Development of a Screening Tool for Pediatric Neuropathic Pain and Complex Regional Pain Syndrome

Mesaroli, Giulia; Campbell, Fiona; Hundert, Amos; Birnie, Kathryn A.; Sun, Naiyi; Davidge, Kristen M.; Lalloo, Chitra; Davies-Chalmers, Cleo; Harris, Lauren; Stinson, Jennifer

doi:10.1097/ajp.0000000000000993

Cited by 8 publications

(19 citation statements)

References 38 publications

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“…1 Taken together, our results indicate that painDETECT screening tool can provide clinicians useful information for directing care and prompting appropriate follow-up. Because painDETECT is a screening tool and not meant to be diagnostic in nature, results or categorizations should be used to direct further assessment or evaluation and inform referral recommendations 12,15,16,21 and should not be used to render a diagnosis. For patients who screen positively on painDETECT, urgent follow-up with a physician with pediatric pain expertise is recommended to confirm a diagnosis and initiate appropriate treatments.…”

Section: Discussionmentioning

confidence: 99%

“…As such, the screening tool should be highly sensitive to the target condition, inexpensive, and easy to implement. 12 PainDETECT has demonstrated reliability 6,23 and validity 6 in adult populations for screening NP but has not been examined in pediatric populations. The goal of this study was to provide an initial evaluation of the validity of the painDETECT in a pediatric population to inform the potential clinical and research utility of the measure.…”

Section: Introductionmentioning

confidence: 99%

“…Most recently, the definition of NP was updated and no longer includes dysfunction of the SNS, propelling complex regional pain syndrome (CRPS) to no longer be considered NP but rather a type of nociplastic pain. 12,26 Therefore, although it is clear that NP can strongly benefit from early identification 12,14 and specifically tailored treatment, barriers exist to receiving such care. Diagnosis of NP often requires specialized evaluations by pain providers and thus requires appropriate and timely referrals.…”

Section: Introductionmentioning

confidence: 99%

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Application of PainDETECT in pediatric chronic pain: how well does it identify neuropathic pain and its characteristics?

Hess,

Van Orden,

Mesaroli

et al. 2023

PR9

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Introduction: Neuropathic pain (NP) arises from nerve damage or disease, and when not defined, it can impair function and quality of life. Early detection allows for interventions that can enhance outcomes. Diagnosis of NP can be difficult if not properly evaluated. PainDETECT is a NP screening tool developed and successfully used in adults. Objectives: We evaluated the validity of painDETECT in a pediatric population. Methods: Adolescents and young adults (10–19 years old) completed painDETECT and quantitative sensory testing (QST), which assessed mechanical allodynia and hyperalgesia, common symptoms of NP. Pain diagnoses, including neuropathic pain (n = 10), were collected through documentation in the medical chart. Descriptive statistics were used to examine age, gender, pain diagnoses, and painDETECT scores. Kruskal–Wallis H tests were conducted to examine differences in QST results across painDETECT categorizations. Results: Youth with chronic pain (N = 110, Mage = 15.08 ± 2.4 years, Nfemale = 88) and peers without pain (N = 55, Mage = 15.84 ± 3.9 years, Nfemale = 39) completed the painDETECT. The painDETECT scores for youth with pain (M = 12.7 ± 6.76) were significantly higher than those for peers without pain (M = 2.05 ± 2.41). PainDETECT demonstrated 80% sensitivity and 33% specificity in a pediatric population. Individuals who screened positively on the PainDETECT had significantly higher mechanical allodynia (M = 0.640 ± 0.994) compared with those who screened negatively (M = 0.186 ± 0.499; P = 0.016). Conclusion: PainDETECT demonstrated the ability to screen for NP, and QST mechanical allodynia results were consistent with a positive NP screen. Results of the study offer preliminary support for the ongoing assessment of the painDETECT as a brief, inexpensive, and simple-to-use screening tool for pediatric patients with primary pain complaints.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Application of PainDETECT in pediatric chronic pain: how well does it identify neuropathic pain and its characteristics?

Hess,

Van Orden,

Mesaroli

et al. 2023

PR9

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“…Given the apparently high incidence of neuropathic pain following surgery for scoliosis, more accurate measurement of neuropathic pediatric postsurgical pain is required, most notably by physical examination and using a validated scale such as the Pediatric PainSCAN. 10 …”

Section: Epidemiology Of Pediatric Chronic Postsurgical Painmentioning

confidence: 99%

Modeling the transition from acute to chronic postsurgical pain in youth: A narrative review of epidemiologic, perioperative, and psychosocial factors

Rosenbloom

Katz

2022

Canadian Journal of Pain

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A growing number of studies have identified high rates of pediatric chronic postsurgical pain (CPSP) after major surgery. Pediatric CPSP is associated with pain-related distress and comorbid mental health outcomes, such as anxiety and depression. From a biopsychosocial perspective, youth factors, such as genetics, epigenetics, sex, presurgical pain, sleep, anxiety, and pain catastrophizing, as well as parent factors, such as cognitive appraisals of their child’s pain expression and pain catastrophizing, converge and lead to chronic pain disability. A comprehensive and testable psychosocial model of the transition from acute to chronic pediatric postsurgical pain has not been developed. This narrative review begins by evaluating the epidemiology and trajectories of pediatric CPSP and moves on to examine the more influential psychosocial models that have been proposed to understand the development of pediatric CPSP. Much of the literature to date has been conducted on adolescents undergoing spinal fusion. To conceptualize the transition from acute to chronic pain in youth, a combined diathesis-stress and interpersonal fear avoidance model is presented. Novel areas of future research include the potential influence that siblings and peers have on a youth’s development of CPSP as well as the influence of gender.

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“… 16 Pediatric PainSCAN is a screening tool for pediatric neuropathic pain and CRPS currently under development. 17 A key indicator of content validity includes the relevance of the items in diagnostic or screening tool. 18 Understanding which symptoms of pediatric CRPS, corresponding to items in these tools, are most prevalent and most discriminant in making a diagnosis would inform the validity of available tools and aid in developing or revising tools.…”

Section: Introductionmentioning

confidence: 99%

Signs and symptoms of pediatric complex regional pain syndrome - type 1: A retrospective cohort study

Mesaroli

McLennan

Friedrich

et al. 2023

Canadian Journal of Pain

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Background Complex regional pain syndrome (CRPS) presents with an array of symptoms that can vary from child to child, making it difficult to diagnose and differentiate from other pain conditions such as chronic musculoskeletal (MSK) pain. Thirteen symptoms and signs are outlined in the Budapest criteria for CRPS (developed and validated for adults) but have not been well described in pediatrics. Aims The aim of this study was to describe the signs and symptoms of pediatric CRPS type 1 (CRPS 1) and determine whether a cluster of symptoms can differentiate CRPS 1 from chronic MSK pain. Methods A retrospective cohort study of pediatric patients with CRPS 1 and MSK pain in a pediatric pain program was conducted. Descriptive statistics were used to report demographics and pain characteristics. The chi-square test was used to evaluate differences in signs and symptoms between patients with CRPS and MSK pain. A logistic regression model was used to evaluate whether a cluster of symptoms could predict a diagnosis of CRPS 1. Results The sample included 187 patients (99 with CRPS 1 and 88 with MSK pain); 81% were female with a mean age 14.1 years. The most prevalent CRPS symptoms were hyperalgesia (54%) and allodynia (52%). A cluster of symptoms (hyperalgesia, color changes, and range of motion) predicted the probability of a diagnosis of CRPS 1. Conclusions A cluster of symptoms may be critical in differentiating pediatric CRPS 1 and MSK pain. Future research is needed to determine if this model is valid in external populations and to explore whether a similar model can differentiate CRPS 1 from other pain conditions (e.g., neuropathic pain).

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Development of a Screening Tool for Pediatric Neuropathic Pain and Complex Regional Pain Syndrome

Cited by 8 publications

References 38 publications

Application of PainDETECT in pediatric chronic pain: how well does it identify neuropathic pain and its characteristics?

Application of PainDETECT in pediatric chronic pain: how well does it identify neuropathic pain and its characteristics?

Modeling the transition from acute to chronic postsurgical pain in youth: A narrative review of epidemiologic, perioperative, and psychosocial factors

Signs and symptoms of pediatric complex regional pain syndrome - type 1: A retrospective cohort study

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