Sarah Nelson

Substantial evidence from animal and human studies supports the hippocampus' role in pain, positioning it as a key contributor to the pain experience. Here, we comprehensively incorporate the hippocampus in our understanding of pain perception and provide critical insight and novelty for future interdisciplinary research in pain.

Background/Objectives: Physical and mental health symptoms commonly affecting children are often under-addressed given the limited availability of pediatric behavioral healthcare. Training school providers (e.g., nurses, mental health professionals) to address these concerns is a promising strategy to explore, considering the unique level of accessibility afforded by school settings. While our earlier work augmented school providers’ pain management skills, providers desired more comprehensive training and youth support tools. Our team of interdisciplinary academic researchers and community partners will bridge this gap by developing the PURSUIT (Preventing Use of Substances for the Underserved with Innovative Technology) provider training program and companion online self-management platform for youth and caregivers. This protocol paper describes our planned approach to developing, implementing, and evaluating the PURSUIT program. Methods: We will draw from evidence-based cognitive–behavioral, trauma-focused, and mindfulness protocols to develop a comprehensive provider training program and interactive online self-management platform for youth and caregivers. Content areas will include core cognitive–behavioral strategies and specific skills for pediatric pain management, trauma-focused care, and substance use prevention. Innovative technological approaches, such as live and animated videos, will be used to promote user engagement. Academic and community partners will have roles in material co-development. Outcomes of this project will include the PURSUIT training program and self-management platform feasibility and acceptability (e.g., completion/engagement rates, quantitative/qualitative reports), as well as the impact of the training program on provider knowledge and the impact of the self-management platform on youth/caregiver outcomes. Conclusions: Interdisciplinary collaboration and community engagement will be critical to developing and evaluating a provider training program and youth/caregiver self-management platform.

Objective: Depressive symptoms and chronic pain commonly co-occur among adolescents and share similar proposed underlying processes, including elevation of proinflammatory cytokines. In this study, we investigate how profiles of 4 commonly measured proinflammatory cytokines (IL-1β, IL-6, IL-8, and TNF-α) differ between adolescents with primary chronic pain disorders and pain-free peers. We explored relationships between these cytokines and depressive symptoms, perceived distress (PD), pain severity, functional disability (FD), pain catastrophizing (Pcat), and fear of pain (FOP). Potential mediating effects of cytokines on the relationship between depressive symptoms and FD were also examined. Methods: Differences in cytokine profiles between groups were compared through t -tests. Relationships between cytokine profiles and outcomes were assessed through partial correlations. Bootstrapping mediation analysis assessed whether cytokines mediated the relationship between depressive symptoms and functional disability. Our sample included 78 youth (chronic pain n = 54, M age = 14 years; pain-free n = 24; M age = 16 years). Results: We found that (1) IL-6 levels were higher among adolescents with chronic pain than pain-free peers; (2) higher IL-1β and IL-6 levels were associated with greater PD among adolescents with and without pain; (3) among the pain group, higher IL-6 levels were associated with greater PD, pain severity, and FD; (4) among the pain group, higher IL-1β levels were associated with greater depressive symptoms, PD, Pcat, and FOP. Mediation effects were not significant. Conclusion: Our findings suggest that IL-1β and IL-6 play critical roles in the pain experience. Interleukin-6 is more strongly associated with physical symptoms, and IL-1β is more related to fear-avoidance.

Objectives: Multidisciplinary management of chronic pain benefits many patients, although some continue to experience refractory pain. Administration of lidocaine infusions (LI) to manage certain chronic pain conditions has been reported in adults, but evidence is limited for its utility in managing pediatric chronic pain. We reviewed LIs for refractory pain in children to (1) describe the patient population that received LI and (2) evaluate the response to LI. Methods: With IRB approval, a retrospective review of patients receiving LI for refractory pain between 2016 and 2021 was conducted at Boston Children’s Hospital. Demographic, medical, pain, sleep, and school function information was collected through self-report and from the electronic medical record. Longitudinal outcomes for a subset of these patients were analyzed using the Chronic Pain Repository database. Results: During the study period, 3959 patients presented for management of chronic pain. Among this population, 184 (5%) patients aged 22 years or younger ultimately received LI as part of their pain management. A total of 350 LIs were administered and were well tolerated. During approximately 42% of the infusions, patients experienced an immediate statistically significant decrease in pain scores. Among the patients with follow-up data, pain improvement was not sustained. Discussion: LI for the treatment of chronic pain appears safe and may be useful for managing refractory pain in pediatrics. Although approximately half of the patients who received LI reported an immediate positive response, the small follow-up sample did not show a continued response. Study limitations preclude demonstrating long-term efficacy of LI; therefore, a prospective study is critical.

The health disparities experienced by gender-diverse youth have not yet been adequately examined within specific pediatric populations, such as chronic pain. Furthermore, such disparities need to be examined within the context of the COVID-19 global pandemic, a time when clinicians observed an increase in gender-diverse patients seeking care for pediatric chronic pain. The goal of this study is to better understand the clinical pain-related and psychosocial presentation of gender-diverse youth who sought treatment for chronic pain prior to and following the start of the COVID-19 pandemic. Deidentified intake data were identified using the data repository of an outpatient multidisciplinary pain clinic at a tertiary hospital between December 2017 and November 2023. Descriptive data and the comparison of the gender-diverse patients presenting before and following the start of the COVID-19 pandemic are presented. Gender-diverse participants with pediatric chronic pain generally reported psychological functioning within the “moderate” range and pain-related measures in the “elevated” range. No significant differences were found between youth presenting for care prior to and following the start of the COVID-19 pandemic. 92% of the sample was seen following the start of the pandemic. Far more gender-diverse participants sought treatment for chronic pain following the start of the pandemic. More research, including qualitative data about patient experiences, is needed to ensure pain providers are offering affirming care.

Objectives: Chronic pain (CP) significantly impacts emotional and physical well-being and overall quality of life across diverse populations in the United States (US). Notably, under-represented minoritized (URM) groups, such as Hispanic/Latinx (H/L) youth, may experience disproportionate effects due to health disparities and lack of access to quality health care. However, this remains understudied. This study aimed to examine the association between CP and its related psychosocial factors—depressive and anxiety symptoms, and pain catastrophizing—in H/L youth, as compared with Non-Hispanic White (NHW) youth. Methods: The current study sample included 58 self-identifying H/L and 58 NHW youth seeking CP treatment at a large Northeastern tertiary pain clinic, ages 12 to 18 years old, (M=15.49, SD=1.71), of which 88% identified as biologically female. Participant samples for each group were age and-sex-matched. Results: Significant associations were found between anxiety and depressive symptoms and pain catastrophizing for youth in both groups. Ethnicity significantly moderated the associations between pain catastrophizing and depressive symptoms and between anxiety and depressive symptoms, with NHW youth with pain exhibiting stronger relations between these constructs when compared with H/L youth with pain. Discussion: Our results suggested that for NHW youth with CP, greater tendencies toward catastrophizing and experiences of anxiety may more strongly contribute to depressive symptoms, when compared with their Hispanic/Latinx youth counterparts. Further investigation of pain-coping mechanisms among H/L youth and other youth from historically marginalized populations (e.g., racial/ethnic minoritized groups) will help advance clinical understanding of sociocultural variability in links between pain-related psychosocial outcomes in the CP experience.