Seasonal Variation in Pediatric Chronic Pain Clinic Phone Triage Call Volume.

Chronic pain is highly prevalent in youth and often results in significant health care usage and familial distress. Telephone triage nurses in pediatric pain clinics provide support and consultation to families and engage parents of pediatric pain patients in interdisciplinary intervention efforts. Despite evidence of winter predominance in rates of pain-related and psychiatric complaints, seasonal variations have not been examined in terms of the demand placed on pain clinic triage nurses. The present study investigated seasonal patterns in the frequency and type of phone calls made over the course of 1 year to an interdisciplinary outpatient pediatric chronic pain clinic at a large Midwestern children's hospital. Pain complaints, reasons for phone calls, and call outcomes (e.g., medication changes, consultation with medical or mental health providers) were recorded in patient charts and retrospectively reviewed by the clinic registered nurse. A total of 721 calls regarding 253 patients were made over the course of 1 year. Results indicated that overall call volume across pain conditions was more than two times greater in the winter than in the summer (χ2 = 64.13, p < .001), and the odds of a call involving headache pain were almost twice as likely in the winter as in the summer. The majority of calls required consultation with physicians and/or mental health providers. Present data may be useful for pediatric chronic pain clinics making staffing decisions throughout the year because the winter season appears to place a significantly greater demand on triage nurses.

A randomized, controlled pilot study of mindfulness-based stress reduction for pediatric chronic pain.

CONTEXT: It is estimated that 1 in 5 children in the United States is affected by chronic pain. Increasing adaptive coping strategies and decreasing stress may be important in treatment. Research has suggested that mindfulness can help alleviate symptoms associated with medical illnesses and increase quality of life. Little is known about the effectiveness of mindfulness-based stress reduction (MBSR) in youth, partly due to insufficient methodological rigor in related studies. OBJECTIVE: The primary purpose of the present study was to examine the feasibility, acceptability, and effectiveness of MBSR for a treatment-seeking sample of youth with chronic pain. DESIGN: The current study was the first randomized, controlled pilot study of MBSR for pediatric chronic pain. The research team had intended to use block randomization involving a total of five recruitment waves, with each wave consisting of one MBSR group and one psychoeducation group. Due to difficulties with recruitment and attrition before the start of either group, however, only MBSR was conducted at each wave after the first wave. SETTING: Participants were recruited from a multidisciplinary pain clinic in a large, Midwestern children's hospital. PARTICIPANTS: The final sample included six adolescents between the ages of 12 and 17 y, four in the MBSR group and two in the psychoeducation group. INTERVENTION: Weekly sessions for the MBSR group were 90 min in length and followed a structured protocol. Sessions included a review of homework, an introduction to and practice of meditation, discussion of the session, and a review of the home practice assignment. The psychoeducation group participated in six group sessions, which were based on a cognitive-behavioral model of pain, and discussion topics included the nature of chronic pain and stress management. PRIMARY OUTCOME MEASURES: Health-related quality of life, pain catastrophizing, anxiety, functional disability, mindfulness, and treatment acceptability were all assessed pre- and postintervention as well as at follow-up. RESULTS: Recruitment and retention difficulties were experienced. Qualitative examination of participants' scores suggested increased mindfulness but inconsistent patterns on other outcome measures. CONCLUSIONS: The research team highlighted critical challenges faced by potential researchers aiming to investigate MBSR for pediatric chronic pain, and the study provides recommendations for research and implications for clinical practice.

The impact of pediatric chronic pain on parents' health-related quality of life and family functioning: reliability and validity of the PedsQL 4.0 Family Impact Module.

OBJECTIVE: To evaluate the psychometric properties of the Family Impact Module (FIM), a parent self-report measure of health-related quality of life (HRQOL) and family functioning, among parents of youth with chronic pain. METHODS: Parents (N = 458) completed the FIM (Total Impact, HRQOL, and Family Functioning scales); parents and youth (N = 332) completed measures of pain catastrophizing, pediatric quality of life, and emotional/behavioral functioning. RESULTS: The FIM demonstrated strong internal consistency and item-total correlations. All FIM scales were positively associated with pain catastrophizing, functional disability, and emotional/behavioral problems; and inversely related to pediatric quality of life. Mothers reported significantly worse HRQOL than fathers. Mothers and fathers did not differ on reports of Family Functioning. HRQOL and Family Functioning did not differ as a function of pain diagnosis. CONCLUSION: The FIM appears to be a suitable measure of parent self-reported HRQOL and family functioning in pediatric chronic pain.

"What Does Weight Have to Do with It?" Parent Perceptions of Weight and Pain in a Pediatric Chronic Pain Population.

Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child's initial appointment; questions addressed parents' perceptions of their child's weight, and their perceptions of multiple aspects of the relationship between their child's weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child's weight; this group of parents was also more concerned (p < 0.05) about their child's weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child's weight contributed to his/her pain, or that weight was relevant to their child's pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child's pain. Results support the need for addressing parents' perceptions of their child's weight status, and educating parents about the relationship between excessive weight and chronic pain.

Parents' initial perceptions of multidisciplinary care for pediatric chronic pain.

Chronic and recurrent pain is experienced by many children and adolescents. Treatment of chronic pain using a multidisciplinary approach has been found to be effective for treatment of chronic pain. Parent satisfaction with treatment and treatment providers highly correlates to children's treatment adherence. Parents of children treated at a multidisciplinary chronic pain clinic were interviewed following their initial appointment. Parents reported high satisfaction with treatment team members and with the treatment plan. Parents also reported appreciation of multidisciplinary structure, the high level of expertise of the team members, and the team members' genuine interest in treating their children. This increase in satisfaction when compared to previous treatment is important since increases in satisfaction may correlate with a reduction in experiences of chronic pain. Parents reported high satisfaction with interactions with treatment team members and with the treatment plan provided for their children. Parents had appreciation of multidisciplinary team structure and the high level of expertise of the team members. This increase in satisfaction when compared to treatment from previous providers is important since increases in satisfaction may correlate with an increase in children's treatment adherence and a reduction in experiences of chronic pain.