Tine Vervoort

Background: Children with cancer frequently experience pain, which may persist into survivorship. Furthermore, many undergo body composition changes throughout their disease trajectory. However, little is still known about the interplay between pain and body composition. Methods: This cross-sectional case–control study compared pain and anthropometric characteristics between 30 children with cancer (8–18 years) and 30 age- and sex-matched healthy controls and examined whether pain was associated with anthropometric characteristics and cancer diagnosis. Pain in the past two weeks, chronic pain, and pressure pain thresholds (PPTs) at the tibialis anterior and trapezius pars descendens muscles were assessed. Anthropometric measures included waist circumference, fat %, fat-free mass, muscle mass, body water %, and Body Mass Index. Results: Children with cancer had a higher prevalence of chronic pain (p = 0.011), lower PPTs at the tibialis anterior (p = 0.030), and fewer pain locations (p = 0.037). They also showed lower body water % (p = 0.020), and higher waist circumference (p = 0.012) and fat % (p = 0.026). Cancer diagnosis and lower muscle mass were associated with lower PPTs at both locations (tibialis anterior: p = 0.016, β = −0.305; p = 0.033, β = 0.267; trapezius pars descendens: p = 0.020, β = −0.286; p = 0.004, β = 0.361, respectively). Conclusions: Children with cancer differ from their healthy peers in both pain and body composition profiles. These findings underscore the need for systematic pain assessment and body composition monitoring in pediatric oncology and may help identify children at risk for heightened pain sensitivity and adverse body composition changes who could benefit from early, targeted interventions.

Background: Research demonstrates racism in pediatric pain care. However, the mechanisms underlying these injustices are not well understood. This study examined White observers’ attentional processing of facial expressions of pain demonstrated by White vs. Black children and observers’ estimations of the pain expressiveness levels of these children. Furthermore, we assessed whether differences in observers’ attentional processing were influenced by observers’ pain beliefs and the pain expressiveness level. Method: Eighty White adults (42 women; 38 men) performed the visual search task (VST), rated the levels of pain that the children expressed, and reported their beliefs concerning the pain experience of White vs. Black children. Results: Findings revealed facilitated attentional engagement towards Black compared to White child pain faces, particularly at high pain expressiveness levels. No attentional disengagement effects were observed. Pain estimations increased with increasing pain expressiveness but, contrary to prior findings, did not differ for White vs. Black children. Observers’ false pain beliefs did not significantly impact their attentional processing nor pain estimations. Conclusions: The results underscore the importance of understanding how racialized disparities in observers’ attentional processing of others’ pain may contribute to racialized inequities in pediatric pain care.

Background: Child pain‐related injustice appraisals, associated with adverse pain‐related functioning, are commonly assessed using the Injustice Experience Questionnaire (IEQ). However, the IEQ was initially developed for adults. Recent qualitative phenomenological work highlighted pain‐related injustice themes among children that are seemingly not captured by the IEQ. Furthermore, research in adults and children has shown strong associations between the IEQ and both pain catastrophising and disability. These issues raise concerns regarding the content validity and discriminant content validity of the IEQ for paediatric populations. This study assessed the content validity and discriminant content validity of the IEQ items and a set of novel items generated through previous qualitative work. Methods: Content and discriminant content validity of the items was assessed by 96 adult judges rating items as measuring child injustice appraisals, as well as measuring competing constructs: pain catastrophising, disability and negative affect. Wilcoxon signed‐rank tests were applied to assess content and discriminant content validity. Results: Four of 12 IEQ items displayed content validity as well as discriminant content validity against pain catastrophising and disability. Eight of 13 newly generated items displayed content validity as well as discriminant content validity against pain catastrophising and disability. Only two of all 25 items displayed discriminant content validity against negative affect. Conclusions: This study revealed the IEQ to lack discriminant content validity for use in a paediatric context. An item pool was created to assess child pain‐related injustice appraisals, displaying both content validity and discriminant content validity against the competing constructs of pain catastrophising and disability. Significance Statement: The current study both reveals issues in applying the IEQ to assess child pain‐related injustice appraisals and advances research on child pain‐related injustice appraisals by providing an item pool displaying both content validity and discriminant content validity against the competing constructs of child pain catastrophising and child disability.

Background: Recent research has found child pain‐related injustice appraisals to be associated with adverse pain‐related outcomes. However, this evidence is mainly based on research using a measure developed for adults in the context of accident‐related injuries, which may not translate to paediatric pain populations. Research on the phenomenology of child pain‐related injustice appraisals is lacking. This study aimed to examine the phenomenology of pain‐related injustice appraisals among both pain‐free children and children living with chronic pain, to compare and contrast their experiences.Methods: Two focus groups were held with pain‐free children (n = 16), and three focus groups were held with paediatric chronic pain patients attending a rehabilitation centre (n = 15) in Belgium. Interpretative phenomenological analysis was applied.Results: Two injustice‐related themes were generated from the focus groups with pain‐free children: (1) ‘Someone else is at fault’ and (2) ‘I am in pain and he is not’. Two injustice‐related themes were generated from the focus groups with paediatric chronic pain patients: (1) ‘People don't see my pain’ and (2) ‘I am missing out because of my pain’.Conclusions: This study offers the first exploration of the phenomenology of child pain‐related injustice appraisals in both pain‐free children and paediatric pain patients. Findings highlight the interpersonal nature of lived injustice experiences caused by chronic pain, which is not fully captured by existing child pain‐related injustice measures. Findings further suggest that pain‐related injustice notions may not be extrapolated from a chronic to an acute pain context.Significance: The current study offers the first exploration of the phenomenology of child pain‐related injustice appraisals in both pain‐free children and paediatric chronic pain patients. Findings highlight the interpersonal nature of injustice appraisals that are specific to the experience of chronic rather than acute pain. These appraisals are not fully captured by current child pain‐related injustice measures.

Background: Youth pain-related injustice appraisals are associated with adverse functioning; however, mechanisms by which injustice appraisals exert their impact have yet to be elucidated. Adult injustice literature suggests anger, sadness, and attention bias to anger (AB) as potential mechanisms. This study examined the effects of injustice appraisals in a healthy youth sample by applying a justice violation manipulation. We hypothesized the justice violation condition to lead to worse pain outcomes with effects mediated by anger, sadness, and AB as compared to the control condition. We further explored associations between both baseline and state injustice appraisals and anger, sadness, and AB across conditions.Methods: A 2 × 2 time by condition design was used to test hypotheses. 133 healthy youth aged 9–16 years old completed two cold pressor tasks (CPTs). In the experimental (i.e., justice violation) group, participants were initially told to complete one CPT, but were told afterwards to perform it again due to experimenter negligence. In the control group, no justice violation occurred. Baseline injustice appraisals and pain catastrophizing were assessed with the Injustice Experience Questionnaire and Pain Catastrophizing Scale for Children; state outcomes (i.e., injustice, catastrophizing, anger, sadness) were assessed after CPTs. AB was indexed using a dot-probe task.Results: Findings indicated no effects of the justice violation on pain outcomes or associated mechanisms, nor on injustice appraisals, suggesting manipulation failure. However, across conditions, baseline and state injustice appraisals were positively associated with anger and sadness, but not with AB.Conclusions: Despite the experimental justice violation failing to elicit differential injustice appraisals across conditions, the current study supports both anger and sadness as key emotional responses associated with pain-related injustice appraisals in a healthy youth sample.

The current study evaluated the feasibility and preliminary clinical impact of robot-led distraction during needle procedures in children with chronic diseases on pain-related memories. Participants were 22 children (8–12 years old) diagnosed with a chronic disease (e.g., chronic immune deficiency) and undergoing a needle procedure as part of their routine treatment. Children were randomized to the experimental group (i.e., robot-led distraction) or control group (i.e., usual care). For feasibility, we evaluated study- and needle-procedure-related characteristics, intervention fidelity and acceptability, and nurse perceptions of the intervention. Primary clinical outcomes included children’s memory bias for pain intensity and pain-related fear (1 week later). Results indicated that intervention components were >90% successful. Overall, the robot-led distraction intervention was perceived highly acceptable by the children, while nurse perceptions were mixed, indicating several challenges regarding the intervention. Preliminary between-group analyses indicated a medium effect size on memory bias for pain intensity (Hedges’ g = 0.70), but only a very small effect size on memory bias for pain-related fear (Hedges’ g = 0.09), in favor of the robot-led distraction intervention. To summarize, while feasible, certain challenges remain to clinically implement robot-led distraction during needle procedures. Further development of the intervention while accounting for individual child preferences is recommended.

Background Children with chronic kidney disease (CKD) have a low quality of life (QoL). The PedsQL™ 4.0 Generic Core Scales are widely used to assess general QoL in children. The aim of this cross-sectional study was to translate the original version of the CKD-specific PedsQL™ 3.0 End Stage Renal Disease Module into a Dutch version and to evaluate its validity and reliability. Methods The forward–backward translation method based on the guidelines from the original developer was used to produce the Dutch version of the PedsQL™ 3.0 ESRD Module. Fifty-eight CKD patients (aged 8–18 years) and their parents (n = 31) filled in both generic and disease-specific modules. The non-clinical control group consisted of the same number of healthy children (matched for gender and age) and their parents. Results Cronbach’s alpha coefficients (α’s) for the PedsQL™ 3.0 ESRD Module demonstrated excellent reliability for the Total Scale scores. For all 7 subscales, α’s were greater than 0.60, except for Perceived Physical Appearance. Overall, intercorrelations with the PedsQL™ 4.0 Generic Core Scales were in the medium to large range, supporting construct validity. Parent proxy reports showed lower generic QoL for all domains in CKD patients compared to healthy children. Child self-reports only demonstrated lower QoL on the domain School Functioning in children with CKD compared to healthy children. Conclusions This study shows good validity and reliability for the Dutch version of the PedsQL™ 3.0 ESRD Module. However, testing with a larger study group is recommended in order to make final conclusions about the psychometric qualities of this measure. Graphical abstract

Research has demonstrated racial disparities in pain care such that Black patients often receive poorer pain care than White patients. Little is known about mechanisms accounting for the emergence of such disparities. The present study had 2 aims. First, we examined whether White observers' attentional processing of pain (using a visual search task [VST] indexing attentional engagement to and attentional disengagement from pain) and estimation of pain experience differed between White vs Black faces. Second, we examined whether these differences were moderated by (1) racially biased beliefs about pain experience and (2) the level of pain expressed by Black vs White faces. Participants consisted of 102 observers (87 females) who performed a VST assessing pain-related attention to White vs Black avatar pain faces. Participants also reported on racially biased beliefs about White vs Black individuals' pain experience and rated the pain intensities expressed by White and Black avatar faces. Results indicated facilitated attentional engagement towards Black (vs White) pain faces. Furthermore, observers who more strongly endorsed the belief that White individuals experience pain more easily than Black individuals had less difficulty disengaging from Black (vs White) pain faces. Regarding pain estimations, observers gave higher pain ratings to Black (vs White) faces expressing high pain and White (vs Black) faces expressing no pain. The current findings attest to the importance of future research into the role of observer attentional processing of sufferers' pain in understanding racial disparities in pain care. Theoretical and clinical implications are discussed, and future research directions are outlined.

Symposium Chair: Sitara de Gagne, Patient Partner, Toronto, Ontario, Canada, sitaradegagne@hotmail.com