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1.
J Pain ; : 104528, 2024 Apr 06.
Artículo en Inglés | MEDLINE | ID: mdl-38588760

RESUMEN

Chronic pain is a common burden among children and adolescents associated with impairments in many aspects of life. Higher pain severity increases this burden. Subsequently, it is important to identify factors predicting the course of pain severity, classified by the chronic pain grading (CPG). In a 1-year longitudinal assessment of a general school-age population (N = 2,280), we aimed to identify biopsychosocial factors associated with CPG trajectories. We focused on children and adolescents who reported chronic pain at the start of the year (N = 689). Using longitudinal latent class analysis, we identified 3 classes of CPG trajectories over 1 year: 1) the "pain recovery group" exhibited initially moderate CPG scores that rapidly and consistently declined to a pain-free level, 2) the "continuously moderate pain severity group" displayed initially high CPG levels with a mild decline over time, and 3) the "continuously low pain severity group" had initially moderate CPG levels, which only slightly declined. In comparison to the pain recovery group, the continuously moderate pain severity group presented with heightened levels of anxiety (odds ratio [OR] = 1.12, 95% confidence interval [CI] [1.02, 1.24], P = .023), depression (OR = 1.10, 95% CI [1.01, 1.19], P = .029), and affective pain perception (OR = 1.10, 95% CI [1.02, 1.18], P = .010) and were more likely to be female (OR = 2.14, 95% CI [1.05, 4.35], P = .036). The continuously low pain severity group was predominantly female (OR = 1.65, 95% CI [1.10, 2.49], P = .016) compared to the pain recovery group. In conclusion, girls and individuals with impaired psychological well-being more often exhibit unfavorable trajectories of chronic pain severity. PERSPECTIVE: Pediatric chronic pain patients, particularly females and those exhibiting elevated anxiety or depression scores or heightened affective pain perception warrant special attention in health care. These individuals have a greater risk of an unfavorable trajectory of chronic pain severity and might need more urgent and specialized treatment.

2.
Headache ; 64(3): 306-316, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38440947

RESUMEN

OBJECTIVE: We aimed to examine factors associated with frequent headache remission in schoolchildren aged 10-18 years. BACKGROUND: Frequent headache is a common health problem in adolescence, and some individuals in this population experience remission. Factors preceding headache remission as opposed to ongoing headache, and their development over time, have not been examined extensively. METHODS: Data were derived from a large school sample (N = 2280). Over the course of 1 year, n = 156 adolescents experienced remission from frequent headaches, while n = 125 adolescents continued to have frequent headaches throughout the year. In this longitudinal case-control study, we predicted headache remission using demographic, pain, psychosocial, sleep, and physiological characteristics. Additionally, we sought to explore the development of psychosocial, sleep, and physiological characteristics in relation to remitted versus ongoing headache over the 1-year period. RESULTS: A model containing the variables sex (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.248-0.76, p = 0.003), headache intensity (OR = 0.85, 95% CI = 0.73-0.99, p = 0.035), anxiety score (OR = 0.92, 95% CI = 0.85-1.01, p = 0.071), and depression score (OR = 0.94, 95% CI = 0.89-1.00, p = 0.041) predicted the outcome variable (remitted vs. non-remitted headache), explaining 17% of the variance in group membership. Schoolchildren reporting remitted headache at the end of the year exhibited lower depression (F[1, 557.01] = 45.77, p < 0.001) and anxiety scores (F[1, 557.01] = 21.72, p < 0.001), higher school satisfaction (F[1, 209.46] = 7.15, p = 0.008), and fewer difficulties falling asleep (F[1, 856.52] = 41.21, p < 0.001) or sleeping through the night (F[1, 731.12] = 26.42, p < 0.001) throughout the year compared to those with non-remitted headache. Depression scores declined significantly over the year in the group with remitted headache, whereas these scores remained constant in the group with non-remitted headache. CONCLUSION: Our results suggest a correlation between headache remission and male sex, improved mental health, and reduced pain-related burden. Moreover, there was an observed decline in symptoms of depression during headache remission. Psychotherapy may be a promising treatment strategy for addressing frequent headaches reported by children and adolescents.


Asunto(s)
Depresión , Cefalea , Adolescente , Humanos , Masculino , Niño , Estudios de Casos y Controles , Depresión/epidemiología , Depresión/complicaciones , Cefalea/epidemiología , Cefalea/terapia , Cefalea/diagnóstico , Dolor/epidemiología , Estudios Longitudinales
3.
BMC Palliat Care ; 23(1): 52, 2024 Feb 23.
Artículo en Inglés | MEDLINE | ID: mdl-38395866

RESUMEN

BACKGROUND: Actigraphy offers a promising way to objectively assess pediatric sleep. Aim of the study was investigating the extent to which actigraphy used in children and adolescents with life-limiting conditions is consistent with two other measures of sleep diagnostics. METHODS: In this monocentric prospective study N = 26 children and adolescents with life-limiting conditions treated on a pediatric palliative care unit were assessed. For three consecutive nights they wore an actigraph; the 24-hours sleep protocol documented by nurses and the Sleep Screening for Children and Adolescents with Complex Chronic Conditions (SCAC) answered by parents were analyzed. Patient characteristics and the parameters sleep onset, sleep offset, wake after sleep onset (WASO), number of wake phases, total sleep time (TST) and sleep efficiency (SE) were descriptively examined. Percentage bend correlations evaluated the three measures' concordance. RESULTS: Descriptively, and except for the number of waking episodes, the different measures' estimations were comparable. Significant correlations existed between actigraphy and the sleep protocol for sleep onset (r = 0.83, p = < 0.001) and sleep offset (r = 0.89, p = < 0.001), between actigraphy and SCAC for SE (r = 0.59, p = 0.02). CONCLUSION: Agreement of actigraphy with the focused sleep measures seems to be basically given but to varying degrees depending on the considered parameters.


Asunto(s)
Actigrafía , Cuidadores , Humanos , Adolescente , Niño , Actigrafía/métodos , Estudios Prospectivos , Juicio , Sueño , Padres , Encuestas y Cuestionarios
4.
J Psychoactive Drugs ; : 1-12, 2023 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-37462539

RESUMEN

As clinical studies about subtypes of the cannabis withdrawal syndrome (CWS) are scant, we performed a re-analysis of longitudinal data with German adult cannabis-users seeking inpatient cannabis detoxification-treatment. Sixty-seven cannabis-dependents without active comorbidity were included for growth-mixture-analysis (GMM) of their CWS-severity-trajectories during a scheduled 24-day detox-treatment. As of treatment-day 12, thirty-six (53.7%) of 67 patients were discharged after successful detoxification. This led to artificial imputations for I-GMM. Therefore, we preferred the results of the GMM including raw data-only (R-GMM). By both, I-GMM and R-GMM, we found two classes of CWS severity time-courses. Class one (n = 44, R-GMM) showed a continuously decreasing CWS-severity; class two (n = 23, R-GMM) exhibited a sharp peak (generally between days 2-6 post-cessation). A short inpatient treatment-period and low urinary 11-nor-9-carboxy-Δ9 -tetrahydrocannabinol-level upon admission predicted the peaking trajectory of R-GMM-class-two-CWS. Withdrawal syndrome medication (PRN), comorbidity, cannabis-history data and gender balance were not significantly different between the CWS-classes. Although possibly confounded by PRN-medication, this exploratory study supports the presence of two CWS-variants in adult cannabis-dependents, characterized by a slowly decreasing ("protracted") slope (class one) or a clear crescendo-decrescendo trajectory (class two). The latter was associated with a significantly shorter inpatient detoxification period and lower urinary THC-COOH-levels at admission.

5.
J Pediatr Psychol ; 48(7): 626-635, 2023 07 20.
Artículo en Inglés | MEDLINE | ID: mdl-37164626

RESUMEN

OBJECTIVE: There are limited data on the prevalence and stability of fatigue in pediatrics, particularly among youth with chronic pain. Little is known about longitudinal effects of fatigue on health outcomes such as sleep quality, psychological distress, Health-Related Quality of Life, and chronic pain. METHODS: A community-based sample of N = 1276 students (9-17 years; 52% female; 30.3% with chronic pain) from 3 schools was screened at 2 measurement points 3 months apart. Prevalence and stability of fatigue were examined. Longitudinal analyses regarding fatigue and health outcomes were run using repeated measures correlations. The impact of change in fatigue on pain progression was analyzed using multilevel linear models. RESULTS: In the total community sample, 4.4% reported severe fatigue symptoms. The prevalence of severe fatigue was significantly higher in students with chronic pain (11.4%) compared to those without (1.3%). Fatigue symptoms persisted for several months, worsening of symptoms was more common and improvement less common in children with chronic pain. Sleep, psychological distress, and Health-Related Quality of Life were significantly associated with fatigue across both measurement points (rs = |0.16-0.44|), with no significant differences in the strength of correlations between children with and without chronic pain (ps > .05). There was a significant interaction between change in fatigue and courses of pain intensity and functional impairment. CONCLUSIONS: Fatigue is highly prevalent, particularly in youth with chronic pain. The negative association of fatigue with health outcomes, and its impact on the course of pain, require early identification and treatment of those affected to prevent negative long-term consequences.


Asunto(s)
Dolor Crónico , Trastornos del Sueño-Vigilia , Adolescente , Humanos , Femenino , Niño , Masculino , Dolor Crónico/epidemiología , Calidad de Vida , Depresión/terapia , Estudios Longitudinales , Trastornos del Sueño-Vigilia/epidemiología , Trastornos del Sueño-Vigilia/psicología , Fatiga/epidemiología
6.
J Sleep Res ; 32(4): e13881, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-36929532

RESUMEN

Children and adolescents with complex chronic conditions, including those with life-threatening or life-limiting conditions, are a heterogeneous population. Many individuals exhibit sleep abnormalities that are measurable by proxy questionnaires. No suitable instrument to assess the wide range of different complex chronic conditions is currently available. The aim of the present study was to develop a screening tool-the Sleep Screening for Children and Adolescents with Complex Chronic Conditions-to effectively obtain sleep behaviour information in this population. Following a mixed-method design, potential items for the Sleep Screening for Children and Adolescents with Complex Chronic Conditions questionnaire were defined through literature research and expert meetings. In a pre-test with N = 60 family and professional caregivers, the items' relevance and comprehensibility as well as the instrument's overall design were assessed. For the main test, N = 315 participants were recruited in three tertiary paediatric hospitals. A principal components analysis detected the questionnaire's scales. Item analysis focused on mean values, range, difficulty and discriminatory power. Convergent validation of the Sleep Screening for Children and Adolescents with Complex Chronic Conditions was assessed via correlations between scale items. Most patients had neurological or neuromuscular diseases. Four scales ("Falling and staying asleep", "Sleep-associated respiration and arousal", "Daytime sleepiness" and "Sleep-associated movements") emerged. The item analysis showed satisfactory discriminative power. In the preliminary validation, all scales correlated positively with a child's care level and with various sleep circumstances items. Three scales additionally correlated with the number of complex chronic condition diagnoses. This newly developed questionnaire can provide clinicians with first indications of possible sleep problems in a growing paediatric population.


Asunto(s)
Trastornos del Sueño-Vigilia , Sueño , Niño , Humanos , Adolescente , Enfermedad Crónica , Encuestas y Cuestionarios , Nivel de Alerta , Trastornos del Sueño-Vigilia/diagnóstico , Trastornos del Sueño-Vigilia/epidemiología
7.
Alcohol ; 110: 23-31, 2023 08.
Artículo en Inglés | MEDLINE | ID: mdl-36898640

RESUMEN

BACKGROUND: The relationship between thiamine blood level (TBL) and cognition remains uncertain, including among alcohol-dependent persons (ADP). AIM: To evaluate this relationship during protocol-driven inpatient alcohol detoxification treatment including thiamine supplementation (AD + Th). METHODS: Prospective 3-week study with 100 consecutively admitted detoxification-seeking ADP (47.7 ± 11 years old, 21% females) without superseding comorbidities requiring treatment. TBL and Montreal Cognitive Assessment (MoCA) were measured at admission (t1, pre-AD + Th) and discharge (t3, post-AD + Th). Frontal Assessment Battery (FAB) was performed at t1. AD + Th included abstinence, pharmacological alcohol withdrawal syndrome treatment, and oral thiamine supplementation (200 mg/day for 14 days). Regression and mediation analyses assessed TBL-cognition relationships. RESULTS: We found no cases of Wernicke Encephalopathy (WE) and only one case of thiamine deficiency. Both MoCA and TBL significantly improved across AD + Th (with medium-to-large effect sizes). At t1, TBL significantly predicted MoCA and FAB sum scores (medium effect sizes; extreme and very strong evidence, respectively). The clear TBL-MoCA association disappeared at t3. In multivariate regression and mediation analyses exploring key influential factors of cognition (identified by LASSO regression), the TBL-MoCA interactions did not relevantly change at t1 and t3. Age, serum transaminases, vitamin D levels, drinking-years, and depression score weakly modified the relationship. CONCLUSION: TBL was a robust predictor of pre-detoxification cognitive impairment, and both TBL and cognition improved significantly during AD + Th (including abstinence) in our ADP population, supporting routine thiamine supplementation for ADP, even those at low WE-risk. The TBL-cognition relationship was minimally confounded by age, alcohol-toxicity proxies, mood, and vitamin D levels.


Asunto(s)
Alcoholismo , Síndrome de Abstinencia a Sustancias , Deficiencia de Tiamina , Encefalopatía de Wernicke , Femenino , Adulto , Humanos , Persona de Mediana Edad , Masculino , Tiamina/uso terapéutico , Alcoholismo/tratamiento farmacológico , Proyectos Piloto , Pacientes Internos , Estudios Prospectivos , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Deficiencia de Tiamina/tratamiento farmacológico , Deficiencia de Tiamina/epidemiología , Encefalopatía de Wernicke/tratamiento farmacológico , Cognición , Vitamina D , Suplementos Dietéticos
8.
Int J Methods Psychiatr Res ; 32(4): e1965, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-36920869

RESUMEN

OBJECTIVES: Anxiety and depression are internalizing mental disorders often commencing in childhood and manifesting in adolescence. The Revised Anxiety and Depression Scale (RCADS) is an internationally widely used standardized diagnostic tool, but the German version has only been validated in a pediatric chronic pain sample; normative data are not available. The aim of this study is to test its reliability (internal consistency) and validity (factorial, convergent, known-groups) in a representative German school sample and to provide norm data. METHODS: Data were collected from N = 1562 German schoolchildren (Mage  = 12.2; SDage  = 2.33; range 8-17 years; 52.4% girls). RESULTS: Cronbach's α ranged from 0.73 to 0.96 for the total and the six subscales (five anxiety and one depression). Confirmatory factor analysis showed the 6-factor model had acceptable to good model fit with CFI = 0.93, TLI = 0.93, RMSEA = 0.05, SRMR = 0.05, which was better than 1- and 2-factor models. The (sub)scales correlated moderate to high negatively with health-related quality of life (-0.31 ≤ τ ≤ -0.51; p < 0.001) and positively with functional impairment (0.31 ≤ τ ≤ 0.48; p < 0.001). Mean scores of anxiety and depression scales were significantly higher in girls and partly in adolescents. CONCLUSION: Findings provide support for the good psychometric properties of the German RCADS in a community sample.


Asunto(s)
Depresión , Calidad de Vida , Femenino , Adolescente , Humanos , Niño , Preescolar , Masculino , Depresión/diagnóstico , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Ansiedad/diagnóstico
9.
Fortschr Neurol Psychiatr ; 90(9): 396-405, 2022 Sep.
Artículo en Alemán | MEDLINE | ID: mdl-35405746

RESUMEN

BACKGROUND: The treatment of patients diagnosed with a narcissistic personality disorder (NPS) is considered to be extra challenging. Well-controlled studies on the effectiveness of psychotherapy in NPS patients are not available; so many interventions are based on theoretical constructs. The clarification-oriented psychotherapy (COP) is a psychotherapeutic approach, which emerged from concepts of the cognitive behavioral therapy, client-centered psychotherapy and various process-oriented procedures. The present ambulatory therapy-evaluation of COP aimed to evaluate the effectiveness of a psychotherapeutic treatment for patients suffering from NPS. METHODS AND RESULTS: Retrospective cohort-study including 173 treatment-seeking NPS-patients. Via pre-post per-protocol-analysis, significant improvements mostly with medium effect sizes were found in all relevant parameters after completion of the COP (58.6±10.5 sessions). In particular, the ambitious/narcissistic personality style in the "Personality Style and Disorders Inventory (PSSI)" (primary outcome) was improved (medium effect size: d=-0.49 [-0.67; -0.31], p<0.001). Analyses revealed even high effect sizes in terms of the improvement of depressive "states" and "traits", neuroticism as well as self-acceptance. The lowest effect sizes however were found for improvements in self-regulation (d=0.2 [0.03; 0.36], p=0.02). DISCUSSION: As no intention-to-treat analysis has been carried out, the effect sizes of COP in the treatment of NPS might be overestimated. Nevertheless, our findings support the use of COP for the treatment of NPS. In light of evidence-based medicine, the present so far most comprehensive study on this topic warranted an increase of the evidence of COP in the treatment of NPS from level IV to level III.


Asunto(s)
Trastornos de la Personalidad , Psicoterapia , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Estudios Longitudinales , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/psicología , Trastornos de la Personalidad/terapia , Psicoterapia/métodos , Estudios Retrospectivos
10.
Pain ; 163(12): 2281-2301, 2022 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-35297804

RESUMEN

ABSTRACT: Chronic noncancer pain in children and adolescents can be impairing and results in substantial health care costs. Intensive interdisciplinary pain treatment (IIPT), an inpatient or day hospital treatment delivered by a team of 3 or more health professionals, may be an effective intervention for these children and adolescents. Based on previous reviews and meta-analyses, we updated findings regarding the description of available treatments and estimated the effectiveness of IIPT, overcoming methodological shortcomings of previous work by requesting and analyzing individual participant data. On June 26, 2021, we searched 5 literature databases (PubMed, PsycINFO, Web of Science, Cochrane Library, and PubPsych) for studies examining the effectiveness of IIPT. Included studies used a pre-post design, assessed patients younger than 22 years, and presented their results in English, German, French, or Spanish. We used standard methodological procedures expected by Cochrane to pool treatment effects and assess risk of bias. We identified 13 different treatment sites with similar treatment inclusion criteria and treatment components, but the descriptions of those treatments varied widely. Regarding treatment effectiveness, IIPT may result in large improvements in the mean pain intensity ( g = -1.28), disability ( g = -1.91), and number of missed school days at the 12-month follow-up ( g = -0.99), as well as moderate improvements in anxiety ( g = -0.77) and depression ( g = -0.76). The certainty of the evidence, however, was graded from very low to low. We recommend that future researchers use more scientific rigor to increase the certainty of the evidence for IIPT and standardize treatment outcomes for children and adolescents with chronic pain.


Asunto(s)
Dolor Crónico , Niño , Humanos , Adolescente , Dolor Crónico/terapia , Analgésicos Opioides , Manejo del Dolor/métodos , Ansiedad/terapia , Resultado del Tratamiento
11.
J Pediatr Psychol ; 47(2): 121-131, 2022 02 14.
Artículo en Inglés | MEDLINE | ID: mdl-34414435

RESUMEN

OBJECTIVE: The combination of parental chronic pain and internalizing characteristics are relevant to chronic pain experiences in their children. A promising unified multifactorial intergenerational model of chronic pain was published in 2019; however, this model was only generalizable to children with severe chronic pain and some factors had limitations. This study aimed to determine validity of an adapted multifactorial model, including parent and child chronic pain status, pain characteristics, pain-related functioning, and internalizing symptoms, in a community setting. Subgroup analyses based on presence of chronic pain in parents and children were explored to determine whether effects were stronger in certain subsamples. METHODS: Adolescents (N = 1,450, Mage=12.7 years, 50% female), and their parents (82% mothers), were recruited from five schools to complete online surveys. Structural equation modeling was used to investigate interrelated pain-related experiences between parents and their offspring. RESULTS: The adapted unified multifactorial model had good model fit in the community sample. Significant weak associations were found between all parent and child factors. The strongest associations were found in the subsample of parents and children with chronic pain. In all subgroups, internalizing factors were the most strongly linked intergenerational constructs. CONCLUSIONS: Our results support the validity of the unified multifactorial model of parental factors in pediatric chronic pain, although associations were weaker in the community sample than those previously reported in a clinical sample. In children who develop chronic pain, it is important to consider their parent's chronic pain and internalizing symptoms to best manage intergenerational effects.


Asunto(s)
Dolor Crónico , Adolescente , Niño , Femenino , Humanos , Masculino , Madres , Dimensión del Dolor , Relaciones Padres-Hijo , Padres
12.
Qual Life Res ; 31(4): 1257-1266, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34773573

RESUMEN

PURPOSE: Fatigue is a common symptom in children and adolescents. Its negative impact on health outcomes is even more pronounced in those with chronic pain. There is currently no fatigue measurement tool in German that is validated for both children and adolescents with and without chronic pain. Therefore, this study aimed to gather quantitative validity evidence to support the use of the German version of the PROMIS® Pediatric Short Form v2.0 - Fatigue 10a (PROMIS® F-SF) in the German pediatric general population as well as in German pediatric chronic pain patients. METHODS: The 10-item self-assessment questionnaire was validated in a sample of N = 1348 school children (9-18 years; 52.4% female) and N = 114 pediatric chronic pain patients (8-17 years; 63.3% female). Construct and convergent validity, reliability, and item and scale characteristics were examined. RESULTS: Confirmatory factor analyses showed sufficient model fit for the 1-factor model of the questionnaire (school sample: CFI = 0.94, RMSEA = 0.10, SRMR = 0.04; patient sample: CFI = 0.90, RMSEA = 0.14, SRMR = 0.05). Convergent validity was supported by weak-to-large significant correlations with sleep quality, health-related quality of life (HRQoL), and pain characteristics. The questionnaire had excellent internal consistency in both samples (α = 0.92 and α = 0.93). Sex differences and age distributions of the PROMIS® F-SF showed that girls reported significantly higher fatigue than boys and that fatigue increased with age. CONCLUSION: The PROMIS® F-SF is a reliable instrument with good psychometric properties. Preliminary evidence is provided that the questionnaire validly measures fatigue in children and adolescents with and without chronic pain.


Asunto(s)
Dolor Crónico , Calidad de Vida , Adolescente , Niño , Fatiga , Femenino , Humanos , Masculino , Medición de Resultados Informados por el Paciente , Psicometría , Calidad de Vida/psicología , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
13.
Children (Basel) ; 8(10)2021 Oct 11.
Artículo en Inglés | MEDLINE | ID: mdl-34682170

RESUMEN

Outcome measurement in pediatric palliative care (PPC) is receiving increasing attention. The FACETS-OF-PPC, a multidimensional outcome measure for children with severe neurological impairment, has been developed and partly validated. This study aimed to conclude the validity of the German version of the FACETS-OF-PPC. A multicenter prospective study with two points of measurement has been conducted, employing confirmatory factor analyses, reliability analyses, and analyses to evaluate the tool's sensitivity to change. Overall, 25 inpatient and outpatient teams throughout Germany recruited N = 227 parents of affected children and N = 238 professional caregivers. Participants filled out the FACETS-OF-PPC on the admission of a child to a palliative care service and at discharge from inpatient settings or two months after admission to outpatient services. The analyses revealed the questionnaire needing further adaption. Now, 17 of the original 34 items contribute to the construction of the questionnaire scales. The other items remain part of the questionnaire and may be evaluated descriptively. Furthermore, the FACETS-OF-PPC has moderate to appropriate internal consistency and is sensitive to change. Creating an outcome measure with good psychometric properties for the vulnerable population of children with severe neurological impairment appears extremely difficult. Considering these challenges, the FACETS-OF-PPC demonstrates adequate psychometric properties.

14.
J Adolesc Health ; 69(5): 721-728, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34521577

RESUMEN

PURPOSE: The current longitudinal observational study aimed to explore how chronic pain among schoolchildren changed before and during the COVID-19 pandemic, and how changes in chronic pain were related to changes in psychological wellbeing and COVID-19-related experiences. METHODS: Data were collected from N = 777 German schoolchildren (aged 9-17 years) at two assessments before and one assessment during the COVID-19 pandemic lockdown. Participants self-reported chronic pain experience, anxiety, depression, and quality of life across all assessments; and COVID-19-related experiences at the last assessment. Trajectories of anxiety, depression, and quality of life as well as COVID-19-related experiences were analyzed separately for groups of stable chronic pain trajectories compared to chronic pain trajectories that changed during the pandemic. RESULTS: Chronic pain prevalence was lowest at the assessment during the COVID-19 pandemic (22.8% vs. 29.2% and 29.9% before the pandemic). However, 4.6% experienced new chronic pain onset during the COVID-19 pandemic. This was preceded by heightened depression and anxiety, as well as lowered quality of life scores. These students were also more likely to describe time with their family during the COVID-19 pandemic as tense compared to students who did not develop chronic pain. During the COVID-19 pandemic boys were more likely to recover from ongoing chronic pain than girls. CONCLUSIONS: Overall, during the COVID-19 pandemic the prevalence of chronic pain decreased. However, stressful situations and pre-existing vulnerabilities in psychological wellbeing can facilitate the development of chronic pain during the pandemic.


Asunto(s)
COVID-19 , Dolor Crónico , Ansiedad/epidemiología , Niño , Dolor Crónico/epidemiología , Control de Enfermedades Transmisibles , Depresión/epidemiología , Femenino , Humanos , Masculino , Pandemias , Calidad de Vida , SARS-CoV-2
15.
Eur J Pain ; 25(7): 1612-1621, 2021 08.
Artículo en Inglés | MEDLINE | ID: mdl-33949051

RESUMEN

BACKGROUND: Chronic pain in children is a serious issue, therefore calling for effective prevention/intervention measures. This study aimed to evaluate the efficacy of an educational movie on pain knowledge in school children in general and on pain-related behaviours and pain intensity in those who are affected by chronic pain. Regarding those affected, the association between pain knowledge and intensity, as well as the potential mediating effect of pain-related behaviours, were investigated. METHODS: Recruited from four schools, N = 381 students (51.7% female; Mage  = 11.4, SD = 0.95) participated, of which n = 108 reported chronic pain. Each school was randomly allocated to the intervention or control group (cluster-randomization). At two time points spaced 4-5 weeks apart, students provided information on their pain knowledge, pain-related behaviour (passive pain coping, pain-related disability, missed school days, medication use) and pain intensity. After the first assessment, students in the intervention group watched an educational movie. Multilevel linear models for all outcomes were calculated as well as a mediation analysis. RESULTS: Pain knowledge increased significantly in the intervention group (ß = 2.76 [95% CI 2.20, 3.31]). However, no significant time-by-group interactions were found for pain-related behaviour or pain intensity. The mediation model identified that the indirect effect of pain knowledge on pain intensity was mediated by pain-related behaviour (ß = -0.18, p = 0.014 and ß = 0.38, p < 0.001, respectively). CONCLUSIONS: Educational movies may be an effective tool for educating students about pain management. However, the knowledge gained may not be sufficient to improve pain behaviour and intensity overall. SIGNIFICANCE: A 10-min educational movie on chronic pain management was tested in school children (N = 381). Following the intervention, knowledge of chronic pain concepts was statistically greater in the intervention group compared to the control group not watching the movie. Furthermore, a mediation model theoretically determined whether an association between pain knowledge and pain intensity exists, and whether this is explained by level of dysfunctional pain-related behaviorisms. Full mediation was confirmed.


Asunto(s)
Dolor Crónico , Películas Cinematográficas , Niño , Dolor Crónico/terapia , Escolaridad , Femenino , Humanos , Masculino , Instituciones Académicas , Estudiantes
16.
Sleep Med ; 81: 194-201, 2021 05.
Artículo en Inglés | MEDLINE | ID: mdl-33714849

RESUMEN

OBJECTIVE: Sleep problems are common in children and adolescents with chronic pain. The revised Adolescent Sleep-Wake Scale (rASWS) is an internationally well-established instrument to assess sleep quality in adolescents. So far, no German version is available. The study aimed to provide a validated German version of the rASWS, specifically for use in children and adolescents with chronic pain. METHODS: The translated questionnaire was validated in a sample of N = 159 pediatric outpatients with chronic pain (8-17 years; 65.4% female), who presented to a specialized pediatric pain center. For cross-validation a community sample of N = 1348 school children was analyzed. RESULTS: Confirmatory factor analysis was conducted to examine the factor structure of the original 10-item 3-factor model in the sample of children and adolescents with chronic pain, which showed poor model fit. Model modifications were carried out by deleting 3 items with low factor loadings stepwise. The overall model fit of the final 3-factor model containing 7 items was excellent. Cronbach's α of the derived scales ranged from 0.74 to 0.86. Cross-validation in a community sample of school children confirmed the superiority of the 7-item model. The convergent validity of the measure was proved by moderate correlations between the rASWS and self-reported sleep problems. Associations with chronic pain characteristics were evident for pain-related disability. CONCLUSIONS: The use of the 7-item version of the rASWS for German-speaking children and adolescents with and without chronic pain is recommended as a self-report measure of sleep quality.


Asunto(s)
Instituciones Académicas , Sueño , Adolescente , Niño , Análisis Factorial , Femenino , Humanos , Masculino , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
17.
Eur J Pain ; 25(6): 1329-1341, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33619774

RESUMEN

BACKGROUND: Findings on the short- and long-term effectiveness of intensive interdisciplinary pain treatment (IIPT) for children with severe chronic functional pain are promising. However, a definitive appraisal of long-term effectiveness cannot be made due to a lack of comparison groups. The aim of the present study was to compare the health status of former patients with the health status of an age- and sex-matched comparison group from the community. METHODS: Data from two samples, a clinical sample of former patients (n = 162; aged 14 to 26) and an age- and sex-matched community sample (n = 162), were analysed. Former patients provided data 7 years after IIPT. Pain characteristics, physical and mental health status, autonomy, coping and health care utilisation were compared between the two samples. RESULTS: Seven years after treatment, the majority (58%) of the clinical sample were completely pain-free. Compared to the community sample, the clinical sample demonstrated worse physical and mental health and continued to seek more frequent health care, irrespective of whether or not they experienced ongoing chronic pain. However, the clinical sample reported better coping strategies and a comparable level of autonomy. CONCLUSION: Patients experiencing severe chronic pain in childhood who engage in IIPT are likely to have recovered from their pain in early adulthood. Long-term treatment effects may manifest in better coping strategies. However, reduced mental and physical health status may indicate a negative long-term effect of early chronic pain experiences or a general vulnerability in people developing a chronic pain condition in childhood. SIGNIFICANCE: The majority of severely impaired paediatric chronic pain patients no longer suffer from chronic pain seven years after intensive interdisciplinary pain treatment. However, former patients have worse physical and mental health status than a community sample, and continue to seek out more frequent health care utilisation, irrespective of whether or not they continue to experience chronic pain. Therefore, potential negative long-term effects of childhood chronic pain experiences need specific attention early on.


Asunto(s)
Dolor Crónico , Adaptación Psicológica , Adulto , Niño , Dolor Crónico/epidemiología , Dolor Crónico/terapia , Humanos , Salud Mental , Manejo del Dolor , Dimensión del Dolor
18.
Palliat Med ; 35(3): 611-620, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33339481

RESUMEN

BACKGROUND: Comprehensive outcome measurement in pediatric palliative care focusing on the entire unit of care, that is, the affected child and its family, is crucial to depict treatment effects. Despite its increasing relevance, no appropriate multidimensional outcome measures exist for the largest patient group in this field, namely children with severe neurological impairments. AIM: The aim of this study was to develop and validate a family-centered multidimensional outcome measure for pediatric palliative care patients with severe neurological impairment that encompasses the entire unit of care. DESIGN: Based on results of a qualitative study, the questionnaire was developed by consensus-based generation of questions. It was validated in a multicenter prospective study employing exploratory and confirmatory factor analyses as well as reliability and item analyses. SETTING: A total of 11 pediatric palliative care teams across Germany aided in the recruitment of study participants. Questionnaires were answered by 149 parents of children with severe neurological impairment and 157 professional caregivers. RESULTS: The exploratory factor analysis of parent data revealed a 6-factor structure of the questionnaire representing: symptoms, the child's social participation, normalcy, social support, coping with the disease and caregiver's competencies. This structure was verified by a confirmatory factor analysis of professional caregiver data. Five separate items regarding siblings, partners, and further symptoms not applicable for all patients were added to ensure full multidimensionality. CONCLUSION: A validated outcome tool for severely neurologically impaired pediatric palliative care patients, the FACETS-OF-PPC, now exists. Due to its concise length and appropriate psychometric properties, it is well suited for clinical application.


Asunto(s)
Evaluación de Resultado en la Atención de Salud , Cuidados Paliativos , Niño , Alemania , Humanos , Estudios Prospectivos , Psicometría , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
19.
Front Psychiatry ; 11: 598150, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33343424

RESUMEN

Background: For cannabis-dependent subjects, the relationship between cannabis withdrawal syndrome (CWS) severity and the urine cannabinoid concentrations are unclear; we investigated this using a commercial point-of-care (POC) enzyme immunoassay detecting 11-nor-9-carboxy-Delta-9-tetrahydrocannabinol (THC-COOH). Methods: Observational study of 78 adult chronic cannabis-dependent subjects assessed over a 24-day inpatient detoxification treatment, with 13 serial measurement days. Repeated Measures Correlation and Multilevel Linear Models were employed. Results: Absolute urinary THC-COOH levels significantly correlated with Marijuana Withdrawal Checklist (MWC) scores across the entire study duration (r = 0.248; p < 0.001). Correlation between serial creatinine-adjusted THC-COOH ratios and serial MWC scores emerged as significant only in the sample with higher MWC scores (>11 points) at admission (n = 21; r = 0.247; p = 0.002). The aforementioned significant relationships have persisted when replacing the absolute THC-COOH-levels with the (relative) day-to-day change in urinary THC-COOH levels. MWC scores were significantly correlated with the Clinical Global Impression-Severity (CGI-S; r = 0.812; p < 0.001). Females showed a significantly slower decline in urine THC-COOH levels and prolonged CWS course characterized by substantial illness severity (per CGI-S), occurring in nearly 30% of cases. Conclusion: Urine cannabinoid levels (THC-COOH) determined by POC assay significantly predicted CWS severity (moderate correlation), guiding detoxification treatment duration. In patients with MWC > 11 points upon admission, creatinine-adjusted THC-COOH ratios also significantly predicted CWS severity-again with moderate effect size. Females showed prolonged urinary THC-COOH elimination and cannabis withdrawal.

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