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Examination of parent and child catastrophizing on functional disability in youth with recurrent abdominal pain
Abstracts (164) Examination of parent and child catastrophizing on functional disability in youth with recurrent abdominal pain N Cunningham, A Lynch-Jordan, K Barnett, and S Kashikar-Zuck; Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
The Journal of Pain
S17
(166) Predictors of school functioning in children and adolescents with chronic headache: the role of protective parenting behavior K Kaczynski and R Claar; Children’s Hospital Boston, Boston, MA
Recurrent abdominal pain (RAP) in youth is a common problem that is associated with increased functional disability. Functional disability in RAP patients has been linked with catastrophizing (both child and parent), pain intensity, and depressive symptoms. However, the effect of child and parent catastrophizing over and above other predictors of disability has not been examined. The purpose of this study was to assess the unique role of parent and child catastrophizing on functional disability in youth with RAP after accounting for the child’s pain intensity levels and depressive symptoms. Eighty-two youth ages 8 to 18 (86.6% female, 84.1% Caucasian) with RAP and their parent completed measures of pain intensity (Visual Analogue Scale), pain catastrophizing (Pain Catastrophizing Scale for Children/Parents), and impairment (Functional Disability Inventory) in a multidisciplinary pain clinic. Children also completed a measure of depressive symptoms (Children’s Depression Inventory). Two multiple regression models were conducted to test the effect of parent and child catastrophizing on functional disability controlling for pain intensity and depressive symptoms. Child reports were used for the first model and parent reports (with the exception of child-reported depressive symptoms) were used for the second model. Child catastrophizing was the strongest predictor of functional disability (b = .37, p < 0.01) compared to pain intensity while depression became non-significant. Child catastrophizing uniquely explained 8.7% of the variance in functional disability, R2 change = .087, F change (1,73), 9.76, p < 0.01. Parent catastrophizing was not a significant predictor of functional disability (b = .06, p = 0.62) whereas depressive symptoms and pain intensity remained significant predictors of functional disability. Child- reported pain catastrophizing was found to be a significant and unique predictor of functional disability in youth with RAP. These findings suggest the importance of targeting children’s cognitions surrounding pain in behavioral interventions.
Headache is the most common pain complaint in pediatrics, with 60% of youth world-wide experiencing headaches of varying frequency and intensity. Children with chronic headaches exhibit greater school difficulties than children with other chronic illnesses, including diabetes and heart disease. Differences in pain intensity do not adequately explain variability in school functioning. According to the biopsychosocial model, chronic headache and associated disability is influenced by physical, psychological, social, and environmental factors. Headache characteristics, child internalizing symptoms, passive pain coping, and protective parental responses to child pain have all been found to independently impact school functioning in youth with chronic headache. We propose to evaluate these variables simultaneously in a regression model to determine their shared influence on school functioning. We predicted that all variables would significantly affect school functioning. Participants included 201 patients ages11-17 years who underwent a multidisciplinary evaluation at a tertiary headache clinic. Headache diagnoses included migraine (25.9%), tension (48.3%), both migraine and tension (18.4%), and other (6.5%). Adolescents completed measures of headache characteristics (frequency, intensity, duration), anxiety, depression, somatization, passive pain coping, and school functioning. Parents completed a measure of protective parental responses. A hybrid regression model specified in SEM provided adequate fit, c2 (24) = 47.68, p < .05; CFI = .93; RMSEA = 0.07. As predicted, protective parenting (r = .52, p < .001) and child internalizing (r = .20, p < .05) were significantly associated with school functioning. Unexpectedly, headache characteristics and passive coping were not associated with school functioning. The model accounted for 30.3% of the variance in school functioning. Results suggest protective parental responses have the strongest influence on school functioning, likely due to parents’ role in limiting or encouraging school attendance. A focus on parent guidance may be particularly effective for improving school functioning in youth with chronic headache.
(165) Predicting the vagaries and vestiges of post-thoracotomy pain
(167) Why patients consume opioids post surgery
B Hastie, M Wallace, R Frye, W Hou, A Boezaart, and C Klodell; University of Florida, Gainesville, Florida Development of chronic pain following thoracotomy is difficult to predict and complicated to treat. Reportedly up to 50% of patients develop post-surgical persistent pain, which lasts for years, while others report minimal pain and negligible interference. Despite variability in outcomes, the determinants and temporal patterns of transition to chronic pain among post-thoracotomy patients have yet to be elucidated. This new study employs a comprehensive, prospective, translational model of multiple domains to identify the most salient predictors and differential pain-patterns among patients undergoing thoracotomy for suspected lung cancer (without advanced disease). 21 individuals (mean age=67) were recruited pre-operatively and completed 6-month follow-up after thoracotomy with 100% retention. Baseline assessments included QST, psychosocial/quality-of-life questionnaires, health history, genetic and pharmacogenetic biomarkers. Immediate pre-operative assessments included mood, blood-draws and recordings of anesthesia block, then all surgical factors and pharmacological data, plus multiple time-points post-operatively in the ICU, Days 1-5 in-hospital, and follow-up at 2-weeks, 6-weeks and monthly up to six months. Analyses of initial data revealed significant associations between baseline QST and psychological factors (r’s range=0.480.84;p’s<.05) with 2-week, 6-week and 3-6 month reports of pain and quality of life. Observed average pain ratings over time were fitted with a nonlinear curve to identify differential temporal patterns out to 6-months post-operatively. Patterns of pain emerged that were below moderate levels (<4 out of 10) between 80-120 days, at which time a distinct change in pain-pattern occurred between days 120-180, which remained after considering changes in disease or treatments. These initial findings lend insight into temporal patterns of transition to chronic pain and characteristics of that pain, not simply whether chronic pain developed or not. It also lends credence to the importance of a multidimensional predictive model to illuminate salient domains of clinical relevance to better understand the vagaries of pain and outcomes in post-thoracotomy patients.
D Clay, I Carroll, P Barelka, C Wang, B Wang, M Gillespie, R McCue, J Younger, J Trafton, K Humphreys, S Goodman, F Dirbas, R Whyte, J Donington, W Cannon, and S Mackey; Stanford University, Stanford, CA Determinants of the duration of opioid use after surgery are under- reported. We hypothesized that independent of pain, validated measures of preoperative psychological distress would predict more durable and prolonged opioid use following surgery. Between January 2007 and April 2009 a prospective longitudinal inception cohort study measured psychological distress and substance abuse preoperatively, and opioid use longitudinally following surgery. 109 of 134 consecutively approached patients scheduled to undergo mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement consented to participate. Starting the day after surgery, opioid use and ongoing pain were measured daily. The primary endpoint was time to opioid cessation. Pain duration accounted for only 48% (95% CI 32%-61%) of the variance in the duration of opioid use. Preoperative depressive symptoms strongly predicted more prolonged opioid use: each 10 point increase on a preoperatively administered Beck Depression Inventory II was associated with a 47% (95% CI 24%-64%) reduction in the rate patients stopped taking their postoperative opioids (p<0.0006). Preoperative legitimate opioid use was associated with a 75% (95% CI 45%-89%) reduction in the rate of opioid cessation following surgery (P<0.02). Preoperative self-perceived susceptibility to addiction was also associated with more persistent opioid use: every one point increase (on a four point scale) was associated with a 51% (95% CI 20%-70%) reduction in the rate patients stopped taking their postoperative opioids (P<0.006). Preoperative factors including: depressive symptoms, legitimate opioid use and self-assessed risk of addiction strongly predicted prolonged opioid use following surgery independent of any effect extending pain duration. These results may contribute to a better understanding of the complex reasons patients continue and discontinue opioid medications following surgery.
The Journal of Pain
S17
(166) Predictors of school functioning in children and adolescents with chronic headache: the role of protective parenting behavior K Kaczynski and R Claar; Children’s Hospital Boston, Boston, MA
Recurrent abdominal pain (RAP) in youth is a common problem that is associated with increased functional disability. Functional disability in RAP patients has been linked with catastrophizing (both child and parent), pain intensity, and depressive symptoms. However, the effect of child and parent catastrophizing over and above other predictors of disability has not been examined. The purpose of this study was to assess the unique role of parent and child catastrophizing on functional disability in youth with RAP after accounting for the child’s pain intensity levels and depressive symptoms. Eighty-two youth ages 8 to 18 (86.6% female, 84.1% Caucasian) with RAP and their parent completed measures of pain intensity (Visual Analogue Scale), pain catastrophizing (Pain Catastrophizing Scale for Children/Parents), and impairment (Functional Disability Inventory) in a multidisciplinary pain clinic. Children also completed a measure of depressive symptoms (Children’s Depression Inventory). Two multiple regression models were conducted to test the effect of parent and child catastrophizing on functional disability controlling for pain intensity and depressive symptoms. Child reports were used for the first model and parent reports (with the exception of child-reported depressive symptoms) were used for the second model. Child catastrophizing was the strongest predictor of functional disability (b = .37, p < 0.01) compared to pain intensity while depression became non-significant. Child catastrophizing uniquely explained 8.7% of the variance in functional disability, R2 change = .087, F change (1,73), 9.76, p < 0.01. Parent catastrophizing was not a significant predictor of functional disability (b = .06, p = 0.62) whereas depressive symptoms and pain intensity remained significant predictors of functional disability. Child- reported pain catastrophizing was found to be a significant and unique predictor of functional disability in youth with RAP. These findings suggest the importance of targeting children’s cognitions surrounding pain in behavioral interventions.
Headache is the most common pain complaint in pediatrics, with 60% of youth world-wide experiencing headaches of varying frequency and intensity. Children with chronic headaches exhibit greater school difficulties than children with other chronic illnesses, including diabetes and heart disease. Differences in pain intensity do not adequately explain variability in school functioning. According to the biopsychosocial model, chronic headache and associated disability is influenced by physical, psychological, social, and environmental factors. Headache characteristics, child internalizing symptoms, passive pain coping, and protective parental responses to child pain have all been found to independently impact school functioning in youth with chronic headache. We propose to evaluate these variables simultaneously in a regression model to determine their shared influence on school functioning. We predicted that all variables would significantly affect school functioning. Participants included 201 patients ages11-17 years who underwent a multidisciplinary evaluation at a tertiary headache clinic. Headache diagnoses included migraine (25.9%), tension (48.3%), both migraine and tension (18.4%), and other (6.5%). Adolescents completed measures of headache characteristics (frequency, intensity, duration), anxiety, depression, somatization, passive pain coping, and school functioning. Parents completed a measure of protective parental responses. A hybrid regression model specified in SEM provided adequate fit, c2 (24) = 47.68, p < .05; CFI = .93; RMSEA = 0.07. As predicted, protective parenting (r = .52, p < .001) and child internalizing (r = .20, p < .05) were significantly associated with school functioning. Unexpectedly, headache characteristics and passive coping were not associated with school functioning. The model accounted for 30.3% of the variance in school functioning. Results suggest protective parental responses have the strongest influence on school functioning, likely due to parents’ role in limiting or encouraging school attendance. A focus on parent guidance may be particularly effective for improving school functioning in youth with chronic headache.
(165) Predicting the vagaries and vestiges of post-thoracotomy pain
(167) Why patients consume opioids post surgery
B Hastie, M Wallace, R Frye, W Hou, A Boezaart, and C Klodell; University of Florida, Gainesville, Florida Development of chronic pain following thoracotomy is difficult to predict and complicated to treat. Reportedly up to 50% of patients develop post-surgical persistent pain, which lasts for years, while others report minimal pain and negligible interference. Despite variability in outcomes, the determinants and temporal patterns of transition to chronic pain among post-thoracotomy patients have yet to be elucidated. This new study employs a comprehensive, prospective, translational model of multiple domains to identify the most salient predictors and differential pain-patterns among patients undergoing thoracotomy for suspected lung cancer (without advanced disease). 21 individuals (mean age=67) were recruited pre-operatively and completed 6-month follow-up after thoracotomy with 100% retention. Baseline assessments included QST, psychosocial/quality-of-life questionnaires, health history, genetic and pharmacogenetic biomarkers. Immediate pre-operative assessments included mood, blood-draws and recordings of anesthesia block, then all surgical factors and pharmacological data, plus multiple time-points post-operatively in the ICU, Days 1-5 in-hospital, and follow-up at 2-weeks, 6-weeks and monthly up to six months. Analyses of initial data revealed significant associations between baseline QST and psychological factors (r’s range=0.480.84;p’s<.05) with 2-week, 6-week and 3-6 month reports of pain and quality of life. Observed average pain ratings over time were fitted with a nonlinear curve to identify differential temporal patterns out to 6-months post-operatively. Patterns of pain emerged that were below moderate levels (<4 out of 10) between 80-120 days, at which time a distinct change in pain-pattern occurred between days 120-180, which remained after considering changes in disease or treatments. These initial findings lend insight into temporal patterns of transition to chronic pain and characteristics of that pain, not simply whether chronic pain developed or not. It also lends credence to the importance of a multidimensional predictive model to illuminate salient domains of clinical relevance to better understand the vagaries of pain and outcomes in post-thoracotomy patients.
D Clay, I Carroll, P Barelka, C Wang, B Wang, M Gillespie, R McCue, J Younger, J Trafton, K Humphreys, S Goodman, F Dirbas, R Whyte, J Donington, W Cannon, and S Mackey; Stanford University, Stanford, CA Determinants of the duration of opioid use after surgery are under- reported. We hypothesized that independent of pain, validated measures of preoperative psychological distress would predict more durable and prolonged opioid use following surgery. Between January 2007 and April 2009 a prospective longitudinal inception cohort study measured psychological distress and substance abuse preoperatively, and opioid use longitudinally following surgery. 109 of 134 consecutively approached patients scheduled to undergo mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement consented to participate. Starting the day after surgery, opioid use and ongoing pain were measured daily. The primary endpoint was time to opioid cessation. Pain duration accounted for only 48% (95% CI 32%-61%) of the variance in the duration of opioid use. Preoperative depressive symptoms strongly predicted more prolonged opioid use: each 10 point increase on a preoperatively administered Beck Depression Inventory II was associated with a 47% (95% CI 24%-64%) reduction in the rate patients stopped taking their postoperative opioids (p<0.0006). Preoperative legitimate opioid use was associated with a 75% (95% CI 45%-89%) reduction in the rate of opioid cessation following surgery (P<0.02). Preoperative self-perceived susceptibility to addiction was also associated with more persistent opioid use: every one point increase (on a four point scale) was associated with a 51% (95% CI 20%-70%) reduction in the rate patients stopped taking their postoperative opioids (P<0.006). Preoperative factors including: depressive symptoms, legitimate opioid use and self-assessed risk of addiction strongly predicted prolonged opioid use following surgery independent of any effect extending pain duration. These results may contribute to a better understanding of the complex reasons patients continue and discontinue opioid medications following surgery.