Paediatric pain: Overview

Abstract
Objectives: The current study investigated the concurrent impact of anxiety and pain catastrophizing on both pain-related impairment (i.e., functional disability, pain-intensity) and on pain-related psychological treatment outcomes in youth with FAPD.

Method: This is a secondary analysis of data from a psychological treatment study (Aim to Decrease Anxiety and Pain Treatment; ADAPT) for youth with FAPD. Participants completed six weeks of ADAPT (psychological intervention) and treatment as usual or treatment as usual alone. Regressions and analysis of covariance models examined the relationship between baseline pain catastrophizing and anxiety on baseline functional disability and pain intensity, while analysis of covariance models assessed the effect of these baseline psychological factors on pain-related outcomes at post-assessment (8 weeks later) while accounting for group assignment. The effects of ADAPT on post-assessment pain catastrophizing and anxiety, as well as their moderating effects on pain-related outcomes were also explored.

Results: Results indicated that baseline pain catastrophizing, but not anxiety, predicted baseline functional disability and pain intensity, as well as post-assessment functional disability. Participants in the ADAPT group also demonstrated significantly lower pain catastrophizing at post-assessment. However, there were no moderating effects of post-assessment pain catastrophizing or anxiety on pain-related outcomes.

Discussion: Findings suggest that assessment of pain catastrophizing is important to better understand pain-related impairment in FAPD.

Abstract
Objective: Pain acceptance predicts better quality of life, physical functioning, and treatment outcomes in youth with chronic pain. However, we know little about the factors that promote pain acceptance in youth. This study investigated body mindsets and their associations with facets of pain acceptance, specifically pain willingness and activity engagement, in adolescents with chronic pain.

Methods: The sample comprised 102 adolescents with chronic musculoskeletal pain (aged 8-17; 72.3% female, 49.5% Caucasian/White) attending a tertiary pain clinic. Hierarchical linear regression analyses examined associations of body mindsets with pain acceptance controlling for demographic factors, pain and mental health symptoms, and basic functioning.

Results: There was significant variation in the mindsets that adolescents with chronic pain held about their bodies - some endorsed the mindset that their Body is an Adversary, others endorsed the mindsets that their Body is Responsive or Body is Capable. Hierarchical linear regression analyses indicated that endorsing the mindset that their Body is an Adversary was associated with lower willingness to experience pain, while endorsing the mindset that their Body is Capable was associated with greater engagement in valued activities despite pain, even after accounting for demographic factors, pain characteristics, and basic functioning. Together, all three mindsets explained 6.6-26.8% unique variance in pain acceptance.

Discussion: Body mindsets are significantly associated with pain acceptance in youth with chronic pain even after controlling for pain characteristics and basic functioning. Experimental research should investigate whether body mindsets are modifiable in this population and whether they could represent interventional targets fostering pain acceptance.

Abstract
Objectives: Attrition from pediatric chronic pain clinics limits patients from receiving maximum benefit from evidence-based interventions, with likely persistence of chronic pain, functional and psychosocial impairments. We aimed to determine attrition prevalence from interdisciplinary pediatric outpatient chronic pain clinics and identify any associated patient and caregiver factors.

Methods: A retrospective analysis was performed of longitudinal data from patients and caregivers attending 10 interdisciplinary pediatric outpatient chronic pain clinics in Australia or New Zealand contributing to the Paediatric electronic Persistent Pain Outcomes Collaboration (PaedePPOC) database. Data was retrieved for patient attrition, patient and caregiver factors at treatment commencement and subsequent documentation of the episode end for treatment completers and non-completers. Statistical associations with patient attrition were assessed using logistic regression analyses.

Results: The prevalence of patient attrition was 19.3% in the PaedePPOC cohort (N=1051), occurring steadily over 11 months. Patients ending their treatment prematurely presented with longer pain duration (>12 mos) (χ2(1, n=879)=8.23, P=0.004) than treatment completers. In the regression model, only older patient age (P=0.010) and higher caregiver psychosocial burden (P=0.025) at treatment commencement were associated with attrition. While pain intensity, patient physical and psychosocial functioning scores and caregiver partner status were not.

Discussion: One in five patients commencing an interdisciplinary pediatric outpatient chronic pain clinic intervention did not complete it. Identifying patients at pre-intervention screening with longer pain duration, older in age and from families with greater reported caregiver burden and providing tailored supports may minimize attrition, therefore optimizing efficiency of service provision.