Marcia Meldrum

Preliminary validation of a self-efficacy scale for child functioning despite chronic pain (child and parent versions)

&NA; Despite frequent targeting of health beliefs in pediatric chronic pain treatment interventions, there are currently no reliable and valid self‐efficacy measures for children with chronic pain and their parents. The current study examined the psychometric properties of parent and child versions of a self‐efficacy measure related to the child functioning normally when in pain. Pediatric pain patients, 9–18 years of age, and a caregiver completed questionnaires before an initial tertiary care clinic appointment. The 67 patients in our sample had an average of 1.7 pain locations, including abdominal pain (43.3%), headaches (50.7%), body pain (25.4%), back pain (23.9%), limb pain (20.9%), and/or chest pain (9.0%). Reliability for the new measures was excellent; the Cronbachs alpha was .89 for the 7 child items and .90 for the 7 parent items. Strong evidence for construct validity was also obtained as 23 of the 27 hypothesized correlations were confirmed. As predicted, parent and child ratings of increased self‐efficacy for the child functioning normally when in pain were significantly correlated with each other, and to parent reports of fewer problems functioning due to physical or emotional problems; parent reports of fewer somatic, behavioral or emotional symptoms; parent reports of increased self‐esteem, and unrelated to child pain, age and gender. Additionally, child ratings of increased self‐efficacy were significantly correlated with child reports of increased self‐esteem and fewer somatic symptoms. Replication with a larger sample size, more complex modeling, and prospective studies are indicated.

Treatment Preferences for CAM in Children with Chronic Pain.

CAM therapies have become increasingly popular in pediatric populations. Yet, little is known about childrens preferences for CAM. This study examined treatment preferences in chronic pediatric pain patients offered a choice of CAM therapies for their pain. Participants were 129 children (94 girls) (mean age = 14.5 years ± 2.4; range = 8–18 years) presenting at a multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Bivariate and multivariate analyses were used to examine the relationships between CAM treatment preferences and patients sociodemographic and clinical characteristics, as well as their self-reported level of functioning. Over 60% of patients elected to try at least one CAM approach for pain. The most popular CAM therapies were biofeedback, yoga and hypnosis; the least popular were art therapy and energy healing, with craniosacral, acupuncture and massage being intermediate. Patients with a diagnosis of fibromyalgia (80%) were the most likely to try CAM versus those with other pain diagnoses. In multivariate analyses, pain duration emerged as a significant predictor of CAM preferences. For mind-based approaches (i.e. hypnosis, biofeedback and art therapy), pain duration and limitations in family activities were both significant predictors. When given a choice of CAM therapies, this sample of children with chronic pain, irrespective of pain diagnosis, preferred non-invasive approaches that enhanced relaxation and increased somatic control. Longer duration of pain and greater impairment in functioning, particularly during family activities increased the likelihood that such patients agreed to engage in CAM treatments, especially those that were categorized as mind-based modalities.

A Review of CAM for Procedural Pain in Infancy: Part I. Sucrose and Non-nutritive Sucking

There is increasing concern regarding the number of painful medical procedures that infants must undergo and the potential risks of alleviating infant pain with conventional pharmacologic agents. This article is Part I of a two-part series that aims to provide an overview of the literature on complementary and alternative (CAM) approaches for pain and distress related to medical procedures among infants up to six weeks of age. The focus of this article is a review of the empirical literature on sucrose with or without non-nutritive sucking (NNS) for procedural pain in infancy. Computerized databases were searched for relevant studies including prior reviews and primary trials. The most robust evidence was found for the analgesic effects of sucrose with or without NNS on minor procedural pain in healthy full-term infants. Despite some methodological weaknesses, the literature to date supports the use of sucrose, NNS and other sweetened solutions for the management of procedural pain in infancy.

“I Can't Be What I Want to Be”: Children's Narratives of Chronic Pain Experiences and Treatment Outcomes

BACKGROUND Chronic or recurrent nonmalignant pain is a significant problem for many children and adolescents and often limits the childs participation in normal physical, academic, and social activities. OBJECTIVE To better understand the impact of chronic or recurrent pain on children within the context of their own lives and experiences, using qualitative analysis, and to suggest the applications of the narrative method to clinical practice. DESIGN Grounded theory and narrative analysis of in-depth semi-structured interviews conducted at baseline and 6-12 months following clinic intake. SETTING Subject homes. PATIENTS Fifty-three children ages 10-17 presenting with recurrent pain to a university-based pain clinic. This sample did not differ significantly from the overall clinic population during the study period. RESULTS Five common themes were identified; these suggested that isolation, changed self-perception, activity limitations, concerns about barriers to future goals, and lack of medical validation were important to the childrens perceived impact of pain on their lives. Five narratives were identified, each of which provided a coherent, integrated description of the factors and perspectives presented by a specific subset of children at baseline. These narratives were then compared against the childrens reports of improvement in pain and functioning at 6-12 months; from this comparison, a sixth narrative of therapeutic change emerged for some of the children. CONCLUSIONS The authors suggest that physicians and parents who take the initiative to elicit the childs narrative can help the child to rewrite the story to promote therapeutic change, a better outcome, and higher satisfaction.

A Review of CAM for Procedural Pain in Infancy: Part II. Other Interventions

This article is the second in a two-part series reviewing the empirical evidence for complementary and alternative medicine (CAM) approaches for the management of pain related to medical procedures in infants up to 6 weeks of age. Part I of this series investigated the effects of sucrose with or without non-nutritive sucking (NNS). The present article examines other CAM interventions for procedural pain including music-based interventions, olfactory stimulation, kangaroo care and swaddling. Computerized databases were searched for relevant studies including prior reviews and primary trials. Preliminary support was revealed for the analgesic effects of the CAM modalities reviewed. However, the overall quality of the evidence for these approaches remains relatively weak. Additional well-designed trials incorporating rigorous methodology are required. Such investigations will assist in the development of evidence-based guidelines on the use of CAM interventions either alone or in concert with conventional approaches to provide safe, reliable analgesia for infant procedural pain.

Efficacy of Complementary and Alternative Medicine Approaches for Pediatric Pain

Pain may be a major cause of physical and emotional distress in chronic pediatric conditions, including cancer, juvenile arthritis, and cystic fibrosis. Complementary and alternative medical (CAM) therapies have become important and frequently used modalities in treating children’s pain. Yet, many practitioners have questioned whether there is sufficient evidence to support the efficacy and safety of CAM approaches for pain relief. This chapter aims to address these concerns by presenting a critical review of the available published evidence. We evaluated published studies testing CAM interventions for chronic or acute procedural pain; these study methodologies employed either controlled trials or multiple baseline studies. The evaluation criteria were developed by the American Psychological Association Division 12 Task Force on Promotion and Dissemination of Psychological Procedures to assess nonpharmacological therapies. Few of the CAM modalities qualify as empirically supported therapies under these rigorous criteria, although several met the standard for possibly efficacious or promising for pediatric pain. Our review of the published literature revealed a number of methodological flaws in existing studies. Clearly, more research on CAM therapies for children’s pain is needed.

Changing technologies of cancer pain relief: themes from the twentieth century

Michelle Winslow*, David Clark, Jane Seymour, Bill Noble*, Henk ten Have, Marcia Meldrum**, Silvia Paz* *Academic Palliative M edicine Unit, University of Sheffield, UK Institute for Health Research, Lancaster University, UK ‡School of Nursing and M idwifery, University of Sheffield, UK Division of Ethics of Science and Technology, Paris, France **Department of History, University of California, Los Angeles, US A

Perceived sources of stress and resilience in men in an African American community.

Background: Little is known about the perceived causes of stress and what strategies African American men use to promote resiliency. Participatory research approaches are recommended as an approach to engage minority communities. A key goal of participatory research is to shift the locus of control to community partners.Objective: To understand perceived sources of stress and tools used to promote resiliency in African American men in South Los Angeles.Methods: Our study utilized a community-partnered participatory research approach to collect and analyze open-ended responses from 295 African American men recruited at a local, cultural festival in Los Angeles using thematic analysis and the Levels of Racism framework.Results: Almost all men (93.2%) reported stress. Of those reporting stress, 60.8% reported finances and money and 43.2% reported racism as a specific cause. More than 60% (63.4%) reported that they perceived available sources of help to deal with stress. Of those noting a specific source of help for stress (n = 76), 42.1% identified religious faith. Almost all of participants (92.1%) mentioned specific sources of resiliency such as religion and family.Conclusions: Stress owing to psychosocial factors such as finances and racism are common among African American men. But, at the same time, most men found support for resiliency to ameliorate stress in religion and family. Future work to engage African American men around alleviating stress and supporting resiliency should both take into account the perceived causes of stress and incorporate culturally appropriate sources of resiliency support.

Women making contraceptive choices in 20th-century America

Christopher Tietze proposed that any contraceptive approach succeeds only if it is “use-effective” – one which individual women and women find appropriate for use within their own lives. This idea has very different connotations; in developed countries they are marketed products and in the developing world they are tactics in government population control programs. This article examines a few historical instances from the United States in the mid-20th century that explore the way women responded to using contraceptives. Many women’s responses to contraception – particularly oral contraceptives intrauterine devices (IUDs) and Norplant – are complex and constantly evolving. They are interwoven with feminism concerns about pharmaceutical marketing and the rising consciousness of women about their own health. Looking back to the 1950s when Tietze’s began his research it is important to understand that where women have options women will make choices. This is where family planning policy must start.

Changing technologies of cancer pain relief: case studies of innovation

In a previous article (1), we presented the first phase of a project within the International Observatory on End of Life Care that is seeking to develop an analysis of the specific problem of cancer pain relief in its historical and cultural context (2). We offered a historical overview of major themes in cancer pain relief in the 20th century by exploring the interplay of regulatory, scientific, clinical, cultural and ethical dimensions – themes which continue to shape contemporary debate and practice. In this article, we present an overview of the second phase of the study in which we explore contemporary debate and practice in case studies of three fields of innovation that emerged from our earlier analysis of the history of cancer pain relief since 1945.