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889 THE RELATIONSHIP BETWEEN PAIN CATASTROPHIZING, SOCIAL SUPPORT SEEKING AND PAIN EXPRESSION IN SCHOOL CHILDREN AND CHILDREN WITH CHRONIC PAIN
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European Journal of Pain 2006, Vol 10 (suppl S1)
887 DEVELOPMENT OF CRPS TYPE 1 IN 12 YEAR OLD BOY DUE TO FATHERS ESTABLISHMENT OF A GAY RELATIONSHIP B. Hval1 ° , E.A. Fors2 , P.C. Borchgrevink3 . 1 Center for Pain and Complex Disorders, St Olavs Hospital, 2 Department of Neuroscience NTNU, 3 Pain and Palliation Research Group, NTNU, Norway Background: The morbidity of CRPS type 1 generally has been associated with psychosocial stressors, especially in children and adolescents. Individual cases that clearly show direct relationships between psychological factors and CRPS type 1 are rare, however, and thus definite case stories are beneficial. Case story: 15 months after father had left his family, a 12 year old boy stopped using his left leg following a minor trauma. Despite several hospitalisations with arthroscopy and examination in general anaesthesia, his leg gradually worsened developing dystrophy, allodynia and constant pain. He was not able to move his knee and nobody was allowed to touch his leg. He was later mobilised at St. Olav’s Hospital while having continuous epidural anaesthesia. A thorough bio-psycho-social pain investigation uncovered repressed psychological aspects. His mother disclosed information to the pain nurse about the real reason why her former husband moved, which was to establish a gay relationship. The boy got no explanation why his father left, and felt guilty about his fathers leaving. After half a year with specific psychological treatment based on this new information, he managed to visit his father and new gay partner accompanied by his mother and his leg recovered completely with mobilisation during pain control. Comment: Although it is often assumed that psychological factors are important in CRPS I for children, it is rare that fulminant cases with grave immobilisation will recover completely after psychological treatment.
888 ATTENTIONAL DISTRACTION FROM PAIN WORKS . . . BUT NOT ALWAYS: A QUESTIONNAIRE STUDY K. Verhoeven1 ° , G. Crombez1 , E. Van den Bussche2 . 1 Department of Experimental Clinical and Health Psychology, University of Ghent, Ghent, 2 Faculty of Psychology and Educational Sciences, University of Leuven, Campus Kortrijk, Belgium Background and Aims: Directing attention away from pain is an intuitive way to attempt to control pain, but empirical results are inconsistent. Eccleston & Crombez (1999) proposed several variables that may interfere with its effectivity, amongst which pain intensity, its threat value and its novelty. We investigated the impact of these variables upon the self-rated effectiveness of distraction. Methods: A questionnaire containing several short descriptions of situations, was developed. The content varied as a function of pain intensity, novelty, threat value, and the nature of the distraction task. 265 students indicated to what extent they believed distraction would work in each situation using a 5-point scale. Results: Results indicated that participants rated distraction to be less effective when pain was intense and threatening (p < 0.001). There was no effect of pain novelty. Finally, social contact was perceived as a better distraction task than positive imagery (p < 0.001). Conclusions: Although attentional distraction to manage pain is often used and intuively appealing, there are some factors that may limit its effectivity. Theoretical models have pointed at some of these variables. This research replicate and extend these considerations. In particular, individuals consider attentional distraction from pain as less effective when pain is intense, threatening, and distraction merely consists of mental activity such as imagery. technique.
Abstracts, 5th EFIC Congress, Free Presentations 889 THE RELATIONSHIP BETWEEN PAIN CATASTROPHIZING, SOCIAL SUPPORT SEEKING AND PAIN EXPRESSION IN SCHOOL CHILDREN AND CHILDREN WITH CHRONIC PAIN T. Vervoort1,2 ° , L. Goubert1,2 , G. Crombez1,2 . 1 Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium, 2 Research Institute for Psychology and Health, The Netherlands Aim of investigation: The present study aimed at investigating the relationship between pain catastrophizing in children, the child’s painrelated support seeking and parental perceptions of their child’s pain expression, in school children and children with chronic pain. Methods: The sample of school children consisted of 660 children (mean age = 12.16 years). The sample of children with chronic pain consisted of 61 children (mean age = 12.23 years). Children reported on their catastrophizing thoughts (PCS-C), pain-related support seeking, and pain intensity (VAS). Parents of school children (n = 633 mothers, mean age = 40.43 years; n = 488 fathers, mean age = 42.32 years) and parents of children with chronic pain (n = 51 mothers, mean age = 42.33 years; n = 34 fathers; mean age = 44.63 years) reported on their perception of pain expressiveness of their child. Results: For both samples, the child’s pain catastrophizing had a significant positive contribution in explaining the child’s pain-related support seeking. For the non-clinical sample, but not for the clinical sample, the child’s pain catastrophizing was a significant predictor of the mothers’ and the fathers’ perception of their child’s communicative pain behaviour. Within this nonclinical sample, pain catastrophizing was also found to be a significant predictor of perception of paternal protective pain behaviour. Conclusions: The results of this study offer support for an expressive orientation to dealing with pain in high catastrophizing children, especially within school children. However, for high catastrophizing children suffering chronic pain, parents do not perceive their child as being more pain expressive. Observational studies should be undertaken to further investigate the expressive features and parental reactions of high pain catastrophizing in children. Acknowledgments: Tine Vervoort is Research Assistant of the Fund for Scientific Research – Flanders (Belgium)(F.W.O.). Liesbet Goubert is Postdoctoral Fellow of the Fund for Scientific Research – Flanders (Belgium)(F.W.O.). F09 PLACEBO 890 PLACEBO NON-RESPONDERS IN GROUP OF PATIENTS WITH CHRONIC NEUROPATHIC PAIN J. Dobrogowski1 ° , J. Wordliczek2 , A. Przeklasa-Muszynska1 , M. Kocot-Kepska1 . 1 Department of Pain Research and Treatment, 2 Department of Pain Treatment and Palliative Care, Jagiellonian University, Krakow, Poland Background and Aim: Conditioning and expectations constitute one of the most important factors that impact on the presence of the placebo effect, whose frequency of occurrence varies considerably (from to 0−100%). The aim of the investigation was to study the placebo effect in patients suffering from chronic neuropathic pain resistant to pharmacotherapy using analgesic drugs. Methods: The study involved 19 patients who, in stage one of the study, were subjected to intravenous pharmacological tests, being interchangeably administered placebo (0.9% NaCl) and analgesics (metamizol, paracetamol, ketoprofen, lidocaine, tramadol, fentanyl) and who did not show any pain relief using drugs tested or placebo. Stage two of the study involved the intravenous administration of placebo to all the patients having informed them first that they will be receiving a strong analgesic. Pain intensity was measured using the Numeric Rating Scale (NRS) before and after analgesic and placebo administration, both in stage one and stage two of the study. Results: In the patient group studied, in stage one of the study no pain relief greater than 1 point on the NRS was observed. Similarly, in stage two, despite the conditioning used, no pain relief was observed.
European Journal of Pain 2006, Vol 10 (suppl S1)
887 DEVELOPMENT OF CRPS TYPE 1 IN 12 YEAR OLD BOY DUE TO FATHERS ESTABLISHMENT OF A GAY RELATIONSHIP B. Hval1 ° , E.A. Fors2 , P.C. Borchgrevink3 . 1 Center for Pain and Complex Disorders, St Olavs Hospital, 2 Department of Neuroscience NTNU, 3 Pain and Palliation Research Group, NTNU, Norway Background: The morbidity of CRPS type 1 generally has been associated with psychosocial stressors, especially in children and adolescents. Individual cases that clearly show direct relationships between psychological factors and CRPS type 1 are rare, however, and thus definite case stories are beneficial. Case story: 15 months after father had left his family, a 12 year old boy stopped using his left leg following a minor trauma. Despite several hospitalisations with arthroscopy and examination in general anaesthesia, his leg gradually worsened developing dystrophy, allodynia and constant pain. He was not able to move his knee and nobody was allowed to touch his leg. He was later mobilised at St. Olav’s Hospital while having continuous epidural anaesthesia. A thorough bio-psycho-social pain investigation uncovered repressed psychological aspects. His mother disclosed information to the pain nurse about the real reason why her former husband moved, which was to establish a gay relationship. The boy got no explanation why his father left, and felt guilty about his fathers leaving. After half a year with specific psychological treatment based on this new information, he managed to visit his father and new gay partner accompanied by his mother and his leg recovered completely with mobilisation during pain control. Comment: Although it is often assumed that psychological factors are important in CRPS I for children, it is rare that fulminant cases with grave immobilisation will recover completely after psychological treatment.
888 ATTENTIONAL DISTRACTION FROM PAIN WORKS . . . BUT NOT ALWAYS: A QUESTIONNAIRE STUDY K. Verhoeven1 ° , G. Crombez1 , E. Van den Bussche2 . 1 Department of Experimental Clinical and Health Psychology, University of Ghent, Ghent, 2 Faculty of Psychology and Educational Sciences, University of Leuven, Campus Kortrijk, Belgium Background and Aims: Directing attention away from pain is an intuitive way to attempt to control pain, but empirical results are inconsistent. Eccleston & Crombez (1999) proposed several variables that may interfere with its effectivity, amongst which pain intensity, its threat value and its novelty. We investigated the impact of these variables upon the self-rated effectiveness of distraction. Methods: A questionnaire containing several short descriptions of situations, was developed. The content varied as a function of pain intensity, novelty, threat value, and the nature of the distraction task. 265 students indicated to what extent they believed distraction would work in each situation using a 5-point scale. Results: Results indicated that participants rated distraction to be less effective when pain was intense and threatening (p < 0.001). There was no effect of pain novelty. Finally, social contact was perceived as a better distraction task than positive imagery (p < 0.001). Conclusions: Although attentional distraction to manage pain is often used and intuively appealing, there are some factors that may limit its effectivity. Theoretical models have pointed at some of these variables. This research replicate and extend these considerations. In particular, individuals consider attentional distraction from pain as less effective when pain is intense, threatening, and distraction merely consists of mental activity such as imagery. technique.
Abstracts, 5th EFIC Congress, Free Presentations 889 THE RELATIONSHIP BETWEEN PAIN CATASTROPHIZING, SOCIAL SUPPORT SEEKING AND PAIN EXPRESSION IN SCHOOL CHILDREN AND CHILDREN WITH CHRONIC PAIN T. Vervoort1,2 ° , L. Goubert1,2 , G. Crombez1,2 . 1 Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium, 2 Research Institute for Psychology and Health, The Netherlands Aim of investigation: The present study aimed at investigating the relationship between pain catastrophizing in children, the child’s painrelated support seeking and parental perceptions of their child’s pain expression, in school children and children with chronic pain. Methods: The sample of school children consisted of 660 children (mean age = 12.16 years). The sample of children with chronic pain consisted of 61 children (mean age = 12.23 years). Children reported on their catastrophizing thoughts (PCS-C), pain-related support seeking, and pain intensity (VAS). Parents of school children (n = 633 mothers, mean age = 40.43 years; n = 488 fathers, mean age = 42.32 years) and parents of children with chronic pain (n = 51 mothers, mean age = 42.33 years; n = 34 fathers; mean age = 44.63 years) reported on their perception of pain expressiveness of their child. Results: For both samples, the child’s pain catastrophizing had a significant positive contribution in explaining the child’s pain-related support seeking. For the non-clinical sample, but not for the clinical sample, the child’s pain catastrophizing was a significant predictor of the mothers’ and the fathers’ perception of their child’s communicative pain behaviour. Within this nonclinical sample, pain catastrophizing was also found to be a significant predictor of perception of paternal protective pain behaviour. Conclusions: The results of this study offer support for an expressive orientation to dealing with pain in high catastrophizing children, especially within school children. However, for high catastrophizing children suffering chronic pain, parents do not perceive their child as being more pain expressive. Observational studies should be undertaken to further investigate the expressive features and parental reactions of high pain catastrophizing in children. Acknowledgments: Tine Vervoort is Research Assistant of the Fund for Scientific Research – Flanders (Belgium)(F.W.O.). Liesbet Goubert is Postdoctoral Fellow of the Fund for Scientific Research – Flanders (Belgium)(F.W.O.). F09 PLACEBO 890 PLACEBO NON-RESPONDERS IN GROUP OF PATIENTS WITH CHRONIC NEUROPATHIC PAIN J. Dobrogowski1 ° , J. Wordliczek2 , A. Przeklasa-Muszynska1 , M. Kocot-Kepska1 . 1 Department of Pain Research and Treatment, 2 Department of Pain Treatment and Palliative Care, Jagiellonian University, Krakow, Poland Background and Aim: Conditioning and expectations constitute one of the most important factors that impact on the presence of the placebo effect, whose frequency of occurrence varies considerably (from to 0−100%). The aim of the investigation was to study the placebo effect in patients suffering from chronic neuropathic pain resistant to pharmacotherapy using analgesic drugs. Methods: The study involved 19 patients who, in stage one of the study, were subjected to intravenous pharmacological tests, being interchangeably administered placebo (0.9% NaCl) and analgesics (metamizol, paracetamol, ketoprofen, lidocaine, tramadol, fentanyl) and who did not show any pain relief using drugs tested or placebo. Stage two of the study involved the intravenous administration of placebo to all the patients having informed them first that they will be receiving a strong analgesic. Pain intensity was measured using the Numeric Rating Scale (NRS) before and after analgesic and placebo administration, both in stage one and stage two of the study. Results: In the patient group studied, in stage one of the study no pain relief greater than 1 point on the NRS was observed. Similarly, in stage two, despite the conditioning used, no pain relief was observed.