Women's Experiences With Flap Failure After Autologous Breast Reconstruction: A Qualitative Analysis.

Clinical experience suggests that flap failure after autologous breast reconstruction can be a devastating experience for women. Previous research has examined women's experiences with autologous breast reconstruction with and without complications, and patients' experiences with suboptimal outcomes from other medical procedures. The authors aimed to examine the psychosocial experience of flap failure from the patient's perspective. Seven women who had experienced unilateral flap failure after deep inferior epigastric perforator flap surgery in the past 12 years completed semistructured interviews about their breast cancer treatments, their experiences with flap failure, the impact of flap failure on their lives, and the coping strategies they used. Interpretive phenomenological analysis, a type of qualitative analysis that provides an in-depth account of participant's experiences and their meanings, was used to analyze the interview data. From these data, patient-derived recommendations were developed for surgeons caring for women who have experienced flap failure. Three main themes (6 subthemes) emerged: coming to terms with flap failure (coping with emotions, body dissatisfaction); making meaning of flap failure experience (questioning, relationship with surgeon); and care providers acknowledging the emotional experience of flap failure (experience of being treated "mechanically," suggestions for improvement). In conclusion, flap failure in breast reconstruction is an emotionally difficult experience for women. Although there are similarities to other populations of patients experiencing suboptimal outcomes from medical procedures, there are also unique aspects of the flap failure experience. A better understanding of women's experiences with flap failure will assist in providing more appropriate supports.

Current Research on Matching Trauma-Focused Therapies to Veterans: A Scoping Review.

INTRODUCTION: Trauma-focused (psycho)therapies (TFTs) are often used to treat post-traumatic stress disorder (PTSD) of (military) veterans, including prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing. However, research thus far has not conclusively determined predictors of TFTs' success in this population. This scoping review's objectives are 1) to explore whether it is possible, based on currently available evidence, to match TFTs to veterans to maximize their outcomes, (2) to identify possible contraindications and adaptations of TFTs for this population, and (3) to identify gaps in the literature to guide future research. MATERIALS AND METHODS: Standard scoping review methodology was used. "White" and "gray" literature searches resulted in 4963 unique items identified. Following title and abstract screening and full-text analysis, 187 sources were included in the review. After data extraction, a narrative summary was used to identify common themes, discrepancies between sources, and knowledge gaps. RESULTS: Included publications most often studied CPT and PE rather than eye movement desensitization and reprocessing. These TFTs were at least partly effective with mostly moderate effect sizes. Attrition rates were slightly higher for PE versus CPT. There was variance in the methodological quality of the included studies. CONCLUSION: The current literature on TFTs to treat PTSD in veterans contains several knowledge gaps, including regarding treatment matching. Future research should examine effectiveness of these treatments using multiple sources of outcomes, longer time periods, combination with other treatment, outcomes outside of PTSD symptoms (such as functioning), and resilience.

Quantitative sensory testing for assessment of somatosensory function in children and adolescents: a scoping review.

Quantitative sensory testing (QST) refers to a group of noninvasive psychophysical tests that examine responses to a range of calibrated mechanical and thermal stimuli. Quantitative sensory testing has been used extensively in adult pain research and has more recently been applied to pediatric pain research. The aims of this scoping review were to map the current state of the field, to identify gaps in the literature, and to inform directions for future research. Comprehensive searches were run in 5 databases. Titles, abstracts, and full texts were screened by 2 reviewers. Data related to the study aims were extracted and analyzed descriptively. A total of 16,894 unique studies were identified, of which 505 were screened for eligibility. After a full-text review, 301 studies were retained for analysis. Date of publication ranged from 1966 to 2023. However, the majority of studies (61%) were published within the last decade. Studies included participants across the developmental trajectory (ie, early childhood to adolescence) and most often included a combination of school-age children and adolescents (49%). Approximately 23% of studies were conducted in healthy samples. Most studies (71%) used only one QST modality. Only 14% of studies reported using a standardized QST protocol. Quantitative sensory testing in pediatric populations is an emerging and rapidly growing area of pain research. Future work is needed using comprehensive, standardized QST protocols to harness the full potential that this procedure can offer to our understanding of pediatric pain.

Child catastrophizing about parent chronic pain: A potential child vulnerability factor.

Objective Robust evidence suggests children's catastrophizing about their own pain is a risk factor for poor child pain-related outcomes. In children of parents with chronic pain, child catastrophizing about their parents' pain might be a unique predictor of child pain-related outcomes given their increased exposure to parental chronic pain and disability. The objective of this study was to examine associations between child and parent catastrophizing about their own and each other's pain and child and parent pain-related outcomes. Methods Seventy-two parents with chronic pain and their children (ages 8-15) completed questionnaires assessing their trait catastrophizing about their own and each other's pain, their own pain, and the child's internalizing symptoms. Children completed the cold pressor task (CPT) in the presence of their parent. Parents and children rated children's worst pain intensity and their own anxiety during the task. Analyses were guided by the Actor-Partner Interdependence Model. Results Greater child catastrophizing about parent pain was associated with children's and parents' increased catastrophizing about their own pain. Child catastrophizing about parent pain was associated with greater child- and parent-reported child internalizing symptoms and greater CPT pain intensity for the child, but not parent/child usual pain or CPT anxiety, over and above the influence of parent and child catastrophizing about their own pain. Conclusions Child catastrophizing about parent pain is a potential vulnerability factor associated with poor pain-related outcomes in children of parents with chronic pain that should be considered in future research and clinical settings. Statement of contribution What is already known on this subject? Higher rates of pain and internalizing symptoms are observed in offspring of parents with vs. without chronic pain. Greater child and parent pain catastrophizing are associated with poorer pain-related outcomes in children. Child catastrophizing about parent chronic pain and its association with child outcomes has not been examined. What does this study add? Greater child catastrophizing about parent chronic pain is associated with greater child internalizing and CPT pain. These effects were seen beyond the association of child and parent catastrophizing about their own pain.

Testing the intergenerational model of transmission of risk for chronic pain from parents to their children: an empirical investigation of social transmission pathways.

Children of parents with chronic pain have higher rates of pain and internalizing (eg, anxiety and depressive) symptoms than children of parents without chronic pain. Parental modeling of pain behaviour and reinforcement of child pain have been hypothesized to underlie these relationships. These mechanisms were tested in a sample of 72 parents with chronic pain and their children (aged 8-15 years). Standardized measures were completed by parents (pain characteristics, pain interference, and child internalizing) and children (pain catastrophizing, pain over previous 3 months, and internalizing). In a laboratory session, children completed the cold pressor task in the presence of their parent, and parent-child verbalizations were coded. Significant indirect effects of parental pain interference on child self-reported (B = 0.12, 95% confidence interval [CI]: 0.01-0.29) and parent-reported (B = 0.16, 95% CI: 0.03-0.40) internalizing symptoms through child pain catastrophizing were found (parental modeling mechanism), and were not moderated by child chronic pain status. Significant indirect effects were found between parent pain-attending verbalizations and child self-reported (B = 2.58, 95% CI: 1.03-5.31) and parent-reported (B = 2.18, 95% CI: 0.93-4.27) cold pressor task pain intensity and tolerance (B = -1.02, 95% CI: -1.92 to -0.42) through child pain-attending verbalizations (parental reinforcement mechanism). Although further understanding of the temporal relationships between these variables is needed, the current study identifies constructs (eg, parent pain interference, child pain catastrophizing, and parent reinforcement of child pain) that should be further examined as potential targets for prevention and intervention of pain and internalizing symptoms in children of parents with chronic pain.

Availability of researcher-led eHealth tools for pain assessment and management: barriers, facilitators, costs, and design.

INTRODUCTION: Numerous eHealth tools for pain assessment and management have been developed and evaluated with promising results regarding psychometric properties, efficacy, and effectiveness. Although considerable resources are spent on developing and evaluating these tools with the aim of increasing access to care, current evidence suggests they are not made available to end users, reducing their impact and creating potential research waste. METHODS: This study consisted of 2 components: (1) a systematic review of eHealth tools for pediatric pain assessment and/or management published in the past 10 years, and (2) an online survey, completed by the authors of identified tools, of tool availability, perceived barriers or facilitators to availability, grant funding used, and a validated measure of user-centeredness of the design process (UCD-11). RESULTS: Ninety articles (0.86% of citations screened) describing 53 tools met inclusion criteria. Twenty-six survey responses were completed (49.06%), 13 of which (50.00%) described available tools. Commonly endorsed facilitators of tool availability included researchers' beliefs in tool benefits to the target population and research community; barriers included lack of infrastructure and time. The average cost of each unavailable tool was $314,425.31 USD ($3,144,253.06 USD total, n = 10). Authors of available tools were more likely to have followed user-centered design principles and reported higher total funding. CONCLUSION: Systemic changes to academic and funding structures could better support eHealth tool availability and may reduce potential for research waste. User-centered design and implementation science methods could improve the availability of eHealth tools and should be further explored in future studies.

A scoping review on the study of siblings in pediatric pain.

Background: Sibling relationships are longstanding across an individual's life and are influential in children's development. The study of siblings in pediatric pain is, although in early stages, a growing field. Aims: This scoping review sought to summarize and map the type of research available examining siblings and pediatric pain to identify gaps and directions for future research. Methods: Studies were identified based on a search of PubMed, CINAHL, PsycInfo, Embase, and Web of Science (up to November 2016). We extracted data about study methods, the sample, outcome assessment, and the influence/relationships investigated. Results: Thirty-five studies were included. Most studies used quantitative methods (n = 28), and participants typically included children (i.e., aged 6-12; n = 24) and adolescents (i.e., aged 13-18; n = 18). The majority of studies examined siblings in the context of chronic and disease-related pain (n = 30). Though quantitative studies primarily focused on the genetic influence of pain conditions (n = 18), qualitative and mixed-methods studies typically focused on exploring the impact of siblings with and without pain on one another (n = 2) and the impact of pain on the broader dyadic relationship/functioning (n = 4). Conclusions: Sibling research in pediatric pain has been primarily focused on the biological/physical components of pain, using quantitative approaches. Conducting more studies using qualitative or mixed-methods designs, incorporating multiple assessment measures (e.g., observational, self-report) and multiple perspectives (e.g., siblings, health professionals), may provide an opportunity to gain richer and more comprehensive information regarding the experience of siblings.

Contexte: Les relations entre membres d'une même fratrie durent toute la vie et influencent le développement des enfants. Bien qu'elle soit encore à ses débuts, l'étude des fratries dans le domaine de la douleur pédiatrique est un domaine en pleine croissance.But: Cette revue exploratoire avait pour but de cartographier et de résumer le type d'études sur les fratries et la douleur pédiatrique actuellement disponibles, afin de répertorier les lacunes existantes et définir les orientations possibles pour les études à venir.Méthodes: Les études ont été répertoriées par le truchement d'une recherche sur PubMed, CINAHL, PsycInfo, Embase et Web of Science (jusqu'en novembre 2016). Nous en avons tiré des données sur les méthodes, l'échantillon, l'évaluation des résultats et l'influence ou les relations à l'étude.Résultats: Trente-cinq études ont été retenues. La majorité de ces études utilisaient des méthodes quantitatives (n = 28) et les participants étaient généralement des enfants (i.e. âgés de 6 à 12 ans; n = 24) et des adolescents (i.e. âgés de 14 à 18 ans; n = 18). La plupart de ces études portaient sur les frères et soeurs dans le contexte de la douleur chronique liée à une maladie (n = 30). Tandis que les études quantitatives portaient généralement sur la dimension génétique de la douleur, (n = 18), les études qualitatives et les études mixtes portaient généralement sur l'effet des frères et sœurs avec douleur et sans douleur l'un sur l'autre (n = 2) ainsi que sur l'effet de la douleur sur la relation au sein d'une dyade ou le fonctionnement de celle-ci (n = 4).Conclusions: La recherche sur les fratries dans le domaine de la douleur pédiatrique met surtout l'accent sur les composantes biologiques/physiques de la douleur, à l'aide d'approches quantitatives. La conduite d'études ayant recours à des devis qualitatifs ou mixtes et intégrant de multiples mesures d'évaluation (i.e. observationnelles, auto-rapportées) et de multiples perspectives (ex. : membres d'une même fratrie, professionnels de la santé) pourrait être une occasion d'obtenir de l'information plus riche et plus exhaustive en ce qui concerne l'expérience des fratries.

Offspring of parents with chronic pain: a systematic review and meta-analysis of pain, health, psychological, and family outcomes.

Offspring of parents with chronic pain may be at risk for poorer outcomes than offspring of healthy parents. The objective of this research was to provide a comprehensive mixed-methods systematic synthesis of all available research on outcomes in offspring of parents with chronic pain. A systematic search was conducted for published articles in English examining pain, health, psychological, or family outcomes in offspring of parents with chronic pain. Fifty-nine eligible articles were identified (31 population-based, 25 clinical, 3 qualitative), including offspring from birth to adulthood and parents with varying chronic pain diagnoses (eg, mixed pain samples, arthritis). Meta-analysis was used to synthesize the results from population-based and clinical studies, while meta-ethnography was used to synthesize the results of qualitative studies. Increased pain complaints were found in offspring of mothers and of fathers with chronic pain and when both parents had chronic pain. Newborns of mothers with chronic pain were more likely to have adverse birth outcomes, including low birthweight, preterm delivery, caesarian section, intensive care admission, and mortality. Offspring of parents with chronic pain had greater externalizing and internalizing problems and poorer social competence and family outcomes. No significant differences were found on teacher-reported externalizing problems. The meta-ethnography identified 6 key concepts (developing independence, developing compassion, learning about health and coping, missing out, emotional health, and struggles communicating with parents). Across study designs, offspring of parents with chronic pain had poorer outcomes than other offspring, although the meta-ethnography noted some constructive impact of having a parent with chronic pain.

A longitudinal investigation of pain-related social support preferences in a chronic pain treatment sample.

OBJECTIVES: Chronic pain patients' pain-related social support preferences have received little clinical or research attention. However, recent research utilizing the Pain Response Preference Questionnaire (PRPQ) has indicated that such preferences are related to pain-related disability. This study investigated whether pain-related social support preferences: (1) were related to disability levels, (2) predicted changes in pain and disability following a group-based treatment program, and (3) changed from pretreatment to posttreatment. METHODS: At pretreatment and posttreatment, chronic pain patients (N=45) participating in a self-management psychoeducation program completed the PRPQ and measures of pain severity and disability. RESULTS: A multiple regression analysis indicated that at pretreatment the Solicitude scale of the PRPQ was positively associated with disability, and that this association was moderated by the other 2 PRPQ scales (Activity Direction and Suppression). The PRPQ scales did not predict changes in pain or disability and there were no significant changes in the PRPQ scale scores. However, participants did not respond to the Solicitude scale in a consistent manner from pretreatment to posttreatment (51.1% decreased, 35.5% increased, and 13.3% remained the same). These changes were unrelated to changes in pain or disability. DISCUSSION: Additional research aimed at identifying the processes underlying the association between pain-related support preferences and disability is warranted. Given the potentially important role that a desire for solicitous support may play in shaping the social context of pain, understanding the unexpected changes in Solicitude scale scores found in the present study may be particularly important for improving self-management treatments for chronic pain.

Associations between pain conditions and borderline personality disorder symptoms: findings from the National Comorbidity Survey Replication.

OBJECTIVES: Associations between 4 forms of pain (ie, arthritis, severe/frequent headaches, chronic spinal pain, and other chronic pain) and borderline personality disorder (BPD) symptoms were investigated in the general population. METHODS: Data from part II of the National Comorbidity Survey Replication (N=5692) were used. Pain conditions were assessed with self-reports. Arthritis was assessed on a lifetime basis. For the other pain conditions, variables were created to identify those with a remitted condition and those experiencing the condition in the past year. BPD symptoms were assessed with items from the International Personality Disorder Examination Screening Questionnaire. Axis I disorders were assessed with the Composite International Diagnostic Interview. RESULTS: Multiple regression analyses adjusting for sociodemographic variables and past-year psychiatric disorders indicated that those with a history of each pain condition (either remitted or past-year) had higher levels of BPD symptoms relative to those with a lifetime absence of the condition. For each condition, follow-up analyses indicated that those experiencing the condition in the past year had higher levels of BPD symptoms than those reporting a remitted condition. After adjusting for axis I psychiatric disorders, only the difference between the remitted and past-year severe/frequent headache groups remained significant. DISCUSSION: This is the first study to demonstrate that BPD symptoms are positively associated with chronic spinal pain, severe/frequent headaches, and other chronic pain conditions in a sample representative of the general population. The findings also suggest that relationships between remitted pain conditions and BPD symptoms warrant additional study.