Longitudinal Associations Between Pain and Psychosocial Adjustment in Youth With Spina Bifida.

OBJECTIVE: This study examined: (a) the nature and prevalence of pain in youth with spina bifida (SB) (b) common coping responses to pain, and (c) longitudinal, bi-directional associations between internalizing symptoms and pain characteristics. METHODS: Data were collected from youth (N = 140, 53.6% female, ages 8-15 at Time 1) and their parents and teachers at two time points spaced 2 years apart. Youth reported on several pain characteristics and coping responses. Multiple informants reported on child internalizing symptoms. Evaluation of Aims 1-3 was based on descriptive analyses, bivariate correlations, and linear and logistic regressions. RESULTS: About 25% of the sample reported chronic pain (e.g., experiencing pain one or more times per week over the past 3 months) at Time 1 or 2, with roughly one-third of this chronic pain subsample reporting chronic pain both time points. Pain was usually rated as mild in intensity for the full sample and most commonly experienced in the head, abdomen, and back, and described as "aching." Youth with chronic pain reported significantly higher pain intensity and tended to use condition-specific methods to cope with pain (e.g., taking off braces). In 2 of 10 analyses, internalizing symptoms at Time 1 were associated with chronic pain and pain intensity at Time 2. CONCLUSIONS: Roughly one-fourth of youth with SB are at risk for experiencing chronic pain, highlighting the need for increased assessment and treatment of pain in this population. Youth psychological functioning appears to more often precede, rather than being a consequence of pain symptoms.

Camp-based psychosocial intervention dosage and changes in independence in young people with spina bifida.

AIM: To examine associations between camp-based intervention dosage and changes in independence-related skills for young people with spina bifida. METHOD: Participants were 110 individuals (mean age [SD] 14y 7mo [6y 1mo], range 6-32y; 66 females, 54 males) who attended a summer camp for individuals with spina bifida between 2 to 6 times (mean 2.40; operationalized as 'dosage'). Parents of young campers (e.g. those <18y) also participated in data collection. Campers and/or parents completed preintervention measures assessing campers' level of medical responsibility, mastery over medical tasks, and social skills. Outcomes included change in preintervention scores from dose 1 to final dose. RESULTS: Hierarchical regression analyses with and without covariates (age, IQ, and lesion level at dose 1) revealed that increased dosage was significantly associated with greater parent-reported improvements in campers' medical responsibility and mastery over medical tasks. Increased dosage was also significantly associated with camper-report of increased medical responsibility, but this relationship was no longer significant when including covariates. Intervention dosage was not associated with changes in campers' social skills. INTERPRETATION: Repeated participation in a camp-based intervention was associated with improvements in condition-related independence. Future work may focus on the development of interventions to promote improvements in social skills for young people with spina bifida. WHAT THIS PAPER ADDS: Participating in an intervention over multiple summers is associated with increases in campers' responsibility for spina bifida-related tasks. Repeated summer camp intervention participation is associated with improved mastery over condition-related tasks for campers with spina bifida. Repeated camp intervention participation is not associated with changes in social skills for campers with spina bifida.

DOSIS DE INTERVENCIÓN PSICOSOCIAL EN CAMPAMENTOS RECREATIVOS Y CAMBIOS EN LA INDEPENDENCIA EN JÓVENES CON ESPINA BÍFIDA: OBJETIVO: Examinar las asociaciones entre la dosis de intervención recibidas en campamentos recreativos y los cambios en las habilidades relacionadas con la independencia de los jóvenes con espina bífida. MÉTODO: Los participantes fueron 110 individuos (edad media [DS] 14 años 7 meses[6y 1 mes], rango 6-32 años; 66 mujeres, 54 varones) que asistieron a un campamento de verano para personas con espina bífida, con una frecuencia entre 2 a 6 veces (media 2,40; considerada como 'dosificación' de la intervención). Los padres de los jóvenes que concurrieron a los campamentos (por ejemplo, aquellos con <18 años) también participaron en la recopilación de datos. Los participantes y / o los padres completaron las escalas previas a la intervención evaluando el nivel de responsabilidad sobre su salud de los participantes, el dominio sobre las tareas sanitarias y las habilidades sociales. Los resultados incluyeron cambios en las puntuaciones preintervención de la primera dosis a la última dosis. RESULTADOS: Los análisis de regresión jerárquica con y sin covariables (edad, coeficiente intelectual y nivel de lesión) revelaron que el aumento de la dosis se asoció significativamente con mayores mejoras informadas por los padres en la responsabilidad sobre su salud de los participantes y el dominio sobre las tareas sanitarias. El aumento de la dosis también se asoció significativamente con el informe de instructores reportando mayor responsabilidad sobre su propia salud, pero esta relación ya no fue significativa al incluir las covariables. La dosis de la intervención no se asoció con cambios en las habilidades sociales de los participantes INTERPRETACIÓN: La participación repetida en una intervención recibida en el campamento se asoció con mejoras en la independencia relacionada con la condición de salud. El trabajo futuro podría centrarse en el desarrollo de intervenciones para promover mejoras en las habilidades sociales de los jóvenes con espina bífida.

DOSAGEM DE INTERVENÇÃO PSICOSSOCIAL BASEADA EM ACAMPAMENTO E MUDANÇAS NA INDEPENDÊNCIA DE JOVENS COM ESPINHA BÍFIDA: OBJETIVO: Examinar associações entre dosagem de intervenção baseada em acampamento e mudanças nas habilidades relacionadas à independência para jovens com espinha bífida. MÉTODO: Participaram 110 indivíduos (idade média [desvio padrão] 14 anos e 7 meses [6 anos e 1 mês], 66 mulheres e 54 homens) que participaram do acampamento de verão para indivíduos com espinha bífida entre 2 e 6 vezes (média de 2,40; operacionalizado como `dosagem`). Os pais de jovens campistas (por exemplo, os <18 anos) também participaram da coleta de dados. Campistas e/ou pais completaram medidas de pré-intervenção avaliando o nível de responsabilidade médica dos campistas, domínio sobre tarefas médicas e habilidades sociais. Os resultados incluíram a mudança nos escores pré-intervenção da dose 1 para a dose final. RESULTADOS: Análises de regressão hierárquica com e sem covariáveis (idade, QI e nível de lesão na dosagem 1) revelaram que o aumento da dosagem foi significativamente associado a maiores melhorias relatadas pelos pais na responsabilidade médica dos campistas e no domínio de tarefas médicas. O aumento da dosagem também foi significativamente associado ao relato por parte do campista de maior responsabilidade médica, mas essa relação não era mais significativa quando se incluíam covariáveis. A dosagem de intervenção não foi associada a mudanças nas habilidades sociais dos campistas. INTERPRETAÇÃO: A participação repetida em uma intervenção baseada em acampamento foi associada a melhorias na independência relacionada à condição. Trabalho futuro pode se concentrar no desenvolvimento de intervenções para promover melhorias nas habilidades sociais para jovens com espinha bífida.

A Multimethod, Case-Controlled Study of Sleep-Wake Disturbances in Adolescents With Spina Bifida.

Objective: This study aimed to compare sleep-wake disturbances in adolescents with spina bifida (SB) to typically developing (TD) peers. Exploratory analyses examined sex as moderator of disrupted sleep. Methods: Adolescents with SB (ages 12-18 years; N = 37) and a demographically matched sample of TD adolescents (N = 37) completed validated sleep questionnaires and underwent 10 days of actigraphy monitoring. Results: Adolescents with SB evidenced worse sleep quality, shorter sleep duration, greater sleep maintenance difficulties, and higher levels of fatigue compared with their TD peers. Exploratory analyses revealed females with SB were particularly vulnerable to developing sleep disturbances. Conclusions: Adolescents with SB are at risk for nighttime sleep disturbances and daytime fatigue. Additional research will need to identify mechanisms and adverse consequences of poor sleep to develop interventions addressing sleep deficiency. Sex-specific disparities in sleep patterns in pediatric SB is a novel finding that requires assessment of etiological underpinnings to clarify clinical implications.

Topical Review: Integrating Findings on Direct Observation of Family Communication in Studies Comparing Pediatric Chronic Illness and Typically Developing Samples.

Objective: To review research on observed family communication in families with children with chronic illnesses compared with families with healthy, typically developing children, and to integrate findings utilizing a unifying family communication framework. Method: Topical review of studies that have directly observed family communication in pediatric populations and included a typically developing comparison group. Results: Initial findings from 14 studies with diverse approaches to quantifying observed family communication suggest that families with children with chronic illnesses may demonstrate lower levels of warm and structured communication and higher levels of hostile/intrusive and withdrawn communication compared with families with healthy, typically developing children. Conclusion: An integrative framework of family communication may be used in future studies that examine the occurrence, correlates, and mechanisms of family communication in pediatric populations.

Developmental Course and Determinants of Sleep Disturbances in Adolescents With Spina Bifida.

OBJECTIVES: To examine (1) trajectories of sleep disturbances in adolescents with spina bifida (SB) compared with a typically developing (TD) group over a 10-year period and (2) individual, family, and socioeconomic determinants of changes in sleep disturbances. METHODS: Participants were 68 families of youth with SB and 68 families of TD youth. Parent-report of adolescent sleep was collected every 2 years at 6 time points (T1: ages 8-9; T6: ages 18-19). Multiple informants and measures were used to examine internalizing, externalizing, and inattention symptoms, dyadic/family conflict, socioeconomic status (SES), and family income. RESULTS: Sleep disturbances increased over the 10-year period. Youth with SB had greater sleep disturbances during early adolescence. Greater preadolescent externalizing symptoms, greater parent-child and marital conflict, and lower SES predicted increased sleep disturbances. CONCLUSIONS: Sleep disturbances are common and persistent in adolescents with SB. Sleep assessment and management are important clinical and research priorities in this population.

Resilience and Disruption in Observed Family Interactions in Youth With and Without Spina Bifida: An Eight-Year, Five-Wave Longitudinal Study.

OBJECTIVE: To examine differences between families of youth with spina bifida (SB) and families of typically developing (TD) youth on family-, parent-, and youth-level variables across preadolescence and adolescence. METHODS: Participants were 68 families of youth with SB and 68 families of TD youth. Ratings of observed family interactions were collected every 2 years at 5 time points (Time 1: ages 8-9 years; Time 5: ages 16-17 years). RESULTS: For families of youth with SB: families displayed less cohesion and more maternal psychological control during preadolescence (ages 8-9 years); parents presented as more united and displayed less dyadic conflict, and youth displayed less conflict behavior during the transition to adolescence (ages 10-13 years); mothers displayed more behavioral control during middle (ages 14-15 years) and late (ages 16-17 years) adolescence; youth displayed less engagement and more dependent behavior at every time point. CONCLUSIONS: Findings highlight areas of resilience and disruption in families of youth with SB across adolescence.

A longitudinal examination of health-related quality of life in children and adolescents with spina bifida.

OBJECTIVE: The current study examined (1) spina bifida (SB) youths' health-related quality of life (HRQOL) compared with nonclinical and chronic health condition (CHC) samples, (2) parent-child agreement regarding HRQOL, and (3) prospective changes in HRQOL. METHODS: Child and parent-proxy reports of Pediatric Quality of Life were collected at two time waves (Time 1: N = 134, ages 8-15 years; Time 2: N = 109, ages 10-17 years) as part of a larger longitudinal study. RESULTS: SB youth had statistically and clinically reduced physical HRQOL compared with the nonclinical and CHC samples at both time points. There were significant discrepancies between youth and parent-proxy reports of HRQOL; youth reported higher levels of physical and social HRQOL than parents. The majority of parent- and child-reported HRQOL domains remained stable, yet youth-reported social HRQOL increased over time. CONCLUSIONS: Youth with SB are at risk for poor HRQOL. Examining modifiable condition and social-environmental predictors of youth HRQOL will be important in informing future interventions.

Longitudinal study of neuropsychological functioning and internalizing symptoms in youth with spina bifida: social competence as a mediator.

OBJECTIVE: To examine the longitudinal relationship between neuropsychological functioning and internalizing symptoms, as mediated by social competence in youth with spina bifida (SB). METHODS: A total of 111 youth (aged 8-15 years, M = 11.37) with SB, their parents, and teachers completed questionnaires regarding attention, social competence, and internalizing symptoms. Youth also completed a battery of neuropsychological tests. RESULTS: An indirect-only mediation model revealed that social competence mediated the relation between neuropsychological functioning and subsequent levels of teacher-reported internalizing symptoms, but not parent or youth report of internalizing symptoms. Specifically, better neuropsychological functioning was associated with better social competence, which, in turn, predicted fewer internalizing symptoms 2 years later. CONCLUSIONS: Youth with SB with lower levels of neuropsychological functioning may be at risk for poorer social competence and, as a result, greater internalizing symptoms. Interventions that promote social competence, while being sensitive to cognitive capacities, could potentially alleviate or prevent internalizing symptoms in these youth.

Observed macro- and micro-level parenting behaviors during preadolescent family interactions as predictors of adjustment in emerging adults with and without spina bifida.

OBJECTIVE: To examine observed autonomy-promoting and -inhibiting parenting behaviors during preadolescence as predictors of adjustment outcomes in emerging adults with and without spina bifida (SB). METHODS: Demographic and videotaped interaction data were collected from families with 8/9-year-old children with SB (n = 68) and a matched group of typically developing youth (n = 68). Observed interaction data were coded with macro- and micro-coding schemes. Measures of emerging adulthood adjustment were collected 10 years later (ages 18/19 years; n = 50 and n = 60 for SB and comparison groups, respectively). RESULTS: Autonomy-promoting (behavioral control, autonomy-relatedness) and -inhibiting (psychological control) observed preadolescent parenting behaviors prospectively predicted emerging adulthood adjustment, particularly within educational, social, and emotional domains. Interestingly, high parent undermining of relatedness predicted better educational and social adjustment in the SB sample CONCLUSIONS: Parenting behaviors related to autonomy have long-term consequences for adjustment in emerging adults with and without SB.

The influence of condition parameters and internalizing symptoms on social outcomes in youth with spina bifida.

OBJECTIVE: To test a model of social competence in youth with spina bifida (SB). Involvement in social activities was expected to mediate associations between SB-related condition parameters (pain, body mass index, and motor function) and social competence. Internalizing symptoms were predicted to amplify the negative impact of condition parameters on social activity involvement. METHODS: 108 youth with SB, their caregivers, peers, and teachers participated in a multimethod study that included cognitive testing, questionnaires, and observational interaction tasks. RESULTS: Social activity involvement partially mediated the relation between pain and lower social competence. Internalizing symptoms had a significant indirect effect on social competence via decreased involvement in social activities. CONCLUSIONS: Pain and internalizing symptoms interfere with social activity involvement, which is, in turn, important for social competence development in youth with SB. Assessing and treating these condition parameters and activity factors may be important areas of focus in clinical practice and research with these youth.

Adolescent predictors of young adult pain and health outcomes: results from a 6-year prospective follow-up study.

ABSTRACT: Adolescent chronic pain may lead to persistent disability and long-term health impairments in adulthood. However, our understanding of which youth are more likely to experience adverse outcomes remains limited. To address this gap, this longitudinal cohort study examined adolescent predictors of various dimensions of young adult health and functioning, including pain, physical health, depression, anxiety, social isolation, and sleep disturbance. As part of a previous clinical trial, we recruited a cohort of adolescents (ages 11-17 years, M age = 14 years) with non-disease-related chronic pain from 15 tertiary pain clinics in North America. Approximately 6 years later, 229 of the original 273 individuals (81% participation rate) completed a follow-up survey as young adults (ages 18-25 years, M age = 21 years). At the young adult follow-up, 73% reported continued chronic pain, with two-thirds experiencing moderate-to-severe pain interference. Youth reported several adverse health outcomes, including below-average physical health (37%), clinically elevated depression (42%), clinically elevated anxiety (48%), and sleep disturbances (77%). Multivariate regression analyses controlling for sociodemographic characteristics revealed that higher pain intensity, more pain locations, lower sleep quality, and greater anxiety symptoms in adolescence predicted worse pain outcomes in young adulthood. Moreover, lower sleep quality, greater anxiety symptoms, and worse family functioning predicted worse physical and psychosocial health in adulthood. These findings represent an important first step toward identifying ways to optimize psychological pain interventions. Tailored psychological pain interventions can directly target adolescent vulnerabilities, including mood, sleep, and family risk factors, with the potential to disrupt a lifelong trajectory of pain and suffering.

A camp-based psychosocialiIntervention to promote independence and social function in individuals with spina bifida: moderators of treatment effectiveness.

PURPOSE: To replicate and extend O'Mahar and colleagues' (O'Mahar, K., Holmbeck, G. N., Jandasek, B., & Zuckerman, J. [2010]. A camp-based intervention targeting independence among individuals with spina bifida. Journal of Pediatric Psychology, 35, 848-856) findings in a new and larger sample of youth and young adults with spina bifida who participated in a modified camp-based intervention targeting independence and social skills. Moderators of intervention effectiveness and clinical significance were examined. METHOD: In all, 119 campers aged 7-41 years participated in an intervention that included goal setting and interactive workshops. Campers and parents completed measures of campers' goal attainment, independence, and social functioning at preintervention and postintervention; counselors reported on campers' goal attainment daily throughout the intervention. RESULTS: Parents and campers reported improvements in campers' goal attainment, management of health-related self-care, and independence. Although benefits were found for most campers, cognitive functioning and family income moderated some outcomes. Campers who improved most on their social goals perceived the intervention to be more effective. CONCLUSIONS: Further support is provided for the effectiveness of a camp-based intervention targeting independence and social skills for individuals with spina bifida. More attention should be directed toward those with cognitive difficulties and low-income backgrounds.

How does pain work? A qualitative analysis of how young adults with chronic pain conceptualize the biology of pain.

BACKGROUND: Pain science education (PSE) is commonly integrated into treatments for childhood-onset chronic pain. A core component of PSE is learning about, and often reconceptualizing, the biology of chronic pain. Yet, few interventions have been developed specifically for young adults and little is known about how young adults conceptualize the biology of pain. This study used a qualitative methodology to examine how young adults with childhood-onset chronic pain understand the biology of pain, and the language they use in this meaning-making process, which may inform future interventions tailored to this age group. METHODS: We identified a cohort of young adults with childhood onset chronic pain, and a subset of 17 young adults with continuing chronic pain completed individual, semi-structured interviews. Telephone interviews were audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: We generated four themes that capture participants' conceptualizations of the biology of pain: (1) Something is wrong with the body, (2) An injury has not healed, (3) Nerves fire when they should not, (4) An overactive stress system. CONCLUSION: These conceptualizations, and the language used by young adults with childhood-onset chronic pain to describe them are discussed. Recommendations are provided for how PSE interventions can be tailored for young adults. SIGNIFICANCE: This study provides new qualitative insights reflecting a variety of ways that young adults with childhood-onset chronic pain conceptualize pain. Some conceptualizations of pain align with modern pain science principles (altered function of nervous and endocrine systems) while others conflict (unhealed injury). Health professionals can use these findings to tailor their pain education interventions by leveraging concepts that 'stick' for youth, being aware of, and interrogating, common misconceptions, and offering language and metaphors familiar to youth.

Pain and sleep-wake disturbances in adolescents with depressive disorders.

The aims of this study were to (a) assess and compare sleep disturbances (including daytime and nighttime sleep patterns) in adolescents with depressive disorders and healthy peers, (b) examine the prevalence of pain in adolescents with depressive disorders and healthy peers, and (c) examine pubertal development, pain intensity, and depressive symptom severity as predictors of sleep disturbance. One hundred six adolescents (46 depressed, 60 healthy), 12 to 18 years (M = 15.10 years; 67% female; 77% Caucasian) completed subjective measures of sleep, presleep arousal, fatigue, and pain. Participants also underwent 10 days of actigraphic monitoring to assess nighttime and daytime sleep duration, sleep efficiency, and wake after sleep onset. Results indicated that youth with depression exhibited greater sleep disturbances on subjective and actigraphic sleep variables than healthy controls. Depressed youth also reported more frequent and severe pain than healthy youth. Linear regression analysis indicated that pain intensity and depressive symptoms predicted worse sleep quality across groups. The interaction term was also significant, such that adolescents with high levels of depressive symptoms had poor sleep quality when pain intensity levels were high. These results indicate that sleep is important to assess in youth with depression, and that pain may be an important target for sleep intervention in this population.

A pilot feasibility and acceptability study of an Internet-delivered psychosocial intervention to reduce postoperative pain in adolescents undergoing spinal fusion.

Background: Spinal fusion surgery is a common and painful musculoskeletal surgery performed in the adolescent population. Despite the known risk for developing chronic postsurgical pain, few perioperative psychosocial interventions have been evaluated in this population, and none have been delivered remotely (via the Internet) to improve accessibility. Aims: The aim of this single-arm pilot study was to evaluate the feasibility and acceptability of the first Internet-based psychological intervention delivered during the perioperative period to adolescents undergoing major spinal fusion surgery and their parents. Methods: Thirteen adolescents (M age = 14.3; 69.2% female) scheduled for spine fusion surgery and their parents were provided access to the online psychosocial intervention program. The program included six lessons delivering cognitive-behavioral therapy skills targeting anxiety, sleep, and acute pain management during the month prior to and the month following surgery. Feasibility indicators included recruitment rate, intervention engagement, and measure completion. Acceptability was assessed via quantitative ratings and qualitative interviews. Results: Our recruitment rate was 81.2% of families approached for screening. Among participating adolescent-parent dyads, high levels of engagement were demonstrated (100% completed all six lessons). All participants completed outcome measures. High treatment acceptability was demonstrated via survey ratings and qualitative feedback, with families highlighting numerous strengths of the program as well as areas for improvement. Conclusions: These findings suggest that this online psychosocial intervention delivered during the perioperative period is feasible and acceptable to adolescents and their parents. Given favorable feasibility outcomes, an important next step is to evaluate the intervention in a full-scale randomized controlled trial.

Contexte: La chirurgie de fusion vertébrale est une chirurgie musculo-squelettique courante et douloureuse pratiquée chez la population adolescente. Malgré le risque connu de développer une douleur post-chirurgicale chronique, peu d'interventions psychosociales périopératoires ont été évaluées chez cette population, et aucune n'a été dispensée à distance (par Internet) pour améliorer son accessibilité. Objectifs: L'objectif de cette étude pilote à un seul volet était d'évaluer la faisabilité et l'acceptabilité de la premiére intervention psychologique sur Internet destinée aux adolescents subissant une chirurgie majeure de fusion vertébrale et à leurs parents, dispensée pendant la période périopératoire. Méthodes: Treize adolescents (âge M = 14,3 ; 69,2 % de filles) devant subir une chirurgie de fusion vertébrale et leurs parents ont eu accés au programme d'intervention psychosociale en ligne. Le programme comprenait six leçons permettant d'acquérir des compétences de thérapie cognitivo-comportementale ciblant l'anxiété, le sommeil et la prise en charge de la douleur aiguë pendant le mois précédant et le mois suivant la chirurgie. Les indicateurs de faisabilité comprenaient le taux de recrutement, l'engagement dans l'intervention et la réponse aux questionnaires de mesure des résultats. L'acceptabilité a été évaluée au moyen d'évaluations quantitatives et d'entretiens qualitatifs.Notre taux de recrutement était de 81,2 % des familles approchées pour le dépistage. Parmi les dyades adolescents-parents participantes, des niveaux élevés d'engagement ont été démontrés (100 % ont terminé les six leçons). Tous les participants ont rempli les questionnaires de mesure des résultats. Une acceptabilité élevée du traitement a été démontrée par le biais de sondages et de rétroaction qualitative, les familles mettant en évidence de nombreux points forts du programme ainsi que les points à améliorer. Conclusions: Ces résultats indiquent que cette intervention psychosociale en ligne dispensée pendant la période périopératoire est faisable et acceptable pour les adolescents et leurs parents. Étant donné les résultats de faisabilité favorables, une prochaine étape importante consistera à évaluer l'intervention dans le cadre d'un essai contrôlé randomisé à grande échelle.

Healthcare Transition Among Young Adults With Childhood-Onset Chronic Pain: A Mixed Methods Study and Proposed Framework.

Chronic pain extends from childhood to adulthood for many young people. The transition from pediatric to adult care is a critical, yet understudied, healthcare task facing young adults with chronic pain. The aims of this observational, sequential mixed methods study were to 1) document the healthcare transition status of young adults with chronic pain (Stage 1, quantitative aim), 2) examine young adults' perspectives of barriers and facilitators of healthcare transition (Stage 2, qualitative aim), and 3) integrate findings to construct a theoretical framework of healthcare transition. A cohort was identified with childhood chronic pain and prior care in one of 15 multidisciplinary pediatric pain clinics across the United States and Canada. Approximately 6 years later, 189 young adults (M age = 21.0; age range = 18-24; 81.5% female) from this cohort with continuing chronic pain completed surveys for Stage 1, and a subsample (n = 17) completed qualitative interviews for Stage 2. Quantitative findings demonstrated that young adults may experience lapses in care, with 41.8% indicating they had not transitioned to adult pain services. Qualitative analysis revealed young adults experienced significant barriers (eg, abrupt departure from pediatric care) as well as facilitators (eg, acceptance of pain prognosis) of healthcare transition. Quantitative and qualitative findings were integrated to construct a healthcare transition framework for chronic pain, which highlights transition as a complex process involving multiple pathways, outcomes, and stakeholders. Advancements in research and practice are needed to develop transition services to bridge gaps in care and optimize health outcomes for young people with chronic pain. PERSPECTIVE: This mixed-methods study demonstrated that 41.8% of young adults with chronic pain experience lapses in adult-centered pain care and identified key barriers and facilitators to successful healthcare transition. Findings were integrated to construct the first healthcare transition framework for youth with chronic pain.

The impact of the COVID-19 pandemic on pain and psychological functioning in young adults with chronic pain.

ABSTRACT: Data are equivocal on the consequences of COVID-19 pandemic on pain and well-being for individuals with chronic pain. Furthermore, little is known regarding its impact on the health of young adults with chronic pain. We conducted a longitudinal study to compare pain, psychological functioning, and substance use before and during the pandemic of 196 young adults with chronic pain. Participants aged 18 to 24 years (M = 21.1 years; 79.6% females) reported on pain, anxiety, depression, and substance use before (October 2018-August 2019) and during the pandemic (October 2020-November 2020), in addition to the assessment of COVID-19 exposure and its impact. Before the pandemic, young adults experienced mild-to-moderate pain intensity (M = 3.75, SD = 2.33) and pain interference (M = 3.44, SD = 2.69). Findings were that pain intensity, pain interference, and depression symptoms remained stable during the pandemic. In contrast, anxiety symptoms increased significantly (M = 8.21, SD = 5.84 vs M = 8.89, SD = 5.95, P = 0.04). Tobacco, alcohol, and cannabis use were unchanged. Mixed linear models revealed that COVID-19 exposure and impact were not associated with changes in pain intensity or interference, with female sex associated with increased pain intensity (ß = 0.86, P = 0.02) and pain interference (ß = 0.87, P = 0.02). Our findings indicated relative stability of pain symptoms experienced by young adults with chronic pain. However, the increases in anxiety highlight the need to facilitate treatment access for mental health services to mitigate downstream impact.

The prevalence of chronic pain in young adults: a systematic review and meta-analysis.

ABSTRACT: Previous systematic reviews have summarized the prevalence and impact of chronic pain in "average" pediatric (ie, school-age children) and adult (ie, middle-aged individuals) age groups. To the best of our knowledge, this is the first study to describe the prevalence of chronic pain in the subgroup of individuals who fall in between established boundaries of "childhood" and "adulthood"-known as young adulthood. The goal of this research was to meta-analyze prevalence data on pain in young adults based on available data published between 2008 and 2020. Searches were identified with MEDLINE, Embase, and PsycINFO. We included general population and university-based studies presenting prevalence estimates of chronic pain (pain lasting ≥3 months) in young adults. We identified 43 articles providing prevalence estimates across a combined population of 97,437 young adult respondents (age range: 15-34 years), with studies undertaken in 22 countries. Available data allowed for stratification of prevalence according to pain condition. The overall pooled random-effect prevalence rate of chronic pain in young adults was 11.6%, suggesting that 1 in every 9 young adults experience chronic pain worldwide. Prevalence rates varied considerably according to pain condition. Estimates did not vary according to sex, geographic location, and several study methodological characteristics (ie, population type, sampling area, sampling year, investigation period, and assessment method). Overall, young adult chronic pain is common and should be recognized as a major public health concern. Considering the difficulties young adults face accessing adult health care, greater attention is needed to develop transition programs and evidence-based treatments tailored to the unique needs of this age group.

Age differences in cognitive-affective processes in adults with chronic pain.

BACKGROUND: Chronic pain is associated with significant physical and psychological impairments across the adult lifespan. However, there is a relative gap in knowledge on individual differences that predict pain-related functioning. The current study highlights one important source of individual variation: age. METHODS: We used cross-sectional data from a large treatment-seeking cohort of 2,905 adults (M age = 46.6 [13.1]; 71.8% women) presenting to a tertiary pain centre in the United Kingdom to determine age differences in cognitive-affective processes (catastrophizing, acceptance, self-efficacy), including their differential patterns and effects on disability and depression. RESULTS: Older adults (ages 65-75) were found to experience higher pain acceptance and pain self-efficacy compared to both middle-aged (ages 40-64) and young adult (ages 18-39) age groups. Older adults also experienced lower levels of catasophizing compared to middle-age adults. Testing age as a moderator, we found that the relationships of pain self-efficacy and acceptance with depression as well as the relationship between pain self-efficacy and disability were comparatively weakest among older adults and strongest among young adults. Similarly, the relationship between pain catastrophizing and depression was relatively stronger for young and middle-aged adults compared to older adults. CONCLUSIONS: Age-related differences in psychological mechanisms that influence pain-related functioning present unique challenges and opportunities for scientists and clinicians to improve our understanding and treatment of pain across the lifespan. Additional work is needed to refine our knowledge of age-related differences in cognitive-affective, biopsychosocial dimensions of chronic pain and to develop and test the efficacy of age-tailored interventions. SIGNIFICANCE: Our cross-sectional analysis of 2,905 treatment-seeking adults with chronic pain presenting to a tertiary care center in the United Kingdom revealed distinct age differences in cognitive-affective linked to disability and depression. This study contributes to the limited knowledge on age-related variance in psychological mechanisms underlying adjustment to chronic pain. Promising avenues for future research include refining our understanding of age-related differences in cognitive-affective, biopsychosocial dimensions of chronic pain and elucidating the most salient treatment targets among different age groups.

A digital health peri-operative cognitive-behavioral intervention to prevent transition from acute to chronic postsurgical pain in adolescents undergoing spinal fusion (SurgeryPalTM): study protocol for a multisite randomized controlled trial.

BACKGROUND: Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk factors have potential to interrupt a negative trajectory of continued pain and poor health-related quality of life (HRQL) over time but have not yet been developed and evaluated. This randomized controlled trial will test effectiveness of a digital peri-operative cognitive-behavioral intervention (SurgeryPalTM) vs. education-control delivered to adolescents and their parents to improve acute and chronic pain and health outcomes in adolescents undergoing spine surgery. METHODS: Adolescents 12-18 years of age undergoing spinal fusion for idiopathic conditions, and their parent, will be recruited from pediatric centers across the USA, for a target complete sample of 400 dyads. Adolescents will be randomized into 4 study arms using a factorial design to SurgeryPalTM or education control during 2 phases of treatment: (1) pre-operative phase (one-month before surgery) and (2) post-operative phase (1 month after surgery). Acute pain severity and interference (primary acute outcomes) and opioid use will be assessed daily for 14 days following hospital discharge. Chronic pain severity and interference (primary acute outcomes), as well as HRQL, parent and adolescent distress, sleep quality, and opioid use/misuse (secondary outcomes), will be assessed at 3 months and 6 months post-surgery. DISCUSSION: Demonstration of effectiveness and understanding optimal timing of perioperative intervention will enable implementation of this scalable psychosocial intervention into perioperative care. Ultimately, the goal is to improve pain outcomes and reduce reliance on opioids in adolescents after spine surgery. TRIAL REGISTRATION: NCT04637802 ClinicalTrials.gov. Registered on November 20, 2020.