Chronic Pediatric Pain Management: a Review of Multidisciplinary Care and Emerging Topics

Collins, Andrew B.

doi:10.1007/s40141-019-0211-7

Cited by 3 publications

(2 citation statements)

References 82 publications

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“…These findings indicated that poorer performance on physical functioning assessments was linked to low mood and pain catastrophizing but not pain intensity. This lends support to the biopsychosocial model of pain and functioning [32,33], specifically the contribution of psychological factors to pain-related functional impairment. The present study suggests this model is nuanced; whereas some psychological factors are associated with physical ability, others are not, revealing the need for further examination of a tailored treatment approach that focuses on mood (e.g., via behavioral activation) and pain catastrophizing (e.g., via cognitive restructuring).…”

Section: Discussionsupporting

confidence: 60%

Psychological predictors of performance-based physical functioning among pediatric pain program participants

Bourchtein,

McLaughlin,

Walainis

et al. 2024

PRM

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PURPOSE: The purpose of the present study was to evaluate changes in performance-based physical functioning and investigate psychological predictors of physical functioning over time in pediatric patients with chronic pain who completed an interdisciplinary rehabilitation intensive outpatient program (IOP). METHODS: Participants (N = 55; mean age = 14.92 years; 12.7% male, 87.3% female; 83.6% White, 5.6% African-American/Black; 9.1% Latinx) completed baseline measures assessing pain intensity and modifiable psychological factors (i.e., pain catastrophizing, kinesiophobia, anxiety and depressive symptoms). Participants were administered performance-based assessments of physical functioning (i.e., physical endurance, high-level motor abilities) before and after IOP completion. RESULTS: Pain intensity was not significantly associated with physical functioning at either timepoint. There was significant improvement on measures of physical functioning after completion of the IOP when controlling for the effects of sex, race, and ethnicity. Depressive symptoms were associated with baseline physical endurance, β = − .28, p = .047, while pain catastrophizing was associated with baseline gross motor abilities, β = − .28, p = .032. CONCLUSION: Participation in an IOP led to significant improvement in physical endurance and high-level motor ability. Depressive symptoms and pain catastrophizing were associated with physical functioning at baseline but not post-program completion. Integration of pain psychology and physical therapy in an IOP can help address the interrelated psychological and physical factors impacting physical functioning to improve outcomes for children with chronic pain.

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Section: Discussionsupporting

confidence: 60%

Psychological predictors of performance-based physical functioning among pediatric pain program participants

Bourchtein,

McLaughlin,

Walainis

et al. 2024

PRM

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“…Considering the growing awareness of autistic patients presenting at pediatric pain clinics [ 27 ], there is an urgent need for disseminating theoretically supported ways to provide care for patients with autism and chronic pain. Interdisciplinary care models that involve collaboration between pain physicians, psychologists, physical therapists, and occupational therapists show promise for treating pain from a biopsychosocial perspective [ 28 , 29 ], but potential adaptations to better serve autistic patients in pain clinics have not yet been explored or established. Prior work focusing on adapting interventions for autistic youth has primarily focused on modifications to cognitive behavioral therapy (CBT) for treating anxiety and depression [ 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team

Han,

Heavner,

Rains

et al. 2024

Children

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Though there is growing awareness of the overrepresentation of autistic patients in chronic pain clinics, potential adaptations for the assessment and treatment of chronic pain in this population have not yet been established. To address this gap, a retrospective review of electronic medical records and discussions by an interdisciplinary pain treatment team were summarized to inform potential biopsychosocial factors affecting the presentation, assessment, and treatment of chronic pain in autistic youth. Our sample included a record review of 95 patients receiving treatment in an interdisciplinary outpatient pediatric pain clinic. Results indicated that 9% (n = 9) of the patients presented to the clinic with a prior diagnosis of autism, but an additional 21% (n = 20) were identified as likely meeting criteria for autism based on the clinical assessment of the developmental history, behaviors observed during the clinical encounter(s), and expert clinical judgment, suggesting that the prevalence rate of autism may be closer to 30% in our outpatient pediatric pain clinic. Over half (52%) of the autistic youth presented to the clinic with widespread pain, 60% identified as female, and 6% identified as gender expansive or transgender. Qualitative insights revealed that most of the autistic patients had co-occurring sensory-processing challenges and difficulty in describing their pain, emotions, and somatic experiences and exhibited cognitive inflexibility and social challenges. We summarize our team’s clinical reflections on how autism-relevant biopsychosocial vulnerability factors may contribute to the experience of pain in autistic youth and propose treatment targets and adaptations for the assessment and treatment of pain in this population. Finally, we recommend the need for interventions focused on sensorimotor integration, especially for autistic youth, and describe how pain clinics may be particularly helpful for identifying and supporting autistic females, for whom the potential role of autism in pain experiences had not been considered until receiving treatment in our clinic.

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Who Gets Referred? A Pilot Study of Risk Stratification and Treatment Referral in Pediatric Headache Using the Pediatric Pain Screening Tool

Salamon

Carlson

Hildenbrand

2021

Journal of Pediatric Psychology

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Objective Headaches are common among youth and are associated with significant negative outcomes. Despite advances in interdisciplinary treatments for youth with chronic pain, research suggests disparities in access to these services. Methods A total of 186 youth (M = 14.19 years old, 70.8% female) presenting to a neurology appointment at a children’s hospital system were screened using the Pediatric Pain Screening Tool (PPST), a brief, validated measure to identify youth that may benefit from additional pain management services. Results Two-thirds of participants (n = 124, 66.7%) screened as medium or high risk on the PPST. Risk categorization did not vary by patient age or sex. A greater proportion of Hispanic/Latino patients were categorized as low-risk relative to non-Hispanic/Latino patients (55.6% vs. 30.1%), and a somewhat lower proportion of patients of color were categorized as medium-risk relative to White patients (14.0% vs. 30.5%). Three-quarters (n = 94, 75.8%) of patients who were screened as medium or high risk were not referred for any additional pain management services. Referrals did not vary by patient age or ethnicity. While not statistically significant, a lower proportion of males received referrals at both medium (8.3% vs. 17.6%) and high levels of risk (15.8% vs. 34.5%), and a greater proportion of youth of color who screened as medium risk received referrals relative to White youth categorized as medium risk (37.5% vs. 10.3%). Conclusion Future research should continue to explore factors influencing decision-making regarding referral to specialized pain management services for youth with headache.

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Chronic Pediatric Pain Management: a Review of Multidisciplinary Care and Emerging Topics

Cited by 3 publications

References 82 publications

Psychological predictors of performance-based physical functioning among pediatric pain program participants

Psychological predictors of performance-based physical functioning among pediatric pain program participants

Chronic Pain in Autistic Youth: Clinical Prevalence and Reflections on Tailoring Evidence-Based Interventions from an Interdisciplinary Treatment Team

Who Gets Referred? A Pilot Study of Risk Stratification and Treatment Referral in Pediatric Headache Using the Pediatric Pain Screening Tool

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