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Pain in children: psychosocial
Abstracts (970) Impact of litigation status on interdisciplinary care of chronic pain R. Robinson, E. Kerley, J. Garofalo, P. Polatin, R. Gatchel; The University of Texas Southwestern Medical Center at Dallas, Dallas, TX This study examined the impact of injury-related pending litigation on pain and disability in chronic low back pain (CLBP) patients participating in an interdisciplinary pain management treatment program. Pending litigation can interfere with treatment because of psychosocial stress related to the litigation, as well as the possible influence of secondary gain. Psychologists administered the Pain Drawing Analogue (PDA), Dallas Back Pain Questionnaire (DPQ), Oswestry Disability Questionnaire (ODQ) and Multidimensional Pain Inventory (MPI) to consecutive CLBP patients with pending litigation (n⫽30) and without pending litigation (n⫽176). The groups did not statistically differ with regard to gender (litigation⫽ 73.9% female; non-litigation⫽66.7% female), but the nonlitigation group was slightly older (litigation Mean age⫽55.7; non-litigation Mean age⫽46.8; p⫽.002). Prior to interdisciplinary treatment, the litigation group scored higher on several MPI scales: Pain Severity (p⫽.024), Pain Interference (p⫽.002), Affective Distress (p⫽.002), Distracting Responses (p⫽.007), Household Chores (p⫽.026), Activities Away from Home (p⫽.032) and General Activity Level (p⫽.012). In addition, the litigation group reported more disability on the DPQ (p⫽..014) and ODQ (p⫽.021). After completing interdisciplinary treatment (medication management, physical therapy and behavioral medicine), differences between groups no longer existed on any measure. Statistically significant improvement, regardless of group, was found on all measures after completion of treatment, with the exception of the Distracting Responses MPI scale. Litigation status related to improvement on the ODQ (p⫽.036) as well as the Affective Distress (p⫽.04) and the General Activity Level (p⫽.05) scales of the MPI. In other words, both groups improved on these scales, but the non-litigation group showed more improvement. Although pre-treatment differences existed between groups, both groups demonstrated statistically significant improvement on 94% of the measures. Patients with pending litigation may initially appear worse on measures of pain and disability, but can still experience significant improvements in pain and disability when an interdisciplinary approach is adopted.
F08 - Pain in Children: Psychosocial (971) Children‘s recollection of pain: Effect of individual differences E. Rocha, T. Marche; University of Saskatchewan, Saskatoon, SK Few studies have examined children‘s memories for pain, although such memories have important clinical implications (Ornstein, PA, et al. Developmental & Behavioral Pediatrics, 1999). The purpose of the present study was to determine how accurately children recall their self-reported pain from dental procedures, and to examine the effect of three individual difference factors on recollection of pain, namely, anxiety, previous experience and temperament. Children (N ⫽ 33) aged 4-12 who underwent various dental procedures, and their parents, participated. Immediately following the procedure, children provided pain ratings on the Faces Pain Scale-Revised (FPS-R). Reports of trait anxiety (State-Trait Anxiety Inventory for Children) were also obtained from the children. Parents responded to questions regarding their child‘s temperament (EAS Temperament Survey) and previous medical/dental experience via a questionnaire. Six to eight weeks following the procedure, children were telephoned at home and asked to rate, on the FPS-R, how much pain they had experienced during the dental procedure. Results showed that most children (85%) accurately recalled their pain (within 1 face), although there was a trend towards decreasing pain reports over time. Temperament and previous experience were not related to immediate or delayed pain ratings. Children with higher trait anxiety scores did not report more pain immediately following the procedure, but did so after a 6-8 week delay. Specifically, with age statistically controlled, trait anxiety was positively related to recall of pain r(33) ⫽ .52, p ⫽ .001. Results suggest that children reporting higher levels of general anxiety may negatively distort their recollections of pain. Implications for management of children‘s pain in clinical settings are discussed.
101 (972) Experiences of fathers of adolescents with chronic pain A. Scotford, C. Eccleston, G. Crombez; University of Bath & The Royal National Hospital for Rheumatic Diseases NHS Trust, Bath, UK Chronic pain can be a significant problem for children and adolescents. Epidemiological studies report the incidence of severely debilitating child and adolescent chronic pain at 2%. The widespread debilitating effects of chronic pain on adolescents are now well documented, and it is now also accepted that these effects can also to be found with parents and siblings of chronic pain patients. However, in the majority of the studies that report on the effects of adolescent chronic pain on parents, closer examination reveals these to be predominantly studies of mothers. There is, at present, no guidance on how to understand the experience of fathers of adolescents with chronic pain. As part of a programme of research on the assessment of the impact of pain on parents with chronic pain, two related studies are reported. First, using the Bath adolescent treatment database 16 fathers were selected at random and compared with 16 mothers, matched on characteristics of child pain and disability. From the existing battery of clinical data, the main findings relate to the measure of parenting stress (Parental Stress Index). Mothers showed elevated scores in comparison to fathers on the subscales of Parental Distress (t⫽4.36, P⬍ 0.01), Parent-Child Dysfunction (t⫽3.07, P⬍0.01) and Difficult Child (t⫽2.804, P⬍0.01). In a further study indepth qualitative interviews were undertaken individually with six fathers. All interviews were recorded and transcribed, and subjected to Interpretative Phenomenological Analysis. The IPA revealed four dominant themes that are discussed under the rubric of: losing control, emotional containment, seeking balance & life re-evaluation. The findings are discussed within the context of unmeasured experience in standard tools of parenting and chronic pain, and for the need to account for gendered parenting experience in psychotherapeutic and rehabilitation approaches to the management of adolescent chronic pain and disability.
(973) Peer influences in adolescents’ pain experiences J. Hatchette, P. McGrath, M. Murray, G. Finley; Dalhousie University, Halifax, NS Adolescence is characterized by independence from parents and increased time spent with peers. The influence of peers in the acquisition of health-related behaviors is well documented, however little is known about peer influences on pain experiences. The purpose of this study was to describe the pain types experienced by adolescents, their attitudes and practices concerning pain and pain management and the influence of peers on pain experiences. 24 junior high school students (11 male: mean age⫽ 13.45 yrs, range⫽12-15 yrs; 13 female: mean age⫽13.31 yrs, range 12-15 yrs) from Halifax, Nova Scotia. Qualitative content analysis reduced textual data to central themes emerging from focus group sessions. Pain types reported were consistent with those described in the pain literature. The pattern of OTC analgesic use was primarily parent-assisted, however girls reported more frequent selfmedicating for head and muscle pain than boys. Despite use, attitudes toward OTCs were largely negative. Pain expression was primarily contextual. Where peer-time was threatened by a pain episode, expression was dampened. However, where pain was unfamiliar or severe, parents were consulted. Peers were influential in the expression of pain. Adolescents were intolerant of peers’ expression of pain that was perceived not to be severe. Gender differences were apparent in pain expression and pain talk. Boys were careful not to discuss or express pain that was embarrassing in front of their peers. Girls felt no restriction on their pain talk or pain expression. Findings provide insight into adolescents’ transition from dependent to independent pain management. Although parents were still involved in pain management peers emerged as important influences in adolescents’ attitudes toward pain and pain expression. Findings are discussed within the context of gender role expectations and social display rules.
F08 - Pain in Children: Psychosocial (971) Children‘s recollection of pain: Effect of individual differences E. Rocha, T. Marche; University of Saskatchewan, Saskatoon, SK Few studies have examined children‘s memories for pain, although such memories have important clinical implications (Ornstein, PA, et al. Developmental & Behavioral Pediatrics, 1999). The purpose of the present study was to determine how accurately children recall their self-reported pain from dental procedures, and to examine the effect of three individual difference factors on recollection of pain, namely, anxiety, previous experience and temperament. Children (N ⫽ 33) aged 4-12 who underwent various dental procedures, and their parents, participated. Immediately following the procedure, children provided pain ratings on the Faces Pain Scale-Revised (FPS-R). Reports of trait anxiety (State-Trait Anxiety Inventory for Children) were also obtained from the children. Parents responded to questions regarding their child‘s temperament (EAS Temperament Survey) and previous medical/dental experience via a questionnaire. Six to eight weeks following the procedure, children were telephoned at home and asked to rate, on the FPS-R, how much pain they had experienced during the dental procedure. Results showed that most children (85%) accurately recalled their pain (within 1 face), although there was a trend towards decreasing pain reports over time. Temperament and previous experience were not related to immediate or delayed pain ratings. Children with higher trait anxiety scores did not report more pain immediately following the procedure, but did so after a 6-8 week delay. Specifically, with age statistically controlled, trait anxiety was positively related to recall of pain r(33) ⫽ .52, p ⫽ .001. Results suggest that children reporting higher levels of general anxiety may negatively distort their recollections of pain. Implications for management of children‘s pain in clinical settings are discussed.
101 (972) Experiences of fathers of adolescents with chronic pain A. Scotford, C. Eccleston, G. Crombez; University of Bath & The Royal National Hospital for Rheumatic Diseases NHS Trust, Bath, UK Chronic pain can be a significant problem for children and adolescents. Epidemiological studies report the incidence of severely debilitating child and adolescent chronic pain at 2%. The widespread debilitating effects of chronic pain on adolescents are now well documented, and it is now also accepted that these effects can also to be found with parents and siblings of chronic pain patients. However, in the majority of the studies that report on the effects of adolescent chronic pain on parents, closer examination reveals these to be predominantly studies of mothers. There is, at present, no guidance on how to understand the experience of fathers of adolescents with chronic pain. As part of a programme of research on the assessment of the impact of pain on parents with chronic pain, two related studies are reported. First, using the Bath adolescent treatment database 16 fathers were selected at random and compared with 16 mothers, matched on characteristics of child pain and disability. From the existing battery of clinical data, the main findings relate to the measure of parenting stress (Parental Stress Index). Mothers showed elevated scores in comparison to fathers on the subscales of Parental Distress (t⫽4.36, P⬍ 0.01), Parent-Child Dysfunction (t⫽3.07, P⬍0.01) and Difficult Child (t⫽2.804, P⬍0.01). In a further study indepth qualitative interviews were undertaken individually with six fathers. All interviews were recorded and transcribed, and subjected to Interpretative Phenomenological Analysis. The IPA revealed four dominant themes that are discussed under the rubric of: losing control, emotional containment, seeking balance & life re-evaluation. The findings are discussed within the context of unmeasured experience in standard tools of parenting and chronic pain, and for the need to account for gendered parenting experience in psychotherapeutic and rehabilitation approaches to the management of adolescent chronic pain and disability.
(973) Peer influences in adolescents’ pain experiences J. Hatchette, P. McGrath, M. Murray, G. Finley; Dalhousie University, Halifax, NS Adolescence is characterized by independence from parents and increased time spent with peers. The influence of peers in the acquisition of health-related behaviors is well documented, however little is known about peer influences on pain experiences. The purpose of this study was to describe the pain types experienced by adolescents, their attitudes and practices concerning pain and pain management and the influence of peers on pain experiences. 24 junior high school students (11 male: mean age⫽ 13.45 yrs, range⫽12-15 yrs; 13 female: mean age⫽13.31 yrs, range 12-15 yrs) from Halifax, Nova Scotia. Qualitative content analysis reduced textual data to central themes emerging from focus group sessions. Pain types reported were consistent with those described in the pain literature. The pattern of OTC analgesic use was primarily parent-assisted, however girls reported more frequent selfmedicating for head and muscle pain than boys. Despite use, attitudes toward OTCs were largely negative. Pain expression was primarily contextual. Where peer-time was threatened by a pain episode, expression was dampened. However, where pain was unfamiliar or severe, parents were consulted. Peers were influential in the expression of pain. Adolescents were intolerant of peers’ expression of pain that was perceived not to be severe. Gender differences were apparent in pain expression and pain talk. Boys were careful not to discuss or express pain that was embarrassing in front of their peers. Girls felt no restriction on their pain talk or pain expression. Findings provide insight into adolescents’ transition from dependent to independent pain management. Although parents were still involved in pain management peers emerged as important influences in adolescents’ attitudes toward pain and pain expression. Findings are discussed within the context of gender role expectations and social display rules.