Adolescent Pediatric Pain Tool Research Articles

Promise of Composite Pain Index as a single pain outcome for sickle cell disease across the lifespan.

This study aimed to validate a Composite Pain Index (CPI) as a single pain outcome measure for sickle cell disease (SCD) across the lifespan from 8years of age. This prospective, cross-sectional study included 55 participants with SCD who completed the PAINReportIt tool and Adolescent Pediatric Pain Tool (APPT) in random order during outpatient visits to derive respective CPI scores for comparison. Of the 55 participants with SCD, 46 (84%) had HgbSS, eight (15%) HgbSC, and one (2%) HgbSβ0+. The mean age of all participants was 17.5±2.6years, and 28 (51%) were female, 52 (95%) were Black, 42 (98%) were non-Hispanic, and 39 (71%) had a ninth grade or higher education. Correlation analyses between the APPT and PAINReportIt revealed positive associations for the number of pain sites (r=.57, p<.001), pain intensity (r=.46, p<.001), pain quality (r=.74, p<.001), and pain pattern (r=.34, p=.01). Patients' mean CPI scores derived from the PAINReportIt was slightly higher than the APPT; 34.2 (SD=14.7) and 30.0 (SD=19.0), respectively. Regression analyses showed that the APPT CPI significantly predicted the PAINReportIt CPI (B=.497, t(53)=6.051, p<.001). This finding holds true even when accounting for the order of measurement or patient's age. The initial validation of CPI as a single pain outcome measure represents a significant advancement in pain assessment for SCD. Further validation is warranted for the CPI as a measure is for both clinicians and researchers to enable longitudinal pain assessment from age 8years across the lifespan as children age into adult care.

The Predictive Power of Pain Characteristics and Sleep Quality on Fatigue in Adolescents With Cancer.

This study was conducted as descriptive, methodological, and cross-sectional research to determine the predictive power of pain characteristics and sleep quality on fatigue in adolescents with cancer. The study was conducted between November 2020 and April 2021 with 139 adolescents with cancer who reported pain. The study data were collected via an AdolescentInformation Form, the Adolescent Pediatric Pain Tool, the Scale For The Assessment Of Fatigue in Pediatric Oncology Patients Aged 13-18, and the Sleep Assessment Scale for Children with Cancer-Adolescent Form. Mean values, percentage calculations, Pearson correlation analysis, and linear regression analysis were used in the analysis of the data. There was a high level and negative correlation between pain characteristics (pain location, severity, and quality) of the adolescents participating in the study and their mean scores from the overall fatigue scale and its subdimensions and a high level and positive correlation with their mean scores from the overall sleep quality scale. Pain characteristics and sleep quality of adolescents with cancer explained 74% of fatigue. Pain, sleep quality, and fatigue are symptoms that should be closely addressed in adolescents with cancer.

Evaluation of vincristine-induced peripheral neuropathy in children with cancer: Turkish validity and reliability study

BackgroundThe evaluation of peripheral neuropathy in children receiving Vincristine treatment is challenging. This study examined the Turkish validity and reliability of the Total Neuropathy Score-Pediatric Vincristine (TNS-PV) measurement tool, which can measure Vincristine-induced peripheral neuropathy symptoms in children with cancer. MethodsA total of 53 children aged 5–17 years who received Vincristine treatment in two pediatric hematology-oncology centers participated in the study. Data was collected using the Total Neuropathy Score-Pediatric Vincristine (TNS-PV), the Common Terminology Criteria for Adverse Events (CTCAE), the Wong-Baker FACES Pain Scale, and the Adolescent Pediatric Pain Tool (APPT). The correlation between the TNS-PV total score and other scales and the inter-rater reliability coefficient was evaluated. FindingsOf the children, 81.1% were diagnosed with ALL and 13.2% with Ewing Sarcoma. Cronbach's alpha values of form A and B of the TNS-PV scale were 0.628 and 0.639, respectively. As the cumulative Vincristine dose increased, the children's scores on TNS-PV were higher. A moderate and significant positive correlation was found between the TNS-PV form A total score and the worst subjective symptoms a, b (A), strength, tendon reflexes, and autonomic / constipation (r = 0.441, r = 0.545, r = 0.472, r = 0.536, p < 0.01). DiscussionThe TNS-PV form B total score was found to have a moderate level, significant correlation with CTCAE sensory neuropathy score and Wong-Baker FACES Pain Scale, and a high level, significant positive correlation with CTCAE motor neuropathy score. Application to practiceThe TNS-PV is valid and reliable for measuring Vincristine-induced peripheral neuropathy in practice in Turkish children 5 years and older.

Pain Quality After Pediatric Pectus Excavatum Repair

BackgroundNeuropathic pain medications are included in multimodal postoperative analgesic strategies, but quality of perioperative pain is rarely assessed. AimsThe purpose of this study was to describe adolescents’ pain experiences after thoracoscopic pectus excavatum repair (Nuss procedure) using the Adolescent Pediatric Pain Tool. DesignThis prospective descriptive longitudinal study was designed to test the hypothesis that pain quality descriptors reported are consistent with neuropathic pain. MethodsA convenience sample of 23 adolescents aged 12 to 17 years from a single urban, university affiliated, nonprofit children's hospital consented to self-report pain using the Adolescent Pediatric Pain Tool before and during hospitalization, and up to 14 months after Nuss procedure. Visual analytic techniques were used to analyze reported pain intensity, location, and affective, evaluative, sensory, and temporal qualities. ResultsPostoperative pain quality, intensity, number of sites, and surface area decreased over time. Word clouds illustrated that neuropathic sensory and temporal pain quality descriptors increased in frequency 2 to 6 weeks after surgery and were the predominant descriptors 2 to 4 months after surgery. Dot matrix charts illustrated an inconsistent relationship of pain quality and intensity with pain surface area. ConclusionsPain quality should be assessed with valid, reliable, and developmentally appropriate tools. Visual analytics help illustrate pain quality at single points in time and longitudinally and may be helpful in guiding postoperative pain treatment.

An Empirical Classification of Chronic Pain Subgroups in Pediatric Sickle Cell Disease: A Cluster-Analytic Approach

Introduction: Youth with sickle cell disease (SCD) and chronic pain are a heterogeneous group with variability in their daily pain experience and physical and psychosocial functioning. We aimed to 1) empirically derive chronic pain subgroups based on sensory pain characteristics using cluster analysis within a sample of youth with chronic SCD pain, and 2) investigate derived subgroups for differences in sociodemographics, clinical characteristics, and psychosocial and functional outcomes. We hypothesized that chronic SCD pain subgroups with higher sensory pain experiences would be associated with poorer functional and psychosocial outcomes.Methods: Children and adolescents receiving care at comprehensive SCD clinics at three tertiary care locations within a southeast children's hospital were included if they were aged 10-18 years, any SCD genotype, reported chronic pain (i.e., pain on most days per month for a duration of at least 3 months), and had English fluency. Youth were excluded if they had comorbid medical conditions typically associated with pain but unrelated to SCD or had significant cognitive or developmental limitations that would interfere with study procedures. Patients completed a battery of patient-reported outcomes including pain characteristics (i.e., intensity, frequency, and the Adolescent Pediatric Pain Tool to assess number of pain locations and pain quality descriptors), PROMIS Pediatric Short Forms for pain interference, anxiety, and depressive symptoms, the Adolescent Sleep Wake Scale for sleep quality, and the Pain Catastrophizing Scale. Clinical characteristics and healthcare utilization outcomes were abstracted from electronic medical records including number of inpatient admissions for pain and emergency department visits for pain in the prior 12 months.Chronic SCD pain subgroups were based on sensory pain characteristics including pain intensity ratings, pain frequency, number of body sites affected by pain, and pain quality descriptors. Hierarchical cluster analysis informed the number of clusters at the patient level. K-means cluster analysis was used to assign patients to clusters once the number of clusters was established. Clusters were compared on sociodemographics, clinical characteristics, healthcare utilization, and child psychosocial and functional outcomes.Results: Youth (n=62) were on average (M) 13.9 years old (SD=2.5), 56% female, 95% Black or African American, and 85% Non-Hispanic/Latinx. Most (75%) had HbSS or HbSβ 0 and 67% were prescribed hydroxyurea. Hierarchical cluster analysis and k-means clustering supported a 2-cluster solution (see Figure 1). Cluster 1 (n=35; Frequent, Moderate Pain) was distinguished by significantly lower scores on worst pain intensity (M=6.4, SD=0.4), lower number of pain days per month (M=12.1, SD=2.8), fewer number of body sites affected by pain (M=8.9, SD=0.9), and lower pain quality ratings (M=15.9, SD=1.3). Cluster 2 (n=27; Almost Daily, High Pain) represented patients who reported high ratings of worst pain intensity (M=8.2, SD=0.3), daily to almost daily pain (M=20.3, SD=1.7), higher number of body sties affected by pain (M=12.5, SD=1.5), and higher ratings of pain quality (M=40.8, SD=1.9) (all p's <.05). There were no differences between chronic SCD pain subgroups by sociodemographics (e.g., age, sex, family income), clinical characteristics (e.g., genotype, history of avascular necrosis, disease-modifying treatments, prescribed long-acting opioids, neuropathic medications, or antidepressants), or healthcare utilization. Patients in the Almost Daily High Pain subgroup reported significantly higher pain interference, depressive symptoms, and pain catastrophizing compared to patients in the Frequent, Moderate Pain subgroup (see Table 1). There were no differences between subgroups on anxiety or sleep quality.Conclusions: Two subgroups of chronic SCD pain were identified based on pain, psychosocial, and functional outcomes. Beyond sensory pain characteristics, pain interference, depressive symptoms, and pain catastrophizing were the only variables that best differentiated the chronic SCD pain subgroups. These empirically derived subgroups are comparable to other non-SCD chronic pain subgroups in pediatrics and adults. Identifying homogenous chronic SCD pain subtypes can inform tailored assessment and management of chronic pain. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Computer vision reimages rigor of APPT pain site and surface area measurement

The Adolescent Pediatric Pain Tool (APPT) contains a body outline diagram (BOD) to facilitate self-report of pain sites and surface area. Inter-rater reliability for manually coded BOD drawings is only fair to moderate. Irregular drawings are prone to manual measurement error. The clinical utility, trending, and interpretability of BOD drawings are significant limitations of APPT. A rigorous method to code BODs and extract data for further analysis is needed. Aim: To digitize BOD drawings and using computer vision improve accuracy of BOD measures to facilitate further analysis. Open source computer vision library, OpenCV, was used to digitize BODs from adolescents with scoliosis (n=42) or pectus excavatum (n=24) obtained preoperatively, daily postoperatively during hospitalization, and at postoperative visits. Pain sites and areas were drawn by adolescents on paper BODs, then scanned and cleaned through grayscaling, median blurring, and thresholding techniques to reduce noise. Scanned images were aligned with reference diagram using homography matrix. Differences between images and reference were extracted. Identified body parts and surface areas were labeled for further analysis. The model was able to extract BOD drawings and identify pain sites that corresponded to APPT scoring template. Correct classification rate for each body location for each patient was 97.2%. Overall sensitivity was 95.5% and specificity 97.3%. This computer vision method of coding BODs is accessible, convenient, and provides better sensitivity and specificity for pain site and surface area than manual coding. Extracted data can be further analyzed for trends and modeled for pain trajectory prediction. While the use of digital applications to prospectively collect BOD data may overcome current APPT limitations, loss of historic data, expense, data access, and electronic medical record (EMR) integration present new limitations. Paper BODs are convenient, inexpensive, easily scanned into EMRs, and now easily analyzed.

Pain in Children and Adolescents With Sickle Cell Disease: Multidimensional Assessment.

Patients with sickle cell disease (SCD) suffer from recurrent painful vaso-occlusive episodes with a significant impact on their quality of life. The aim of this study was to perform a multidimensional assessment of pain in Portuguese children and adolescents with SCD. Subjects were children and adolescents and their parents recruited from the outpatient pediatric hematology clinic in a Portuguese Hospital. Pain frequency and a broader multidimensional evaluation was performed using the Pediatric Pain Questionnaire (PedsQL) (that includes Visual Analog Scales, color indicators, qualitative descriptors of pain [open question] and body diagram) and a structured questionnaire (PQ2), that included a term list of the Adolescent Pediatric Pain Tool, among other questions. Included 60 children and adolescents (36 boys and 24 girls) with a mean age of 11±4.0 years (range, 5 to 18). The majority of children (83.1%) reported no present pain and 57.6% reported pain last month, with several degrees of pain intensity. Abdomen, thorax, and limbs were the most frequent localizations. Red was the color most chosen to describe "severe pain," whereas blue and green were more used to describe "no pain." The number of pain descriptors is different using an open-ended question (2.1±1.5) than a given list of terms (15.3±8.1). The most frequent terms used in the open question were "strong/very strong," "hurts a lot," "makes cry," and "horrible." Parents used similar pain descriptors. "Makes cry," "horrible," "tiring," "unbearable," and "uncomfortable" were the most frequent terms chosen in the PQ2. Pain interfered variably with daily activities for most of the patients. Pain experienced in SCD has a broad range of intensity levels, localization, and frequency. There are a number of pain descriptors and socio-emotional factors related to the pain experience. A comprehensive multidimensional assessment that includes both child's and parents' perspective seem to be the most adequate strategy to assess pain.

Pain Experience, Physical Function, Pain Coping, and Catastrophizing in Children With Sickle Cell Disease Who Had Normal and Abnormal Sensory Patterns

ContextSickle cell disease (SCD) is associated with recurrent pain that could lead to abnormal sensory patterns (ASPs). ObjectivesThe purpose of this study is to compare children with SCD who had normal sensory patterns (NSPs) and ASPs in pain experience, physical function, pain coping, and pain catastrophizing. MethodsChildren with quantitative sensory testing data were selected from a larger study that examined pain and symptoms in children with SCD. Comparisons were made between children with NSP (n = 35; 13.9 ± 1.9 years) and ASP (n = 13; 12.8 ± 1.9 years). Children completed the Adolescent Pediatric Pain Tool, Functional Disability Inventory, Pain Coping Questionnaire, and Pain Catastrophizing Scale. ResultsNo significant differences were found in pain intensity (2.9 ± 3.0 vs. 2.6 ± 2.8 on 0–10 Visual Analogue Scale) between the NSP and ASP, respectively. The most common marked pain sites for both groups were lower extremities (22.9%), head and neck (20.8%), and upper extremities (20.8%). Functional Disability Inventory scores were significantly worse in ASP (38.5%) compared with NSP (11.4%). The ASP group had significantly worse scores in emotion-focused pain coping subscales. ConclusionChildren with SCD with ASP had worse functional disability, were expressing more affective pain quality, and had emotion-focused pain coping compared with NSP. Future studies are needed to examine the effectiveness of physical activities on the physical function as well as psychosocial interventions such as peer support and creative arts expression to minimize development of ASP in children with SCD.

Translation, Cross-Cultural Adaptation, and Validation of the Adolescent Pediatric Pain Tool (APPT) for Multidimensional Measurement of Pain in Children and Adolescents

BackgroundPain is subjective and multidimensional in nature. Its assessment is very challenging especially in the pediatric population. Adequate assessment of pain in children is the keystone for effective management. Accurate and comprehensive evaluation of the child’s pain experience requires the use of multidimensional pain assessment tools such as the Adolescent Pediatric Pain Tool (APPT) which measures the intensity, location and quality of pain. AimsThe aim of this study was to translate and culturally validate the APPT for use in Lebanese children and adolescents with cancer. MethodsThe instrument was translated and culturally adapted following the WHO four steps; 1) forward translation and back-translation, 2) expert panel, 3) pre-testing and 4) cognitive interviewing. The semantic validation of the pain quality descriptors was performed by healthy children and children with cancer aged 8-17 years, using the Q-sort method. ResultsA final Arabic version with 31 pain descriptors equivalent to the original tool was produced based on the results from the pilot study and the children’s interviews. Children were able to differentiate between the different words they use to describe their pain. ConclusionOur results showed that the Lebanese version of the APPT is a culturally sensitive tool to assess the location, intensity and quality of pain in Lebanese children with cancer. Health professionals are encouraged to use this tool to assess the pain characteristics in Lebanese children with cancer, hence leading to effective pain management.

Management of Sickle Cell Disease Pain among Adolescent and Pediatric Patients

Management of sickle cell pain in adolescent and pediatric patients is inadequate, and the employment of proper management guidelines and practices are highly variable among different regions and populations. APPT, the multidimensional adolescent pediatric pain tool, promotes optimal pain management and introduces best practical guidelines for pain management. The goal of this study is to assess pain and pain management among young patients diagnosed with sickle cell disease (SCD) by introducing the APPT as a tool for pain management, and analyze factors contributing to pain management. Information relevant to demographic data, SCD characteristics, APPT assessment, and satisfaction of patients regarding pain management were collected using a structured questionnaire. Results showed that SCD is highly associated with gender (p = 0.022), consanguinity (p = 0.012), and number of surgeries (p = 0.013). Most patients (58.9%) indicated the involvement of more than six body areas affected during pain crisis. Severe pain was described by more than half the patients (55.6%), while moderate pain was reported by 31.1%. Most patients described their pain by sensory, affective, and temporal words. The number of painful areas, pain intensity, and use of descriptive pain words was correlated and interpreted by age, BMI, school absence, and number of surgeries. Results of this study could provide guidance to healthcare providers to improve current practices for SCD pain management in order to improve health outcomes and patients’ satisfaction.

The Experience of Pain and Pain Tool Preferences of Hospitalized Youth

BackgroundAn accurate holistic pediatric pain assessment is necessary for quality pain management. Evidence continues to be published indicating inadequacies in pediatric pain management. It is important for clinicians to consider the pain assessment process while caring for youth. AimThe purpose of this study was to understand the pain experience through focused interviews and to explore how youth use, interpret and understand self-report pain assessment tools including their tool preferences. DesignA qualitative descriptive study using a research developed semi-structured interview guide was conducted with 40 hospitalized youth, 10-17 years (M: 13yr; S.D. 2.4); 21 (52.5%) female on a medical inpatient unit. Interview questions focused on: current pain experience; pain related symptoms; evaluation of pain treatment and preferences for select pain assessment tools: 0-10 Numeric Rating Scale, The Oucher, Faces Pain Scale-Revised, and Adolescent Pediatric Pain Tool (APPT). SettingLarge tertiary and quaternary care pediatric hospital located in northeastern United States. Participants/SubjectsHospitalized youth, 10-17 years of age. ResultsAnalysis of transcribed interviews yielded 3 themes: My Pain Now, Pain Treatment Expectations, and Telling Healthcare Providers about My Pain. Additionally, pain tools preference, assessment frequency, and discussion of how behavior, activity level, and pain expression was different for each youth. APPT was the preferred pain assessment tool. Descriptive words such as sharp, throbbing, and aching were identified most often. Youth identified that activity and pain level often do not match. ConclusionsBecause pain is multi-dimensional, assessing each dimension (quality, location, intensity, and meaning) is key to thorough assessment. Results provide insight into youth preferences influencing clinical practice such as offering options for interventions and having a voice in the pain management process. All nurses caring for children should discuss available pain tools preferably before the child is in pain and assure the child knows how to use the tool.

Academy of Oncologic Physical Therapy EDGE Task Force on Cancer: A Systematic Review of Outcome Measures for Pain in Children

Background: Children with cancer can experience pain throughout their clinical course. Accurate assessment of pain can lead to more effective pain management. Purpose: To identify outcome measures used to assess pain in children and to appraise each tool based on psychometric properties, clinical utility, and application to pediatric oncology. Methods: The authors searched 3 electronic databases (MEDLINE, CINAHL, and SCOPUS), using specific search terms to identify measures used to evaluate pain in children with cancer. Of the 956 articles found, 270 were reviewed and 17 measures were identified for further assessment. Each outcome measure was reviewed by 2 independent reviewers, who then ranked each measure using the 4-point Cancer EDGE Task Force Outcome Measure Rating Scale. Discrepancies were discussed to reach consensus. Results: The Wong-Baker FACES Pain Rating Scale is highly recommended (4). The Oucher Pain Scale, Adolescent Pediatric Pain Tool, and Pieces of Hurt Assessment Tool/Poker Chip Tool are recommended (3). Six additional tools are deemed reasonable to use (2) and 7 tools are not recommended (1). Conclusions: Based on clinical utility, psychometric properties, and application to children with oncologic diseases, 4 outcome measures are recommended for the assessment of pain in children with a diagnosis of cancer.

Validation of the Adolescent Pediatric Pain Tool for the Multidimensional Measurement of Pain in Children and Adolescents Diagnosed with Osteogenesis Imperfecta

ABSTRACT Background The Adolescent Pediatric Pain Tool (APPT) is a self-reported, multidimensional assessment of pain location, intensity, and quality in children and adolescents. Yet, it has not been validated for use in children and adolescents with osteogenesis imperfecta (OI). Aims This study aimed to validate and evaluate the feasibility of the APPT for pain assessment in children and adolescents with OI. Methods A prospective observational study was conducted at a university-affiliated pediatric hospital in Canada. Thirty-three children and adolescents with OI participated by completing the APPT pre-bisphosphonate intravenous infusion and 1 week post-bisphosphonate intravenous infusion. Main outcomes were internal consistency, convergent and discriminative validity, and feasibility. Results The Kuder-Richardson test of internal consistency was 0.863, 0.661, and 0.729 for the Sensory, Affective, and Evaluative subscales, respectively. For the entire pain quality scale, the Cronbach’s alpha was 0.835. Regarding convergent validity, a moderate correlation was observed between the ratings on the pain intensity scale and the Faces Pain Scale–Revised (Spearman’s rho = 0.711). Patients for whom pain was a problem reported higher pain intensity (Mann Whitney U = 41.50, P = 0.032) and more pain quality descriptors (Mann Whitney U = 45.50, P = 0.020) and painful body areas (Mann-Whitney U = 25.50, P = 0.001) than those for whom it was not (Mann-Whitney U, P < 0.05). In terms of feasibility, completing the tool may require a considerable time commitment and assistance from a clinician or parent, especially if the patient is experiencing pain and provides detailed pain location and quality information by completing the APPT. Conclusions This study suggests that the APPT is valid for the multidimensional assessment of pain in children and adolescents with OI, but feasibility needs to be enhanced.

CROSS-CULTURAL ADAPTATION OF THE ADOLESCENT PEDIATRIC PAIN TOOL FOR BRAZILIAN CHILDREN AND ADOLESCENTS WITH CANCER

ABSTRACT Objective: to describe the steps in the cross-cultural adaptation process of the Adolescent Pediatric Pain Tool, a pain assessment measure, for use with Brazilian children and adolescents with cancer. Method: a methodological and cross-sectional study was undertaken. The steps in the cross-cultural adaptation process of the tool that resulted in the semantic validation followed an adapted method, including: initial translation, consensus version of translations, evaluation by Expert Committee, back-translation, comparison with original tool and actual semantic validation. Results: the initial translation process of the tool until the final consensus was reached took approximately four months. In the evaluation by the Expert Committee, three health professionals participated in the study, who were knowledgeable on the theme and mastered the English language. In the semantic validation, 35 children and adolescents aged between eight and 18 unfinished years participated, who were patients at the institution where children and adolescents with cancer were treated and monitored. After concluding all steps, the researchers met to discuss the proposed changes. At the end of the cross-cultural adaptation process of the Adolescent Pediatric Pain Tool, all initially proposed 67 pain descriptors were maintained in their Portuguese version. Conclusion: the steps in the cross-cultural adaptation process of the Adolescent Pediatric Pain Tool were executed and described in detail, evidencing the rigorous development of the study.

Cultural adaptation of the Adolescent Pediatric Pain Tool in Turkish children with cancer.

Pain is very common among pediatric cancers. This study aimed to assess the reliability and validity of the Turkish version of the Adolescent Pediatric Pain Tool (APPT). In this methodological study, language validity and content validity of the words in the third section of the scale, which was administered to children with cancer, were tested using the Q-sort method. The APPT was used to measure test-retest reliability once for each of the 1st, 2nd and 3rd weeks of the chemotherapy protocols for 30 children. A reliability test was conducted using the APPT for 96 children with cancer. The number of words included in the third section of the APPT was reduced to 56 following the completion of the language and content validity using the Q-sort method. In the test-retest method, results from the three measures taken showed that the intra-class correlation coefficient was good. The internal consistency of the scale was also good (α = .78) in terms of the total number of body areas marked on body outline diagram, pain severity, pain intensity ratings, total number of word descriptors, and total number of sensory, affective, evaluative and temporal word descriptors. Correlations were found between the total number of body areas marked on the body outline diagram and the total number of word descriptors (r = .53), the pain severity and pain intensity ratings (r = .95), and the total number of word descriptors (r = .38). The Turkish version of the APPT was determined to be valid, reliable and easy to use for pediatric cancer patients.

Pain and its Impact on the Functional Ability in Children Treated at the Children's Cancer Center of Lebanon

PurposeThe purpose of this study was to describe the characteristics of pain in children under treatment at the Children Cancer Centre of Lebanon at the American University of Beirut Medical Centre.Design and MethodsA cross-sectional correlational survey was used. The Adolescent Pediatric Pain Tool and the Functional Disability Inventory were used to examine the characteristics of pain experienced in a consecutive sample of children treated at the CCCL and its impact on their functional abilities. ResultsThe mean age of the 62 participants was 12.3 (SD 2.9). The overall mean pain intensity rating for the sample was 5.06 (SD 1.87) on a 10 cm Word Graphic Rating Scale. More than one-half of the children in the sample (57.4%) reported having pain “sometimes” with a median duration of two hours per pain episode. The most frequently reported locations of pain were the forehead, the abdomen, and the lower back. For the most part, the children used sensory words to describe their pain experience. The children reported moderate levels of functional disability (mean FDI score 25.04, SD 13.81). Multivariable linear regression analysis identified frequency, duration, location, use of affective descriptors, and treatments as statistically significant predictors of pain intensity. ConclusionRegrettably, the findings reported attest once again to unrelieved pain in a pediatric oncology population. Practice ImplicationsPolicy makers can contribute to pain control by introducing legislation and national policies to ensure adequate pain management for children with cancer in Lebanon.

(108) The pain experience of hospitalized youth: assessment and management preferences

Accurate pediatric pain assessment is necessary to ensure quality pain management. Patient self-report of pain intensity is the most common assessment of pain in clinical practice. Assessing pain is complicated by the child's age and developmental level. A number of reliable, valid tools exist to measure pediatric pain. However, evidence continues to be published indicating inadequacies in pediatric pain management. Therefore, it is useful to consider how the process of pain assessment might be implicated in this problem. We conducted a qualitative, descriptive study using semi-structured interviews to explore patient pain experience and discuss select validated pain scales to illicit pain reports and preferences. Interviews were 20-40 minutes in length with questions focused on current pain experience, pain related symptoms, evaluation of pain treatment and preferences for select pain assessment scales: a 0-10 point numeric rating scale, The Oucher, Faces Pain Scale - Revised and the Adolescent Pediatric Pain Tool (APPT). Subjects were 40 youth hospitalized on a medical inpatient unit; ages 10-17 yrs. (mean 13 yr., S. D. 2.4); subjects were mainly White (47.5%) or Black (45%); female (52.5%); and had diagnoses inclusive of the following: SCD pain/fever (28%), asthma (12,5%), Rheumatology (12.5%), Inflammatory Bowel Disease (10%), Aplastic anemia (7.5%), General Surgery (7.5%), Migraine (5%) & other (17,5%). Each patient had previous experience with pain and the majority (62.5%) had either chronic or episodic pain. Analysis of transcribed interviews yielded three themes: My Pain Now, including detailed descriptors of pain; Patient Treatment Expectations, such as goals for improvement and methods to alleviate pain; & Telling Healthcare Providers About My Pain, preferences for pain scales, desired frequency of assessment and discussion of how behavior, activity and pain expression is different for each person. Multidimensional individualized assessment was deemed superior. Interviewed youth indicated personal preferences for pain management and their expected outcomes.

The Use of Acupuncture for Pain Management in Pediatric Patients: A Single-Arm Feasibility Study

Abstract Background: Chronic pain is a prevalent issue in children. When pain persists in childhood, it can impair quality of life (QoL) greatly and have significant physical, psychologic, and social consequences. Achieving treatment goals involves developing personalized plan of care, including a combination of pharmacologic and nonpharmacologic treatments, and increasingly, using integrative medicine. In adult populations, acupuncture is considered to be a safe and effective treatment for several pain conditions. However, evidence supporting the efficacy of acupuncture in pediatric pain management is lacking. This study examined the impact of acupuncture on pain, nausea, and QoL in children with diverse chronic pain conditions. Materials and Methods: This single group, pretest–post-test study used the Adolescent Pediatric Pain Tool (APPT), the Pediatric Nausea Assessment (PeNAT), and the Pediatric Quality of Life Inventory (PedsQL 4.0) as measurement tools. Setting: The study was conducted at an integra...

Pain in Children Following Microsurgical Reconstruction for Obstetrical Brachial Plexus Palsy

To determine the prevalence and characteristics of pain experienced by children who have had microsurgical reconstruction for obstetrical brachial plexus palsy (OBPP). A prospective case series study was conducted of 65 children aged 6 to 18 years with a diagnosis of OBPP and who had microsurgery at less than 12 months of age with nerve grafting or transfer. A total of 28 patients (43%) had upper OBPP and 37 (57%) had total OBPP. We evaluated pain using the Faces Pain Scale-Revised and the Adolescent Pediatric Pain Tool. Sensory symptoms in the affected limb were also collected. Mean age was 11.0 ± 3.3 years. We evaluated 65 children. The point prevalence of pain (pain at the time of assessment) was 25%. The reported lifetime prevalence of pain (experienced anytime during life) was 66%. A total of 71% reported that the affected extremity felt different at least once in their lifetime. Average intensity of those with pain (n = 43) was 40 ± 19 mm on a 100-mm visual analog scale. Seventy percent of children reported that symptoms occurred every day or at least once a week. Anatomical distribution of pain was throughout the affected upper extremity irrespective of the severity of injury, with the exception of children with upper plexus injuries who did not report pain in their hand. Words typically used to describe neuropathic or musculoskeletal symptoms were chosen by the children to represent their pain. Children with OBPP who had microsurgical reconstruction commonly reported pain. These symptoms were typically frequent but were episodic and low in intensity. The descriptions of the type of pain include terms typical of both neuropathic and musculoskeletal origins. Prognostic IV.

Pain assessment using the adolescent pediatric pain tool: a systematic review.

The Adolescent Pediatric Pain Tool (APPT) is a multidimensional pain assessment tool designed to assess pain location (body outline diagram), intensity (word graphic rating scale) and quality (list of pain descriptors) in hospitalized children eight to 17 years of age. To identify the age range, health conditions, settings and purpose for which APPT has been used; the components of the APPT that have been used; and the reported clinical and research utility of the APPT. A systematic review of published studies using the APPT was performed. Studies were identified through electronic searches in CINAHL, Medline, PubMed, SciELO and PsycInfo. Twenty-three studies were analyzed. APPT has been used in patients between two and 68 years of age, with various acute and chronic conditions, in and out of hospital. All but six studies used the three components of the APPT. Most of the studies used the total number of sites marked, mean pain intensity and mean number of pain descriptors selected as main outcome measures; however, scoring methods varied. Studies report that the use of the APPT is relevant for clinical practice and for research. Obtaining self-report of pain using the APPT may help clinicians to tailor pain management interventions. It may also be used in studies to provide a deeper understanding of the pain experience and to examine the effectiveness of pain management interventions. However, outcome measures and methods of scoring the different components of the APPT need to be clearly identified.