Psychosocial Functioning of Parents of Youth Receiving Intensive Interdisciplinary Pain Treatment.

OBJECTIVE: Parents of youth with chronic pain report psychosocial difficulties, yet treatment often focuses on improving their child's functioning and pain. This study evaluated changes in parents' social and emotional functioning and explored predictors of change, as they completed a parent-focused intervention while their child was enrolled in an intensive interdisciplinary pain treatment (IIPT) program. METHODS: Parents (n = 69) completed questionnaires at baseline and weekly (average duration of 4 weeks) during their child's participation in IIPT. Parents engaged in 3 groups per week providing education, therapeutic art, and psychotherapy (3 hr/week total). RESULTS: At baseline, 38% of parents reported scores in the clinically elevated range for at least 1 psychosocial variable. Linear mixed modeling for the full sample indicated reduced parent anxiety (t = -2.72, p <.01) and depression (t = -3.59, p <.001), but not increased emotional support (t = 1.86, p >. 05) or reduced social isolation (t = -1.20, p >.05). For parents with at least moderately elevated psychosocial concerns, statistically significant improvements were observed for all 4 outcomes (all p's<.01). Psychological flexibility, cognitive reappraisal, and emotional suppression were found to be related to changes in parent outcomes (anxiety, depression, isolation, and support). CONCLUSIONS: Findings support the benefit of parent-focused interventions in addition to child-focused interventions. Many parents of youth participating in IIPT had elevated scores for at least 1 psychosocial concern at baseline. Brief, parent-focused intervention including psychoeducation, therapeutic art, and psychotherapy targeting mindfulness, acceptance, and values had a significant impact on these parents, particularly those with greater struggles at baseline.

The Effects of Body Tempering on Force Production, Flexibility and Muscle Soreness in Collegiate Football Athletes.

There has been limited research to explore the use of body tempering and when the use of this modality would be most appropriate. This study aimed to determine if a body tempering intervention would be appropriate pre-exercise by examining its effects on perceived soreness, range of motion (ROM), and force production compared to an intervention of traditional stretching. The subjects for this study were ten Division 1 (D1) football linemen from Sacred Heart University (Age: 19.9 ± 1.5 years, body mass: 130.9 ± 12.0 kg, height: 188.4 ± 5.1 cm, training age: 8.0 ± 3.5 years). Subjects participated in three sessions with the first session being baseline testing. The second and third sessions involved the participants being randomized to receive either the body tempering or stretching intervention for the second session and then receiving the other intervention the final week. Soreness using a visual analog scale (VAS), ROM, counter movement jump (CMJ) peak force and jump height, static jump (SJ) peak force and jump height, and isometric mid-thigh pull max force production were assessed. The results of the study concluded that body tempering does not have a negative effect on muscle performance but did practically reduce perceived muscle soreness. Since body tempering is effective at reducing soreness in athletes, it can be recommended for athletes as part of their pre-exercise warmup without negatively effecting isometric or dynamic force production.

Comparing Three Music Therapy Interventions for Anxiety and Relaxation in Youth With Amplified Pain.

Research in pediatric hospitals has shown that active music engagement, preferred music listening, and music-assisted relaxation can decrease anxiety and increase relaxation responses. However, there is little research on the use of music therapy with pediatric chronic pain conditions such as amplified pain syndromes. The purpose of the current study was to examine the effects of 3 specific music therapy interventions (active music engagement, live patient-selected music, and music-assisted relaxation) on anxiety and relaxation levels in youth (ages 10-18) participating in a 40 hr per week hospital-based intensive interdisciplinary pain treatment program. A sample of 48 patients participated in this study which utilized a 3-period, 3-treatment cross-over design with 3 interventions delivered in a quasi-randomized order determined by when the patients started the treatment program. State anxiety was measured via the state form of the State-Trait Inventory for Cognitive and Somatic Anxiety for Children and relaxation scores were assessed with a Visual Analog Scale. Statistically significant changes were found in anxiety and relaxation outcomes across all interventions provided. Results suggest that music therapy services (using active music engagement, live patient-selected music, and music-assisted relaxation) may be an effective modality to decrease anxiety and increase relaxation levels in pediatric patients with amplified pain syndromes.

Novel multifunctional pharmacology of lobinaline, the major alkaloid from Lobelia cardinalis.

In screening a library of plant extracts from ~1000 species native to the Southeastern United States, Lobelia cardinalis was identified as containing nicotinic acetylcholine receptor (nicAchR) binding activity which was relatively non-selective for the α4ß2- and α7-nicAchR subtypes. This nicAchR binding profile is atypical for plant-derived nicAchR ligands, the majority of which are highly selective for α4ß2-nicAchRs. Its potential therapeutic relevance is noteworthy since agonism of α4ß2- and α7-nicAchRs is associated with anti-inflammatory and neuroprotective properties. Bioassay-guided fractionation of L. cardinalis extracts led to the identification of lobinaline, a complex binitrogenous alkaloid, as the main source of the unique nicAchR binding profile. Purified lobinaline was a potent free radical scavenger, displayed similar binding affinity at α4ß2- and α7-nicAchRs, exhibited agonist activity at nicAchRs in SH-SY5Y cells, and inhibited [(3)H]-dopamine (DA) uptake in rat striatal synaptosomes. Lobinaline significantly increased fractional [(3)H] release from superfused rat striatal slices preloaded with [(3)H]-DA, an effect that was inhibited by the non-selective nicAchR antagonist mecamylamine. In vivo electrochemical studies in urethane-anesthetized rats demonstrated that lobinaline locally applied in the striatum significantly prolonged clearance of exogenous DA by the dopamine transporter (DAT). In contrast, lobeline, the most thoroughly investigated Lobelia alkaloid, is an α4ß2-nicAchR antagonist, a poor free radical scavenger, and is a less potent DAT inhibitor. These previously unreported multifunctional effects of lobinaline make it of interest as a lead to develop therapeutics for neuropathological disorders that involve free radical generation, cholinergic, and dopaminergic neurotransmission. These include neurodegenerative conditions, such as Parkinson's disease, and drug abuse.

Amplified pain syndromes in children: treatment and new insights into disease pathogenesis.

PURPOSE OF REVIEW: Although many diagnostic terms are used for pediatric chronic pain, evidence suggests a common thread of signal amplification, leading to the unifying term 'amplified pain syndromes'. Ongoing research provides new insights into biopsychosocial contributors and treatments for pediatric amplified pain syndromes. RECENT FINDINGS: Basic science indicates a complex interplay of genetic, epigenetic, neurochemical, endocrine, and inflammatory contributors, along with environmental and psychological factors. Although medications and interventions remain common approaches to children with chronic pain, their evidence is limited. Preliminary evidence exists for mindfulness-based therapies, yoga, and other complementary/alternative medicine approaches. The strongest evidence is for exercise-based and cognitive-behavioral treatments, in particular, when combined in a multidisciplinary format. Intensive approaches (pain rehabilitation) have the potential to effectively and efficiently treat those most disabled by amplified pain syndromes, and lead to sustained improvement in pain, functioning, and medical utilization. SUMMARY: Although understanding of the mechanisms underlying pediatric amplified pain syndromes evolves, standard of care is multidisciplinary emphasizing exercise therapy, cognitive-behavioral treatment, and self-regulation. Treatment should target full return to physical function, which leads to subsequent improvement or resolution of pain. Multidisciplinary care can be coordinated by a rheumatologist or other physician with appropriate referrals, or through a multidisciplinary team.

Oral creatine supplementation's decrease of blood lactate during exhaustive, incremental cycling.

PURPOSE: To determine the effects of creatine supplementation on blood lactate during incremental cycling exercise. METHODS: Thirteen male subjects (M ± SD 23 ± 2 yr, 178.0 ± 8.1 cm, 86.3 ± 16.0 kg, 24% ± 9% body fat) performed a maximal, incremental cycling test to exhaustion before (Pre) and after (Post) 6 d of creatine supplementation (4 doses/d of 5 g creatine + 15 g glucose). Blood lactate was measured at the end of each exercise stage during the protocol, and the lactate threshold was determined as the stage before achieving 4 mmol/L. Lactate concentrations during the incremental test were analyzed using a 2 (condition) × 6 (exercise stage) repeated-measures ANOVA. Differences in power at lactate threshold, power at exhaustion, and total exercise time were determined by paired t tests and are presented as M ± SD. RESULTS: Lactate concentrations were reduced during exercise after supplementation, demonstrating a significant condition effect (p = .041). There was a tendency for increased power at the lactate threshold (Pre 128 ± 45 W, Post 143 ± 26 W; p = .11). Total time to fatigue approached significant increases (Pre 22.6 ± 3.2 min, Post 23.3 ± 3.3 min; p = .056), as did maximal power output (Pre 212.5 ± 32.5 W, Post 220 ± 34.6 W; p = .082). CONCLUSIONS: Our findings demonstrate that creatine supplementation decreases lactate during incremental cycling exercise and tends to raise lactate threshold. Therefore, creatine supplementation could potentially benefit endurance athletes.

Evaluation of the effects of the VibraJect attachment on pain in children receiving local anesthesia.

PURPOSE: The purpose of this study was to evaluate the effectiveness of VibraJect, a vibrating attachment for a traditional syringe, in reducing pain related disruptive behavior and self-reported pain in children receiving local anesthesia. METHODS: The procedure involved a randomized, controlled, single-blinded study of 90 children receiving local anesthesia for routine restorative procedures. Participants were randomly assigned to either a control (injection as usual) or experimental (injection using the VibraJect) group. Participants were recruited from a large, urban pediatric dental clinic within a university medical center. RESULTS: Using 2-way analysis of variance and 2-tailed, between-subject t tests, there were no significant differences between injection with and without the VibraJect on any measures of pain, including self-reported intensity, independent direct observations of pain related disruptive behavior, and subjective dentist ratings. CONCLUSIONS: VibraJect did not provide any benefits over a conventional approach to anesthesia injection for children in this study.