Pediatric Chronic Pain Clinic Research Articles

Development and Usability Evaluation of an Art and Narrative-Based Knowledge Translation Tool for Parents With a Child With Pediatric Chronic Pain: Multi-Method Study.

BackgroundChronic pain in childhood is increasingly being recognized as a significant clinical problem for children and their families. Previous research has identified that families want information about the causes of their child’s chronic pain, treatment options, and effective strategies to help their child cope with the pain. Unfortunately, parents have reported that finding this information can be challenging.ObjectiveThe aim of this study was to actively work together with children attending a pediatric chronic pain clinic and their parents to develop, refine, and evaluate the usability of an art and narrative-based electronic book (e-book) for pediatric chronic pain.MethodsA multiphase, multi-method research design employing patient engagement techniques was used to develop, refine, and evaluate the usability of an art and narrative based e-book for pediatric chronic pain management to facilitate knowledge translation for parents with a child with chronic pain. The multiple phases included the following: (1) qualitative interviews to compile parents’ narratives using qualitative interviews; (2) qualitative data analysis; (3) development of an e-book prototype; (4) expert clinician feedback; (5) parent usability evaluation, knowledge change, and confidence in knowledge responses using an electronic survey; (6) e-book refinement; and (7) dissemination of the e-book.ResultsA 48-page e-book was developed to characterize the experiences of a family living with a child with chronic pain. The e-book was a composite narrative of the parent interviews and encompassed descriptions of the effects the condition has on each member of the family. This was merged with the best available research evidence on the day-to-day management of pediatric chronic pain. The e-book was vetted for clinical accuracy by expert pediatric pain clinicians. All parents that participated in the usability evaluation (N=14) agreed or strongly agreed the content of the e-book was easy to understand and stated that they would recommend the e-book to other families who have children with chronic pain. Our research identified up to a 21.4% increase in knowledge after using the e-book, and paired t tests demonstrated a statistically significant difference in confidence in answering two of the five knowledge questions (chronic pain is a disease involving changes in the nervous system; the use of ibuprofen is usually effective at controlling chronic pain); t13=0.165, P=.001 and t13=0.336, P=.002, respectively, after being exposed to the e-book.ConclusionsOur results demonstrate that parents positively rated an e-book developed for parents with a child with chronic pain. Our results also identify that overall, parents’ knowledge increased after using the e-book, and confidence in their knowledge about chronic pain and its management increased in two aspects after e-book exposure. These results suggest that art and narrative-based knowledge translation interventions may be useful in transferring complex health information to parents.

A Cost-Analysis of an Interdisciplinary Pediatric Chronic Pain Clinic

Chronic pain is characterized by high rates of functional impairment, health care utilization, and associated costs. Research supports the use of comprehensive, interdisciplinary treatment approaches. However, many hospitals hesitate to offer this full range of services, especially to Medi-Cal/Medicaid patients whose services are reimbursed at low rates. This cost analysis examines the effect on hospital and insurance costs of patients' enrollment in an interdisciplinary pediatric pain clinic, which includes medication management, psychotherapy, biofeedback, acupuncture, and massage. Retrospective hospital billing data (inpatient/emergency department/outpatient visits, and associated costs/reimbursement) from 191 consecutively enrolled Medi-Cal/Medicaid pediatric patients with chronic pain were used to compare 1-year costs before initiating pain clinic services with costs 1 year after. Pain clinic patients had significantly fewer emergency department visits, fewer inpatient stays, and lower associated billing, compared with the year before without interdisciplinary pain management services. Cost savings to the hospital of $36,228 per patient per year and to insurance of $11,482 per patient per year were found even after pain clinic service billing was included. Analyses of pre-pain clinic costs indicate that these cost reductions were likely because of clinic participation. Findings provide economic support for the use of interdisciplinary care to treat pediatric chronic pain on an outpatient basis from a hospital and insurance perspective. PerspectiveThis article presents a cost analysis of an interdisciplinary pediatric pain outpatient clinic. Findings support the incorporation of a comprehensive treatment approach that can reduce costs from a hospital and insurance perspective over the course of just 1 year.

Seasonal Variation in Pediatric Chronic Pain Clinic Phone Triage Call Volume

Chronic pain is highly prevalent in youth and often results in significant health care usage and familial distress. Telephone triage nurses in pediatric pain clinics provide support and consultation to families and engage parents of pediatric pain patients in interdisciplinary intervention efforts. Despite evidence of winter predominance in rates of pain-related and psychiatric complaints, seasonal variations have not been examined in terms of the demand placed on pain clinic triage nurses. The present study investigated seasonal patterns in the frequency and type of phone calls made over the course of 1 year to an interdisciplinary outpatient pediatric chronic pain clinic at a large Midwestern children's hospital. Pain complaints, reasons for phone calls, and call outcomes (e.g., medication changes, consultation with medical or mental health providers) were recorded in patient charts and retrospectively reviewed by the clinic registered nurse. A total of 721 calls regarding 253 patients were made over the course of 1 year. Results indicated that overall call volume across pain conditions was more than two times greater in the winter than in the summer (χ2 = 64.13, p < .001), and the odds of a call involving headache pain were almost twice as likely in the winter as in the summer. The majority of calls required consultation with physicians and/or mental health providers. Present data may be useful for pediatric chronic pain clinics making staffing decisions throughout the year because the winter season appears to place a significantly greater demand on triage nurses.

Somatosensory Test Responses and Physical and Psychological Functioning of Children and Adolescents with Chronic Non-neuropathic Pain: An Exploratory Study.

This study was designed to establish preliminary feasibility testing of a set of inherently benign somatosensory stimulus-response tests (to cutaneous and deep stimuli) for bedside or office evaluation of pain disorders in children and adolescents. Associations between, and the relative influence of, cutaneous somatosensory testing (SST) responses, deep SST responses, and psychological factors (depression, pain-related catastrophizing) on pain outcomes (worst pain intensity, pain-related disability) were considered. Sixty participants (6 to 18 y) were recruited from the pediatric chronic pain clinic. SST responses were assessed at the pain site (PS) and control sites to diverse stimuli (static/dynamic touch, punctate pressure, vibration, cool, deep pressure) using Colored Analogue Scales (CAS) with modified anchors. Validated measures of depression, pain-related catastrophizing, and pain-related functional interference were administered. Responses at the PS were more frequently hypersensitive than hyposensitive for all SST measures except vibration. Deep pressure responses were the only statistically significant predictor of worst pain intensity. Depression and pain-related catastrophizing accounted for a statistically significant amount of variance of pain-related disability, over and above that which was accounted for by SST responses. Preliminary feasibility of a set of somatosensory stimulus-response tests for bedside or office evaluation of pain disorders in children and adolescents was established. Deep pressure responses contributed unique information in predicting worst pain intensity but not functional interference. Although cutaneous SST responses at the PSs were frequently abnormal, cutaneous SST responses were not confirmed in this study to have clinical utility, but rather might be centrally mediated epiphenomena.

Understanding the use of over-the-counter pain treatments in adolescents with chronic pain

ABSTRACTBackground: The prevalence of chronic pain in children and adolescents is well established. What is not well understood is how over-the-counter (OTC) oral and topical pain treatments are being used by adolescents with chronic pain, their decision making around use of these products, and how they communicate with their health care providers about their use.Aims: The aim of this study was to explore the use, decision-making process, and communication about the use of OTC pain medications with health care professionals among adolescents living with chronic pain and their primary caregiver.Methods: A qualitative descriptive design with semistructured, audiotaped individual interviews was undertaken with adolescents with chronic pain (n = 15, aged 12–18 years, mean age = 16, SD = 1.79) and their caregivers (n = 16). A convenience sample of patient–caregiver dyads was recruited from a tertiary care pediatric chronic pain clinic in Ontario.Results: Interview questions focused on four topics: (1) experience with chronic pain and medication; (2) perceptions of medications and concerns with long-term consumption; (3) decision making for use of OTC medications guided mainly by a trusted source or health care professional; and (4) topical OTC medications perceived as harmless. Content analysis within these four topics uncovered two to four subthemes, which are described in detail.Conclusions: An improved understanding of the prevalence of use, decision-making process around use, and how patients and their families communicate about the use of OTC pain medications with health care providers can help clinicians better personalize treatments and help adolescents with chronic pain to make sound self-care decisions.

"What Does Weight Have to Do with It?" Parent Perceptions of Weight and Pain in a Pediatric Chronic Pain Population.

Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child’s initial appointment; questions addressed parents’ perceptions of their child’s weight, and their perceptions of multiple aspects of the relationship between their child’s weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child’s weight; this group of parents was also more concerned (p < 0.05) about their child’s weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child’s weight contributed to his/her pain, or that weight was relevant to their child’s pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child’s pain. Results support the need for addressing parents’ perceptions of their child’s weight status, and educating parents about the relationship between excessive weight and chronic pain.

Integrating Complementary and Alternative Techniques within a Pediatric Chronic Pain Clinic

Integrating Complementary and Alternative Techniques within a Pediatric Chronic Pain Clinic

Pain-QuILT: clinical feasibility of a web-based visual pain assessment tool in adults with chronic pain.

BackgroundChronic pain is a prevalent and debilitating problem. Accurate and timely pain assessment is critical to pain management. In particular, pain needs to be consistently tracked over time in order to gauge the effectiveness of different treatments. In current clinical practice, paper-based questionnaires are the norm for pain assessment. However, these methods are not conducive to capturing or tracking the complex sensations of chronic pain. Pain-QuILT (previously called the Iconic Pain Assessment Tool) is a Web-based tool for the visual self-report and tracking of pain (quality, intensity, location, tracker) in the form of time-stamped records. It has been iteratively developed and evaluated in adolescents and adults with chronic pain, including usability testing and content validation. Clinical feasibility is an important stepping-stone toward widespread implementation of a new tool. Our group has demonstrated Pain-QuILT clinical feasibility in the context of a pediatric chronic pain clinic. We sought to extend these findings by evaluating Pain-QuILT clinical feasibility from the perspective of adults with chronic pain, in comparison with standard paper-based methods (McGill Pain Questionnaire [MPQ] and Brief Pain Inventory [BPI]).ObjectiveThe goal of our study was to assess Pain-QuILT for (1) ease of use, (2) time for completion, (3) patient preferences, and (4) to explore the patterns of self-reported pain across the Pain-QuILT, MPQ, and BPI.MethodsParticipants were recruited during a scheduled follow-up visit at a hospital-affiliated pain management and physical rehabilitation clinic in southwestern Ontario. Participants self-reported their current pain using the Pain-QuILT, MPQ, and BPI (randomized order). A semistructured interview format was used to capture participant preferences for pain self-report.ResultsThe sample consisted of 50 adults (54% female, 27/50) with a mean age of 50 years. Pain-QuILT was rated as significantly easier to use than both the MPQ and BPI (P<.01) and was also associated with the fewest difficulties in completion. On average, the time to complete each tool was less than 5 minutes. A majority of participants (58%, 29/50) preferred Pain-QuILT for reporting their pain over alternate methods (16%, 8/50 for MPQ; 14%, 7/50 for BPI; 12%, 6/50 for “other”). The most commonly chosen pain descriptors on MPQ were matched with Pain-QuILT across 91% of categories. There was a moderate-to-high correlation between Pain-QuILT and BPI scores for pain intensity (r=.70, P<.01).ConclusionsThe results of this clinical feasibility study in adults with chronic pain are consistent with our previously published pediatric findings. Specifically, data indicate that Pain-QuILT is (1) easy to use, (2) quick to complete, (3) preferred by a majority of patients, and (4) correlated as expected with validated pain measures. As a digital, patient-friendly method of assessing and tracking pain, we conclude that Pain-QuILT has potential to add significant value as one standard component of chronic pain management.

ICanCope with Pain™: User-centred design of a web- and mobile-based self-management program for youth with chronic pain based on identified health care needs.

While there are emerging web-based self-management programs for children and adolescents with chronic pain, there is currently not an integrated web- and smartphone-based app that specifically addresses the needs of adolescents with chronic pain. To conduct a needs assessment to inform the development of an online chronic pain self-management program for adolescents, called iCanCope with Pain™. A purposive sample of adolescents (n=23; 14 to 18 years of age) was recruited from two pediatric chronic pain clinics in Ontario. Interdisciplinary health care providers were also recruited from these sites. Three focus groups were conducted with adolescents (n=16) and one with pediatric health care providers (n=7). Individual adolescent interviews were also conducted (n=7). Qualitative analysis uncovered four major themes: pain impact; barriers to care; pain management strategies; and transition to adult care. Pain impacted social, emotional, physical and role functioning, as well as future goals. Barriers to care were revealed at the health care system, patient and societal levels. Pain management strategies included support systems, and pharmacological, physical and psychological approaches. Transition subthemes were: disconnect between pediatric and adult systems; skills development; parental role; and fear⁄anxiety. Based on these identified needs, the iCanCope with Pain™ architecture will include the core theory-based functionalities of: symptom self-monitoring; personalized goal setting; pain coping skills training; peer-based social support; and chronic pain education. The proposed iCanCope with Pain™ program aims to address the self-management needs of adolescents with chronic pain by improving access to disease information, strategies to manage symptoms and social support.

The Interplay of Parent and Adolescent Catastrophizing and Its Impact on Adolescents’ Pain, Functioning, and Pain Behavior

Catastrophizing is a coping style linked to poorer patient outcomes. Little attention has focused on the parent-adolescent dyad and catastrophizing as a shared coping style. The purpose of this study was to: (1) examine the effects of adolescent and parent pain catastrophizing on adolescent functioning and (2) explore concordance in catastrophizing in parent-adolescent dyads, with equal interest in outcomes of dyads with discordant coping styles. Pain intensity, catastrophizing, depressive symptoms, quality of life, and pain behaviors were assessed in adolescents (ages 11 to 17) presenting to a pediatric chronic pain clinic (N=240). Significant correlations between (1) parent and adolescent catastrophizing; (2) catastrophizing and pain behaviors; and (3) catastrophizing and adolescent outcomes were found. Parents and adolescents were classified into concordant or discordant dyads based on catastrophizing with a majority of dyads (>70%) showing concordant coping styles. Among discordant dyads, functional disability and depressive symptoms were significantly higher in a dyad with a high catastrophizing adolescent and low catastrophizing parent. Results provide further support for catastrophizing being a maladaptive coping strategy for adolescents with pain and their parents. Greater adolescent catastrophizing was related to increased pain behaviors and poorer adolescent functioning. Parent catastrophizing also seems related to poorer adolescent outcomes, and most parent-adolescent dyads showed concordance in use of catastrophizing, which may suggest a shared tendency for adaptive or maladaptive styles of coping with pain. Future research should investigate pain coping at a dyadic or family level to explore how family coping styles magnify distress and disability or buffer adolescents from such problems.

Marijuana and Chronic Nonmalignant Pain in Adolescents

C hronic nonmalignant pain in children and adolescents occurs worldwide and can be associated with a lower selfreported quality of life. Headache, abdominal pain, or musculoskeletal pain is the most common complaint. Comorbid symptoms such as fatigue, sleep disturbance, depression, and anxietymay exacerbate pain andcontribute tonotable disability, psychological distress, and impaired functioning. Patients may find it difficult to attend school, concentrate on homework, socialize with friends, or engage in physical activityd ie, activities at the core of being a normal adolescent (patients 13-17 years of age)ddue to ongoing pain. In affected adolescents, evaluations and medical tests may be undertaken over months or longer, with protracted investigations often failing to determine the etiology. Many patients have had unsuccessful medication trials and procedures engendering frustration that “something is being missed.” Patients expect a “quick fix” that, when not forthcoming, may cause them to turn to alternative treatments. Marijuana is one such treatment. Given its widespread availability throughout the United States and expanded use for medical conditions, it is reasonable to anticipate increasing numbers of adolescents turning to marijuana to treat chronic pain. There is a paucity of original research data regarding risks and benefits of marijuana use for treating chronic pain in adults, and there is even less data for treating adolescents. Although benefits may accrue in specific conditions, adverse effects influencing daily functioning (eg, impaired concentration or lengthened reaction time when performing tasks) often limit treatment. More studies are needed in all ages of patients to determine if marijuana effectively reduces chronic nonmalignant pain, withoutmajor adverse effects worsening debility. We could find only one study describing marijuana use to manage pain, mood, and sleep disturbances in an adolescent population. A limitation of this study was its failure to describe participants’ ability to function daily while using marijuana. In this commentary, we describe how marijuana use in 3 adolescent patients presenting to a pediatric chronic pain clinic may have contributed to their functional difficulties. We offer speculative synthesis about the consequences of marijuana consumption and appropriate methods for patient management. During their evaluations, the described patients volunteered that they used marijuana regularly. Urine drug screens are not routinely performed in our clinic and were not used to evaluate these 3 patients. Institutional review board approval was obtained before reporting.

Factor Structure of the Children's Depression Inventory in a Multisite Sample of Children and Adolescents With Chronic Pain

This study examined the factor structure of the Children's Depression Inventory (CDI) among children and adolescents with chronic pain using exploratory and confirmatory factor analysis in a large, multisite sample of treatment-seeking youth. Participants included 1,043 children and adolescents (ages 8–18) with a range of chronic pain complaints who presented for initial evaluation at 1 of 3 tertiary care pediatric chronic pain clinics across the United States. They completed the CDI and reported on pain intensity and functional disability. Factor analysis was conducted using a 2-step (exploratory and confirmatory) approach. Results supported a 5-factor model for the CDI with good fit to the data. The distribution and item-total correlations of the somatic items (eg, pain complaints, fatigue) were explored in this sample. Results indicate that the CDI is a useful tool for assessing depressive symptoms in youth with chronic pain, but some caution is warranted in interpreting the clinical significance of scores in light of the overlap of specific symptoms common to both pain and depression. PerspectiveThe CDI can be considered a valid tool for assessing mood symptoms in children with chronic pain. Caution is encouraged when interpreting the clinical significance of scores due to symptom overlap between chronic pain and depression.

Parent/child catastrophizing matches and mismatches: the effect on pain, symptoms, and disability

Catastrophizing is a cognitive coping style that significantly relates to pain in adults, children, and their parents. Greater catastrophizing by parents and children is linked to poor outcomes for pediatric chronic pain patients. However, the interaction of parent and child catastrophizing styles, i.e., the degree to which they are matched or mismatched, and the effect that has on pediatric outcomes has not been investigated. 341 parent and child dyads were recruited at their initial evaluation at a pediatric chronic pain clinic. Parents and children completed the Pain Catastrophizing Scale (PCS), a reliable and valid measure assessing parents' and children's degree of rumination, magnification, and helplessness about children's pain. Measures were summed and a median split was conducted, creating low and high catastrophizing groups for parents and children. Four parent/child groups were created: two groups of matched parent/child catastrophizing styles, low/low and high/high; and two mismatched groups of parent/child catastrophizing styles, low child/high parent, and high child/low parent. Analyses of variance were conducted for parent/child catastrophizing group by outcome: pain intensity, somatic symptoms, and disability. Outcomes were measured by child report on the Numeric Rating Scale, Child Somatization Inventory, and Functional Disability Inventory. Analyses revealed significant main effects of group by outcome for all variables; post hoc tests showed the matched high/high parent/child catastrophizing group demonstrated the worst child outcomes, with greater pain, symptoms, and disability than the mismatched groups (high child/low parent and low child/high parent), which were in turn greater than the low/low matched group, which had the best outcomes of all. In summary, shared high catastrophizing styles between children and parents may enhance the negative effect of catastrophizing on outcomes. Conversely, the effect of a high catastrophizing parent or child on outcomes may be buffered when the other member of the dyad has a low catastrophizing style.

Rapid Resolution of Chronic Back Pain with Magnesium Glycinate in a Pediatric Patient

A 10-year-old male presented to a pediatric complex chronic pain clinic with debilitating back pain associated with vertebral compression fractures secondary to corticosteroid-induced osteoporosis. The pain failed to respond to routine analgesics and zoledronic acid. Oral magnesium glycinate and topical magnesium/guaifenesin cream were initiated upon presentation to the clinic, and resulted in a rapid and sustained reduction in pain, increased flexibility and improved quality of life. Magnesium is a known N-methyl-D-aspartate receptor antagonist, and should be considered in the management of chronic pain. The roles of glycine and guaifenesin in the management of chronic pain are not well-understood, but may warrant further examination in the context of chronic pain.

What Do the Parents of Children Who Have Chronic Pain Expect from Their First Visit to a Pediatric Chronic Pain Clinic?

Chronic pain in childhood is increasingly recognized as a significant clinical problem. Best-practice management of pediatric chronic pain in a multidisciplinary pain clinic involves a variety of treatment modalities. It is important that parents of children treated in these settings understand the different treatment options available for their children. By involving parents more effectively, care providers may more efficiently address unmet treatment needs and improve tailoring of treatment programs aimed at increasing function, reducing pain-related disability and improving quality of life. To explore the expectations held by parents for their first visit to a pediatric multidisciplinary pain clinic. Fourteen parents completed a paper-based survey exploring their expectations immediately before their first visit to a multidisciplinary pediatric pain clinic in a tertiary care children's hospital. Responses from parents suggest a clear desire for information about the causes of their child's pain, treatment options available at the pain clinic, effective strategies to enhance children's ability to cope with pain, and the effects of pain on both body and mood. Most parents rated the various treatment options as important for their child. All parents indicated it was very important to have the pain team 'be there' for them. These findings indicate that parents want more information about chronic pain and treatment options. Pediatric chronic pain clinics have the ability to assist children with chronic pain and their families considerably by providing information about chronic pain and the various treatment options available to them.

Socio-demographic factors in a pediatric chronic pain clinic: the role of minority status in pain and health outcomes

Socio-demographic factors in a pediatric chronic pain clinic: the role of minority status in pain and health outcomes

Testing Gender as a Moderator of Associations Between Psychosocial Variables and Functional Disability in Children and Adolescents with Chronic Pain

To evaluate gender as a moderator of associations between psychosocial variables and functional disability in children and adolescents with chronic pain. Participants included 266 patients (177 girls; mean age = 13.3 years) with chronic or recurrent headache or abdominal pain who were evaluated at a pediatric chronic pain clinic. Patients completed measures of pain intensity, anxiety, depression, pain coping, and functional disability. Parents completed a measure of protective behavior. Girls and boys reported similar levels of pain intensity. Girls were more likely to endorse depressive symptoms, and internalizing symptoms were associated with disability in girls, not in boys. No gender differences were found in links between coping and protective parenting and disability. In general, psychosocial factors influenced functional disability similarly in girls and boys, although some gender differences were found. Findings highlight the importance of considering child gender when evaluating factors that contribute to functional disability.

School Impairment in Adolescents With Chronic Pain

The purpose of this study was to assess and describe school functioning among adolescents presenting for evaluation in a tertiary care pediatric chronic pain clinic. Adolescents (n = 220, aged 12-17) and their parents participated in the study, providing self-reported data on school attendance, school performance, and perceived academic competence. Participants' schools provided official attendance records, descriptions of accommodations implemented to address the student's pain problems in the school setting, and teacher ratings of academic competence. Results show that many adolescents with chronic pain miss a significant amount of school, experience a decline in grades, and perceive pain to interfere with their school success. Various indicators of school impairment are highly intercorrelated, suggesting that impairment or success in 1 domain is typically associated with similar patterns in other domains of school functioning. However, as a group, adolescents with pain are viewed by themselves and their teachers as academically competent. Strong correlations emerged between different reporters of school functioning indicators such as attendance, suggesting that reliance on parent or adolescent reporting may be sufficient when assessing these domains. Findings underscore the importance of broadly assessing school functioning in adolescents with chronic pain. This study extends our understanding of school functioning among adolescents with chronic pain. It highlights the need to assess both school attendance and performance in this population as well as how schools respond to pain problems. Devising summary indicators of school impairment can be useful in both clinical and research contexts.

Social desirability response bias and self-report of psychological distress in pediatric chronic pain patients

The objective of this study was to investigate associations between social desirability response bias and self-report of pain, disability, and psychological distress (depression, anxiety, and somatic symptoms) in a sample of children presenting to a multidisciplinary pediatric chronic pain clinic. A retrospective review was conducted on 414 consecutive clinic patients, ages 12–17 years, with chronic pain complaints of at least 3 months’ duration. As part of a clinical battery, children completed self-report psychological questionnaires including the Children’s Depression Inventory, Children’s Somatization Inventory, and Revised Children’s Manifest Anxiety Scale including the Lie Scale, an indicator of social desirability influence. Children also provided self report of pain intensity, pain duration and functional disability. Clinician ratings of anxiety and depressive symptoms also were collected. Results show that children scoring high on the measure of social desirability reported fewer symptoms of depression and anxiety compared to children scoring low on the social desirability index. No differences arose between these groups on reports of somatic symptoms, pain duration, or pain-related disability. These findings suggest that social desirability response bias may have implications for the self-report of psychological distress among pediatric chronic pain patients. The limits of self-report of symptoms should be considered in the clinical and research contexts.

Sex and Age Differences in Coping Styles Among Children with Chronic Pain

The purpose of this study was to examine sex and age differences in coping strategies among pediatric patients with chronic pain. Sex differences are reported in the adult pain and coping literatures, but little attention has been given to possible distinctions in coping styles in the pediatric chronic pain population. Investigating pain coping skills at an early age may provide clinicians with a better understanding of the evolution of characteristic coping styles and identify areas for intervention. Pain intensity (Visual Analog Scale), pain coping strategies (Pain Coping Questionnaire), and coping efficacy were assessed in children (ages 8–12 years) and adolescents (ages 13–18 years), presenting to a pediatric chronic pain clinic ( n = 272). Significant sex differences in coping strategies were found. After controlling for pain intensity, girls used social support seeking more than boys, while boys used more behavioral distraction techniques. Adolescents engaged in more positive self-statements (a cognitive strategy) than children. Both boys and girls showed a trend toward pain coping efficacy being negatively correlated with average pain intensity. For girls, pain coping efficacy was also significantly negatively correlated with internalizing/catastrophizing. However, no sex or age differences in coping efficacy were found. This study demonstrates the early emergence of sex- and aged-based preferences in coping strategies among children and adolescents with chronic pain. The findings establish a basis for further research on early social influences in the development of pain coping styles in males and females. Implications for further clinical research in this area are discussed.