Pain-related fears in children and adolescents with chronic pain and their parents: mechanism of change and implications for treatment

Abstract

s The Journal of Pain P83 (428) Pain-related fears in children and adolescents with chronic pain and their parents: mechanism of change and implications for treatment L Simons, D Logan, C Conroy, G Chiang, J Gaughan, K Olson, and M Hogan; Children’s Hospital Boston, Boston, MA Approximately one quarter of youth report chronic pain, that affects the entire family and often has a lasting impact due to disability during a formative time in a young person’s life. An emerging psychological construct of interest related to pain-related disability is pain-related fear. Heightened pain-related fear results in behavioral avoidance leading to disuse, disability, and depression; whereas confrontation results in a reduction of fear over time and reengagementwith activities of daily living. Using ameasure specifically developed to assess pain-related fear among children and adolescents, the current study examined the influence of pain-related fear among pediatric chronic pain patients through examining whether decreases in pain-related fears directly improved functional outcomes in youth with chronic pain participating in an intensive pain rehabilitation program. Currently 113 youth and their parents have completed measures at admission and discharge as part of an intensive pain rehabilitation program that involves physical, occupational, and psychological therapy, and medical and nursing support. Measures include the pain experience (e.g., pain level, somatic symptoms, catastrophizing), pain related fear, and functioning (e.g., functional disability, upper/lower limb functioning, depressive symptoms). Mediation analyses conducted thus far provide evidence that ameliorating pain-related fear partially mediates the relation between the pain experience and subsequent functioning. Longitudinal structural equationmodelingwill be used to test themagnitude of the indirect effects of pain-related fear on functional outcomes. In addition to results from these analyses, preliminary results from focus groups conducted with parents and children with high pain-related fears to inform the development of an In vivo Exposure Treatment Protocol will be discussed. Knowledge gained by this proposed research is expected to positively affect the health and well-being of youth with chronic pain. Supported by the American Pain Society Future Leaders in Pain Management Small Grants Research Program. (429) Cognitive functioning in children and adolescent chronic pain patients K Weiss, C Harbeck-Weber, and T Harrison; Mayo Clinic, Rochester, MN Many pediatric pain patients report difficulties in concentration and school performance. Eccleston’s and Crombez’s (1999) functional model of pain and attention suggest disruption of attention can be adaptive when pain is acute and caused by a specific stimulus. However, when pain is chronic, interruption of attention can becomedebilitating as it interfereswithwork, school, or home activities. Attention and memory deficits have been demonstrated in adults with chronic pain and via experimental studies. However, only one study has examined cognitive functioning in children with chronic pain. Ho and colleagues (2009) found in 57 chronic pain patients, ages 8 to18 years old, overall cognitive and achievement scores were mostly in the average range and workingmemorywas a relativeweakness. Given the scarcity of research on this issue, a retrospective chart review was conducted to examine cognitive functioning of pediatric pain patients. 111 children and adolescents, 11-18 years old (M = 15, SD = 1.85) who attended the Mayo Clinic Pediatric Pain Rehabilitation Program from 2008 to 2010 were examined. 85 (76.6%) were female. 21.6% of these patients demonstrated difficulties with attention and concentration, 11.7% were behind grade level in at least one subject, 7.2% showed a significant split between verbal and performance skills on the WAIS, and 7.2% met criteria for specific learning disorder. 19.8%were receiving school accommodations for these issues or due to their pain prior to our program. 32.4% received additional recommendations for academic planning in accordance with their screening results. Thus, pediatric pain patients can benefit from receiving psychoeducational assessment as part of their multidisciplinary treatment. Such services can be useful in academic planning which is important given many of these patients enter treatment on homebound instruction but leave with the goal of returning to school. (Iezzi et al., International J Beh Med, 2004) (430) Efficacy of an interdisciplinary adolescent pain management program: preliminary outcomes G Revivo, D Amstutz, and C Gagnon; RIC, Chicago, IL Recognizing the need for specialized treatment focusing on adolescents with chronic pain, we developed an interdisciplinary treatment program that addresses the complexities of treating childhood chronic pain. The program includes physical and occupational therapy, biofeedback training, psychological counseling and medical intervention. Patients are seen in clinic two half-days a week, and receive both individual and group therapy. Parents are also frequently included in physician and psychology visits to provide education and treatment to the family. We stress the importance of parents reinforcing healthy behaviors and encouraging pain coping activities. Our goals include symptom relief, maximizing functional independence, and a successful return to school and peer participation.We assessed the efficacy of this program in 34 adolescent patients who completed the program. Outcomemeasures included each subscale score of the Bath Adolescent Pain Questionnaire (BAPQ) and the total scores obtained on the Spence Children’s Anxiety Scale (SCAS), Functional Disability Inventory (FDI), Child Depression Inventory (CDI), and Pain Catastrophizing ScaleChild version (PCSC). Paired-samples t-tests showed significant reductions in anxiety [t = 3.114, P = .000], disability [t = 4.477, P = .000], depression [t = 4.424, P = .000], and pain-related catastrophizing [t = 7.077, P = .000], as measured by the SCAS, FDI, CDI, and PCSC. Significant changes were also indicated on each subscale of the BAPQ: Social, Physical [t = 3.128, P = .004], Depression [t = 5.384, P = .000], General Anxiety [t = 3.160, P = .004], Pain Anxiety [t = 5.254, P = .000], Family Functioning [t = 6.224, P = .000], and Development [t = 3.156, P = .004]. Thus, this preliminary data suggests that the adolescent interdisciplinary pain management program is effective in improving emotional and physical functioning in a sample of adolescents with chronic pain. H08 Social and Cultural Variables (431) Increased catastrophizing and reduced recovery expectations in the early aftermath of motor vehicle collision among African Americans vs. European Americans L Edwards, P Mitchell, J Jones, P Hendry, D Peak, R Swor, D Lee, N Rathlev, R Domeier, A Bortsov, T Platts-Mills, R Fillingim, and S McLean; University of North Carolina at Chapel Hill, Chapel HIll, NC More than 1 million African Americans (AA) present to US Emergency Departments (ED) each year for care after motor vehicle collision (MVC). More than 90%of these EDpatients do not have serious physical injury and are discharged to home after evaluation; however chronic musculoskeletal pain is a common sequela in this group. Evidence suggests that AA may be at increased risk of post-MVC pain vs. European Americans (EA). In other settings, AA have been found to exhibit increased catastrophizing and/or reduced recovery expectations. The current study examined cross-sectional associations between selfidentified ethnicity (AA vs. EA) and catastrophizing [Pain Catastrophizing Scale (PCS)] and recovery expectations (estimated time to physical and emotional recovery) among 489 EA patients and 88 AA patients evaluated in the ED after an MVC. This was an observational study done prospectively in six EDs in three states. Univariate associations were performed usingMann-Whitney U. Associations between ethnicity and catastrophizing and recovery expectations adjusting for age, gender, income, education, and current pain (0-10 Numerical Rating Score) were evaluated using logistic regression. Because of non-normal distributions, logistic regressions outcome variables were dichotomized at the highest quartile. AA were more likely to have higher catastrophizing scores (U =13,206 p = .047) and estimate a longer time to physical recovery (U =13,866, p = .000) and emotional recovery (U = 9,308, p = .001). These results persisted after adjustment for age, gender, income, education, and pain severity at the time of interview evaluation. Further research is needed to understand the reason for these ethnic differences in response to common traumatic events such as MVC, additional characteristics associated with any such potential differences, and whether such disparities are associated with increased rates of chronic pain development. Funded by NIH 1R01AR056328 and NIH 3R01AR056328-03S1.