The Psychometric Properties of the Screen for Child Anxiety Related Emotional Disorders in Pediatric Chronic Pain

The Journal of Pediatrics

Jagpal

Tran

et al. 2016

Objective To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). Study design The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for Anxiety Related Emotional Disorders (SCARED) was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory [FDI]) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. Results Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F (1, 36) = 13.68 p < 0.01). A similar effect was observed for FDI, such that the group with clinical anxiety had a significantly smaller response to treatment (F (1, 38) = 4.33 p < 0.05). The differences in pain and disability between groups following CBT suggest moderate effects (Cohen’s d = 0.77 and 0.78, respectively). Conclusions Although youth with clinical anxiety are more likely to start and/or complete pain-focused CBT, anxiety has an adverse impact on CBT treatment response in children with chronic pain. Identification of patients with anxiety and use of tailored behavioral interventions may improve clinical outcomes.

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain

The Journal of Pediatrics

Jagpal

Tran

et al. 2016

“…The SCARED has been validated in a pediatric pain sample 34 and has been used in clinical samples of youth with FGIDs 8, 9, 35 . Patients report frequency of anxiety symptoms over the past three months on a 41-item measure with responses including “not true” “sometimes true”, and “often true”.…”

Section: Methodsmentioning

confidence: 99%

Risk Categorization Predicts Disability in Pain‐associated Functional Gastrointestinal Disorders After 6 Months

J. pediatr. gastroenterol. nutr.

Jagpal

Peugh

et al. 2017

Introduction For a large portion of youth, pain-associated functional gastrointestinal disorders (FGIDs) are associated with significant impairment over time. Clinically feasible methods to categorize youth with FGIDs at greatest risk for persistent pain-related impairment have not yet been identified. Methods Measures of functional disability, pain intensity and anxiety were collected on 99 patients with FGIDs (ages 8–18) during a visit to a pediatric gastroenterology office to assess for the presence of risk. Follow-up data was obtained on a subset of this sample (n=64) after 6 months, either in person or via mail. This study examined whether a greater number of risk factors at baseline predicted greater pain-related disability at follow-up. Results Patients were divided into 4 groups based on number of risk factors present at the initial assessment: zero (18.2%) one (24.2%), two (26.3%), and three (31.3%). The presence of 2 or 3 risk factors significantly predicted greater disability at follow-up compared to those with 0 risk factors (R2= 0.311) and those with just 1 risk factor (Cohen’s d values of −1.07 and −1.44, respectively). Discussion A simple approach to risk categorization can identify youth with FGIDs who are most likely to report increased levels of pain-related impairment over time. These findings have important clinical implications that support the utility of a brief screening process during medical care to inform referral for targeted treatment approaches to FGIDs.

Pain, Fatigue, and Psychological Impact on Health‐Related Quality of Life in Childhood‐Onset Lupus

Jones

Arthritis Care & Research

Kashikar‐Zuck

et al. 2015

100

Objectives To evaluate pain, fatigue and psychological functioning of childhood-onset lupus (cSLE) patients and examine how these factors impact health-related quality of life (HRQoL). Methods At a tertiary rheumatology clinic, 60 cSLE patients completed: a Visual Analog Scale of pain intensity (0-10; Pain-VAS), the Pediatric Quality of Life (PedsQL) multidimensional Fatigue Scale (FS), Pain Coping Questionnaire (PCQ), Pain Catastrophizing Scale (PCS), Children's Depression Inventory I (CDI-I), the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire and the PedsQL-generic core scale (PedsQL-GC) and rheumatology module (PedsQL-RM). Sociodemographics and multiple disease activity indicators were recorded. Results Fatigue was present in 65% of the patients; clinically relevant pain (Pain-VAS > 3), anxiety (SCARED ≥ 25) and depressive symptoms (CDI-I > 12) were observed in 40%, 37% and 30% of the patients, respectively; 22% had high catastrophizing (PCS ≥ 26). On average, the PedsQL-GC/RM for cSLE were lower than in healthy norms. Reduced PedsQL-GC/RM scores were highly correlated with greater levels of fatigue, anxiety, and depressive symptoms (Pearson r > 0.65), but had weak correlation with disease activity (Pearson r < 0.25). Regression analysis demonstrated HRQoL was most impacted by fatigue, pain, and anxiety when evaluating all factors concurrently (p <0.001). Conclusion cSLE is associated with decreased HRQoL, and psychological aspects of health contribute substantially to low HRQoL, whereas measures of cSLE activity seem less relevant. Fatigue, pain, mood, and anxiety symptoms are present in a large subgroup of patients and need medical attention to achieve optimal health outcomes.