Gordon Allen Finley

Objective: This study aimed to describe the need for multidisciplinary management in a pediatric chronic pain service, characteristics of pediatric patients, types of pain management, and outcomes in a tertiary care university hospital in Thailand. Methods: This retrospective study included pediatric patients aged between 0 and 17 years old receiving chronic pain services, both inpatient and outpatient, between August 2021 and December 2023. Demographic data, primary medical diagnosis, pain diagnosis, pain characteristics, psychological diagnosis, multidisciplinary management, and patient outcomes were collected. Pain-related diagnoses were then coded into the 11^th revision of the International Classification of Diseases (ICD-11) of the World Health Organization. Results: There were 99 patients included in the study. Mean (SD) age of the patients was 11.5 (4.8) years old. Most patients were male sex (60.6%). The most common pain diagnoses were chronic cancer-related pain (43.4%) and chronic neuropathic pain (21.2%). For multidisciplinary management, 46 (46.5%) patients were sent for psychiatric consultation (95% CI 37.0– 56.2), which turned out to be 36 (36.4%) patients who had mental health disorders (95% CI 27.6– 46.2). Fifty-six (56.6%) patients had rehabilitation (95% CI 46.7– 65.9). Twenty (20.2%) patients required both psychiatric and rehabilitation treatments. Gabapentinoids were used in 68 (68.7%) patients. Strong opioids via oral route were reported in 59 (59.6%) patients. Overall, 54 (54.5%) patients were able to be discharged from the service, while 27 (27.3%) patients died. Conclusion: A significant proportion of children with chronic pain required psychiatric and rehabilitation management.

Loneliness, the perception that one’s social relationships do not meet the desire for social connection, is a risk factor for poor mental and physical health. Adolescents with chronic pain experience higher rates of peer loneliness which persists over time. Previous studies used a single loneliness measure, limiting our understanding of the nature of their loneliness. This study describes the types of peer loneliness (intimate, relational, and collective) experienced by these adolescents and the impact that peer loneliness has on pain-related outcomes. A cross-sectional online survey was completed by 128 Canadian adolescents aged 12–18 years who experienced pain for at least 3 months. Validated measures captured demographics, pain-related characteristics, types of peer-related loneliness, measures of social well-being, and mental and physical health outcomes. Friedman’s tests of z-scores indicate that participants equally experienced dyadic, relational, and collective peer loneliness. MANCOVA revealed that those who identify as Black were lonelier after controlling for socioeconomic status. Multiple regression showed that loneliness was a robust predicter of worse scores on social well-being and mental health outcomes with males and females equally impacted by loneliness. Despite moderate correlations between loneliness and pain interference and pain intensity, loneliness did not predict school absences, suggesting that loneliness’ influence on physical pain outcomes may be temporally earlier (e.g. contribute to pain chronification). Peer loneliness among adolescents with chronic pain negatively impacts their social well-being and mental health outcomes. Interventions addressing loneliness to target all three types of peer loneliness may be key to improving pain-related outcomes.

Objective: Families and children are not consistently included in pediatric pain management decisions. Shared decision making (SDM) is a collaborative process where health care professionals (HCPs) and families exchange information about treatment options along with families’ preferences to make an optimal health decision. SDM is recommended and beneficial for children, parents, and HCPs alike; however, the process of SDM has not been routinely integrated into pediatric pain management, despite families’ desire to be involved in these decisions. In this commentary, we discuss the implications of the dearth of literature about SDM in pediatric pain on clinical practice and highlight the potential benefits of engaging in SDM to improve pain management. Method: This commentary will describe clinical approaches and considerations to implementing SDM in pediatric pain management, such as consideration of families’ preferences for SDM, the quality of the evidence, and decisional complexity. Results: This commentary will propose recommendations to further advance the understanding and utility of SDM in pediatric pain, such as identifying opportunities to engage in SDM as well as factors that support its implementation. Conclusions: SDM provides a rich and structured opportunity to engage children and families in their care, while also creating opportunities for HCPs to engage in evidence-based practice. As such, SDM should be recognized as a key priority when engaging in best practices for pediatric pain management. Implications for Impact Statement: Shared decision making (SDM) facilitates the engagement of children and families in pain management decisions. SDM is not yet common practice in pediatric pain; however, it holds promise to improve pain outcomes for children by increasing application of evidence-based practices as well as satisfaction with care.

Editorial: Highlights in pediatric pain 2021/22

Pain impacts the life of every child; however, it remains undermanaged in both acute and chronic care contexts.1–3 Undermanaged pain can lead to significant physiological and psychological effects ...

Health-Related Quality of Life (HRQL) can be used to measure the impact of Sickle Cell Disease (SCD) on the child and their family and is generally reduced. No research has yet measured HRQL in Portuguese pediatric SCD patients. Objectives: (1) Describe and compare HRQL of children with SCD reported by them and their parents; (2) Compare with a pediatric population with no SCD; (3) Find predictive factors of HRQL in SCD children. Methods: Descriptive, case-control study that included sixty-eight children and adolescents with SCD (aged 3 to 18 years) and their parents. Control group—children with no SCD, matched by age, gender and ethnic background. HRQL was assessed using the multidimensional self-report PedsQL^® 4.0 Generic Scales. Summary scores for overall HRQL and subscale scores for physical, emotional, social and school functioning were compared within groups (children-parents) and with the control group. Clinical and socio-demographic variables were analyzed to find predictive factors of HRQL in pediatric SCD patients. Results: Children with SCD and their parents had significantly lower overall and all subdomains of HRQL, compared with the control group. Children with SCD also rated lower when compared with their parents (only significant for social functioning), with low to moderate correlations. Children and parent reports declined with increasing age. Higher pain frequency was associated with worse total and psychosocial domains of HRQL. The number of hospitalizations was a predictor of worse school score, and female gender was a predictor of worse emotional score. Conclusions: SCD significantly affects children’s HRQL. Parents can provide a good proxy report, although both evaluations are beneficial. Disease status, like number of hospitalizations and frequency of pain, influences HRQL. Interventions in SCD should consider improvements in HRQL as an important outcome.

Chronic pain affects 1 in 5 youth, many of whom manage their pain using a biopsychosocial approach. The COVID-19 pandemic has impacted the way that healthcare is delivered. As part of a larger program of research, this study aimed to understand the impact of the pandemic on pediatric chronic pain care delivery including impact on patients’ outcomes, from the perspective of pediatric healthcare providers. A qualitative descriptive study design was used and 21 healthcare providers from various professional roles, clinical settings, and geographic locations across Canada were interviewed. Using a reflexive thematic analysis approach 3 themes were developed: (1) duality of pandemic impact on youth with chronic pain (i.e., how the pandemic influenced self-management while also exacerbating existing socioeconomic inequalities); (2) changes to the healthcare system and clinical practices (i.e., triaging and access to care); (3) shift to virtual care (i.e., role of institutions and hybrid models of care). These findings outline provider perspectives on the positive and negative impacts of the pandemic on youth with chronic pain and highlight the role of socioeconomic status and access to care in relation to chronic pain management during the pandemic in a high-income country with a publicly funded healthcare system.

This study describes the minimum incidence of pediatric complex regional pain syndrome (CRPS), clinical features, and treatments recommended by pediatricians and pain clinics in Canada. Participants in the Canadian Paediatric Surveillance Program reported new cases of CRPS aged 2 to 18 years monthly and completed a detailed case reporting questionnaire from September 2017 to August 2019. Descriptive analysis was completed, and the annual incidence of CRPS by sex and age groupings was estimated. A total of 198 cases were reported to the Canadian Paediatric Surveillance Program, and 168 (84.8%) met the case definition. The minimum Canadian incidence of CRPS is estimated at 1.14/100,000 (95% confidence interval 0.93-1.35/100,000) children per year. Incidence was highest among girls 12 years and older (3.10, 95% confidence interval 2.76-3.44/100,000). The mean age of CRPS diagnosis was 12.2 years (SD = 2.4), with the mean time from symptom onset to diagnosis of 5.6 months (SD = 9.9) and no known inciting event for 19.6% of cases. Most cases had lower limb involvement (79.8%). Nonsteroidal anti-inflammatory drugs (82.7%) and acetaminophen (66.0%) were prescribed more commonly than antiepileptic drugs (52.3%) and antidepressants (32.0%). Referrals most commonly included physical therapy (83.3%) and multidisciplinary pain clinics (72.6%); a small number of patients withdrew from treatment because of pain exacerbation (5.3%). Pain education was recommended for only 65.6% of cases. Treatment variability highlights the need for empiric data to support treatment of pediatric CRPS and development of treatment consensus guidelines.

Introduction: Chronic pain, defined as persistent or recurring pain or pain lasting longer than 3 months, is a common childhood problem and can profoundly impact children’s physical, psychological and social functioning. The last comprehensive systematic review estimating the prevalence of chronic pain in children and adolescents was published in 2011. Since then, the literature on paediatric chronic pain has grown substantially. This manuscript outlines a protocol for an updated systematic review to provide updated estimates of the prevalence of various forms of chronic pain in children and adolescence. The review will also examine the relationship between sociodemographic and psychosocial factors related to chronic pain prevalence. Methods and analysis: This review will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search EMBASE, PubMed, CINAHL and PsycINFO for observational studies published in English between 2009 and 2020 reporting population-based estimates of chronic non-disease-related pain prevalence in children or adolescents (age ≤19 years). Two independent reviewers will screen the titles and abstracts retrieved from the search based on predefined eligibility criteria. The full texts of relevant studies will then be assessed by two reviewers. Studies meeting inclusion criteria will be categorised according to the type of pain investigated: headache only, abdominal pain only, back pain only, musculoskeletal pain, combined pain, general pain and other pain. Data will be extracted using customised forms and studies will be assessed for risk of bias using a 10-item tool developed by Hoy et al (2012). A narrative synthesis will summarise the prevalence estimates of paediatric chronic pain and associated sociodemographic and psychosocial correlates. Meta-analyses and meta-regressions will be performed if the data permit. Ethics and dissemination: Ethical approval is not required. Findings will be disseminated through publication in an academic journal, presentations at conferences and in various media. PROSPERO registration number: CRD42020198690.

To achieve health, Indigenous people seek a life that balances mental, spiritual, emotional, and physical wellness, yet the scope of these four dimensions is not typically considered in the Western‐based health system. Indigenous people experience ongoing pain and hurt in all these dimensions as a result of a colonial legacy that persists in current‐day policy and care contexts. Exploring ways to support Indigenous people to embrace ways of being well and reducing chronic pain has not been a priority area in health research. This community‐based, qualitative study in four First Nations communities involved conversation sessions with 188 First Nations children, youth, parents, and Elders and 32 professionals who practice in those communities. The purpose was to gather perspectives related to pain expression, care experiences, and the strategies to improve the healthcare encounter. Thematic analysis was used to identify a more culturally thoughtful approach for clinicians to consider when First Nations people seek care. Two‐Eyed Seeing consisting of four iterative steps was used to co‐create the FIRST approach validating for community members that their perspectives were heard and providing a clinical approach for culturally safe practices with children, youth, and families. An overarching theme in the results was a clearer understanding about how pain and hurt translate into participants' health experiences and their desire to have their knowledge reflected in their health care. Participants describe experiencing pain and hurt in all four dimensions of health and from a historical, cultural, and spiritual identity, as well as from a community, family, and individual perspective. The FIRST approach captures Indigenous knowledge relating to Family, Information, Relationship, Safe‐Space, and Two‐Eyed treatment in the healthcare encounter. Considerations of this approach in clinical practice could enhance respectful and trusting relationships, knowledge exchange for better care experiences, and potentially improvement of culturally sensitive outcomes for Indigenous people.