Pain Management In Adolescents Research Articles

Pain management and emergency care in adolescent patients with hidradenitis suppurativa: a cross-sectional hospital-based study.

Pain management and emergency care in adolescent patients with hidradenitis suppurativa: a cross-sectional hospital-based study.

Intervention for Sleep and Pain in Youth (ISPY-RCT): protocol for a two-phase randomized controlled trial of sequenced cognitive-behavioral therapy for insomnia and pain management in adolescents with migraine

BackgroundMigraine is a major pediatric health problem impacting 10–12% of youth. About 1 in 3 youth with migraine are diagnosed with insomnia. Sleep and migraine share a cyclical relationship, and data indicate that insomnia symptoms increase migraine severity. CBT for insomnia (CBT-I) has demonstrated efficacy for improving insomnia in adults with migraine and other pain conditions; however, effects in youth have not been evaluated. Moreover, in adults, there is some indication that CBT-I may lead to changes in pain after there are sustained improvements in sleep, but this has never been empirically tested. Cognitive-behavioral therapy for pain management (CBT-Pain) is an established treatment approach for youth with migraine, leading to reductions in headache frequency and disability. In the proposed study, we will address these gaps in knowledge by using an innovative two-phase trial design to (1) test the efficacy of Internet-delivered CBT-I intervention for youth with migraine and comorbid insomnia compared to Internet-delivered sleep education for modifying sleep and (2) investigate how changes in sleep may modify the response to Internet-delivered CBT-Pain intervention.MethodsWe will study a cohort of 180 adolescents, ages 11–17 years, with migraine (with or without aura, chronic migraine) and comorbid insomnia. In phase 1, youth will be randomly assigned to receive Internet-delivered CBT-I intervention or Internet sleep education control. In phase 2, all youth will receive Internet-delivered CBT-Pain intervention. Assessments will occur at baseline, immediately after phase 1 intervention, immediately after phase 2 intervention, and 6 months post-intervention. We will use a comprehensive multidimensional assessment of sleep and headache including self-report questionnaires, ambulatory actigraphy monitoring, and 14-day daily diaries.DiscussionGiven the high prevalence of insomnia in adolescents with migraine, an extension of CBT-I intervention to this population will address an important gap in clinical practice and in conceptual understanding of the relationship between sleep and migraine. By testing a separate CBT-I intervention, we will be able to apply this treatment in the future to other pediatric populations (e.g., cancer, arthritis) who commonly experience comorbid insomnia.Trial registrationClinicalTrials.gov NCT04936321. Registered on June 23, 2021.

The mediating role of maladaptive cognitive schemas regarding the relationship between parenting styles and chronic pain in adolescents: a structural equation modelling approach

BackgroundAlthough there is a growing body of evidence linking parenting styles to health outcomes, little emphasis has been dedicated to how parenting styles affect chronic pain in adolescents. Given the high prevalence of chronic pain in adolescents and taking into consideration the complexity of chronic pain and the factors affecting it, further research is needed to better understand the processes through which parenting styles affect adolescents’ pain. The purpose of the present study was to explore the mediating role of maladaptive schemas in the association between different parenting styles and chronic pain.Method1302 adolescents aged 12 to 21 in Shiraz, Iran, were randomly selected to participate in this study. To identify adolescents with chronic pain, screening questions based on the 11th revision of the International Classification of Diseases were used. Buri’s Parental Authority Questionnaire (PAQ), and Young’s Schema Questionnaire-Short Form (YSQ-SF) were used to assess the parenting styles and maladaptive cognitive schemas, respectively. The structural equation modeling approach was carried out to evaluate the direct, indirect, and total effects of different parenting styles on chronic pain.ResultsThe results in the SEM models revealed that disconnection/ rejection (β = − 0.043, 95%CI = − 0.07 to − 0.02), impaired autonomy/ performance (β = − 0.01, 95%CI = − 0.02 to -0.003), over-vigilance/inhibition (β = − 0.007, 95%CI = − 0.01 to − 0.008), and impaired limits schemas (β = − 0.004, 95%CI = − 0.006 to − 0.002) significantly mediated the protective effects of the authoritative parenting style on chronic pain. It was also found that the mediating effects of disconnection/ rejection (β = 0.01, 95%CI = 0.01 to 0.02), and over-vigilance/ inhibition (β = 0.002, 95%CI = 0.001 to 0.02) existed in the relationship between the authoritarian style and chronic pain. The permissive style may also affect chronic pain through disconnection/ rejection (β = 0.004, 95%CI = 0.001 to 0.01), other-directedness (β = 0.01, 95%CI = 0.005 to 0.015), and impaired limits schemas (β = 0.05, 95%CI = 0.04 to 0.06).DiscussionThe findings of the present study showed that maladaptive cognitive schemas play a mediating role in the relationship between parenting styles and chronic pain in adolescents. It seems that the interventions that target the effective communication between the parents and the adolescents can be considered as an important part in the chronic pain management in adolescents.

Understanding the relationship between parenting style and chronic pain in adolescents: a structural equation modelling approach

BackgroundAlthough the context of parenting has been incorporated into psychosocial pain research, very little attention has been paid to how parenting styles influence chronic pain in adolescents. The present study aimed to investigate the mediating role of self-esteem, emotional intelligence, and psychological distress in the association between parenting styles and chronic pain.MethodSeven hundred and thirty nine adolescents and their parents participated in this study. To identify adolescents with chronic pain, screening questions based on the 11th revision of the International Classification of Diseases were used. Baumrind parenting style questionnaire was used to assess the parenting style (permissive, authoritarian, and authoritative parenting styles). The structural equation modelling (SEM) was carried out in M-Plus version 6 to evaluate the direct, indirect, and total effects of different parenting styles on chronic pain.ResultsThe results in the SEM models revealed that only the indirect paths from authoritative and authoritarian parenting styles to pain through emotional intelligence (βauthoritative = − 0.003, 95% CI = − 0.008 to − 0.003; βauthoritarian = 0.001, 95% CI = 0.001 to 0.003) and psychological distress (βauthoritative = − 0.010, 95% CI = − 0.021 to − 0.004; βauthoritarian = 0.008, 95% CI = 0.004 to 0.016) were significant. Indirect paths from permissive style to pain and the mediating role of self-esteem were not significant.DiscussionEmotional intelligence and psychological distress significantly mediated the effects of authoritative and authoritarian parenting styles on chronic pain. The current results support the notion that interventions targeting effective parent–adolescent communication may be an important part of chronic pain management in adolescents. Moreover, the results provide rationale for targeting emotional intelligence and psychological distress in adolescents by explicitly teaching effective communication skills, expressing opinions and minds, and emotion regulation strategies.

Design and Analysis of a Clinical Pressure Cuff Algometer, Compatible with an fMRI Machine.

Chronic pain affects both adolescent and adult Canadians. To study the effect of social rejection on pain management in adolescents with chronic pain, an algometer can be used in conjunction with functional Magnetic Resonance Imaging (fMRI) to measure brain activity in real time. The algometer uses an automated pneumatic control system that follows a customizable pain schedule, controlling the amount of airflow in and out of a pressure cuff wrapped around a human participant's thigh. Plastic components allow compatibility with an fMRI environment. Measurable pain stimuli allow repeatable pressure schedules to be administered with a standard deviation between trials of 300 Pa (2.25 mmHg). A Failure Mode Effects Analysis was used to reduce participant, researcher and facility harm, with multiple safety features incorporated into the design. Through the analysis of medical standards and studies, the algometer is shown to be biologically safe to use on research subjects within the suggested usage parameters of a maximum pressure of 42.6 kPa (320 mmHg) and a pressure application period of up to one hour. This makes it feasible for research studies using fMRI machines.

Pain Self-management in Adolescent with Dysmenorrhea

Introduction: Complaints that often occur are dysmenorrhea that is not harmful but can interfere with comfort and activity. An adolescent who know the proper management of dysmenorrhea can overcome it and have good pain management. The study aimed to analyze pain self-management in adolescents with dysmenorrhoea.Methods: This study used correlational research with a cross-sectional approach. The population in this study were adolescent at Public Junior High School IV Lamongan. The samples were 129 respondents selected by simple random sampling. The inclusion criteria were an adolescent who analyzes dysmenorrhea. The exclusion criteria for this study were not in place due to illness or alpha. Data was collected using questionnaire self-efficacy, decision making, information support, and pain self-management that had been tested for validity and reliability—test statistics using the Spearman's rho test.Results: The results of the study found a correlation between self-efficacy with pain self-management (p = 0.004; r = 0.24), decision making with pain self-management (p = 0.003; r = 0.26), information support with pain self-management (p = 0.003; r = 0.26).Conclusion: Self-efficacy is a mediator to improve pain self-management optimally to improve quality of life. There are three factors in decision making for pain management in adolescents who experience dysmenorrhea is personal, social, and psychological. Adolescents who have initiatives in finding information about dysmenorrhea have good pain management. It is expected that parents, schools, and health workers provide knowledge to an adolescent who experiences dysmenorrhea to be able to do pain management.

Patient, caregiver, and provider perceptions of pain and pain management in adolescents and young adults with bleeding disorders.

Recurrent bleeding and associated pain are critical components in the management of bleeding disorders, yet scant data describe perceptions of pain in this patient population. This study assessed perceptions of pain and pain management in adolescents and young adults (AYAs) with haemophilia or von Willebrand disease (VWD) to determine agreement/disagreement between patients, caregivers and health care providers. Using an online questionnaire, AYA patients (N=89), their caregivers (N=77), and providers (N=54) reported on pain perception, pain treatment and pain control. Acute and chronic pain was measured in patients via the Faces Pain Scale-Revised (FPS-R). Questionnaires queried about pharmacologic and non-pharmacologic pain management methods and how well providers and caregivers helped to manage pain. Poor agreement existed between patients and caregivers across all pain levels, perception of pain control and effectiveness of pain management. Specifically for chronic pain, poor agreement was noted between patients and caregivers (kappa=0.04; 29% agreement) and patients and providers (kappa=-0.07; 21.4% agreement). Among patients reporting acute or chronic pain, only 67% and 43%, respectively, utilized medication for their specific pain. Patients used more opioid medications than expected by their providers. On average, AYAs reported initial use of pain medications for chronic pain at 11.5years. Ongoing research is needed in haemophilia and VWD pain management, and on the differences in pain perception between patients, caregivers and providers. As chronic pain often begins at an early age, optimal pain management should include acknowledging patient complaints, exploring pharmacologic and non-pharmacologic options, and optimizing prophylaxis.

Opioid Prescription and Usage in Adolescents Undergoing Orthopaedic Surgery in the United States: A Systematic Review.

The proper use of opioid analgesia for postoperative pain management is controversial. While opioids are considered the standard of care for multimodal postoperative pain modulation in the United States, there is a lack of established protocols for prescribing opioids in adolescents undergoing outpatient orthopaedic surgery. The objective of this review was to identify and report on current literature on opioid prescription for pain management in adolescents undergoing all procedures, as well as in adults undergoing outpatient orthopaedic surgery. A comprehensive literature search using PRISMA guidelines was performed to identify all articles relevant to opioid use in adolescents for postoperative pain and in adults following outpatient orthopaedic procedures. A total of 4,446 results were identified from databases and relevant journal web sites. Of these, 9 articles were selected that fit the criteria for review. Five studies discussed the dosage and type of opioids prescribed in adolescent populations, and 4 quantified patient self-administration in adult populations. Adolescent opioid pain management following outpatient orthopaedic surgery is not documented. Current recommendations for opioid prescription in adolescents lack support and are primarily based on adult dosages. Adult studies suggest that opioid medications may be overprescribed following outpatient orthopaedic surgery. These results clearly indicate that there is a pressing need for quantitative research on pain management following outpatient orthopaedic surgery in the adolescent population in the United States. There appear to be no studies on self-administered opioid pain medication following orthopaedic surgery in an adolescent population, suggesting that there is no objective basis for the current prescription recommendations.

Dexmedetomidine as an adjuvant for perioperative pain management in adolescents undergoing bariatric surgery: An observational cohort study

BackgroundThe anesthetic management of adolescents undergoing bariatric surgery presents a number of challenges, including increased risk of postoperative opioid-related respiratory depression. These patients could benefit from adjunctive analgesics with opioid-sparring effects to optimize perioperative pain control. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has sedative and analgesic properties with no respiratory depressant effects. ObjectiveTo determine the effect of intraoperative dexmedetomidine on opioid requirement and perioperative pain management in obese adolescents undergoing bariatric surgery. MethodsAn observational study of 26 consecutive patients treated with and without dexmedetomidine during the intraoperative period was conducted. The dexmedetomidine treated patients received a loading dose over 30min and a continuous infusion thereafter. The standard group represented patients who received an institutional standard anesthetic without dexmedetomidine. The primary outcome was total perioperative intravenous morphine equivalent (MEq). We also examined reported pain scores during the perioperative period. ResultsWhile there were no significant differences in age, height and weight category, there were imbalances on race distribution between the two groups. Both groups received similar doses of ketorolac and acetaminophen perioperatively. Overall, during 48h postoperatively, the dexmedetomidine group received significantly less total MEq administration compared with the standard group. Three patients in the dexmedetomidine group required ephedrine to treat an episode of hypotension. DiscussionThese results suggest that the use of dexmedetomidine during bariatric surgery in the morbidly obese adolescent population is associated with decreased opioid utilization during the perioperative period. Future randomized studies will determine the role of dexmedetomidine in the pain management of obese adolescents undergoing bariatric surgery. Study typeTherapeutic, Level III.

Effect of vibroacoustic therapy on pain management in adolescents with low back pain

Vibroacoustic Therapy (VT) is a very distinct form of treatment. The purpose of this study was to determine the effect of vibroacoustic therapy on low back pain management in adolescents. A total of 40 adolescents (13-18 years old) were randomly divided into two equal groups (exercise – control group, and exercise and vibroacoustic therapy – vibroacoustic group), and participated in a 3-week physiotherapy program for back pain management. The participants in both groups performed the same exercise program five times per week. The participants in the vibroacoustic group apart from exercise also received treatment on a special vibro chair set at 4-8 Hz frequency for relaxation. Music was heard through the headphones. Standard tests (Oswestry disability index and the visual analogue pain scale) to assess low back pain were used before and after the intervention to monitor changes. The intensity of low back pain significantly decreased in both groups after the intervention (P < 0.05), but there were no significant differences between the groups in low back pain management in adolescents.

Prescription Opioid Abuse, Prescription Opioid Addiction, and Heroin Abuse Among Adolescents in a Recovery High School: A Pilot Study

ABSTRACTThe progression from prescription opioid (RXO) abuse to RXO addiction is not well understood in adolescents, nor is the progression from RXO addiction to heroin abuse. The purpose of this pilot study was to characterize the development of RXO drug abuse, RXO drug addiction, and heroin abuse in a small cohort of adolescents recovering from opioid addiction at Massachusetts Recovery High Schools (RHS). A self-report questionnaire was administered to 31 adolescent, former RXO abusers across two Massachusetts RHS. RXO abuse was primarily initiated due to curiosity; RXOs were initially obtained through illicit and licit methods. Fifty-eight percent (N = 18) of the RXO abusers became addicted to RXOs. Many addicted adolescents initiated RXO abuse under the influence of marijuana, yet believed that they became addicted due to the stress from difficult life situations. A subgroup indicated they abused and became addicted to RXOs that had been obtained from legitimate prescriptions due to their pain. Sixteen percent (N = 5) of the sample abused heroin. Most heroin abusers (4/5) were addicted to RXOs prior to onset of heroin use. Heroin abusers indicated that they considered using heroin after they began tampering with RXOs. A portion of the sample felt that abuse deterrent formulations (ADFs) would have reduced their RXO use. This pilot study discovered areas where further research could be targeted, such as drug combinations, adolescent coping mechanisms, adolescent pain management, and the use of ADFs to disrupt the transition from RXO addiction to heroin use.

Readiness to change in pediatric chronic pain: Initial validation of adolescent and parent versions of the Pain Stages of Change Questionnaire

Despite the clinical importance of readiness to change in predicting treatment outcomes among adults, no studies have examined this construct among pediatric pain patients. Because parents play a key role in adolescent pain management, both adolescent and parent readiness to adopt a self-management approach to pain merit further study. The primary goal of the current study was to validate adolescent and parent-report adaptations of the adult Pain Stages of Change Questionnaire (PSOCQ). Participants included 259 adolescent patients with chronic pain syndromes and their parents presenting to 2 pediatric pain management clinics. Using confirmatory factor analytic techniques, a 4-factor solution was supported for the parent version (PSOCQ-P) that included Precontemplation, Contemplation, Action, and Maintenance factors, whereas the adolescent version (PSOCQ-A) version supported a three-factor model that combines the Action and Maintenance scales. Within both versions, each of the factors was found to be internally consistent. The PSOCQ-A and PSOCQ-P showed evidence of criterion validity through significant correlations with coping strategies and pain catastrophizing. Stability findings at 4 and 8weeks after a multidisciplinary pain clinic evaluation are reported. Associations between pediatric PSOCQ scores and demographic, pain, and functional domains were explored to inform future research. Further validation of the PSOCQ-A and PSOCQ-P measures with new, separate samples of pediatric pain patients and parents are needed before use in clinical contexts.

Peer mentorship to promote effective pain management in adolescents: study protocol for a randomised controlled trial

BackgroundThis protocol is for a study of a new program to improve outcomes in children suffering from chronic pain disorders, such as fibromyalgia, recurrent headache, or recurrent abdominal pain. Although teaching active pain self-management skills through cognitive-behavioral therapy (CBT) or a complementary program such as hypnotherapy or yoga has been shown to improve pain and functioning, children with low expectations of skill-building programs may lack motivation to comply with therapists' recommendations. This study will develop and test a new manualized peer-mentorship program which will provide modeling and reinforcement by peers to other adolescents with chronic pain (the mentored participants). The mentorship program will encourage mentored participants to engage in therapies that promote the learning of pain self-management skills and to support the mentored participants' practice of these skills. The study will examine the feasibility of this intervention for both mentors and mentored participants, and will assess the preliminary effectiveness of this program on mentored participants' pain and functional disability.MethodsThis protocol will recruit adolescents ages 12-17 with chronic pain and randomly assign them to either peer mentorship or a treatment-as-usual control group. Mentored participants will be matched with peer mentors of similar age (ages 14-18) who have actively participated in various treatment modalities through the UCLA Pediatric Pain Program and have learned to function successfully with a chronic pain disorder. The mentors will present information to mentored participants in a supervised and monitored telephone interaction for 2 months to encourage participation in skill-building programs. The control group will receive usual care but without the mentorship intervention. Mentored and control subjects' pain and functioning will be assessed at 2 months (end of intervention for mentored participants) and at 4 month follow-up to see if improvements persist. Measures of treatment adherence, pain, disability, and anxiety and depression will be assessed throughout study participation. Qualitative interviews for mentors, mentored participants, and control subjects will also be administered.Trial registrationClinicalTrials.gov NCT01118988.

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

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

Efficacy of an interdisciplinary adolescent pain management program: preliminary outcomes

Efficacy of an interdisciplinary adolescent pain management program: preliminary outcomes

Pediatric pain management use of urine toxicology

Pediatric pain management use of urine toxicology The management of chronic non malignant pain is evolving with a wide variety of pharmacologic therapies which includes opioid in the comprehensive treatment. Pediatrics and adolescent pain management has enlarged the scope of opioid prescription practice to include chronic nonmalignant conditions sub acute pain post-operative pain In both adults and pediatrics, guidelines have been recently recommended regarding protocols for monitoring chronic opioid therapy for non-malignant pain.