Anna Huguet

The epidemiology of chronic pain in children and adolescents revisited: A systematic review

Summary Chronic pain is prevalent in children and adolescents, with headaches being most common. Quality assessment indicated that most epidemiological studies do not meet quality criteria. ABSTRACT Chronic and recurrent pain not associated with a disease is very common in childhood and adolescence, but studies of pain prevalence have yielded inconsistent findings. This systematic review examined studies of chronic and recurrent pain prevalence to provide updated aggregated prevalence rates. The review also examined correlates of chronic and recurrent pain such as age, sex, and psychosocial functioning. Studies of pain prevalence rates in children and adolescents published in English or French between 1991 and 2009 were identified using EMBASE, Medline, CINAHL, and PsycINFO databases. Of 185 published papers yielded by the search, 58 met inclusion criteria and were reviewed, and 41 were included in the review. Two independent reviewers screened papers for inclusion, extracted data, and assessed the quality of studies. Prevalence rates ranged substantially, and were as follows: headache: 8–83%; abdominal pain: 4–53%; back pain: 14–24%; musculoskeletal pain: 4–40%; multiple pains: 4–49%; other pains: 5–88%. Pain prevalence rates were generally higher in girls and increased with age for most pain types. Lower socioeconomic status was associated with higher pain prevalence especially for headache. Most studies did not meet quality criteria.

Evidence for the use of a numerical rating scale to assess the intensity of pediatric pain

The aim of this work was to evaluate the psychometric properties of the Numerical Rating Scale‐11 (NRS‐11) when used to assess pediatric pain intensity. We performed two studies: 175 schoolchildren, aged 8–12, participated in Study 1 and 63 children undergoing surgery and aged 6–16, participated in Study 2. The NRS‐11 showed (a) adequate convergent construct validity when correlated with the Faces Pain Scale – Revised (FPS‐R; r1 = 0.78, r2 = 0.93); (b) adequate discriminant validity in relation to measures of pain‐related affect (z1 = 3.55, z2 = 7.62) and disability (z1 = 7.62, z2 = 6.83); and (c) adequate criterion‐related validity using measures of pain‐related affect (r1 = .58, r2 = .66), disability (r1 = 0.22, r2 = .39), and quality of life (r2 = −.46). Schoolchildren were asked whether they preferred using the NRS‐11 or the FPS‐R when reporting the intensity of their pain. While both sexes and both the younger and older age groups preferred the FPS‐R, this preference was more marked among girls and younger children.

Judging the quality of evidence in reviews of prognostic factor research: adapting the GRADE framework

BackgroundPrognosis research aims to identify factors associated with the course of health conditions. It is often challenging to judge the overall quality of research evidence in systematic reviews about prognosis due to the nature of the primary studies. Standards aimed at improving the quality of primary studies on the prognosis of health conditions have been created, but these standards are often not adequately followed causing confusion about how to judge the evidence.MethodsThis article presents a proposed adaptation of Grading of Recommendations Assessment, Development and Evaluation (GRADE), which was developed to rate the quality of evidence in intervention research, to judge the quality of prognostic evidence.ResultsWe propose modifications to the GRADE framework for use in prognosis research along with illustrative examples from an ongoing systematic review in the pediatric pain literature. We propose six factors that can decrease the quality of evidence (phase of investigation, study limitations, inconsistency, indirectness, imprecision, publication bias) and two factors that can increase it (moderate or large effect size, exposure-response gradient).ConclusionsWe describe criteria for evaluating the potential impact of each of these factors on the quality of evidence when conducting a review including a narrative synthesis or a meta-analysis. These recommendations require further investigation and testing.

Measurement of self-reported pain intensity in children and adolescents

Acute and chronic pain is a common experience in children and youth. A thorough assessment is fundamental to understand this experience and to assess and monitor treatment responses. The intensity of pain is the parameter most commonly assessed. In this article, we describe the different methods employed to assess pediatric pain intensity and review well-validated and commonly used self-report measures of pain. This review is based on the recent systematic reviews conducted for the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials Consensus Group and the Society of Pediatric Psychology. Amongst the several types of pediatric pain measures, self-report, when available, is regarded as the primary source of information about pain intensity, to be complemented by observation and knowledge of the context. There is a large number of self-report measures of pediatric pain intensity; and there is some agreement that professionals in the clinical and research practice should assess pain intensity using the Pieces of Hurt Tool, the Faces Pain Scale, the Oucher, or Visual Analogue Scales because these measures have shown to have sound psychometric properties and clinical utility. Despite the increased number of age-appropriate self-report measures of pediatric pain intensity over the last years, we report several research gaps and priorities of future research.

The fear-avoidance model in whiplash injuries

The aim of this work was to study whether fear of movement, and pain catastrophizing predict pain related‐disability and depression in sub‐acute whiplash patients. Moreover, we wanted to test if fear of movement is a mediator in the relation between catastrophizing and pain‐related disability/depression as has been suggested by the fear‐avoidance model [Vlaeyen JWS, Kole‐Snijders AMJ, Boeren RGB, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62:363–72]. The convenience sample used was of 147 sub‐acute whiplash patients (pain duration less than 3 months). Two stepwise regression analyses were performed using fear of movement and catastrophizing as the independent variables, and disability and depression as the dependent variables. After controlling for descriptive variables and pain characteristics, catastrophizing and fear of movement were found to be predictors of disability and depression. Pain intensity was a predictor of disability but not of depression. The mediation effect of fear of movement in the relationships between catastrophizing and disability, and between catastrophizing and depression was also supported. The results of this study are in accordance with the fear‐avoidance model, and support a biopsychosocial perspective for whiplash disorders.

Evaluation of reliability, validity, and preference for a pediatric pain intensity scale: the Catalan version of the faces pain scale: revised

&NA; The main objective of this research was to determine the initial psychometric properties of the Faces Pain Scale – Revised (FPS‐R) as a measure of pain intensity for use with Catalan children and adolescents. Results of the Catalan version of this scale (FPS‐R‐C) are similar to those obtained with the original instrument. In order to assess the validity and reliability of the FPS‐R‐C, two different samples were studied. The first sample contained 124 hospitalized children and adolescents (mean age 10.86; SD 2.5). They were asked to rate their affective state on the Faces Affective Scale (FAS) and the intensity of their pain on the FPS‐R‐C and the Coloured Analogue Scale (CAS). The pain intensity ratings reported with FPS‐R‐C and CAS were very similar, correlations ranging from 0.83 to 0.9. The relationship between the intensity of pain experienced and childrens affective state was also statistically significant (r=0.32, P<0.01). The second sample contained 247 schoolchildren (mean age 9.43; SD 1.55), who were asked to imagine themselves in eight hypothetical painful situations and rate the degree of pain using the FPS‐R‐C and the CAS (correlations ranging from 0.83 to 0.96). Test–retest correlations on this questionnaire (Painful Events Inventory) ranged from 0.26 to 0.70. Overall, these results provide preliminary evidence of the reliability, and convergent and criterion‐related validity of the FPS‐R‐C. Moreover, all participating subjects were asked to choose the pain scale they preferred the most. Our data suggest that, regardless of their age and/or gender, the subjects prefer the FPS‐R‐C to the CAS.

A Systematic Review of Cognitive Behavioral Therapy and Behavioral Activation Apps for Depression

Depression is a common mental health condition for which many mobile apps aim to provide support. This review aims to identify self-help apps available exclusively for people with depression and evaluate those that offer cognitive behavioural therapy (CBT) or behavioural activation (BA). One hundred and seventeen apps have been identified after searching both the scientific literature and the commercial market. 10.26% (n = 12) of these apps identified through our search offer support that seems to be consistent with evidence-based principles of CBT or BA. Taking into account the non existence of effectiveness/efficacy studies, and the low level of adherence to the core ingredients of the CBT/BA models, the utility of these CBT/BA apps are questionable. The usability of reviewed apps is highly variable and they rarely are accompanied by explicit privacy or safety policies. Despite the growing public demand, there is a concerning lack of appropiate CBT or BA apps, especially from a clinical and legal point of view. The application of superior scientific, technological, and legal knowledge is needed to improve the development, testing, and accessibility of apps for people with depression.

The Catalan version of the Pain Catastrophizing Scale: a useful instrument to assess catastrophic thinking in whiplash patients.

UNLABELLED The main aims of this work were to test the psychometric properties of the Catalan version of the Pain Catastrophizing Scale (PCS) and to assess the usefulness of the scale when used with whiplash patients. This article reports results from 2 complementary studies. In the first one, the PCS was administered to 280 students and 146 chronic pain patients to examine the psychometric properties of a new Catalan version of the instrument. A confirmatory factor analysis supported a second-order structure, in which 3 second-order factors (ie, rumination, helplessness, and magnification) load in a higher-order factor (ie, catastrophizing). The reliability of the Catalan version was supported by an acceptable internal consistency and test-retest values. Validity was supported by the correlations found among the PCS and pain intensity, pain interference, and depression. The objective of the second study was to evaluate the PCS when used with whiplash patients. In this second study, 141 patients with whiplash disorders participated. In general, the psychometric properties of the PCS were found appropriate, with factor analysis supporting the structure described in patients with chronic pain. Our data suggest that the PCS is a good instrument to assess catastrophic thinking in whiplash patients. PERSPECTIVE The usefulness of the PCS in whiplash disorders has been explored in this study. Results of our work show that the PCS can be a very useful tool to assess catastrophic thinking about pain in whiplash patients.

Commercially Available Mobile Phone Headache Diary Apps: A Systematic Review

Background Headache diaries are often used by headache sufferers to self-monitor headaches. With advances in mobile technology, mobile electronic diary apps are becoming increasingly common. Objective This review aims to identify and evaluate all commercially available mobile headache diary apps for the two most popular mobile phone platforms, iOS and Android. Methods The authors developed a priori a set of 7 criteria that define an ideal headache diary app intended to help headache sufferers better understand and manage their headaches, while providing relevant data to health professionals. The app criteria were intended as minimum requirements for an acceptable headache diary app that could be prescribed by health care professionals. Each app was evaluated and scored against each criterion. Results Of the 38 apps identified, none of the apps met all 7 app criteria. The 3 highest scoring apps, meeting 5 of the app criteria, were iHeadache (developed by Better QOL), ecoHeadache (developed by ecoTouchMedia), and Headache Diary Pro (developed by Froggyware). Only 18% of the apps were created with scientific or clinical headache expertise and none of the apps reported on psychometric properties. Conclusions Despite the growing market and demand, there is a concerning lack of scientific expertise and evidence base associated with headache diary apps.

Disability in subacute whiplash patients: usefulness of the neck disability index.

Study Design. Cross-sectional study. Objective. To analyze the psychometric properties of the neck disability index (NDI), with a special emphasis in its factor structure, and its usefulness, in a sample of patients suffering from a subacute whiplash problem. Summary of Background Data. A valid and reliable instrument to assess pain-related disability would be of great help to clinicians and researchers interested in whiplash associated disorders. First, to better understand the impact of whiplash on the patient’s life, and his or her progress over time. Second, to formulate comprehensive treatment plans, and evaluate the results from therapeutic actions. Finally, to follow-up patients’ changes and improvement. The NDI could be an appropriate instrument for these purposes. Methods. A convenience sample of 150 subacute whiplash patients participated. They were requested to complete the Catalan version of the NDI, and report about their pain intensity, pain interference and depression. Results. An exploratory factor analysis showed that the NDI can be viewed as a 2-factor instrument. The items and the instrument’s total score were normally distributed. Internal consistency was also appropriate both for the total score (Cronbach’s &agr;: 0.87) and the 2 subscales (0.7 for the pain and interference with cognitive functioning scale, and 0.83 for the physical functioning scale). Total NDI and subscales scores significantly correlated with pain intensity, pain interference, and depression. Conclusion. The NDI showed excellent psychometric properties in a sample of subacute whiplash patients. Additional research is needed to replicate the NDIs factor structure.