Brief report: cognitive functioning and academic achievement in children and adolescents with chronic pain.

OBJECTIVE: To examine the patterns of cognitive functioning and academic achievement in children and adolescents with chronic pain attending a tertiary-care interdisciplinary pain service. METHODS: The standardized psychoeducational testing results of 57 children and adolescents with chronic pain aged 8-18 were retrospectively reviewed. RESULTS: On average, participants scored higher in general intelligence, verbal ability, nonverbal reasoning, word reading, and math reasoning than the general population. The level of academic achievement for most participants was consistent with their intellectual ability. CONCLUSIONS: In this clinical sample with complex, disabling pain, the group mean data do not indicate overall cognitive impairment, or a single atypical achievement pattern. Future research will need to look beyond cognitive and achievement scores to explore the links between school functioning and chronic pain in children.

Finding common ground: patient-centeredness and evidence-based chronic illness care.

Health outcomes for patients with major chronic illnesses depend on the appropriate use of proven pharmaceuticals and other therapeutic technologies, and effective self-management by patients. Effective chronic illness care then bases clinical decisions on the best, rigorous scientific evidence, or evidence-based medicine. Effective support for patient self-management includes efforts to increase patient participation in care and collaborative goal-setting and planning of treatment. These interventions appear somewhat consistent with recent conceptualizations of patient-centered care. The consistent delivery of proven therapies and information and support for self-management requires practice systems organized for that purpose. The Chronic Care Model is a compilation of those practice system changes shown to improve chronic care. This paper explores the concept of patient-centeredness and its relationship to the Chronic Care Model. We conclude that the Model is both evidence-based and patient-centered and that these can be properties of health systems, and not just of individual practitioners.

The impact of maternal behavior on children's pain experiences: an experimental analysis.

OBJECTIVE: To provide an experimental investigation of the impact of maternal behavior on children's pain experiences. METHOD: Participants were 120 healthy children (60 boys, 60 girls) between the ages of 8 and 12 years and their mothers. Mothers were randomly assigned and trained to interact with their children in one of three ways while the children were exposed to lab-induced cold pressor pain: (1) a pain-promoting interaction, (2) a pain-reducing interaction, and (3) a no training control group. Training was based on behaviors presumed to have the expected impact, as based on correlational studies reported in the literature. Children's pain experiences during the cold pressor were assessed using self-reports of intensity and affect, coding of facial activity, tolerance, and heart rate responsiveness. RESULTS: Girls whose mothers interacted with them in the pain-promoting manner reported more pain than daughters of mothers in the control group, who in turn reported more pain than girls whose mothers interacted with them in the pain-reducing manner. This effect was not significant for boys. Maternal interaction type had no effect on children's pain affect, facial activity, tolerance, or heart rate. CONCLUSIONS: Results indicate that maternal behavior can have a direct impact on their daughters' subjective reports of pain. These data support the importance of social learning factors in influencing children's pain experiences.