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BACKGROUND: Parental cognitive-affective and behavioural responses impact on the chronification of the child's pain. Whether mothers and fathers differ in their responses and whether top-down variables (parental somatization, anxiety symptoms) and bottom-up variables (child's pain-related disability, anxiety symptoms) impact on parental responses remains unresolved. OBJECTIVES: (1) A comparison of maternal and paternal somatization, anxiety, symptoms and their responses (parental catastrophizing, solicitousness) to children with chronic pain; (2) an analysis of the impact of top-down variables (parental somatization, anxiety symptoms) and bottom-up variables (child's pain-related disability, anxiety symptoms) on parental maladaptive responses. METHODS: Pediatric chronic pain and anxiety symptoms, parental somatization and anxiety symptoms, as well as parental responses in Nâ¯=21 parent-child triads (child, mother, father; Nâ¯= 21 each, total-Nâ¯= 63; children: 50% female, 11-19 years, ∅15.14 years) were assessed via validated questionnaires during child and adolescent psychiatric treatment for child chronic pain. RESULTS: Mothers and fathers did not differ in somatization, anxiety symptoms and responses. Parental catastrophizing was higher if the child suffered from anxiety symptoms and from pain-related disability. Parental solicitousness was higher if parents reported more own anxiety symptoms. Younger children and girls received more solicitous responses. CONCLUSION: As shown by previous studies, parental and child anxiety symptoms, but not parental gender, play a pivotal role in modulating parental maladaptive pain-related responses. This should be taken into account in prevention as well as in the treatment of children with chronic pain and their caregivers.
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Dolor Crónico , Relaciones Padres-Hijo , Adolescente , Ansiedad , Niño , Dolor Crónico/terapia , Femenino , Humanos , Masculino , Dimensión del Dolor , PadresRESUMEN
Objective: To determine whether fear can be triggered when experiencing interoceptive sensations locally proximal to the primary pain region. Two groups of adolescents (11-18 years) with chronic headache ( n = 20) or chronic abdominal pain (CAP; n = 20) completed three muscle tensing tasks to induce proximal versus distal sensations: (1) "frown" task (proximal for chronic headache; distal for CAP), (2) "tighten stomach" task (proximal for CAP; distal for chronic headache), and (3) safe comparison task (clench fist). Fear and avoidance were assessed via self-report. Adolescents with CAP reported greater fear and avoidance after the proximal compared with the distal task, while adolescents with chronic headache did not. Both groups reported similar levels of fear and avoidance in the frown and safe comparison task. Results suggest that the perception of proximal interoceptive sensations appears to activate the fear system in adolescents with CAP. Future research is warranted.
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Dolor Abdominal/psicología , Dolor Crónico/psicología , Miedo/psicología , Trastornos de Cefalalgia/psicología , Interocepción , Adolescente , Reacción de Prevención , Niño , Femenino , Humanos , Masculino , AutoinformeRESUMEN
BACKGROUND: In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs. inpatients and b) patients who declined intensive inpatient treatment and completed outpatient treatment instead (decliners) vs. those who completed inpatient treatment (completers). METHODS: The study compared treatment outcomes between n = 992 outpatients vs. n = 320 inpatients (Analysis A) who were treated at a tertiary treatment centre and returned for a return visit within a one-year interval. In Analysis B, treatment outcomes were compared between n = 67 decliners vs. n = 309 completers of inpatient treatment. The three outcome domains were compared by calculating standardized change scores and clinically significant changes. RESULTS: In analysis A, outpatients and inpatients reported comparably low levels of pain intensity (NRS 0-10; mean = 4, SD = 2.7) and disability (Paediatric Pain Disability Index (PPDI: 12-60; mean = 24; SD = 10) at the return visit. Compared to outpatients, more inpatients achieved clinically significant changes in pain intensity (52% vs. 45%) and disability (46% vs. 31%). There were also significantly greater changes in disability in the inpatient group (change score outpatients = 1.0; change score inpatients = 1.4; F(1,1138) = 12.6, p = .011). School absence was substantially reduced, with approximately 80% in each group attending school regularly. Analysis B showed that even though inpatient decliners achieved improvements in the outcome domains, they reported greater disability at the return visit (PPDI mean decliners = 27, SD = 9.9; PPDI mean completers = 24, SD = 10) because they had achieved fewer changes in disability (change score decliners = 0.9; change score completers = 1.4; F(1.334) = 5.7, p = .017). In addition, less decliners than completers achieved clinically significant changes in disability (25% vs. 47%). CONCLUSIONS: Inpatient and outpatient treatments are able to elicit substantial changes in pain intensity, disability and school absence. The results highlight the necessity of intensive inpatient pain treatment for highly affected children, as children who declined inpatient treatment and were treated as outpatients did less well.
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Atención Ambulatoria , Dolor Crónico/terapia , Hospitalización , Evaluación del Resultado de la Atención al Paciente , Absentismo , Adolescente , Niño , Preescolar , Evaluación de la Discapacidad , Femenino , Alemania , Humanos , Lactante , Masculino , Clínicas de Dolor , Dimensión del Dolor , Grupo de Atención al Paciente , Adulto JovenRESUMEN
BACKGROUND: One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology. OBJECTIVE: The aim of the present study was to identify predictors of dropout from this Web program. METHODS: A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants' age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method. RESULTS: The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout. CONCLUSIONS: Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.
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Depresión/complicaciones , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Internet , Motivación , Pacientes Desistentes del Tratamiento/psicología , Adolescente , Adulto , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Femenino , Humanos , Persona de Mediana Edad , Adulto JovenRESUMEN
ABSTRACT: According to the bio-informational theory of emotion by Lang, mental imagery of fearful stimuli activates physiological and behavioural response systems, even in the absence of sensory input. We investigated whether instructed mental imagery of pain-associated (not painful) interoceptive sensations entails a threat value and elicits increased startle response, skin conductance level (SCL), and heart rate (HR) indicative of defensive mobilization in adolescents with chronic pain. Additionally, self-reported measures (fear, fear of pain, desire to avoid) were assessed. Adolescents (11-18 years) with chronic headache (CH, n = 46) or chronic abdominal pain (CAP, n = 29) and a control group (n = 28) were asked to imagine individualized pain-associated, neutral and standardized fear scripts. During pain-associated compared with neutral imagery, both pain groups showed higher mean HR, with CH also showing higher HR reactivity, while HR acceleration was not observed within control group. In contrast, during pain-associated compared with neutral imagery, startle response magnitude and SCL remained unchanged in all groups. Additionally, overall levels in self-reports were higher during pain-associated compared with neutral imagery, but significantly more pronounced in the pain groups compared with the control group. Results suggest that the mere imagination of pain-associated sensations elicits specific autonomic fear responses accompanied by increased self-reported fear in adolescents with chronic pain. The specific modulation of heart rate shed new light on our understanding of multimodal fear responses in adolescents with chronic pain and may help to refine paradigms to decrease fear of interoceptive sensations in chronic pain.
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Dolor Crónico , Humanos , Adolescente , Miedo/psicología , Emociones/fisiología , Imaginación/fisiología , SensaciónRESUMEN
OBJECTIVE: To investigate the long-term effectiveness of a 3-week multimodal inpatient program for children and adolescents with chronic pain. METHODS: 167 adolescents were evaluated at pretreatment baseline, 3-, and 12-month follow-up. Long-term effectiveness was investigated for pain-related variables (pain-related disability, school absence, pain intensity) and emotional distress. RESULTS: We found statistically and clinically significant changes in all variables. After 1 year, the majority (56%) showed overall improvement as indexed by decreased pain-related disability or school absence. 22% had an unsuccessful treatment outcome. Those showing only short-term improvements had higher levels of emotional distress at baseline. CONCLUSIONS: 1 year after completing a multimodal inpatient program adolescents report less chronic pain, disability, and emotional distress. Clinically significant changes remain stable. Adolescents with high levels of emotional distress at admission may require special attention to maintain positive treatment outcomes. Specialized inpatient therapy is effective for children with chronic pain.
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Adaptación Psicológica , Dolor Crónico/terapia , Pacientes Internos , Estrés Psicológico/psicología , Adolescente , Niño , Dolor Crónico/psicología , Terapia Combinada , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Manejo del Dolor , Dimensión del Dolor , Resultado del TratamientoRESUMEN
To deliver tailored pain science education, assessing children's biopsychosocial pain concepts is necessary. As validated tools are lacking, a new tool is presented, the biopsychosocial pain concept matrix (BiPS matrix), which assesses children's biological, psychological, and social pain concepts in five domains according to the Common-Sense Model of Self-Regulation (Hagger and Orbell, 2003): (1) illness identity, (2) causes, (3) consequences, (4) duration, and (5) treatment. The present preliminary study aims to (1) assess the items' readability and understandability in cognitive interviews with N = 9 healthy children (9 to 19 years, M = 13.78 years, SD = 3.05; 44% female) and (2) pre-test the BiPS matrix within an online survey of N = 27 healthy children (9 to 19 years, M = 13.76 years, SD = 3.03; 56% female). Results revealed difficulties in understanding some items. Children's understanding increased with age. Age, chronic pain status, and pain in the social environment were positively associated with the BiPS total score, whereas the latter explained the most variance in pain concepts of children. Patient-focused methods such as cognitive interviews proved essential in testing the readability and understanding of items in children. Future studies are warranted to further validate the BiPS matrix.
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Cross-sectional studies on somatosensory perception in children demonstrate lower pain thresholds for children compared with adolescents. The aim of the present longitudinal study was to replicate these age-related differences in a longitudinal design. Total 38 children and adolescents aged 6 to 16 years (two girls and two boys within each year) participated in this study. Quantitative sensory testing (QST) according to the protocol of the German research network on neuropathic pain (DFNS) was assessed twice with an interval of 15.8 ± 3.0 months. Bland-Altman analyses describe the short-term reliability of the measurements. Intraindividual sensory development was measured using paired t-test and quantified by effect sizes Cohen's d between the two measurements. QST parameters showed good short-term reliability. Over a period of 1 year, children became less sensitive to painful stimuli, especially to cold pain, pressure pain, and mechanical pain. No systematic developmental changes were observed in response to the other somatosensory stimuli. QST is reliable over short retest intervals. In line with previous results from cross-sectional studies, we find a decrease in pain sensitivity with increasing age but no differences in nonnociceptive somatosensory processing over a period of 1 year in children between 6 and 16 years of age. Taken together, these results highlight the importance of a reference-based interpretation of the individual QST data.
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Desarrollo Infantil/fisiología , Umbral del Dolor/fisiología , Percepción/fisiología , Sensación , Adolescente , Vías Aferentes/fisiología , Factores de Edad , Niño , Estudios Transversales , Femenino , Humanos , Individualidad , Estudios Longitudinales , Masculino , Estimulación Física , Tiempo de Reacción , Reproducibilidad de los Resultados , Estadística como Asunto , Factores de TiempoRESUMEN
BACKGROUND: Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period. METHODS: Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation. Subgroup analysis for sex, age and pain location was conducted and multivariate logistic regression applied to identify parameters associated with extremely high impairment. RESULTS: The retrospective study consisted of 2249 children assessed at the first evaluation. Tension type headache (48%), migraine (43%) and functional abdominal pain (11%) were the most common diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletal pain disease. Irrespective of pain location, chronic pain disorder with somatic and psychological factors was diagnosed frequently (43%). 55% of the children suffered from more than one distinct pain diagnosis. Clinically significant depression and general anxiety scores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13 were more likely to seek tertiary treatment compared to boys. Nearly half of children suffered from daily or constant pain with a mean pain value of 6/10. Extremely high pain-related impairment, operationalized as a comprehensive measure of pain duration, frequency, intensity, pain-related school absence and disability, was associated with older age, multiple locations of pain, increased depression and prior hospital stays. 43% of the children taking analgesics had no indication for pharmacological treatment. CONCLUSION: Children with chronic pain are a diagnostic and therapeutic challenge as they often have two or more different pain diagnoses, are prone to misuse of analgesics and are severely impaired. They are at increased risk for developmental stagnation. Adequate treatment and referral are essential to interrupt progression of the chronic pain process into adulthood.
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Dolor Crónico , Dolor Abdominal/diagnóstico , Dolor Abdominal/fisiopatología , Dolor Abdominal/psicología , Dolor Abdominal/terapia , Absentismo , Adolescente , Ansiedad/etiología , Niño , Servicios de Salud del Niño/estadística & datos numéricos , Preescolar , Dolor Crónico/diagnóstico , Dolor Crónico/fisiopatología , Dolor Crónico/psicología , Dolor Crónico/terapia , Femenino , Alemania , Cefalea/diagnóstico , Cefalea/fisiopatología , Cefalea/psicología , Cefalea/terapia , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Modelos Logísticos , Masculino , Dolor Musculoesquelético/diagnóstico , Dolor Musculoesquelético/fisiopatología , Dolor Musculoesquelético/psicología , Dolor Musculoesquelético/terapia , Dimensión del Dolor , Psicometría , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y CuestionariosRESUMEN
In this study, we investigated the experience of children who died of cancer, as perceived by their parents. All the pediatric oncology departments in one German federal state were contacted and asked to invite parents who had lost a child to cancer in the period 2005-2006 to participate. Those parents who accepted were interviewed by means of a semi-structured questionnaire. In the participating 16 departments, 158 children died in 2005-2006. Parents of 48 children (38.3 percent) agreed to participate and were interviewed. Nearly all of the children had suffered from at least one distressing symptom. Pain and fatigue occurred most frequently. Symptoms were successfully treated over 65 percent of the time. In all, 64 percent of the children received home care services; 50 percent died at home, and only 10 percent in the ICU. Results suggest that some progress has been made in pediatric palliative care. To further improve end-of-life care for children with cancer, it is also necessary to evaluate parents' perspectives on structures for pediatric palliative care delivery.
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Actitud Frente a la Salud , Neoplasias/terapia , Cuidados Paliativos , Padres , Calidad de la Atención de Salud , Actitud Frente a la Muerte , Niño , Toma de Decisiones , Femenino , Alemania , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Humanos , Masculino , Padres/psicología , Calidad de VidaRESUMEN
The present study describes the development and validation of a German questionnaire assessing motivation to change in individuals with eating disorders (Stages of Change Questionnaire-Eating Disorders, SOCQ-ED). The SOCQ-ED measures stages of change separately for each eating disorder symptom domain. Psychometric properties were assessed in a sample of N=63 women with Anorexia Nervosa or Bulimia Nervosa. Test-retest reliability ranged from rtt=0.42 to 0.78 (Mdn=0.56), correlations with the University of Rhode Island Change Assessment were between r=0.21 and 0.32 and correlations with measurements of eating pathology ranged from r=0.19 to 0.46. The results provide initial support for the reliability and validity of the SOCQ-ED.
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Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Motivación , Encuestas y Cuestionarios , Anorexia/diagnóstico , Anorexia/psicología , Bulimia/diagnóstico , Bulimia/psicología , Trastornos de Alimentación y de la Ingestión de Alimentos/psicología , Femenino , Alemania , Humanos , Psicometría , Reproducibilidad de los Resultados , Adulto JovenRESUMEN
Interoception may play an important role for emotion regulation and stress, thereby affecting mental health in children and adults. Yet, little is known on interoception in preschool children. Therefore, we investigated interoceptive accuracy using the adapted Jumping Jack Paradigm (JJP) and its relationship with emotion regulation and stress. In Study I, 40 preschoolers completed the JJP and an emotion regulation task, demonstrating a positive relationship between interoceptive accuracy and emotion regulation at trend level (R² = 0.231, p = .023; ß = .278, p = .073). In Study II, 31 preschoolers completed the adapted JJP before and after an acute laboratory stress test. Higher total cortisol output following acute stress induction was associated with reduced interoceptive accuracy (r = -0.670, p = .017). Extending earlier findings in adults and school-children, the relationship of interoceptive accuracy with emotion regulation and stress highlights the importance to investigate interoception in early childhood.
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Regulación Emocional , Interocepción , Adaptación Fisiológica , Adulto , Concienciación , Niño , Preescolar , Frecuencia Cardíaca , Humanos , Solución de ProblemasRESUMEN
OBJECTIVE: This study aims to investigate the effectiveness of the "pain provocation technique" (PPT)--a focused treatment strategy incorporating interoceptive exposure (i.e., imagining increases in pain intensity), bilateral stimulation (tactile stimulation), and implementation of pain-related coping to decrease pain intensity--for adolescents suffering from chronic pain. DESIGN: Prospective observational comparative study. METHODS: Adolescents utilizing PPT (19 boys and 21 girls) within multimodal inpatient treatment were compared with adolescents in standard multimodal inpatient treatment matched for age, gender, and diagnosis. Core outcome variables (pain intensity, disability, emotional distress) were assessed at admission and 3 months posttreatment. RESULTS: Adolescents in the PPT group demonstrated a sharper decrease in pain intensity and school aversion. Both groups demonstrated significant reductions in disability and emotional distress. CONCLUSIONS: Results are discussed in terms of the importance of focused treatment strategies such as interoceptive exposure for adolescents suffering from disabling chronic pain. Future studies are warranted to carefully investigate the effectiveness and possible process of change during the PPT such as sensory, cognitive, emotional, and memory aspects.
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Enfermedad Crónica/terapia , Manejo del Dolor , Dolor/psicología , Adaptación Psicológica/fisiología , Adolescente , Adulto , Ansiedad , Niño , Terapia Combinada , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Dolor/fisiopatología , Dimensión del Dolor , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
PURPOSE: Children of parents with chronic pain are a high-risk group to develop own chronic pain. There is evidence that parental responses such as catastrophizing and solicitousness play an important role in the familial transmission of chronic pain. However, little is known about factors that modulate these responses. Based on the literature, we assumed that top-down processes, such as parent chronic pain and anxiety, would be associated with increased catastrophizing and solicitousness. Bottom-up processes, such as child chronic pain and anxiety, were assumed to moderate this association. METHODS: N = 118 parents (mean age: 43 years, 80.5% females) with chronic pain and/or anxiety symptoms with N = 190 children (mean age: 11 years, 49% females) were recruited in specialized hospitals and via online panels. Parents reported chronic pain, anxiety, catastrophizing and solicitousness by use of validated questionnaires. Child pain and anxiety were assessed via parent report. RESULTS: Multilevel model results showed that top-down processes, rather than bottom-up processes, predicted parental responses to child's pain. Specifically, parents with more severe chronic pain reported less catastrophizing. Parent anxiety was positively associated with parental catastrophizing and solicitousness. While child chronic pain and anxiety did not exert an impact on parental responses, the parents' and child's age emerged as additional modulating factors for parental solicitousness. CONCLUSION: Findings support the assumption that top-down processes, particularly parent anxiety, rather than bottom-up processes, exert an impact on parental responses. Specific interventions to decrease parent anxiety in the context of chronic pain and effects of adult treatment on parental responses to child's pain warrant further investigation. SIGNIFICANCE: This study increases our knowledge on modulating factors on maladaptive parental reactions such as parental pain-related catastrophizing towards their children in pain. According to our findings, it is not the child variables, that is (parental perception of) child chronic pain or anxiety that modulate parental reactions but parent factors, particularly parent anxiety. Thus, parent anxiety should be regularly assessed and addressed during pain treatment of adult populations, and in interventional studies in children with chronic pain and their parents with chronic pain and anxiety symptoms.
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Catastrofización , Dolor Crónico , Adulto , Ansiedad , Niño , Femenino , Humanos , Masculino , Dimensión del Dolor , Relaciones Padres-Hijo , PadresRESUMEN
Little is known about the conscious experience of internal bodily sensations in preschool-aged children. Given that preschoolers are in the most rapid phase of brain development, and display profound emotional development, it was the aim of the present study to establish an adapted interoceptive accuracy paradigm and to investigate associations between sociodemographic (age, sex) and emotional variables with interoceptive accuracy. Forty-nine children (aged 4-6â¯years) completed the jumping jack paradigm (JJP), a heartbeat tracking paradigm, which includes a noninvasive physical perturbation via performing jumping jacks for 10â¯s. An interoceptive accuracy score was based on the comparison between self-reported and objectively recorded heart rate prior to and after completion of jumping jacks. Children also completed validated measures for emotion recognition and emotion regulation. Children's objectively recorded heart rate significantly increased after the JJP by 20â¯bpm on average. There was a positive relationship between reactivity on self-reported heart rate and objectively recorded heart rate increase. The derived scores for interoceptive accuracy increased with age, suggesting older children to report more self-reported heart rate change than objectively recorded, but were unrelated to children's sex or BMI. While emotion recognition and regulation significantly increased with age, the interoceptive accuracy score was unrelated to emotion recognition, but marginally associated to emotion regulation. Children with higher interoceptive accuracy score (i.e., self-reporting more heart rate change than objectively recorded) received lower emotion regulation score. The present study is the first to depict a novel behavioral paradigm to assess interoceptive accuracy in preschool-aged children.
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Regulación Emocional/fisiología , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Interocepción/fisiología , Reconocimiento en Psicología/fisiología , Niño , Preescolar , Femenino , Frecuencia Cardíaca/fisiología , Humanos , MasculinoRESUMEN
INTRODUCTION: Fear of pain seems to be a key factor in the development and maintenance of chronic pain and pain-related disability. Interoceptive fear conditioning is assumed to constitute an important mechanism in the origins and maintenance of fear of pain. If conditioned stimuli such as internal bodily sensations are repeatedly paired with pain (unconditioned stimulus), they in turn elicit a conditioned fear response, including defence mobilization such as startle modulation and changes in heart rate and electrodermal activity. Research into emotional imagery suggests that defensive responses can also be elicited through imagery of fear scripts. OBJECTIVES: We present 2 novel paradigms adapted from research on anxiety disorders, which allow to test, if perceived or imagined sensations locally proximal to the main pain location trigger heightened defence response mobilization in adolescents with chronic headaches and abdominal pain. METHODS: The provocation paradigm includes the anticipation and provocation of locally proximal and locally distal interoceptive sensations through disorder-specific muscle tensing tasks (tightening the neck or the abdominal muscles). The imagery paradigm includes 3 imagery scripts (standard neutral, standard fear, and disorder-specific). Startle probes are presented in both paradigms. Defence response mobilization is assessed using psychophysiological measures (startle response modulation, skin conductance level, and heart rate), as well as self-reported measures of fear. PERSPECTIVE: The paradigms will give insight into the defence response of adolescents with chronic pain, when confronted with or imagining interoceptive sensations. Results may inform the improvement of clinical interventions aimed to decrease fear of bodily sensations such as interoceptive exposure or interoceptive imagery exposure.
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Dolor Crónico , Interocepción , Niño , Dolor Crónico/epidemiología , Humanos , Salud MentalRESUMEN
In individuals with chronic pain harmless bodily sensations can elicit anticipatory fear of pain resulting in maladaptive responses such as taking pain medication. Here, we aim to broaden the perspective taking into account recent evidence that suggests that interoceptive perception is largely a construction of beliefs, which are based on past experience and that are kept in check by the actual state of the body. Taking a Bayesian perspective, we propose that individuals with chronic pain display a heightened prediction of pain [prior probability p(pain)], which results in heightened pain perception [posterior probability p(pain|sensation)] due to an assumed link between pain and a harmless bodily sensation [p(sensation|pain)]. This pain perception emerges because their mind infers pain as the most likely cause for the sensation. When confronted with a mismatch between predicted pain and a (harmless bodily) sensation, individuals with chronic pain try to minimize the mismatch most likely by active inference of pain or alternatively by an attentional shift away from the sensation. The active inference results in activities that produce a stronger sensation that will match with the prediction, allowing subsequent perceptual inference of pain. Here, we depict heightened pain perception in individuals with chronic pain by reformulating and extending the assumptions of the interoceptive predictive coding model from a Bayesian perspective. The review concludes with a research agenda and clinical considerations.
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Terapia Combinada/métodos , Manejo del Dolor , Dolor/complicaciones , Adolescente , Niño , Enfermedad Crónica , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Pacientes Internos , Masculino , Dolor/psicología , Dimensión del Dolor , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVE: Pediatric debilitating chronic pain is a severe health problem, often requiring complex interventions such as intensive interdisciplinary pain treatment (IIPT). Research is lacking regarding the effectiveness of IIPT for children. The objective was to systematically review studies evaluating the effects of IIPT. METHODS: Cochrane, Medline/Ovid, PsycInfo/OVID, PubMed, PubPsych, and Web of Science were searched. Studies were included if (1) treatment was coordinated by ≥3 health professionals, (2) treatment occurred within an inpatient/day hospital setting, (3) patients were <22 years, (4) patients experienced debilitating chronic pain, (5) the study was published in English, and (6) the study had ≥10 participants at posttreatment. The child's pain condition, characteristics of the IIPT, and 5 outcome domains (pain intensity, disability, school functioning, anxiety, depressive symptoms) were extracted at baseline, posttreatment, and follow-up. RESULTS: One randomized controlled trial and 9 nonrandomized treatment studies were identified and a meta-analysis was conducted separately on pain intensity, disability, and depressive symptoms revealing positive treatment effects. At posttreatment, there were large improvements for disability, and small to moderate improvements for pain intensity and depressive symptoms. The positive effects were maintained at short-term follow-up. Findings demonstrated extreme heterogeneity. CONCLUSIONS: Effects in nonrandomized treatment studies cannot be attributed to IIPT alone. Because of substantial heterogeneity in measures for school functioning and anxiety, meta-analyses could not be computed. There is preliminary evidence for positive treatment effects of IIPT, but the small number of studies and their methodological weaknesses suggest a need for more research on IIPTs for children.