[Complementary procedures for chronic pain disorders in childhood and adolescence]. / Komplementäre Verfahren bei chronischen Schmerzerkrankungen im Kindes- und Jugendalter.

Pain that persists or recurs over a period of at least 3 months in childhood and adolescence is referred to as chronic pain. The primary localization of pain changes according to age: abdominal pain is more common at a younger age, headache is more common in adolescents and later back pain as well as muscle and joint pain. In the multimodal and interdisciplinary treatment of chronic pain, complementary procedures can expand the treatment spectrum. This article provides an overview of the existing evidence that for childhood and adolescence can at best be evaluated as readily understandable. In addition, the experiences of two children's hospitals show that complementary medicine can be used as a low-threshold and easily implemented therapy.

[Medical pain care for children and adolescents with chronic pain in Germany : An inventory]. / Schmerzmedizinische Versorgung chronisch schmerzkranker Kinder und Jugendlicher in Deutschland : Eine Bestandsaufnahme.

Chronic pain in children and adolescents is increasing in prevalence, affects the quality of life, predisposes to pain in adulthood and causes numerous contacts to the healthcare system. In contrast, the number of therapeutic offers tailored to the special needs of this age group is insufficient and confusing. The working group on pain in children and adolescents of the German Pain Society therefore documented appropriate facilities in a questionnaire survey carried out using a snowball system. The response rate of 27/109 questionnaires was low. Thus, the results may not be entirely representative. Nevertheless, the heterogeneity of the offers and in total an undersupply became very clear. In order to improve the care situation, joint efforts by the various pediatric subdisciplines dealing with pain, an increase in the number of child pain treatment centers and a better networking are necessary.

Pediatric chronic pain grading-a revised classification of the severity of pediatric chronic pain.

ABSTRACT: In this study, we describe the development and validation of a revised Pediatric Chronic Pain Grading (P-CPG) for children aged 8 to 17 years that adds emotional impairment to previously used measures of pain intensity and functional impairment. Such a measure enables the assessment of chronic pain severity in different epidemiological and clinical populations, the stratification of treatment according to pain severity, and the monitoring of treatment outcome. The P-CPG was developed using a representative sample of school children with chronic pain (n = 454; Mage = 12.95, SD = 2.22). Construct validity and sensitivity to change were examined within a sample of N = 2448 children and adolescents (Mage = 12.71, SD = 2.47) comprising 3 subsamples (school n = 1562, primary care n = 129, and tertiary care n = 757) affected by chronic pain to varying extents. Results showed that P-CPG grades differed significantly among the 3 subsamples, with school children being least affected by chronic pain and tertiary care patients being most affected. As P-CPG grade increased, so did pain intensity, functional impairment, pain-related school absence, and emotional impairment. Convergent validity was demonstrated by significant positive correlations between the P-CPG and global ratings of pain severity as well as objective claims data; the latter reflects greater health care costs with increasing P-CPG scores. Sensitivity to change was supported by a significant reduction in baseline P-CPG grades 3 and 6 months after intensive interdisciplinary pain treatment in tertiary care sample. In conclusion, the P-CPG is an appropriate measure of pain severity in children and adolescents with chronic pain in clinical as well as epidemiological settings.

Etiology, Risk Factors, and Diagnosis of Back Pain in Children and Adolescents: Evidence- and Consensus-Based Interdisciplinary Recommendations.

Using a structured approach and expert consensus, we developed an evidence-based guideline on the diagnosis of back pain and the treatment of non-specific back pain in children and adolescents. The first part comprises etiology, risk factors, and diagnosis. The second part, published in the same issue, includes treatment and prevention. A comprehensive and systematic literature search was conducted to identify relevant guidelines and studies. Based on the findings of this literature search, recommendations on risk factors and diagnosis were formulated and voted on by experts in a structured consensus-building process. Notable red flags for specific back pain and evidence-based risk factors for non-specific back pain in children and adolescents were identified. Only three evidence-based recommendations could be formulated for causes, red flags, and risk factors for back pain, while two recommendations are based on expert consensus. Regarding diagnostics, eight expert consensus recommendations and one evidence-based recommendation could be provided. Despite the importance of adequate diagnosis for the treatment of back pain in children and adolescents, results of this work confirm the deficit in research investment in this area.

Treatment of Unspecific Back Pain in Children and Adolescents: Results of an Evidence-Based Interdisciplinary Guideline.

Using a structured approach and expert consensus, we developed an evidence-based guideline on the treatment and prevention of non-specific back pain in children and adolescents. A comprehensive and systematic literature search identified relevant guidelines and studies. Based on the findings of this literature search, recommendations on treatment and prevention were formulated and voted on by experts in a structured consensus-building process. Physical therapy (particularly physical activity) and psychotherapy (particularly cognitive behavioral therapy) are recommended for treating pediatric non-specific back pain. Intensive interdisciplinary treatment programs should be provided for chronic and severe pain. Drug therapy should not be applied in children and adolescents. Further research on non-specific back pain in childhood and adolescence is strongly needed to reduce the imbalance between the high burden of non-specific back pain in childhood and adolescence and the low research activity in this field.

Successful treatment of methotrexate intolerance in juvenile idiopathic arthritis using eye movement desensitization and reprocessing - treatment protocol and preliminary results.

BACKGROUND: Methotrexate (MTX), commonly used in juvenile idiopathic arthritis (JIA), frequently has to be discontinued due to intolerance with anticipatory and associative gastrointestinal adverse effects. Eye Movement Desensitization and Reprocessing (EMDR) is a psychological method where dysfunctional experiences and memories are reprocessed by recall combined with bilateral eye movements. The objective of this study was to assess efficacy of EMDR for treatment of MTX intolerance in JIA patients. METHODS: We performed an open prospective study on consecutive JIA patients with MTX intolerance. Intolerance was determined using the Methotrexate Intolerance Severity Score (MISS) questionnaire prior to treatment, directly after treatment and after four months. Health-related quality of life was determined using the PedsQL prior to and four months after treatment. Patients were treated according to an institutional EMDR protocol with 8 sessions over two weeks. Changes in MISS and PedsQL were analyzed using non-parametric statistics. RESULTS: Eighteen patients with MTX intolerance (median MISS at inclusion 16.5, IQR = 11.75-20.25) were included. Directly after treatment, MTX intolerance symptoms were significantly improved (median MISS 1 (IQR = 0-2). After four months, median MISS score was at 6.5 (IQR = 2.75-12.25, p = 0.001), with 9/18 patients showing MISS scores ≥6. Median PedsQL after 4 months improved significantly from 77.6% to 85.3% (p = 0.008). CONCLUSION: MTX intolerance in children with JIA was effectively treated using an EMDR protocol, with lasting effect over a period of 4 months. EMDR treatment can potentially increase quality of life of affected patients and enable continued MTX treatment.

Electrophysiological indices of processing aesthetics: Spontaneous or intentional processes?

Processes underlying aesthetic appreciation of formal graphic black and white patterns were investigated. In previous EEG studies on aesthetic and symmetry judgments, an early frontocentral negativity has been observed for not beautiful judgments, and interpreted as reflecting an impression formation. In addition, a lateralized late positivity, more pronounced in the aesthetic than in the symmetry judgment task, has been interpreted as reflecting evaluative categorization; and a sustained posterior negativity for not symmetric judgments, has been interpreted as reflecting a prolonged symmetry analysis. Here, we investigated whether these processes occur spontaneously, i.e. independent of an aesthetics task instruction or a judgment task demand. Participants were randomly assigned to two group conditions. In the Viewing condition, participants were instructed to view graphic patterns, and to detect a probe. In the Contemplation condition, participants were instructed to contemplate the beauty of the patterns, and to detect a probe. No aesthetics-related response was required in either condition. ERP results suggest that symmetry analysis occurred spontaneously. Evaluative categorization, reflected by a late positivity, required an aesthetics instruction and did not occur spontaneously. This process was elicited without an overt aesthetic judgment. An early frontocentral negativity for not beautiful patterns, interpreted as reflecting impression formation, did not occur (in contrast to previous studies that required an overt aesthetic judgment). Given the present data, aesthetic appreciation of graphic patterns requires different sub-processes. Aesthetic contemplation is reflected by a lateralized late positivity, whilst an aesthetic judgment is additionally reflected by an early frontocentral negativity. Aesthetic appreciation of beauty appears to require intention and is not spontaneous in character.

Beauty and the teeth: perception of tooth color and its influence on the overall judgment of facial attractiveness.

This study investigated the influence of changes in tooth color on judgments of facial attractiveness. Standardized photographs were presented, and teeth were digitally manipulated (main categories: original, whitened, colored; filler category: impaired). Participants were instructed to evaluate the faces for attractiveness. Additionally, they were asked to name facial features they found either positive or negative with regard to attractiveness. Whitened teeth were mentioned more often in a positive way but did not improve participants' assessment of attractiveness. A colored tooth did not attract attention, and the attractiveness judgment did not worsen. Tooth color is thus not necessarily perceived and does not have a major impact on facial attractiveness.

Temporal stability and consistency of aesthetic judgments of beauty of formal graphic patterns.

Temporal stability and consistency of nonartists' aesthetic judgments of beauty of formal graphic patterns was assessed. Temporal stability decreased markedly over several months. When items were repeated in an aesthetic judgment task participants responded consistently over trials rather than performing genuine repeated aesthetic judgments of beauty.

Aesthetic judgments of novel graphic patterns: analyses of individual judgments.

Aesthetic judgments were investigated using a combined nomothetic and idiographic approach. Participants judged novel graphic patterns with respect to their own personal definitions of "beauty." Judgment analysis was employed to derive individual case models of judgment strategies as well as a group model. As predicted, symmetry had the highest correlations with aesthetic judgments of beauty. Stimulus complexity was the second-highest correlate of a positive evaluation. Thus, there was agreement at the group level. The judgment analyses, however, indicated substantial individual differences. These included use of symmetry or complexity cues that were contrary to the main group use, e.g., a few participants considered nonsymmetric patterns more beautiful. These findings suggest that exclusive consideration of the group model would have leveled the individual differences and been misleading. The group model is significant; however, the individual judgment analyses represent individual patterns of judgment in a notedly more accurate way.

Aesthetic judgments of music in experts and laypersons--an ERP study.

We investigated whether music experts and laypersons differ with regard to aesthetic evaluation of musical sequences. 16 music experts and 16 music laypersons judged the aesthetic value (beauty judgment task) as well as the harmonic correctness (correctness judgment task) of chord sequences. The sequences consisted of five chords with the final chord sounding congruous, ambiguous or incongruous relative to the harmonic context established by the preceding four chords. On behavioural measures, few differences were observed between experts and laypersons. However, several differences in event-related potential (ERP) parameters were observed in auditory, cognitive and aesthetic processing of chord cadences between experts and laypersons. First, established ERP effects known to reflect the processing of harmonic rule violation were investigated. Here, differences between the groups were observed in the processing of the mild violation - experts and laypersons differed in their early brain responses to the beginning of the chord sequence. Furthermore, ERP data indicated distinctions between experts and laypersons in aesthetic evaluation at three different stages. Firstly, during the interval of task-cue presentation, a stronger contingent negative variation (CNV) to the beauty judgment task was observed for experts, indicating that experts invest more effort into preparation for aesthetic processes than into correctness judgments. Secondly, during the first four chords, preparation for the correctness judgment required more exertion on the laypersons' side. Thirdly, during the last chord, laypersons showed a larger late and widespread positivity for the beauty compared to the correctness judgment, indicating a stronger reliance on internal affective states while forming a judgment.

Electrophysiological correlates of aesthetic music processing: comparing experts with laypersons.

We analyzed the processes of making aesthetic judgments of music, focusing on the differences between music experts and laypersons. Sixteen students of musicology and 16 control subjects (also students) judged the aesthetic value as well as the harmonic correctness of chord sequences. Event-related potential (ERP) data indicate differences between experts and laypersons in making aesthetic judgments at three different processing stages. Additionally, effects of expertise on ERP components that have previously been proven to be sensitive to musical training were replicated. The study thus provides insights into the effects of musical expertise on neural correlates of aesthetic music processing.

Brain correlates of aesthetic judgment of beauty.

Functional MRI was used to investigate the neural correlates of aesthetic judgments of beauty of geometrical shapes. Participants performed evaluative aesthetic judgments (beautiful or not?) and descriptive symmetry judgments (symmetric or not?) on the same stimulus material. Symmetry was employed because aesthetic judgments are known to be often guided by criteria of symmetry. Novel, abstract graphic patterns were presented to minimize influences of attitudes or memory-related processes and to test effects of stimulus symmetry and complexity. Behavioral results confirmed the influence of stimulus symmetry and complexity on aesthetic judgments. Direct contrasts showed specific activations for aesthetic judgments in the frontomedian cortex (BA 9/10), bilateral prefrontal BA 45/47, and posterior cingulate, left temporal pole, and the temporoparietal junction. In contrast, symmetry judgments elicited specific activations in parietal and premotor areas subserving spatial processing. Interestingly, beautiful judgments enhanced BOLD signals not only in the frontomedian cortex, but also in the left intraparietal sulcus of the symmetry network. Moreover, stimulus complexity caused differential effects for each of the two judgment types. Findings indicate aesthetic judgments of beauty to rely on a network partially overlapping with that underlying evaluative judgments on social and moral cues and substantiate the significance of symmetry and complexity for our judgment of beauty.

Descriptive and evaluative judgment processes: behavioral and electrophysiological indices of processing symmetry and aesthetics.

Descriptive symmetry and evaluative aesthetic judgment processes were compared using identical stimuli in both judgment tasks. Electrophysiological activity was recorded while participants judged novel formal graphic patterns in a trial-by-trial cuing setting using binary responses (symmetric, not symmetric; beautiful, not beautiful). Judgment analyses of a Phase 1 test and main experiment performance resulted in individual models, as well as group models, of the participants' judgment systems. Symmetry showed a strong positive correlation with beautiful judgments and was the most important cue. Descriptive judgments were performed faster than evaluative judgments. The ERPs revealed a phasic, early frontal negativity for the not-beautiful judgments. A sustained posterior negativity was observed in the symmetric condition. All conditions showed late positive potentials (LPPs). Evaluative judgment LPPs revealed a more pronounced right lateralization. It is argued that the present aesthetic judgments engage a two-stage process consisting of early, anterior frontomedian impression formation after 300 msec and right-hemisphere evaluative categorization around 600 msec after onset of the graphic patterns.