In this study, we describe the development and validation of a revised Pediatric Chronic Pain Grading (P-CPG) for children aged 8 to 17 years that adds emotional impairment to previously used measures of pain intensity and functional impairment. Such a measure enables the assessment of chronic pain severity in different epidemiological and clinical populations, the stratification of treatment according to pain severity, and the monitoring of treatment outcome. The P-CPG was developed using a representative sample of school children with chronic pain (n = 454; M age = 12.95, SD = 2.22). Construct validity and sensitivity to change were examined within a sample of N = 2448 children and adolescents (M age = 12.71, SD = 2.47) comprising 3 subsamples (school n = 1562, primary care n = 129, and tertiary care n = 757) affected by chronic pain to varying extents. Results showed that P-CPG grades differed significantly among the 3 subsamples, with school children being least affected by chronic pain and tertiary care patients being most affected. As P-CPG grade increased, so did pain intensity, functional impairment, pain-related school absence, and emotional impairment. Convergent validity was demonstrated by significant positive correlations between the P-CPG and global ratings of pain severity as well as objective claims data; the latter reflects greater health care costs with increasing P-CPG scores. Sensitivity to change was supported by a significant reduction in baseline P-CPG grades 3 and 6 months after intensive interdisciplinary pain treatment in tertiary care sample. In conclusion, the P-CPG is an appropriate measure of pain severity in children and adolescents with chronic pain in clinical as well as epidemiological settings.
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http://dx.doi.org/10.1097/j.pain.0000000000003226 | DOI Listing |
Graefes Arch Clin Exp Ophthalmol
December 2024
Department of Ophthalmology and Laboratory of Eye Research, Rabin Medical Center - Beilinson Hospital, Felsenstein Medical Research Center, 39 Jabotinski St., Petach Tikva, 49100, Israel.
Background: Diabetes poses a risk to diabetic keratopathy in up to two-thirds of patients. Insulin-degrading enzyme (IDE) is a protease that can break down insulin and several growth factors and may impair wound healing. Increased IDE levels have been found in fluid from diabetic skin ulcers.
View Article and Find Full Text PDFScand J Pain
January 2024
Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Jan Waldenströms Gata 35, 202 13 Malmö, Sweden.
Objectives: The efficacy of long-term opioid therapy (LTOT) in treating patients with chronic non-cancer pain (CnCP) is questionable, and the potential risks of adverse effects are well established. The aims were as follows: (1) compare characteristics in patients exposed to LTOT vs non-exposed. (2) Regarding opioid-exposed patients, describe characteristics of patients with risk factors for opioid use disorder or overdose in relation to opioid dosage.
View Article and Find Full Text PDFThe peripheral nervous system has been widely implicated in pathological conditions that exhibit distinct clinical presentations in men and women, most notably in chronic pain disorders. Here, we explored this sexual dimorphism at a molecular level. We expanded the available omics landscape in the PNS to include quantitative proteomics of the human dorsal root ganglia (hDRG) and nerve.
View Article and Find Full Text PDFChronic Stress (Thousand Oaks)
December 2024
Department of Surgery and Perioperative Care, Dell Medical School, Austin, TX, USA.
Background: Greater unhelpful thinking is associated with greater musculoskeletal discomfort and incapability. Cognitive-behavioral therapy (CBT) fosters healthy thinking to help alleviate symptoms.
Questions: In a meta-analysis of randomized control trials (RCT) of CBT for unhelpful thinking among people with musculoskeletal symptoms, we asked: 1) Does CBT reduce unhelpful thinking and feelings of distress, and improve capability, in individuals with musculoskeletal symptoms? 2) Are outcomes affected by CBT delivery methods?
Methods: Following QUOROM guidelines, we searched databases using keywords of pain catastrophizing, kinesiophobia, cognitive-behavioral therapy, musculoskeletal and variations.
Cureus
November 2024
General Surgery, Northeast Georgia Medical Center Braselton, Braselton, USA.
Mesh plugs are commonly used in inguinal hernia repair due to their perceived efficacy in reducing recurrence rates. However, their use has been associated with significant complications, including mesh migration, chronic pain, infection, hernia recurrence, adhesions, and erosion into adjacent organs. This case series presents three patients who experienced complications from mesh plug migration post-hernia repair.
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