Pediatric Neural Changes to Physical and Emotional Pain After Intensive Interdisciplinary Pain Treatment: A Pilot Study.

Objective: Brain areas activated during pain can contribute to enhancing or reducing the pain experience, showing a potential connection between chronic pain and the neural response to pain in adolescents and youth.

Methods: This study examined changes in brain activation associated with experiencing physical pain and observing physical and emotional pain in others by using functional magnetic resonance imaging (fMRI) before and after intensive interdisciplinary pain treatment (IIPT). Eighteen youths (age 14 to 18) with widespread chronic pain completed fMRI testing before and after IIPT to assess changes in brain activation in response to physical and emotional pain.

Psychosocial Functioning of Parents of Youth Receiving Intensive Interdisciplinary Pain Treatment.

Objective: Parents of youth with chronic pain report psychosocial difficulties, yet treatment often focuses on improving their child's functioning and pain. This study evaluated changes in parents' social and emotional functioning and explored predictors of change, as they completed a parent-focused intervention while their child was enrolled in an intensive interdisciplinary pain treatment (IIPT) program.

Methods: Parents (n = 69) completed questionnaires at baseline and weekly (average duration of 4 weeks) during their child's participation in IIPT.

Pediatric Neural Changes to Physical and Emotional Pain After Intensive Interdisciplinary Pain Treatment: A Pilot Study.

Brain areas activated during pain can contribute to enhancing or reducing the pain experience, showing a potential connection between chronic pain and the neural response to pain in adolescents and youth. This study examined changes in brain activation associated with experiencing physical pain, and the observation of physical and emotional pain in others, by using functional magnetic resonance imaging (fMRI) before and after intensive interdisciplinary pain treatment (IIPT). Eighteen youth (age 14 to 18) with widespread chronic pain completed fMRI testing before and after IIPT to assess changes in brain activation in response to physical and emotional pain.

Development and Validation of the Scale for Pain Self-Efficacy (SPaSE) in German and English Languages for Children and Adolescents.

No validated measure for pain self-efficacy in children and adolescents is currently available in the German language, and existing English versions have limitations. This study used a thorough development process to create the Scale for Pain Self-Efficacy (SPaSE) in both German and English languages. Scale development was based on self-efficacy theory, adapting items from existing self-efficacy measures, and review of patients' perspectives.

Comparing Three Music Therapy Interventions for Anxiety and Relaxation in Youth With Amplified Pain.

Research in pediatric hospitals has shown that active music engagement, preferred music listening, and music-assisted relaxation can decrease anxiety and increase relaxation responses. However, there is little research on the use of music therapy with pediatric chronic pain conditions such as amplified pain syndromes. The purpose of the current study was to examine the effects of 3 specific music therapy interventions (active music engagement, live patient-selected music, and music-assisted relaxation) on anxiety and relaxation levels in youth (ages 10-18) participating in a 40 hr per week hospital-based intensive interdisciplinary pain treatment program.

Parent psychological flexibility in the context of pediatric pain: Brief assessment and associations with parent behaviour and child functioning.

Background: The parent's role in the context of pediatric chronic pain is essential. There is growing evidence that parent psychological flexibility positively impacts child functioning. To assess parents' abilities to respond with psychological flexibility to their child's pain, the Parent Psychological Flexibility Questionnaire (PPFQ) was developed.

Fluoroscopy Dose and Time Characteristics During Endoscopic Retrograde Cholangiopancreatography (ERCP).

Radiation exposure during endoscopic retrograde cholangiopancreatography is known, however, data in relation to radiation usage is unclear. We evaluate radiation exposure using fluoroscopy dose (FD) and time (FT). A prospective analysis of 197 patients undergoing endoscopic retrograde cholangiopancreatography was completed.

Neuropsychological Functioning of Youth Receiving Intensive Interdisciplinary Pain Treatment.

Objective: Chronic pain is associated with school difficulties; however, there is limited published evidence on the cognitive or neuropsychological functioning of youth with chronic pain.

Method: When beginning intensive interdisciplinary pain treatment, 94 youth (age = 10-18) with chronic pain completed neuropsychological assessment (e.g.

Parent Responses to Child Pain During Intensive Interdisciplinary Pain Treatment and 1-Year Follow-Up.

Targeting parents' responses to their child's pain during intensive interdisciplinary pain treatment (IIPT) could influence child functioning. This longitudinal, observational study investigated changes in these responses and concurrent relationships between parent responses and changes in levels of child functioning and pain. Parents of youths 10 to 19 years of age (mean = 15 years, SD = 1.

The Relationship Between Pain Characteristics, Peer Difficulties, and Emotional Functioning Among Adolescents Seeking Treatment for Chronic Pain: A Test of Mediational Models.

Objective: To evaluate patterns of relationships between pain characteristics, peer difficulties, and emotional functioning in a sample of adolescents seeking treatment for chronic pain.

Methods: Participants were 172 adolescents (age M = 14.88 years; 76% female, 88% White) with heterogeneous chronic pain disorders who completed measures of pain characteristics, peer difficulties, and emotional functioning before their new patient appointment in a pain management clinic.

Using quality improvement methods to increase use of pain prevention strategies for childhood vaccination.

Aim: To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement methodology.

Methods: Specific intervention strategies (., comfort positioning, nonnutritive sucking and sucrose analgesia, distraction) were identified, selected and introduced in three waves, using a Plan-Do-Study-Act framework.

Ocular Radiation Threshold Projection Based off of Fluoroscopy Time During ERCP.

Objectives: Current international guidelines for ocular radiation exposure suggest a threshold of 20 millisieverts (mSv)/year. Although endoscopists wear lead aprons, use of protective eye wear is optional. This study was conducted to analyze the lens radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) for endoscopists to determine the time of fluoroscopy needed to warrant using lens protection during ERCP.

Parental Perceptions of Pediatric Pain and POTS-Related Disability.

Adolescents with postural orthostatic tachycardia syndrome (POTS) often have pain and functional impairment. This study evaluated how parental attributions of children's symptoms relate to child functional impairment. Adolescents with chronic pain and clinical symptoms suggestive of autonomic dysfunction (fatigue, dizziness, nausea) that attended a multidisciplinary chronic pain clinic completed measures of depression, anxiety, and functioning (n = 141).

Adaptation of the State-Trait Inventory for Cognitive and Somatic Anxiety for Use in Children: A Preliminary Analysis.

Objective: Anxiety has both state/trait and cognitive/somatic dimensions, and these distinctions may be particularly relevant for children with medical problems. This two-part study adapted the State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA) and confirmed its factor structure in a sample of children in a primary care clinic.

Methods: STICSA items were adapted for reading level and piloted in a small group of children.

Parent Attitudes Toward Pain Management for Childhood Immunizations.

Objectives: Evidence-based pain-limiting strategies for pediatric immunizations remain underutilized, with barriers identified to date mostly pertaining to health care providers and systems of care. The present study sought to quantify and investigate parent attitudes toward pain management as another potential barrier to the routine use of pain-mitigating strategies during immunizations.

Materials And Methods: Questionnaires measuring parent attitudes, willingness to pay, and perceived barriers for using pain management for immunizations were completed by 259 parent/guardians of children ages 0 to 5 years attending appointments at an urban primary care clinic in the Midwestern United States.

A brief primary care intervention to reduce fear of movement in chronic low back pain patients.

Fear avoidance model of chronic pain-based interventions are effective, but have not been successfully implemented into primary care. It was hypothesized that speed walking times and key measures of the fear avoidance model would improve following the brief intervention delivered in primary care. A brief primary care-based intervention (PCB) that included a single educational session, speed walking (an in vivo desensitization exposure task), and visual performance feedback was designed to reduce fear avoidance beliefs and improve function in 4 patients with chronic low back pain.

The role of parent psychological flexibility in relation to adolescent chronic pain: further instrument development.

Unlabelled: Parental responses to their child's pain are associated with the young person's functioning. Psychological flexibility--defined as the capacity to persist with or change behavior, depending on one's values and the current situation, while recognizing cognitive and noncognitive influences on behavior--may provide a basis for further investigating the role of these responses. The Parent Psychological Flexibility Questionnaire (PPFQ) is a promising but preliminary measure of this construct.

Amplified pain syndromes in children: treatment and new insights into disease pathogenesis.

Purpose Of Review: Although many diagnostic terms are used for pediatric chronic pain, evidence suggests a common thread of signal amplification, leading to the unifying term 'amplified pain syndromes'. Ongoing research provides new insights into biopsychosocial contributors and treatments for pediatric amplified pain syndromes.

Recent Findings: Basic science indicates a complex interplay of genetic, epigenetic, neurochemical, endocrine, and inflammatory contributors, along with environmental and psychological factors.

Where's the ulcer? Spontaneous bleeding from Zenker's diverticulum.

An 89-year-old man with a history of coronary artery disease status post coronary artery bypass grafting and atrial fibrillation on aspirin and warfarin, presented to the emergency department with a symptom of haemoptysis. He reported a history of dysphagia for 3 months prior to presentation, but had yet to seek medical attention. On presentation, he was hypotensive and tachycardic with a haemoglobin of 6.

Effectiveness of using noncontingent escape for general behavior management in a pediatric dental clinic.

In a randomized controlled trial, 151 children 2 to 9 years old were exposed to either usual behavior management or to a fixed-time schedule of brief breaks (noncontingent escape) from ongoing dental treatment. Results demonstrated that the routine delivery of scheduled breaks from treatment significantly reduced the vocal and physical disruptive behavior and the need for restraint in a nonclinical sample of children undergoing restorative dental treatment. In addition, the treatment did not add significantly to the typical time spent on behavior management by dentists.

Acceptance of pain: associations with depression, catastrophizing, and functional disability among children and adolescents in an interdisciplinary chronic pain rehabilitation program.

Objectives: The aims of this study were: (1) investigate relations between pain acceptance, depressive symptoms, catastrophizing, and functional disability in pediatric patients in an interdisciplinary chronic pain rehabilitation program, (2) examine changes in acceptance from pre- to posttreatment, and (3) test if changes in acceptance predict changes in depressive symptoms, catastrophizing, and functional disability from pre- to posttreatment.

Methods: 112 participants, ages 11-18 years, completed the Chronic Pain Acceptance Questionnaire, Adolescent Version, Center for Epidemiological Studies-Depression-Children's Scale, Pain Catastrophizing Scale for Children, and Functional Disability Inventory on admission to and completion of the program.

Results: Significant and strong relations between acceptance, depression, catastrophizing, and functional disability were demonstrated.

Use of video eyewear to manage distress in children during restorative dental treatment.

Purpose: The purpose of this study was to evaluate the effectiveness of video eyewear in reducing disruptive behavior in a typical pediatric dental population during restorative treatment appointments.

Methods: One hundred twenty-eight 4- to 16-year-olds were recruited from a continuous sample of patients seen in an urban dental clinic. Direct observations of distress, self-reported measures of pain, and patient satisfaction were obtained in a randomized clinical trial comparing 2 different types of glasses: (1) wraparound video eyewear; and (2) sunglasses (typical treatment in this dental clinic).