Pain and Post-traumatic Stress Disorder Symptoms: Dyadic Relationships Between Canadian Armed Forces Members/Veterans with Chronic Pain and their Offspring.

Chronic pain and mental health issues occur at higher rates in Veterans than the general population. One widely recognized mental health issue faced by Veterans is post-traumatic stress disorder (PTSD). Trauma symptoms and pain frequently co-occur and are mutually maintained due to shared mechanisms. Many Veterans are also parents. Parental physical and mental health issues significantly predict children's chronic pain and related functioning, which can continue into adulthood. Only one US-based study has examined pain in the offspring of Veterans, suggesting heightened risk for pain. Research to date has not examined the associations between trauma and pain, and the dyadic influences of these symptoms, among Veterans and their children. The current study aimed to describe pain characteristics in Canadian Armed Forces (CAF) Members/Veterans with chronic pain and their offspring (youth and adult children aged 9-38). Cross-lagged Panel Models (CLPM) were conducted to examine dyadic relationships between pain interference and trauma symptoms of CAF Members/Veterans and their offspring. Over half of adult offspring and over one quarter of youth offspring reported chronic pain. Results revealed effects between one's own symptoms of PTSD and pain interference. No significant effects of parents on offspring or offspring on parents were found. The findings highlight the interconnection between pain and PTSD consistent with mutual maintenance models, and a lack of significant interpersonal findings suggestive of resiliency in this unique population. PERSPECTIVE: We characterized chronic pain in offspring of Canadian Armed Forces Members/Veterans with chronic pain and examined dyadic relationships between PTSD symptoms and chronic pain interference. Findings revealed that PTSD symptoms and pain interference were related within Veterans and offspring, but no dyadic relationships were found, which could reflect resiliency.

The Silhouettes Fatigue Scale: further validation in Spanish-speaking university students and adults with chronic pain.

PURPOSE: The aim of this study was to evaluate the psychometric properties of the Silhouettes Fatigue Scale (SFS) when used to assess fatigue in undergraduates and middle-aged adults with chronic pain. MATERIALS AND METHODS: A total of 426 undergraduates and 207 middle-aged individuals with chronic pain participated in this study. Participants were asked to respond to a survey including the SFS as well as another validated measure of fatigue, questionnaires about pain catastrophizing and pain interference, and questions about pain (i.e., location, duration, and intensity). Convergent, discriminant, criterion and known-groups validity were evaluated. RESULTS: Convergent validity was supported by a strong association between the two scales measuring fatigue. Discriminant validity was supported by stronger associations between the two fatigue scales scores compared to those between the SFS and pain catastrophizing scores. Criterion validity was supported by moderate associations between the SFS and measures of pain intensity and pain interference. Finally, known-groups validity was supported by significant differences in the SFS scores between students without chronic pain, students with chronic pain, and middle-aged individuals with chronic pain. CONCLUSIONS: The findings support the validity of the SFS scores when used to assess fatigue in undergraduates and middle-aged adults with chronic pain.

Fatigue is a significant problem among people with chronic pain that can lead to disability.Assessing and treating fatigue in people with pain is essential.The Silhouettes Fatigue Scale (SFS) is a new single-item self-report of fatigue, fast and easy to use.Results support convergent and discriminant validity as well as sensibility to detect differences in fatigue between groups.

Immigration background as a risk factor of chronic pain and high-impact chronic pain in children and adolescents living in Spain: differences as a function of age.

ABSTRACT: The number of people immigrating from one country to another is increasing worldwide. Research has shown that immigration background is associated with chronic pain and pain disability in adults. However, research in this issue in children and adolescents has yielded inconsistent results. The aims of this study were to examine (1) the association between immigration background and chronic pain in children and adolescents; (2) the association between immigration background and pain interference in children and adolescents with chronic pain; and (3) the extent these associations differed as a function of sex and age. Participants of this cross-sectional study were 1115 school children and adolescents (mean age = 11.67 years; 56% girls). Participants were asked to provide sociodemographic information and respond to a survey including measures of pain (location, extension, frequency, intensity, and interference). Results showed that having an immigration background was associated with a greater prevalence of chronic pain (odds ratio [OR] = 1.91, P < 0.001) and that this association was higher in children (OR = 6.92, P < 0.001) and younger adolescents (OR = 1.66, P < 0.05) than in older adolescents. No significant association between immigration background and pain interference was identified. Children and adolescents with an immigration background, especially younger children, are at higher risk for having chronic pain. More resources should be allocated in the prevention of chronic pain in children and adolescents with an immigration background.

Increases in Sleep Difficulties and Psychological Symptoms are Associated With the Increase of Chronic Back Pain in Adolescents: The HBSC Study 2002 to 2018.

Cross-national research using data from the Health Behavior in School-aged Children (HBSC) survey showed an increase in the prevalence of chronic back pain from 2002 to 2014. However, it is unknown if this trend has persisted beyond 2014. The aims of this study were to 1) determine if the prevalence of chronic back pain in girls and boys aged 11, 13, and 15 continued to increase from 2014 to 2018 and if this was the case, 2) examine whether this increase in the prevalence of chronic back pain between 2002 and 2018 was explained indirectly by increases in sleep difficulties and psychological symptoms. Data from 7,89,596 adolescents retrieved from 5 waves of the HBSC survey conducted in 2002, 2006, 2010, 2014, and 2018 in 32 countries/regions were used. Logistic regressions and path analyses were conducted. Results showed an overall increase of .5% in the prevalence of chronic back pain between 2014 and 2018, ranging from .4% for 15-year-old girls to 1.3% for 11-year-old boys, indicating a continued overall increase in chronic back pain in adolescents beyond 2014. For 13-year-old girls and for 15-year-old girls and boys, the increase in the prevalence of chronic back pain between 2002 and 2018 was partially mediated by increases in sleep difficulties, which in turn were associated with increases in psychological symptoms. The findings provide important information that may aid stakeholders in enhancing public health initiatives to prevent or reduce the increasing trend in the prevalence of chronic back pain in adolescents. PERSPECTIVE: This study shows that chronic back pain prevalence continues to increase among adolescents, with sleep difficulties and psychological symptoms contributing significantly to this trend. The findings provide insights that may inform strategies to prevent or reduce the increasing trend of chronic back pain in adolescents.

School bullying and peer relationships in children with chronic pain.

ABSTRACT: Preliminary evidence suggests that there are significant associations between bullying and chronic pain, as well as between the quality of peer relationships and psychological function in youth with chronic pain. However, these findings have yet to be replicated, and the role that bullying plays in anxiety in children and adolescents with chronic pain has not yet been examined. This study sought to expand our understanding of the associations between measures of bullying and quality of peer relationships and pain-related function domains in a community sample of schoolchildren with chronic pain. One thousand one hundred fifteen schoolchildren participated in this study; 57% were girls, the mean age of the study sample was 11.67 years (SD = 2.47), and 46% reported having chronic pain. Participants completed measures of pain characteristics, pain interference, anxiety, and depressive symptoms, bullying (past and current), and quality of peer relationships. Youth with chronic pain reported a significantly higher percentage of being bullied in the past compared with youth without chronic pain. In the group of youth with chronic pain, the measures of past and current bullying, and quality of peer relationships, were not significantly associated with pain intensity, pain interference, or anxiety. However, having a history of being bullied and the quality of peer relationships were significantly associated with depressive symptom severity. The findings indicate that research to evaluate the potential causal role of bullying and the quality of peer relationships on pain-related function domains in youth with chronic pain is warranted.

Adverse Childhood Events and Chronic Pain in Adolescents: The Role of Sleep Disturbance.

OBJECTIVES: This study aimed to (1) examine the extent to which the association between exposure to adverse childhood events (ACEs) and having chronic pain in adolescents is explained by the association between exposure to ACEs and sleep disturbance and (2) explore the role of sleep disturbance in the association between exposure to ACEs and anxiety and depressive symptoms in adolescents with chronic pain. METHODS: Cross-sectional data from 469 adolescents aged 13-18 years old were drawn from an epidemiological study on pediatric chronic pain conducted in Catalonia (Spain). Participants provided self-reports of demographic characteristics, exposure to ACEs, pain characteristics, sleep disturbance, anxiety, and depressive symptoms. Mediation and moderation models were conducted. RESULTS: Sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and the presence of chronic pain. Moreover, sleep disturbance explained a significant amount of the variance in the association between exposure to ACEs and depressive symptoms and moderated the association between exposure to ACEs and anxiety in adolescents with chronic pain. CONCLUSION: The study findings suggest the possibility that addressing sleep disturbance in adolescents exposed to ACEs may help to prevent the development of chronic pain, anxiety, and depressive symptoms in those adolescents who already have chronic pain.

Validation of the pediatric version of the Graded Chronic Pain Scale Revised in school-aged children and adolescents.

ABSTRACT: The Graded Chronic Pain Scale (GCPS) was originally developed to grade the severity of chronic pain conditions in adults. A revised version of this instrument (ie, GCPS-R) has been developed for use with adults to account for advances in pain metrics and new operational definitions of chronic pain and high-impact chronic pain. The purpose of the current study was to adapt the GCPS-R for use with pediatric samples (P-GCPS-R) and evaluate the adapted measure's concurrent validity. One thousand five hundred sixty-four school-aged children and adolescents (55% girls; 8-18 years) completed the P-GCPS-R and provided responses to measures of physical health, anxiety and depressive symptoms, maladaptive pain coping strategies, and activity limitations. Results showed that 14% of participants had chronic pain, of which 37% (5% of the whole sample) had mild chronic pain, 45% (6% of the whole sample) bothersome chronic pain, and 18% (3% of the whole sample) high-impact chronic pain. Participants without chronic pain and those with mild chronic pain showed no significant between-group differences in any of the study measures. Participants with bothersome chronic pain and high-impact chronic pain reported worse physical health, more anxiety and depressive symptoms, pain catastrophizing, and activity limitations than those with mild chronic pain. Participants with high-impact chronic pain reported more activity limitations than those with bothersome chronic pain. The findings support the concurrent validity of the P-GCPS-R for use with pediatric samples.

Psychological factors and pain medication use in adolescents with chronic pain.

OBJECTIVE: The purpose of this study was to examine (1) the associations of anxiety, depressive symptoms, and pain catastrophizing with pain medication use in adolescents with chronic pain and (2) the extent to which these associations differed as a function of adolescents' sex. METHODS: Cross-sectional data from 320 adolescents 12-18 years of age with chronic pain were drawn from an epidemiological study on pediatric chronic pain conducted in Reus (Catalonia, Spain). Participants were asked to provide sociodemographic information and respond to measures assessing pain (location, frequency, intensity, and interference), pain medication use, anxiety, depressive symptoms, and pain catastrophizing. Point biserial correlations were conducted to examine univariate associations between the psychological variables and pain medication use. Hierarchical logistic regression analysis was used to examine these associations while controlling for demographic characteristics, pain intensity, and pain interference. RESULTS: Anxiety, depressive symptoms, and pain catastrophizing were significantly associated with pain medication use in univariate analyses. Regression analysis identified pain catastrophizing as a unique independent predictor of pain medication use after controlling for the effect of demographic variables (sex and age), pain intensity, and pain interference (odds ratio = 1.1, P < .05). No moderating effect of adolescents' sex on the associations between psychological factors and pain medication use was found. CONCLUSIONS: Adolescents with chronic pain with higher levels of pain catastrophizing use pain medications more often. Research to examine the impact of interventions targeting pain catastrophizing on pain medication use among adolescents with chronic pain would be an important next step.

The Use of Rumination and Reappraisal in Adolescents Daily Life: Links to Affect and Emotion Regulation Style.

This study explored the association between temperament-i.e., positive affect (PA) and negative affect (NA)-and emotion regulation (ER), and what momentary factors influence the selection of rumination or reappraisal during adolescents' daily life. The type of social situation in which negative events occurred, the self-rated degrees of discomfort, the types of predominant emotions experienced, and the use of reappraisal and rumination were assessed at 24 different times with an ecological momentary assessment approach given to 71 adolescents. PA, NA, and ER style were evaluated using self-reports. Bivariate Pearson correlations analysis revealed that NA and negative ER style correlated positively with the rumination use whereas PA correlated negatively with the rumination use. Negative ER style moderated the relationship between NA and the frequency with which rumination was used. The moderated function of positive ER style could not be tested due to its lack of association with the rumination use. Adolescents selected rumination more often during family-related events and when experiencing depression-like emotions. No interaction effects were shown between negative ER style and the momentary factors related with the type of social situation and the type of prevailing emotion during negative event. No associations between study variables and reappraisal were found. This study provides a better understanding of ER patterns in adolescence.

Chronic Pain and High Impact Chronic Pain in Children and Adolescents: A Cross-Sectional Study.

The aims of this study were to: 1) estimate the prevalence of chronic pain (CP) and high impact chronic pain (HICP) in a community sample of children and adolescents; and 2) compare groups (those without CP, those with CP but no HICP, and those with HICP) with respect to demographic variables, pain variables, and physical, psychological, and school-related function. One thousand one hundred and fifteen children and adolescents participated (56% girls; age: ߂ = 11.67; SD = 2.47; range = 8-18 years). The prevalence of CP and HICP was 46% and 5%, respectively, and was higher in girls and increased with age. Participants with HICP reported greater pain intensity and higher pain frequency than those with CP but no HICP. In addition, participants with HICP reported lower mobility, greater fatigue, worst sleep quality, more anxiety and depression symptoms, worst cognitive function, missing more school days, and worse perceived school performance. HICP is a prevalent condition in children and adolescents and is associated with many negative consequences. Stakeholders must be aware of this and ensure that treatment programs are available to reduce the individual and societal impact of HICP in young individuals. PERSPECTIVE: This article provides information on CP and HICP prevalence and impact in children and adolescents. By better understanding the nature and score of these conditions, we will be able to develop more effective early interventions to help this population and thereby reduce their long-term negative impact.

The explanatory role of sedentary screen time and obesity in the increase of chronic back pain amongst European adolescents: The HBSC study 2002-2014.

BACKGROUND: Previous research has shown that chronic back pain amongst European adolescents is increasing. Determining the factors associated with this increasing trend is crucial for developing prevention strategies. In this study, we used data from the Health Behaviour in School-aged Children (HBSC) survey to examine whether increases in screen time and/or obesity between 2002 and 2014 were associated with the increase in the prevalence of chronic back pain amongst European adolescents during the 12-year period. METHODS: Data from 423,092 adolescents from 27 European countries/regions were drawn from the HBSC questionnaire-based surveys conducted in 2002, 2006, 2010 and 2014. The Karlson-Holm-Breen method was used to examine the explanatory role of increases in screen time and obesity on the increase in the prevalence of chronic back pain whilst controlling for sex and age. RESULTS: Increases in both screen time and obesity between 2002 and 2014 were associated with increases in the prevalence of chronic back pain (p < 0.001). The percent of chronic back pain prevalence increase accounted for by screen time and obesity was 3.98% and 1.65%, respectively. CONCLUSIONS: The increase in the prevalence of chronic back pain amongst European adolescents may be explained, in part, by the rising trends in both sedentary screen time and obesity. The fact that screen time and obesity only accounted for a small part of the increase in the prevalence of chronic back pain indicates that other unmeasured factors also play a role. SIGNIFICANCE: More screen time and obesity are slightly associated with more chronic back pain (CBP) prevalence in adolescents across the WHO European Region. The findings may be used to identify ways to prevent or reduce the rising trend of CBP in adolescents.

Diminished complexity of heart rate time series in adolescents facing negative events during everyday life / Complejidad reducida de las series temporales de frecuencia cardíaca en adolescentes afrontando eventos negativos diarios

Physiological systems need to be flexible in order to adapt to a changing environment. Negative events, however, induce flexibility reductions thatseem necessary for coping purposes. To date, studies have measured linear variability and entropy in heart output, but none have examined thescaling properties of the cardiac system when individuals deal with stressful everyday events. This study was aimed at testing the hypothesis thatthe complexity of the cardiac dynamics is diminished when individuals face negative events in real life. Cardiac variability (linear) and complexity(nonlinear), as well as discomfort and effectiveness of event-related emotion regulation (EER) were ecologically examined in N = 65 adolescents(Mage = 14.80 years; SDage = 0.86; 55.38% girls). Repeated Measures MANOVAs revealed higher heart rate (HR) and lower cardiac complexity(higher long-term scaling exponent, p = .029; lower Fractal Dimension FD, p = .030; and lower Sample Entropy, p = .001) during EER in comparisonwith non-emotion regulation conditions (NER). Wilcoxon non-parametric tests revealed higher Hurst exponents (p = .006) in EER than in NER. Nosignificant correlations were found between discomfort and cardiac variables although the higher the cardiac entropy in NER conditions, the greaterthe self-rated effectiveness of EER (p < .050). EER processes involved increases in HR as well as scaling and FD changes that might reflect thereal-time scale’s predominance in HR output when adolescents are dealing with negative events.(AU)

Los sistemas fisiológicos necesitan ser flexibles para adaptarse a un entorno cambiante. Sin embargo, los eventos negativos disminuyen dicha flexibilidad que parecenecesaria para lograr un afrontamiento exitoso. Hasta entonces, los estudios han medido la variabilidad lineal y la entropía de la frecuencia cardíaca(FC), pero ninguno ha examinado las propiedades de escala del sistema cardíaco cuando se afrontan acontecimientos estresantes diarios. Esteestudio investigó si la complejidad cardíaca disminuye cuando los individuos se enfrentan a eventos negativos cotidianos. La variabilidad cardíaca(lineal) y la complejidad (no lineal), así como el malestar y la eficacia de los episodios de regulación emocional (EER) se examinaron ecológica-mente en N = 65 adolescentes (Medad = 14,80; DEedad = 0,86; 55,38% chicas). Los MANOVA de medidas repetidas revelaron una mayor FC y unamenor complejidad cardíaca (mayor exponente de escala a largo plazo, p = .029; menor dimensión fractal DF, p = .030; y menor entropía muestral,p = .001) durante los EER en comparación con las condiciones de no regulación emocional (NER). Las pruebas de Wilcoxon revelaron mayoresexponentes de Hurst (p = .006) en EER que en NER. No hubo correlaciones significativas entre el malestar y las variables cardíacas, pero a mayorentropía cardíaca en NER, mayor eficacia autocalificada en EER (p < .050). Los EER implicaron aumentos en la FC, así como cambios en la escalay en la DF que podrían reflejar el predominio de la escala en tiempo real del sistema cardíaco cuando los adolescentes afrontan eventos negativos.(AU)

Decrements in Adolescent Cardiac Complexity During Mother-Adolescent Conflicts.

The present study aimed to provide further evidence on the usefulness of non-linear cardiac measures when examining the output of the cardiac system. Scale-invariant self-similarity and entropy, in addition to heart rate variability (HRV) given by time- and frequency-domain measures were calculated in a sample of N = 55 healthy adolescents (Mage = 14.122, SDage = 0.698) during 10-min positive (non-stressful) and negative (stressful) interactions with their mothers. We also explored sex influence in adolescents' cardiac output using both HRV measures and non-linear cardiac measures. Repeated measures MANOVA revealed a marginal within-group effect for HRV measures, F(3,51) = 2.438, p = 0.075, η2p = 0.125), and a significant within-group effect for non-linear cardiac measures, F(6, 48) = 3.296, p = 0.009, η2p = 0.292, showing a significant decrement in adolescents' cardiac complexity during the negative interaction. No significant effect for sex was found in either non-linear cardiac measures or HRV measures, but results suggest lower cardiac scaling in females than in males. These findings suggest a real-time scale predominance in heart rate output when adolescents face an aversive situation and support the importance of non-linear cardiac measures to gain insight into the cardiac system and its regulatory mechanisms. Further research is needed to examine sex-differences in cardiac complexity during aversive situations.

Adolescents' Positive Cognitive Emotion Regulation Predicts Heart Trajectories During a Mother-Adolescent Conflict Interaction.

This paper aimed to (a) validate a novel technique that quantifies the length of the trajectories the cardiac system follows within a two-dimensional state-space, and (b) test its usefulness to better understand how cognitive emotion regulation (CER) style is associated with cardiac output. A positive CER style was assessed in a sample of healthy adolescents (n = 57), and mean and total distances, in addition to heart rate variability (HRV) measures and cardiac entropy (SampEn), were calculated during a conflict discussion with the adolescents' mothers. Associations between distances and HRV measures in time and frequency-domains and SampEn were examined to better understand the physiological meaning of distances; further, whether a positive CER style would predict distances, HRV, and SampEn. Correlation analysis revealed that associations of distances with time-domain HRV measures were stronger than associations with frequency-domain HRV measures, while correlations between distances and SampEn were moderate. Hierarchical multiple regression analysis revealed that a positive CER style predicted distances and SampEn, but not HRV measures. Distances are clearly time-domain measures of HRV, but only partly capture the complexity of the heart signal. The results highlight the importance of assessing heart rate dynamics beyond HRV in the study of CER.

Emotion Regulation Style and Daily Rumination: Potential Mediators between Affect and Both Depression and Anxiety during Adolescence.

Adolescence is a vulnerable period for depressive and anxious symptom development, and emotion regulation (ER) may be one mechanism linking temperament-i.e., positive affect (PA) and negative affect (NA)-with such symptomatology. Rumination is a common ER strategy that is traditionally assessed using self-reported questionnaires, but it would also be interesting to examine it with an Ecological Momentary Assessment (EMA) approach. Sixty-five adolescents (Mage = 14.69; SDage = 0.82; range = 14-17 years old; 53.80% girls) completed self-report measures of temperament, ER style, depression and anxiety, and underwent an EMA to investigate rumination use. Results revealed that negative ER style and rumination use mediated the relationship between NA and depression, while only rumination use mediated the relationship between PA and depression. Moreover, NA contributed to increase anxiety, but negative ER style did not significantly mediate this relationship. Rumination use also had no effect on anxiety. This study provides further support for the relationship between temperament, ER, and internalizing problems. It seems that both a negative ER style and rumination use mediate the relationship between NA and depression whereas only NA had a significant direct effect on anxiety. Furthermore, PA buffered the effect of rumination use on depression in this study.

Adolescents at risk of anxiety in interaction with their fathers: Studying non-verbal and physiological synchrony.

Adolescence is a vulnerable period in terms of the onset of anxiety disorders, and dyadic parent-adolescent interactions may play a key role in either increasing or reducing the risk of psychopathologies. This study examines the presence of physiological synchrony (specifically, linkage in interbeat interval series) and non-verbal synchrony in positive and negative interactions between adolescents (aged 13-16) and their fathers. Non-verbal synchrony was quantified through the coordination of the interactants' body movements, using an automated video-analysis algorithm (motion energy analysis). Participants were made up of 53 parent-adolescent dyads, the latter at either low (n = 28) or high (n = 25) risk of anxiety. Adolescents at low risk of anxiety displayed statistically significant levels of non-verbal synchrony with their fathers during positive interactions. Non-verbal synchrony was not found in the father-adolescent dyads featuring adolescents at high risk of anxiety. Physiological synchrony was not significantly present above chance level in either of the groups of adolescents. Overall, the results suggest that adolescents at high risk of anxiety may have difficulties in managing non-distressing interactions with their fathers. The results also suggest that physiological synchrony is not a straightforward phenomenon.