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Pediatric chronic pain, coping and health-related quality of life
S72 (855) Improvements in functionality reduced pain differ on emotional status across diagnostic subgroups in migraine and orofacial pain P. Davis, J. Reeves II, S. Graff-Radford; The Pain Center, Cedars Sinai Medical Center Department of Anesthesiology, Los Angeles, CA The differential effects of emotions were compared across diagnoses of neurovascular, myofacial and neuropathic types in a sample of 361 migraine and orofacial pain patients. Exploratory analysis revealed significant differences between groups on outcome when higher and lower levels of depression and anxiety were assessed. For all groups, treatment was most successful in reducing pain and increasing functionality when uncomplicated depression was present, even more than those patients without depression. Worst outcomes for all groups were seen in those reporting both higher anxiety and depression. The disparity between best outcomes for depressed patients and worst outcome for patients both anxious and depressed was greatest for the neuropathic patients. Subsequently, data was gathered for an additional 100 neuropathic patients that confirmed the wider continuum of treatment response for this group and greater sensitivity to emotional status as a determinant of treatment success.
Abstracts (857) Pediatric chronic pain, coping and health-related quality of life J. Gold, M. Carson, A. Griffin, A. Kant, M. Joseph; Children’s Hospital Los Angeles, Los Angeles, CA Previous research has examined the debilitating effect of pediatric chronic pain on a child’s health-related quality of life (HRQOL): school attendance, physical and social activities, and psychological distress. Yet, prior studies have failed to investigate whether coping behaviors in these patients can alleviate pain and therefore, enhance HRQOL. The current study is a cross-sectional sample exploring correlations between coping and HRQOL within the pediatric chronic pain population. Twenty-eight participants (21 girls, 7 boys) with a mean age of 13.4 were recruited from pain management services at Children’s Hospital. HRQOL was assessed with the Pediatric Quality of Life Inventory (PedsQLTM 4.0), which contains 23 self-report items that yield three summary scores (physical, psychosocial and total health) ranging from 0-100; higher scores indicated greater HRQOL. Pain and qualitative data were obtained with a clinic-developed pain questionnaire. Coping behaviors were measured using the Response to Stress Questionnaire (RSQ) Child Self-Report, a 57-item inventory yielding four main strategies: primary/ secondary control engagement coping, disengagement coping, involuntary engagement, and involuntary disengagement. Children (8-12) reported poor HRQOL (M⫽59.8), physical (M⫽53.8) and psychosocial (M⫽63.0) functioning. Adolescents (13-18) also reported low HRQOL (M⫽55.8), physical (M⫽46.9), and psychosocial functioning (M⫽60.1). No associations were noted between primary or secondary control engagement coping and all measures of HRQOL. However associations were detected between disengagement coping and total emotional functioning (r⫽⫺.41*). Correlations also existed between involuntary disengagement and total HRQOL (r⫽⫺.47**), physical (r⫽⫺.39*), and psychosocial (r⫽⫺.48**) functioning. Similar relationships were detected between involuntary engagement and total HRQOL ⫺(-.52**), physical (r⫽⫺.46*), and psychosocial (r⫽⫺.50**) functioning. These results suggest that pediatric chronic pain patients may be incorporating coping skills that interfere with their daily life functioning, which is already impaired. Interventions focused on building control engagement coping may facilitate improved HRQOL.
(856) Pain and acute stress reaction in pediatric physical injury
(858) Older and younger adults in pain management programs in the United States: differences and similarities
J. Gold, M. Carson, A. Kant, M. Joseph, G. Mahour; Children’s Hospital Los Angeles, Los Angeles, CA Children who experience physical injury requiring hospitalization have been shown to develop Acute Stress Disorder (ASD) and later Posttraumatic Stress Disorder (PTSD). When a trauma requires medical intervention, the physical integrity of the child is threatened along with the child’s psychological integrity. The injury, resulting medical procedures and associated pain symptoms can each be a traumatic experience. Recent studies argue that chronic pain and PTSD can be a mutually maintaining condition and that effective pharmacological interventions for pain may actually decrease the incidence of ASD/PTSD symptoms. The current study is investigating children (8-18) and their caregivers following a traumatic event requiring hospitalization. The study is an ongoing prospective multi-rater quasi-experimental design to assess the immediate, 1-month and 3-month impact of physical injury on the development of ASD and later PTSD. Instrumentation includes the Acute Stress Checklist-Kids, the UCLA PTSD Checklist and child/parental self-report questionnaires (i.e., CBCL, Pain Inventory, PedsQL, KIDCOPE, PCL-C). Two case reports are discussed comparing acute stress symptoms, acute pain, and physiological measures from initial paramedic intervention to the emergency department. Both children reported acute stress symptoms, significant pain levels, and increased physiological levels (heart rate and mean arterial blood pressure (MAP)). The data revealed that the child who received early and dose/weight specific analgesia (.06mg/kg) had fewer acute stress symptoms, faster pain relief, and decreased heart rate responsivity. Whereas, the child who received a sub-therapeutic dose of pain medication (.03mg/kg) continued to have an elevated heart rate and met criteria for ASD. While acute pain following an acute physical injury has not been an identified as a symptom or a trigger of ASD/PTSD, this data begins to suggest that untreated acute pain may exacerbate a child’s risk of developing ASD and that the assessment and treatment of pain symptoms require closer investigation.
H. Wittink, W. Rogers, A. Lipman, W. McCarberg, M. Ashburn, G. Oderda, D. Carr; New England Medical Center, Boston, MA Chronic pain is a common problem in the United States for about 20% of the people over the age of 65 years. Their pain is due in part to the progression of chronic disease and because the incidence of many painful conditions, such as arthritis, increases with age. The high prevalence of pain and its impact on older adults make this an increasingly important public health issue, yet to date it has received little attention. Although the American Geriatric Society chronic pain guideline recommends multidisciplinary management it has been reported that older adults tend to be infrequently referred and treated in pain programs, while on the older adults that are treated in multidisciplinary pain programs little information exists. It is, for instance, unclear whether chronic pain has a similar impact on health related quality of life (HRQoL) in older adults as it has on younger adults. We used initial assessments of more than 6,000 patients from three pain management programs in different regions in the United States to investigate HRQoL of older (equal to and ⬎ 60 years) and younger adults (⬍ 60 years) with chronic pain. We compared their HRQoL with existing normative data on healthy adults and examined more fully differences in HRQoL between younger and older adults with chronic pain. As an outcomes measure we used the Treatment Outcomes of Pain Survey, a disease specific instrument that includes the SF-36. We found that HRQoL is impaired to a similar degree in both older and younger chronic pain patients as compared to healthy adults, but older adults with chronic pain differ in a number of important domains from younger adults with chronic pain.
Abstracts (857) Pediatric chronic pain, coping and health-related quality of life J. Gold, M. Carson, A. Griffin, A. Kant, M. Joseph; Children’s Hospital Los Angeles, Los Angeles, CA Previous research has examined the debilitating effect of pediatric chronic pain on a child’s health-related quality of life (HRQOL): school attendance, physical and social activities, and psychological distress. Yet, prior studies have failed to investigate whether coping behaviors in these patients can alleviate pain and therefore, enhance HRQOL. The current study is a cross-sectional sample exploring correlations between coping and HRQOL within the pediatric chronic pain population. Twenty-eight participants (21 girls, 7 boys) with a mean age of 13.4 were recruited from pain management services at Children’s Hospital. HRQOL was assessed with the Pediatric Quality of Life Inventory (PedsQLTM 4.0), which contains 23 self-report items that yield three summary scores (physical, psychosocial and total health) ranging from 0-100; higher scores indicated greater HRQOL. Pain and qualitative data were obtained with a clinic-developed pain questionnaire. Coping behaviors were measured using the Response to Stress Questionnaire (RSQ) Child Self-Report, a 57-item inventory yielding four main strategies: primary/ secondary control engagement coping, disengagement coping, involuntary engagement, and involuntary disengagement. Children (8-12) reported poor HRQOL (M⫽59.8), physical (M⫽53.8) and psychosocial (M⫽63.0) functioning. Adolescents (13-18) also reported low HRQOL (M⫽55.8), physical (M⫽46.9), and psychosocial functioning (M⫽60.1). No associations were noted between primary or secondary control engagement coping and all measures of HRQOL. However associations were detected between disengagement coping and total emotional functioning (r⫽⫺.41*). Correlations also existed between involuntary disengagement and total HRQOL (r⫽⫺.47**), physical (r⫽⫺.39*), and psychosocial (r⫽⫺.48**) functioning. Similar relationships were detected between involuntary engagement and total HRQOL ⫺(-.52**), physical (r⫽⫺.46*), and psychosocial (r⫽⫺.50**) functioning. These results suggest that pediatric chronic pain patients may be incorporating coping skills that interfere with their daily life functioning, which is already impaired. Interventions focused on building control engagement coping may facilitate improved HRQOL.
(856) Pain and acute stress reaction in pediatric physical injury
(858) Older and younger adults in pain management programs in the United States: differences and similarities
J. Gold, M. Carson, A. Kant, M. Joseph, G. Mahour; Children’s Hospital Los Angeles, Los Angeles, CA Children who experience physical injury requiring hospitalization have been shown to develop Acute Stress Disorder (ASD) and later Posttraumatic Stress Disorder (PTSD). When a trauma requires medical intervention, the physical integrity of the child is threatened along with the child’s psychological integrity. The injury, resulting medical procedures and associated pain symptoms can each be a traumatic experience. Recent studies argue that chronic pain and PTSD can be a mutually maintaining condition and that effective pharmacological interventions for pain may actually decrease the incidence of ASD/PTSD symptoms. The current study is investigating children (8-18) and their caregivers following a traumatic event requiring hospitalization. The study is an ongoing prospective multi-rater quasi-experimental design to assess the immediate, 1-month and 3-month impact of physical injury on the development of ASD and later PTSD. Instrumentation includes the Acute Stress Checklist-Kids, the UCLA PTSD Checklist and child/parental self-report questionnaires (i.e., CBCL, Pain Inventory, PedsQL, KIDCOPE, PCL-C). Two case reports are discussed comparing acute stress symptoms, acute pain, and physiological measures from initial paramedic intervention to the emergency department. Both children reported acute stress symptoms, significant pain levels, and increased physiological levels (heart rate and mean arterial blood pressure (MAP)). The data revealed that the child who received early and dose/weight specific analgesia (.06mg/kg) had fewer acute stress symptoms, faster pain relief, and decreased heart rate responsivity. Whereas, the child who received a sub-therapeutic dose of pain medication (.03mg/kg) continued to have an elevated heart rate and met criteria for ASD. While acute pain following an acute physical injury has not been an identified as a symptom or a trigger of ASD/PTSD, this data begins to suggest that untreated acute pain may exacerbate a child’s risk of developing ASD and that the assessment and treatment of pain symptoms require closer investigation.
H. Wittink, W. Rogers, A. Lipman, W. McCarberg, M. Ashburn, G. Oderda, D. Carr; New England Medical Center, Boston, MA Chronic pain is a common problem in the United States for about 20% of the people over the age of 65 years. Their pain is due in part to the progression of chronic disease and because the incidence of many painful conditions, such as arthritis, increases with age. The high prevalence of pain and its impact on older adults make this an increasingly important public health issue, yet to date it has received little attention. Although the American Geriatric Society chronic pain guideline recommends multidisciplinary management it has been reported that older adults tend to be infrequently referred and treated in pain programs, while on the older adults that are treated in multidisciplinary pain programs little information exists. It is, for instance, unclear whether chronic pain has a similar impact on health related quality of life (HRQoL) in older adults as it has on younger adults. We used initial assessments of more than 6,000 patients from three pain management programs in different regions in the United States to investigate HRQoL of older (equal to and ⬎ 60 years) and younger adults (⬍ 60 years) with chronic pain. We compared their HRQoL with existing normative data on healthy adults and examined more fully differences in HRQoL between younger and older adults with chronic pain. As an outcomes measure we used the Treatment Outcomes of Pain Survey, a disease specific instrument that includes the SF-36. We found that HRQoL is impaired to a similar degree in both older and younger chronic pain patients as compared to healthy adults, but older adults with chronic pain differ in a number of important domains from younger adults with chronic pain.