Lisa Scharff

Social desirability response bias and self-report of psychological distress in pediatric chronic pain patients.

&NA; The objective of this study was to investigate associations between social desirability response bias and self‐report of pain, disability, and psychological distress (depression, anxiety, and somatic symptoms) in a sample of children presenting to a multidisciplinary pediatric chronic pain clinic. A retrospective review was conducted on 414 consecutive clinic patients, ages 12–17 years, with chronic pain complaints of at least 3 months’ duration. As part of a clinical battery, children completed self‐report psychological questionnaires including the Children’s Depression Inventory, Children’s Somatization Inventory, and Revised Children’s Manifest Anxiety Scale including the Lie Scale, an indicator of social desirability influence. Children also provided self report of pain intensity, pain duration and functional disability. Clinician ratings of anxiety and depressive symptoms also were collected. Results show that children scoring high on the measure of social desirability reported fewer symptoms of depression and anxiety compared to children scoring low on the social desirability index. No differences arose between these groups on reports of somatic symptoms, pain duration, or pain‐related disability. These findings suggest that social desirability response bias may have implications for the self‐report of psychological distress among pediatric chronic pain patients. The limits of self‐report of symptoms should be considered in the clinical and research contexts.

Psychological, behavioral, and family characteristics of pediatric patients with chronic pain : A 1-year retrospective study and cluster analysis

Objectives:There has been a longstanding recognition that adult patients with chronic pain are not a homogenous population and that there are subgroups of patients who report high levels of distress and interpersonal difficulties as well as subgroups of patients who report little distress and high functioning. The purpose of the present study was to attempt to identify similar subgroups in a pediatric chronic pain population. Methods:The sample consisted of 117 children with chronic pain and their parents who were assessed in a multidisciplinary pain clinic during 2001. Participants completed a set of psychologic self-report questionnaires, as well as demographic and pain characteristic information. A cluster analysis was conducted to identify 3 distinct subgroups of patients to replicate similar studies of adult chronic pain sufferers. Results:Overall, mean scores were within population norms on measures of distress and family functioning, with somatic symptoms at a level of clinical significance. The cluster analysis identified the 3 subgroups that were strikingly similar to those identified in adult chronic pain populations: one with high levels of distress and disability, another with relatively low scores on distress and disability, and a third group that scored in between the other 2 on these measures but with marked low family cohesion. Discussion:The similarity of these subgroups to the adult chronic pain population subgroups as well as implications for future studies are discussed.

The Role of Minimal- and No-Contact Behavioural Treatments in Migraine

The impact of migraine is substantial for both the individual who suffers from it and society in general in terms of lost work hours, medication costs and healthcare usage. Many different forms of treatment are available for migraine, including biobehavioural approaches such as relaxation training and biofeedback.Research regarding the efficacy of these nonpharmacological treatments has been extensive and consistently demonstrates lasting success with the use of the skills taught in treatment. Such treatment approaches have demonstrated effectiveness even when delivered in as few as 2 or 3 sessions with a therapist, thus substantially reducing the cost of treatment. Other treatment formats such as group and no-contact therapies have demonstrated success as well.This article reviews the efficacy and cost efficiency of minimal-contact biobehavioural treatments for migraine as outlined in the research literature. Strictly self-help approaches are also reviewed, and resources for self-help information are discussed. The research indicates that such time-limited and focused treatment approaches are highly effective with select patients; however, there is a lack of research specifying the specific types of patients with migraine who benefit the most from these approaches. Future research needs to address this issue in order to provide the most efficacious and cost-effective treatments for all patients with migraine.

Functional Abdominal Pain

Functional abdominal pain (FAP) is a frequent complaint seen in the pediatric primary care setting. Current diagnostic criteria for functional gastrointestinal disorders (FGIDs) are defi ned in the Rome III criteria, which outline a positive symptom profi le for diagnosis. In addition, clinicians should be aware of specifi c “red fl ag ” rule-out symptoms that may suggest organic disease rather than FAP. Although an organic etiology for functional abdominal pain is unclear, substantive research supports the role of “visceral hyperalgesia ” and biopsychosocial determinants in the maintenance of FAP. Prognostic factors for this condition suggest that individuals reluctant to adopt a biopsychosocial model of pain are more likely to experience continued symptoms and impairment into adulthood. Assessment of FAP generally involves a thorough history and minimal laboratory tests. For treatment, several promising biobehavioral strategies have received empirical support for successfully addressing FAP symptoms. This chapter will review our current understanding of FAP, how to adequately assess for this condition, and promising treatment strategies for children with living with painful FGIDs.