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S62 (844) Adolescents with chronic musculoskeletal pain: The role of pain catastrophizing, psychological distress and parental pain reinforcement J Guite, J Rose, R McCue, D Sherry, J Sherker; The Children’s Hospital of Philadelphia, Philadelphia, PA
Abstracts
F09 - Placebo (846) Relationship between expectation and -opioid receptor (MOR) binding prior acupuncture and sham acupuncture treatment in fibromyalgia
Pain catastrophizing has been found to be an important predictor of pain intensity and functional disability for individuals with chronic pain. However, little is known about relationships among pain catastrophizing, psychological functioning and parenting behaviors for adolescents with chronic pain. The goal of this study was: 1) to confirm that pain catastrophizing is a significant predictor of pain intensity and functional disability for adolescents with chronic, non-disease specific, musculoskeletal pain, and 2) to explore the contribution of psychological functioning and parental pain reinforcing behaviors to catastrophizing. A review of initial evaluation records was conducted for 138 adolescents with chronic musculoskeletal pain (84% female, mean age⫽15.6, SD⫽1.3, range 13-18 years) who consulted a tertiary care pediatric multidisciplinary pain management clinic. Measures included adolescents’ reports of usual pain intensity, the Functional Disability Inventory, the Illness Behavior Encouragement Scale, the Brief Symptom Inventory, and the Pain Catastrophizing Scale. Results showed that catastrophizing was significantly correlated with pain intensity (r⫽.34, p⬍.001), disability (r⫽.38, p⬍.001), parental pain reinforcement (r⫽.26, p⬍.01), global psychological distress (r⫽.40, p⬍.001), depression (r⫽.47, p⬍.001), anxiety (r⫽.34, p⬍.001), and interpersonal sensitivity (r⫽.32, p⬍.001). Multiple regression analyses confirmed that catastrophizing, but not parental pain reinforcement or global psychological distress, made a unique contribution to predicting pain intensity (⫽.37, p⬍.001). Furthermore, catastrophizing predicted disability beyond the significant effect found for pain intensity (R2 change⫽.07, p⬍.05). Finally, a model including depression and parental pain reinforcement accounted for 29% of the variance in catastrophizing (p⬍.001), with parental pain reinforcement making a unique contribution in predicting catastrophizing beyond depression (R2 change⫽.07, p⬍.001). Our findings confirm that pain catastrophizing plays an important role in understanding pain and disability for adolescents with musculoskeletal pain and will be considered with respect to its capacity to affect, and to be affected by, parental responses to the adolescent’s pain condition.
M Guevara, D Scott, J Zubieta, D Clauw, R Harris; Chronic Pain and Fatigue Research Center, Ann Arbor, MI Expectation of analgesia is proposed to be a significant factor in placebo effects and has been previously associated with the pain-suppressive endogenous opioid system. Using positron emission tomography (PET), we investigated the relationship between MOR binding and expectations of pain relief prior to treatment within fibromyalgia patients. 18 female patients (ages 18-75) diagnosed with fibromyalgia underwent 11C-carfentanil PET prior to receiving either one acupuncture (n⫽9) or one sham (n⫽9) acupuncture treatment. All patients met ACR 1990 criteria for the diagnosis of fibromyalgia for at least 1 year. Expectancies prior to treatment were assessed by asking, “How confident are you that the insertion of acupuncture needles into your body will alleviate your pain?” and using a numerical rating scale 0 (not confident) – 100 (extremely confident). MOR binding was determined by 11C-carfentanil PET prior to treatment. Images were processed with Logan plot analysis resulting in maps of whole-brain MOR binding potential (BP). MOR binding within specific brain regions was correlated with patient expectations using SPM99. Additional correlations between expectancies for pain relief and MOR BP from identified regions were performed using SPSS v14.0. The mean and standard deviation for expectations were 53.89 and 13.78 respectively. Significant positive correlations between expectancy for pain relief and MOR BP were detected in the insula (r⫽0.677;p⫽0.001) and the temporal cortex ( r⫽0.593;p⫽0.005). MOR BP within the left caudate demonstrate a trend to negative correlation with expectancy for pain relief (r⫽-0.393;p⫽-0.053). These data indicate that expectations for pain relief are associated with differential MOR binding prior to treatment. Effects of expectations on placebo analgesia may be mediated in part by the effects of endogenous opioids and the concentration of MOR’s in these regions.
(845) Evaluation of a brief intervention to train parents in behavioral pain management strategies for post-operative pain
(847) Classical Conditioning Increases Autonomic and Subjective Pain Responses in Human Subjects
J MacLaren, C Thompson, K Crofton, C Hammell, Z Kain; Yale University, New Haven, CT Over five million children undergo surgery each year, and evaluations of postoperative pain indicate that that up to 65% of these children report mild to severe pain (Kotiniemi et al., 1997). Specific parent behaviors have been found to be associated with increased and decreased pain, but little attention has been paid to disseminating this information to parents in the perioperative setting. This study evaluated a brief intervention teaching parents behavioral management of their children’s postoperative pain. Forty-five parents of children undergoing surgery were randomly assigned to receive either training or standard care. Training included an introduction to pain management interventions (distraction, deep breathing, appropriate medication use) and a review of behaviors associated with increased pain (e.g., reassurance, apologies). Treatment integrity analyses indicated that the intervention was successful in modifying parents’ behavior; parents in the training condition used significantly more distraction than parents in standard care, t (43) ⫽ 6.67, p ⬍ .001. Very few pain promoting behaviors were exhibited in either group of parents. Analyses over children’s first hour in the recovery room revealed that self-reported pain significantly decreased over time F (1, 15) ⫽ 17.7, p ⬍ .001, and a trend toward children of training condition parents to report less pain, F (1, 15) ⫽ 3.77, p ⫽ .07. There was no significant interaction. There were also no significant differences in nurse-reported pain or analgesic use across groups, but parents in the training group reported feeling significantly more effective in the management of their children’s pain than parents in the standard care group, t (22) ⫽ 2.58, p ⬍ .05. Although statistically significant findings were limited due to small sample size, results of this study indicate that a brief intervention can impact parent behaviors and decrease children’s self-reported pain in the recovery room.
P. Aslaksen; University of Tromsø, Tromsø, Norway Society for Neuroscience abstract
Abstracts
F09 - Placebo (846) Relationship between expectation and -opioid receptor (MOR) binding prior acupuncture and sham acupuncture treatment in fibromyalgia
Pain catastrophizing has been found to be an important predictor of pain intensity and functional disability for individuals with chronic pain. However, little is known about relationships among pain catastrophizing, psychological functioning and parenting behaviors for adolescents with chronic pain. The goal of this study was: 1) to confirm that pain catastrophizing is a significant predictor of pain intensity and functional disability for adolescents with chronic, non-disease specific, musculoskeletal pain, and 2) to explore the contribution of psychological functioning and parental pain reinforcing behaviors to catastrophizing. A review of initial evaluation records was conducted for 138 adolescents with chronic musculoskeletal pain (84% female, mean age⫽15.6, SD⫽1.3, range 13-18 years) who consulted a tertiary care pediatric multidisciplinary pain management clinic. Measures included adolescents’ reports of usual pain intensity, the Functional Disability Inventory, the Illness Behavior Encouragement Scale, the Brief Symptom Inventory, and the Pain Catastrophizing Scale. Results showed that catastrophizing was significantly correlated with pain intensity (r⫽.34, p⬍.001), disability (r⫽.38, p⬍.001), parental pain reinforcement (r⫽.26, p⬍.01), global psychological distress (r⫽.40, p⬍.001), depression (r⫽.47, p⬍.001), anxiety (r⫽.34, p⬍.001), and interpersonal sensitivity (r⫽.32, p⬍.001). Multiple regression analyses confirmed that catastrophizing, but not parental pain reinforcement or global psychological distress, made a unique contribution to predicting pain intensity (⫽.37, p⬍.001). Furthermore, catastrophizing predicted disability beyond the significant effect found for pain intensity (R2 change⫽.07, p⬍.05). Finally, a model including depression and parental pain reinforcement accounted for 29% of the variance in catastrophizing (p⬍.001), with parental pain reinforcement making a unique contribution in predicting catastrophizing beyond depression (R2 change⫽.07, p⬍.001). Our findings confirm that pain catastrophizing plays an important role in understanding pain and disability for adolescents with musculoskeletal pain and will be considered with respect to its capacity to affect, and to be affected by, parental responses to the adolescent’s pain condition.
M Guevara, D Scott, J Zubieta, D Clauw, R Harris; Chronic Pain and Fatigue Research Center, Ann Arbor, MI Expectation of analgesia is proposed to be a significant factor in placebo effects and has been previously associated with the pain-suppressive endogenous opioid system. Using positron emission tomography (PET), we investigated the relationship between MOR binding and expectations of pain relief prior to treatment within fibromyalgia patients. 18 female patients (ages 18-75) diagnosed with fibromyalgia underwent 11C-carfentanil PET prior to receiving either one acupuncture (n⫽9) or one sham (n⫽9) acupuncture treatment. All patients met ACR 1990 criteria for the diagnosis of fibromyalgia for at least 1 year. Expectancies prior to treatment were assessed by asking, “How confident are you that the insertion of acupuncture needles into your body will alleviate your pain?” and using a numerical rating scale 0 (not confident) – 100 (extremely confident). MOR binding was determined by 11C-carfentanil PET prior to treatment. Images were processed with Logan plot analysis resulting in maps of whole-brain MOR binding potential (BP). MOR binding within specific brain regions was correlated with patient expectations using SPM99. Additional correlations between expectancies for pain relief and MOR BP from identified regions were performed using SPSS v14.0. The mean and standard deviation for expectations were 53.89 and 13.78 respectively. Significant positive correlations between expectancy for pain relief and MOR BP were detected in the insula (r⫽0.677;p⫽0.001) and the temporal cortex ( r⫽0.593;p⫽0.005). MOR BP within the left caudate demonstrate a trend to negative correlation with expectancy for pain relief (r⫽-0.393;p⫽-0.053). These data indicate that expectations for pain relief are associated with differential MOR binding prior to treatment. Effects of expectations on placebo analgesia may be mediated in part by the effects of endogenous opioids and the concentration of MOR’s in these regions.
(845) Evaluation of a brief intervention to train parents in behavioral pain management strategies for post-operative pain
(847) Classical Conditioning Increases Autonomic and Subjective Pain Responses in Human Subjects
J MacLaren, C Thompson, K Crofton, C Hammell, Z Kain; Yale University, New Haven, CT Over five million children undergo surgery each year, and evaluations of postoperative pain indicate that that up to 65% of these children report mild to severe pain (Kotiniemi et al., 1997). Specific parent behaviors have been found to be associated with increased and decreased pain, but little attention has been paid to disseminating this information to parents in the perioperative setting. This study evaluated a brief intervention teaching parents behavioral management of their children’s postoperative pain. Forty-five parents of children undergoing surgery were randomly assigned to receive either training or standard care. Training included an introduction to pain management interventions (distraction, deep breathing, appropriate medication use) and a review of behaviors associated with increased pain (e.g., reassurance, apologies). Treatment integrity analyses indicated that the intervention was successful in modifying parents’ behavior; parents in the training condition used significantly more distraction than parents in standard care, t (43) ⫽ 6.67, p ⬍ .001. Very few pain promoting behaviors were exhibited in either group of parents. Analyses over children’s first hour in the recovery room revealed that self-reported pain significantly decreased over time F (1, 15) ⫽ 17.7, p ⬍ .001, and a trend toward children of training condition parents to report less pain, F (1, 15) ⫽ 3.77, p ⫽ .07. There was no significant interaction. There were also no significant differences in nurse-reported pain or analgesic use across groups, but parents in the training group reported feeling significantly more effective in the management of their children’s pain than parents in the standard care group, t (22) ⫽ 2.58, p ⬍ .05. Although statistically significant findings were limited due to small sample size, results of this study indicate that a brief intervention can impact parent behaviors and decrease children’s self-reported pain in the recovery room.
P. Aslaksen; University of Tromsø, Tromsø, Norway Society for Neuroscience abstract