD plus evidence of clinical anxiety based on a validated screening tool (the Generalized Anxiety Disorder-7 [GAD-7] measure). Eligible participants will undergo baseline neuroimaging involving the WL-SPT, and assessment of self-reported pain, anxiety, and additional symptoms, prior to being randomized to a six-week remotely delivered ADAPT program plus standard medical care or standard medical care alone (waitlist). Thereafter, subjects will complete a post assessment neuroimaging visit similar in nature to their first visit. Conclusions This small scale RCT aims to increase understanding of potential neural mechanisms of response to ADAPT. Trial registration ClinicalTrials.gov registration: NCT03518216.

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“…This is particularly true in the adolescent population as FAPD [5,8] and anxiety [75] increases and can become more severe as children age and transition to adolescence. This is a period marked by pubertal and developmental changes that may alter changes in neural functioning associated with pain processing [76]. Therefore, additional investigation of the impact of pubertal status on pain processing following effective treatments will be important in future research.…”

Section: Discussionmentioning

confidence: 99%

Study protocol for a pilot clinical trial to understand neural mechanisms of response to a psychological treatment for pain and anxiety in pediatric functional abdominal pain disorders (FAPD)

Cunningham,

Adler,

Barber Garcia

et al. 2024

Preprint

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Background. Functional abdominal pain disorders (FAPD) are the most common chronic pain conditions of childhood and are made worse by co-occurring anxiety. Our research team found that the Aim to Decrease Pain and Anxiety Treatment (ADAPT), a six-session coping skills program using cognitive behavioral therapy strategies, was effective in improving pain-related symptoms and anxiety symptoms compared to standard care. In follow-up, this current randomized clinical trial (RCT) aims to test potential neural mechanisms underlying the effect of ADAPT. Specifically, this two-arm RCT will explore changes in amygdalar functional connectivity (primary outcome) following the ADAPT protocol during the water loading symptom provocation task (WL-SPT). Secondary (e.g., changes in regional cerebral blood flow via pulsed arterial spin labeling MRI) and exploratory (e.g., the association between the changes in functional connectivity and clinical symptoms) outcomes will also be investigated. Methods. We will include patients ages 11 to 16 years presenting to outpatient pediatric gastroenterology care at a midwestern children’s hospital with a diagnosis of FAPD plus evidence of clinical anxiety based on a validated screening tool (the Generalized Anxiety Disorder-7 [GAD-7] measure). Eligible participants will undergo baseline neuroimaging involving the WL-SPT, and assessment of self-reported pain, anxiety, and additional symptoms, prior to being randomized to a six-week remotely delivered ADAPT program plus standard medical care or standard medical care alone (waitlist). Thereafter, subjects will complete a post assessment neuroimaging visit similar in nature to their first visit. Conclusions. This small scale RCT aims to increase understanding of potential neural mechanisms of response to ADAPT. ClinicalTrials.gov registration:NCT03518216

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Alterations in pain during adolescence and puberty

Cited by 12 publications

References 106 publications

Sex related difference in postoperative pain and opioid use following posterior spinal fusion for adolescent idiopathic scoliosis

Sex related difference in postoperative pain and opioid use following posterior spinal fusion for adolescent idiopathic scoliosis

Study protocol for a pilot clinical trial to understand neural mechanisms of response to a psychological treatment for pain and anxiety in pediatric functional abdominal pain disorders (FAPD)

Study protocol for a pilot clinical trial to understand neural mechanisms of response to a psychological treatment for pain and anxiety in pediatric functional abdominal pain disorders (FAPD)

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