Cecelia I. Nelson

Self-report is the gold standard for assessing pain intensity, although the method of acquiring pain reports may influence the ratings obtained. Retrospective reports of pain intensity are often found to be elevated relative to daily diary reports, possibly due to recall bias and the influence of psychosocial factors on memory. In this study, we sought to examine differences between retrospective reporting of average pain intensity in the past week vs averaged daily diary reporting of pain intensity in a sample of adolescents with juvenile fibromyalgia (JFM). We also sought to determine the predictive effects of pain catastrophizing, functional disability, and depressive symptoms on discrepancies between retrospective and daily diary report. As part of a randomized controlled trial, 317 adolescents with JFM (Mage = 15.7, SD = 1.6, 88.4% female) completed daily diary and one-week retrospective pain intensity measures, the Children's Depression Inventory-2, Functional Disability Inventory, and Pain Catastrophizing Scale at baseline, post-treatment, and 3-month follow-up. We examined the predictive effects of psychosocial factors on mean differences between averaged daily and one-week retrospective reports of pain intensity. Retrospective reports of pain intensity were significantly higher than diary reports across time. A longitudinal multiple linear regression model showed that the magnitude of discrepancies between daily diary and retrospective reports was not significantly predicted by functional disability, depressive symptoms, or pain catastrophizing. These findings raise the possibility that other factors such as cognitive biases (eg, threat interpretation, saliency, recency bias) may play a larger role than psychosocial factors in explaining pain reporting discrepancies.

Objectives: For youth with gastrointestinal (GI) conditions, mental health symptoms can exacerbate GI symptoms. In a cyclical fashion, experiencing GI symptoms at school can contribute to depression, anxiety, and embarrassment. This study evaluated the impact of school instruction type on mental health and GI symptoms for youth with GI conditions during the COVID-19 pandemic. Method: Data were collected from caregivers and patients aged 8 to 17 years with inflammatory bowel disease, celiac disease, and irritable bowel syndrome (N = 146) from September to December 2020. Patients completed measures of depression, anxiety, anger, and GI symptoms; caregivers provided their child's school instruction type (online, hybrid, or in-person). Analyses were conducted to examine the relations of mental health symptoms, GI symptoms, and school instruction type. Results: Participants generally had mild levels of depressive symptoms (T = 55.50), and anxiety (T = 53.02) and anger (T = 49.92) symptoms were within normal limits. Anxiety and GI symptoms were positively related ( b = 0.14, p < 0.01), and if participants were attending school online, they had worse GI symptoms ( b = 0.46, p < 0.05). However, there was no significant interaction between anxiety and instruction type. Depression and anger were not significantly related to GI symptoms and there were no significant interactions. Conclusion: For children with GI conditions during the pandemic, as their anxiety symptoms increased, so did their GI symptoms. Further research should examine the long-term effects of virtual learning for those with GI conditions.

Objective: Juvenile idiopathic arthritis (JIA) is one of the leading causes of chronic pain in pediatric patients. Treatment regimens, which are critical to symptom management, can be burdensome, involving medication with potentially aversive side effects and exercise that can cause joint pain. Thus, it is important to examine the barriers and facilitators to adherence in JIA. While systematic reviews exist for rheumatic disease in adults, there has not yet been a synthesis of the literature examining adherence in JIA. Methods: PsychINFO, PubMed, and MEDLINE databases were systematically searched to identify qualitative and quantitative empirical studies that investigate adherence to JIA. Keywords included: “patient compliance” OR “adherence” OR “persistence”; “youth” OR “children” OR “juvenile” OR “pediatric” OR “teen” OR “child” OR “adolescent”; and “rheumatoid arthritis” OR “idiopathic arthritis” OR “arthritis.” Articles were excluded from the review if they involved nonhuman or adult samples, were nonexperimental (e.g., practice recommendations), were not peer-reviewed, or were not written in English. After abstract selection, 32 articles were included in the analyses. Results: Adherence to exercise regimens was consistently lower than adherence to medication. Researchers relied heavily on self-report of adherence, which suggests a need for additional research with more objective measures of adherence. Across studies, psychological treatment was not included, so adherence to this treatment component in JIA remains understudied. Conclusions: Results suggest that future research should target devising and evaluating interventions to improve adherence to exercise and perhaps psychological treatment. Implications for Impact Statement: To facilitate adherence to JIA, behavioral health providers should focus on building a strong therapeutic alliance between provider and child, fostering positive coping skills in parents and children, and monitoring the parent–child relationship.

Objective : This review examines the role that two types of self-control may play in youth’s self-management of migraine. Although traditionally conceptualized from an inhibitory lens, self-control has both initiatory and inhibitory functions, and the authors suggest the distinction is important in relation to youth’s ability to adhere to different components of migraine treatment regimens. Methods : A topical review of the literature was conducted to identify evidence-based interventions to treat pediatric migraine and conceptualize the role self-control (both initiatory and inhibitory) may play in adherence to its regimen. Both PsycInfo and PubMed databases were used to identify relevant articles. Results : Existing evidence-based interventions and recommendations for pediatric migraine require inhibitory self-control (e.g., avoiding caffeine, tobacco) and initiatory self-control (e.g., taking medication). Formal intervention programs (e.g., cognitive behavioral therapy) tend to employ initiatory self-control (e.g., modifying physical reactions in response to biofeedback). Conclusions : Understanding the distinct types of self-control required for adherence to different interventions allows for a better conceptualization of self-management of pediatric migraine. Individuals may struggle with adherence when they have deficits in one or both types of self-control skills. Future research should consider whether self-control is associated with differential adherence patterns in pediatric migraine management.

Background: The experience of pain is a complex interaction of somatic, behavioural, affective and cognitive components. Negative psychological states (e.g., anxiety, fear and depression) are intertwined with pain and contribute to poorer outcomes for individuals suffering from chronic and acute pain by exacerbating the overall experience of pain and leading to increased dysfunction, disability, and distress. A need exists for efficient assessment of aversive emotional states that are associated with pain.Methods: A multistage developmental process included expert judges, two undergraduate samples, and a chronic pain patient sample. The 4‐item Brief Assessment of Distress about Pain (BADP) scale was developed to assess anxiety, fear, and depression related to pain, as well as an overall evaluation of distress about pain.Results: Principal components analyses indicated that the BADP consisted of one factor. Inter‐scale correlation coefficients revealed that the BADP was highly related to other measures that assess similar constructs, suggesting evidence for convergent validity. Intra‐scale correlation coefficients indicated that the items of the BADP were only moderately associated with each other. Findings also supported evidence for discriminative validity, test–retest reliability, and internal consistency of the BADP.Conclusions: The BADP has good psychometric properties as a measure of negative affectivity related to pain. The scale's single negative affectivity item may be useful for screening. The BADP helps address a gap in the literature with regard to a brief measure assessing fear, anxiety, depression, and negative affect in relation to pain. Demonstrated utility in a patient sample indicates the measure is suitable for further clinical study.Significance: The BADP provides an efficient, psychometrically‐supported means to assess affective distress (i.e., anxiety, fear, depression, and negative affect) associated with pain.

Background The link between anxiety/fear and gut dysfunction has been robustly documented in both physical and mental health literatures. The current study explored distress tolerance as a potential mechanism in the relation between anxiety sensitivity and gut-specific anxiety. Method A cross-sectional sample of 828 adults completed measures of distress tolerance, gut-specific anxiety, and anxiety sensitivity. Multiple linear regression analyses were conducted to determine variable associations, including potential mediating factors. Results The results demonstrated a bidirectional relation between anxiety sensitivity and gut-specific anxiety (ß = 0.23, p < 0.001; ß = 0.22, p < 0.001). Findings suggest distress tolerance is a significant mediator that may partially explain the relation between gut-specific anxiety and anxiety sensitivity more broadly (ß = 0.11, CI [0.07–0.14]). Mediation results were consistent when individual subscales of distress tolerance or anxiety sensitivity were incorporated. Conclusion The outcome of the present study merits additional examination of the psychosomatic nature of distress tolerance as a potential clinical target for individuals with both anxiety and gut-related disorders.