"The mere imagination scares me"-evidence for fear responses during mental imagery of pain-associated interoceptive sensations in adolescents with chronic pain.

According to the bio-informational theory of emotion by Lang, mental imagery of fearful stimuli activates physiological and behavioural response systems, even in the absence of sensory input. We investigated whether instructed mental imagery of pain-associated (not painful) interoceptive sensations entails a threat value and elicits increased startle response, skin conductance level (SCL), and heart rate (HR) indicative of defensive mobilization in adolescents with chronic pain. Additionally, self-reported measures (fear, fear of pain, desire to avoid) were assessed.

Know Pain, No Pain? Preliminary Testing and Application of a New Tool to Assess Biopsychosocial Pain Concepts in Children.

To deliver tailored pain science education, assessing children's biopsychosocial pain concepts is necessary. As validated tools are lacking, a new tool is presented, the biopsychosocial pain concept matrix (BiPS matrix), which assesses children's biological, psychological, and social pain concepts in five domains according to the Common-Sense Model of Self-Regulation (Hagger and Orbell, 2003): (1) illness identity, (2) causes, (3) consequences, (4) duration, and (5) treatment. The present preliminary study aims to (1) assess the items' readability and understandability in cognitive interviews with = 9 healthy children (9 to 19 years, = 13.

Interoception in preschoolers: New insights into its assessment and relations to emotion regulation and stress.

Interoception may play an important role for emotion regulation and stress, thereby affecting mental health in children and adults. Yet, little is known on interoception in preschool children. Therefore, we investigated interoceptive accuracy using the adapted Jumping Jack Paradigm (JJP) and its relationship with emotion regulation and stress.

[Parental responses to child pain : The role of parental and child somatic and anxiety symptoms].

Background: Parental cognitive-affective and behavioural responses impact on the chronification of the child's pain. Whether mothers and fathers differ in their responses and whether top-down variables (parental somatization, anxiety symptoms) and bottom-up variables (child's pain-related disability, anxiety symptoms) impact on parental responses remains unresolved.

Objectives: (1) A comparison of maternal and paternal somatization, anxiety, symptoms and their responses (parental catastrophizing, solicitousness) to children with chronic pain; (2) an analysis of the impact of top-down variables (parental somatization, anxiety symptoms) and bottom-up variables (child's pain-related disability, anxiety symptoms) on parental maladaptive responses.

Bottom-up or top-down?: The role of child and parent chronic pain and anxiety in the context of parental catastrophizing and solicitousness.

Purpose: Children of parents with chronic pain are a high-risk group to develop own chronic pain. There is evidence that parental responses such as catastrophizing and solicitousness play an important role in the familial transmission of chronic pain. However, little is known about factors that modulate these responses.

Interoceptive accuracy, emotion recognition, and emotion regulation in preschool children.

Little is known about the conscious experience of internal bodily sensations in preschool-aged children. Given that preschoolers are in the most rapid phase of brain development, and display profound emotional development, it was the aim of the present study to establish an adapted interoceptive accuracy paradigm and to investigate associations between sociodemographic (age, sex) and emotional variables with interoceptive accuracy. Forty-nine children (aged 4-6 years) completed the jumping jack paradigm (JJP), a heartbeat tracking paradigm, which includes a noninvasive physical perturbation via performing jumping jacks for 10 s.

Defence response mobilization in response to provocation or imagery of interoceptive sensations in adolescents with chronic pain: a study protocol.

Introduction: Fear of pain seems to be a key factor in the development and maintenance of chronic pain and pain-related disability. Interoceptive fear conditioning is assumed to constitute an important mechanism in the origins and maintenance of fear of pain. If conditioned stimuli such as internal bodily sensations are repeatedly paired with pain (unconditioned stimulus), they in turn elicit a conditioned fear response, including defence mobilization such as startle modulation and changes in heart rate and electrodermal activity.

Do Interoceptive Sensations Provoke Fearful Responses in Adolescents With Chronic Headache or Chronic Abdominal Pain? A Preliminary Experimental Study.

To determine whether fear can be triggered when experiencing interoceptive sensations locally proximal to the primary pain region.  Two groups of adolescents (11-18 years) with chronic headache ( n  = 20) or chronic abdominal pain (CAP; n  = 20) completed three muscle tensing tasks to induce proximal versus distal sensations: (1) "frown" task (proximal for chronic headache; distal for CAP), (2) "tighten stomach" task (proximal for CAP; distal for chronic headache), and (3) safe comparison task (clench fist). Fear and avoidance were assessed via self-report.

Why Harmless Sensations Might Hurt in Individuals with Chronic Pain: About Heightened Prediction and Perception of Pain in the Mind.

In individuals with chronic pain harmless bodily sensations can elicit anticipatory fear of pain resulting in maladaptive responses such as taking pain medication. Here, we aim to broaden the perspective taking into account recent evidence that suggests that interoceptive perception is largely a construction of beliefs, which are based on past experience and that are kept in check by the actual state of the body. Taking a Bayesian perspective, we propose that individuals with chronic pain display a heightened prediction of pain [prior probability ], which results in heightened pain perception [posterior probability ] due to an assumed link between pain and a harmless bodily sensation [].

Systematic Review on Intensive Interdisciplinary Pain Treatment of Children With Chronic Pain.

Background And Objective: Pediatric debilitating chronic pain is a severe health problem, often requiring complex interventions such as intensive interdisciplinary pain treatment (IIPT). Research is lacking regarding the effectiveness of IIPT for children. The objective was to systematically review studies evaluating the effects of IIPT.

Chronic pain treatment in children and adolescents: less is good, more is sometimes better.

Background: In children with chronic pain, interdisciplinary outpatient and intensive inpatient treatment has been shown to improve pain intensity and disability. However, there are few systematic comparisons of outcomes of the two treatments. The present naturalistic study aimed to compare the clinical presentation and achieved changes at return in three outcome domains (pain intensity, disability, school absence) between a) outpatients vs.

Internet-based motivation program for women with eating disorders: eating disorder pathology and depressive mood predict dropout.

Background: One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology.

Objective: The aim of the present study was to identify predictors of dropout from this Web program.

Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects.

Pediatric chronic pain, which can result in deleterious effects for the child, bears the risk of aggravation into adulthood. Intensive interdisciplinary pain treatment (IIPT) might be an effective treatment, given the advantage of consulting with multiple professionals on a daily basis. Evidence for the effectiveness of IIPT is scarce.

Did increased availability of pediatric palliative care lead to improved palliative care outcomes in children with cancer?

Background: Awareness for pediatric palliative care in children with cancer increased in the last ten years in Germany. In this study we sought to determine whether this change in awareness led to improved palliative care outcomes in children dying due to cancer.

Methods: In 2005 we interviewed a cohort of 48 bereaved parents who had a lost a child to cancer approximately five years earlier (2000 cohort), and in 2010 we interviewed another cohort of 48 parents who had lost a child due to cancer approximately five years before (2005 cohort).

Snake: the development and validation of a questionnaire on sleep disturbances in children with severe psychomotor impairment.

Objective: Sleep disturbance and daytime restlessness are present in 50% to 80% of children with severe psychomotor impairment due to neurologic or other complex diseases. Although these issues severely impair the quality of life of the children and their families, they are not well addressed or managed by professionals. The lack of validated assessment tools prevents further research and the development of adequate therapies.

Children dying from cancer: parents' perspectives on symptoms, quality of life, characteristics of death, and end-of-life decisions.

In this study, we investigated the experience of children who died of cancer, as perceived by their parents. All the pediatric oncology departments in one German federal state were contacted and asked to invite parents who had lost a child to cancer in the period 2005-2006 to participate. Those parents who accepted were interviewed by means of a semi-structured questionnaire.

[Development and validation of a German questionnaire assessing motivation to change in eating disorders - the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED)].

The present study describes the development and validation of a German questionnaire assessing motivation to change in individuals with eating disorders (Stages of Change Questionnaire-Eating Disorders, SOCQ-ED). The SOCQ-ED measures stages of change separately for each eating disorder symptom domain. Psychometric properties were assessed in a sample of N=63 women with Anorexia Nervosa or Bulimia Nervosa.

Maintaining lasting improvements: one-year follow-up of children with severe chronic pain undergoing multimodal inpatient treatment.

Objective: To investigate the long-term effectiveness of a 3-week multimodal inpatient program for children and adolescents with chronic pain.

Methods: 167 adolescents were evaluated at pretreatment baseline, 3-, and 12-month follow-up. Long-term effectiveness was investigated for pain-related variables (pain-related disability, school absence, pain intensity) and emotional distress.

Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients.

Background: Prevalence of pain as a recurrent symptom in children is known to be high, but little is known about children with high impairment from chronic pain seeking specialized treatment. The purpose of this study was the precise description of children with high impairment from chronic pain referred to the German Paediatric Pain Centre over a 5-year period.

Methods: Demographic variables, pain characteristics and psychometric measures were assessed at the first evaluation.

Development of somatosensory perception in children: a longitudinal QST-study.

Cross-sectional studies on somatosensory perception in children demonstrate lower pain thresholds for children compared with adolescents. The aim of the present longitudinal study was to replicate these age-related differences in a longitudinal design. Total 38 children and adolescents aged 6 to 16 years (two girls and two boys within each year) participated in this study.

Sleep disturbances in children with multiple disabilities.

Introduction: Although sleep disturbances in disabled children are of central clinical importance, there is little research on that topic. There are no data available on frequency, severity or aetiology of sleep disturbances and related symptoms in this specific patient group.

Objective: To review the current state of research and outline future research objectives.

Specialized multimodal outpatient treatment for children with chronic pain: treatment pathways and long-term outcome.

Objective: Despite the increased recognition of paediatric chronic pain, centres for providing appropriate treatment are scarce, and much remains unknown about optimal treatment approaches. The purpose of this study was to investigate effectiveness of multimodal outpatient treatment (MOT) through the examination of treatment pathways and long-term outcomes.

Methods: Within an observational longitudinal study, 275 children (4-18years) formed the study group and received MOT.

Parental catastrophizing about their child's chronic pain: are mothers and fathers different?

Preliminary evidence suggests that parental catastrophizing about their child's pain may be important in understanding both parental responses to their child's pain and the child's pain experience. However, little is known about potential differences between mothers and fathers. There were three aims of the present study addressing this lack of knowledge: (i) to investigate the three-factor structure of the German version of the Parental Pain Catastrophizing Scale (PCS-P) (Goubert et al.

The pain provocation technique for adolescents with chronic pain: preliminary evidence for its effectiveness.

Objective: This study aims to investigate the effectiveness of the "pain provocation technique" (PPT)--a focused treatment strategy incorporating interoceptive exposure (i.e., imagining increases in pain intensity), bilateral stimulation (tactile stimulation), and implementation of pain-related coping to decrease pain intensity--for adolescents suffering from chronic pain.