Chronic Pain
What parent factors have been found to, or theorized to, impact child pain?
Maternal depression, maternal anxiety, social reinforcement of pain behaviors, pain catastrophizing, attention to pain, parent health/pain
What were the similarities and differences in the interventions used in the Levy et al. and Palermo et al. studies?
They both used CBT.
Levy: parent only in person and phone delivered SLCBT (social learning and CBT).
Palermo: parent and child internet delivered CBT
How does this clinic's treatment compare to the treatments described in the intervention articles (Palermo et al. & Levy et al.)?
While the video and articles talked about CBT, the clinic took a multipronged approach which wasn’t done in all of the articles. In Palermo, there was a child focused and parent focused approaches, and Levy did a parent only focus.
What do RAP and FAPD stand for, and how is each defined?
Recurrent abdominal pain (RAP) = three or more episodes of pain within a three-month period accompanied by functional impairment.
Functional abdominal pain disorders (FAPD) = Abdominal pain without evidence of an inflammatory, anatomic, metabolic, or neoplastic process that could explain symptoms; includes FAP and IBS.
What large population was excluded from both of the intervention studies (Levy et al. & Palermo et al.) from this week? Why might this be a problem?
Non-English speaking, leaves a population out that is at increased risk of stress, don’t know if can extend findings
As a provider at this clinic, what factors would you want to assess based on the readings from this week?
pain intensity & duration, functional impairment (e.g. school, sleeping), child mental health (e.g. anxiety, depression), family functioning, how parents respond to pain, treatment acceptability and satisfaction, impact of child chronic pain on parent.
What family-level factors did we read about this week that have come up several times before as related to pediatric illnesses?
parent communication and behavior, family organization
According to Johnson et al., why might the Emergency Department setting in particular contribute to providers' use of racial/ethnic stereotyping? (2 factors)
The stressful ED setting may foster providers’ use of mental shortcuts or heuristics including racial/ethnic profiling and stereotyping. Combined with lack of an established patient-provider relationship in EDs, and the subjective nature of abdominal pain, may all enhance the use of heuristic methods
If you got to design your own treatment at this clinic, what child-focused components would you include and why?
Psychoeducation about chronic pain, recognizing stress and negative emotions, distraction, relaxation, using skills at school, cognitive coping skills, sleep hygiene and lifestyle, staying active, and relapse prevention, multidisciplinary approach with many team members, reintegration into normal activities. Maybe substitute some in-person treatment for telephone or internet-delivered support
What is parental solicitousness/miscarried parenting, as it refers to child pain behaviors? (Palermo et al review article and Levy et al)
frequent attending to pain symptoms and granting permission to avoid regular activities
In the Dufton et al. study, why is the finding that pain tolerance was not related to physiological reactivity to stress (as measured by heart rate) surprising? How does this contrast previous research we've read about?
Biological embedding theory and allostatic load theory both suggest that chronic stress experiences impact physiological stress management systems. e.g. In patients with diabetes, higher levels of stress reactivity on a self-report measure were related to lower levels of self-management, which, in turn, were related to poorer QOL and higher A1C. Also, in studies of early puberty development, greater basal cortisol in children was found to directly predict poorer later mental health.
If you got to design your own treatment at this clinic, what parent-focused components would you include and why?
Psychoeducation about chronic pain, recognizing stress and negative emotions, differentially attend to and reinforce wellness and illness behaviors, reduce catastrophizing and threat appraisals, and model healthy responses to somatic symptoms, support use of adaptive coping skills, sleep hygiene and lifestyle, staying active, and relapse prevention. Multidisciplinary approach with many team members, reintegration into normal activities. Maybe substitute some in-person treatment for telephone or internet-delivered support.