Effectiveness of a multimodal inpatient treatment for pediatric chronic pain: a comparison between children and adolescents.

OBJECTIVES: To evaluate short and long-term treatment outcome of children (7-10 years) in comparison to adolescents (11-18 years) with disabling chronic pain following multimodal inpatient pain treatment. PATIENTS AND METHODS: Thirty-three children and 167 adolescents underwent multimodal inpatient pain treatment. Standardized assessment of pain-related variables, disability, coping, and use of analgesics was performed at admission, 3- and 12-month follow-up. RESULTS: Children and adolescents displayed similar pain-characteristics at admission. Adolescents demonstrated significantly higher disability and passive pain coping. Children relied more on others when in pain. All core variables (i.e., pain intensity, pain-related disability, school absence and pain-related coping) decreased significantly in both children and adolescents after 3 months. Both groups maintained this decline 12 months later. More than half of the children and adolescents demonstrated a 50%-reduction in pain intensity after 3 months, and almost 60% after 12 months. Use of analgesics was significantly reduced at 3-month follow-up with no additional changes after 12 months. While age did not exert any impact on results, there were significant gender differences in pain intensity and school absence. Girls demonstrated higher pain intensity and higher school absence 1 year following treatment. CONCLUSIONS: Children display similar pain-characteristics to adolescents when entering inpatient treatment. A multimodal inpatient program appears to stop the the long-term vicious cycle of disability and pain for both children and adolescents. The demonstrated gender differences raise issues for further research and the possibility of additional pain management strategies for girls.

Effectiveness of a 3-week multimodal inpatient pain treatment for adolescents suffering from chronic pain: statistical and clinical significance.

OBJECTIVE: The present study aimed to investigate the effectiveness of a 3-week multimodal inpatient pain program for children and adolescents with chronic pain. METHODS: Effectiveness was investigated for pain-related variables (pain intensity, pain-related disability) and emotional distress in 3 ways: (1) in terms of statistically significant changes; (2) in terms of the clinical significance of these changes by creating post-hoc outcome groups for pain-related variables and emotional distress; and (3) in terms of the clinically significant overall amelioration generalizing the outcome over 3 variables (ie, pain intensity, pain-related disability, and school absence). One hundred sixty-seven adolescents (aged between 11 and 18 y) with various pain disorders (50% with headache) who met inpatient criteria were evaluated at baseline and 3 months posttreatment. RESULTS: Patients demonstrated statistically significant changes in all variables with large to medium effect sizes. Seventy-two percent and 45% of the patients demonstrated clinically significant changes in pain intensity and pain-related disability, respectively. The percentages of patients demonstrating clinically significant change in emotional distress ranged from 13% to 26%. Seventy-seven adolescents demonstrated overall amelioration. DISCUSSION: Results of the study are promising in at least 2 ways: (1) a multimodal inpatient program might stop the negative effects of chronic pain, disability, and emotional distress in children and adolescents, and (2) the exploration of clinical significance testing has demonstrated utility and can be applied to future effectiveness studies in pediatric pain.

Effects on growth and physiological parameters in wheat (Triticum aestivum L.) grown in soil and irrigated with cyanobacterial toxin contaminated water.

The present study investigates the germination and growth of Triticum aestivum exposed to two different microcystins (microcystin-LR [where the two variable places in the toxin molecule are leucine (L) and arginine (R) (MC-LR)] and microcystin-RR) and to cell-free cyanobacterial crude extract containing MC-LR. The concentration of the microcystins was set to 0.5 microg L(-1) and therefore is in the range of concentrations normally detected in the environment. In three experiments, the inhibition of germination, the inhibition of root and shoot development, photosynthesis, and activity of oxidative stress-response enzymes, such as glutathione-S-transferase, glutathione peroxidase, and glutathione reductase, were measured. All plants were placed in pots containing normal garden soil to investigate the effects of soil in the uptake of toxin by Triticum aestivum. The results showed clear effects on the morphology of roots and shoots, which were inhibited in exposures with cyanotoxins and crude extract. The inhibition of photosynthesis and the elevation of antioxidative-response enzymes indicate the generation of reactive oxygen species due to the exposure to the toxins resulting in oxidative stress for the plants.