APS Press Room
News Highlights from The Journal of Pain • October 2007
The Peer Review Journal of the American Pain Society
| For immediate release | Contact: Chuck Weber (847) 705-1802 |
Three Articles Focus on Pain in Children
Studies Show Emotions Influence Chronic Pediatric Pain Outcomes
GLENVIEW, Oct. 15, 2007—For physicians and families seeking relief for children with chronic pain, there are three new studies published in The Journal of Pain that identify several psychological and social influences that may contribute to the development of chronic pediatric pain and pain-related disability.
In one study, a Spanish research team reviewed the literature and interviewed 30 clinicians and researchers with broad pediatric pain experience to identify consensus factors contributing chronic pediatric pain and disability. The goal was to learn if factors predictive of chronic pain are different from those of functional disability.
For development of chronic pain in children, the authors reported that factors exerting the greatest influence on pediatric pain management were negative emotions and excessive fear or catastrophizing, excessive utilization of healthcare services and medications, and a tendency for children to show negative expectations and other psychological factors related to the pain experience.
For pain-related disability, a child's self perception as being disabled and hesitancy to exercise for fear of injury were cited as the most influential predictive factors.
The study concluded development of chronic pain and pain-related disability can result from interacting psychological, emotional and social forces. Results of the study ultimately can be helpful for developing psychological intervention programs to help prevent long-term pain and disability in children.
In another article, researchers at UCLA's David Geffen School of Medicine examined the relationship between anxiety sensitivity and poorer health-related quality of life in pediatric pain patients. Anxiety sensitivity is the fear of anxiety sensations. The concept of health-related quality of life describes perceived mental and physical health over time. It is valuable for assessing how chronic illness interferes with everyday quality of life. Previous studies have not examined this relationship in children with chronic pain.
The study analyzed 87 children with chronic pain and found that higher anxiety sensitivity levels were associated with poorer perceived general and physical health, a greater level of impairment in family activities, lower self esteem, increased behavior problems and more social and academic and limitations due to emotional problems.
The authors concluded their findings support using anxiety sensitivity as a as part of an extensive pain assessment process in children.
In a third article covering pediatric pain, German researchers reported that negative psychological responses to pain, such as catastrophizing, correlate positively with depressive symptoms and with the frequency and intensity of pain episodes. They concluded that an abbreviated and internationalized pain questionnaire is valuable for assessing pain-related cognitions.
Sources: Predictive Factors of Chronic Pediatric Pain and Disability: A Delphi Poll, Anna Huguet, Jordi Miro and Ruben Nieto, Department of Psychology, Virgili University, Catalonia, Spain
Anxiety Sensitivity and Health Related Quality of Life in Children with Chronic Pain, Jennie C. Tsao, Marcia Meldrum, Su C. Kim and Lonnie K. Zeltzer, David Geffen School of Medicine at UCLA
The Assessment of Pain Coping and Pain-related Cognitions in Children and Adolescents: Current Methods and Further Development, Christine Hermann, Johanna Hohmeister, Katrin Zohsel, Friedrich Ebinger and Herta Flor, University of Heidelberg and University of Leipzig, Germany
Opioid Treatment Contracts Too Hard to Understand
A study conducted at the University of Tennessee Graduate School of Medicine is the first to examine the literacy of opioid contracts that provide instructions and guidance to patients regarding their treatment. A review of 162 such contracts showed that most were written in overly technical medical language. The authors recommended the contracts be simplified by writing at a sixth grade reading level to be more consistent with low health literacy. Only 12 percent of Americans have proficient health literacy skills.
In a second article, theses authors developed a valid and readable low-literacy opioid contract, written at a seventh grade reading level that eliminated difficult medical terminology. The low-literacy contract was validated with a sample of patients, which showed that 19 of the 26 statement in the contract were understood by all. The authors concluded that the low-literacy opioid contract is suitable for use in clinical practice.
Sources: Literacy Demands and Formatting Characteristics of Opioid Contracts in Chronic Non-Malignant Pain Management, Steven E. Roskos, Amy J. Keenum and Lindsay M. Newman, University of Tennessee Graduate School of Medicine
Development and Validation of a Low-literacy Opioid Contract, Lorraine S. Wallace, Amy J. Keenum, Steven E. Roskos and Kelly S. McDaniel, University of Tennessee Graduate School of Medicine