A Comparison of Maternal versus Paternal Nonverbal Behavior During Child Pain

Parental behavior plays a significant role in children's pain response. Prior research has found generally no differences between mothers’ and fathers’ verbal behavior during child pain. This study compared mothers’ and fathers’ nonverbal behavior during child pain. Nonverbal behavior of mothers (n= 39) and fathers (n= 39) of 39 children (20 boys) aged 8 to 12 years who participated in the cold pressor task (counterbalanced once with each parent) was coded. A range of nonverbal behaviors were coded, including distraction, physical proximity, physical comfort/reassurance, procedure-related attending behavior, and fidgeting. The most common behaviors parents engaged in were fidgeting, procedure-related attending behaviors, and physical proximity. Results indicated that the types of nonverbal behavior parents engage in did not differ between mothers and fathers. However, children of mothers who engaged in more physical comfort/reassurance reported higher levels of pain intensity, and children of mothers who engaged in more procedure-related attending behaviors had lower pain tolerance. Further, both mothers and fathers who engaged in higher levels of verbal nonattending behaviors also engaged in lower levels of nonverbal procedure-related attending behaviors. These findings further support the importance of considering the influence of mothers and fathers in children's pain, and provide novel insights into the role of nonverbal behavior

Sociodevelopmental Challenges Faced by Young People with Chronic Pain: A Scoping Review

OBJECTIVE: Map the current literature investigating autonomy development, identity development, and peer relationships in young people aged 10-24 years with chronic pain. METHODS: A scoping review method was used to systematically search four databases (APA PsycNET, PubMed, Web of Science, and Cinahl) for peer-reviewed articles. Search results were screened against inclusion and exclusion criteria to ensure they met the objective. Eligible papers were assessed for quality, their data relating to the objective were extracted, and results are synthesized. RESULTS: Searches returned 3,815 papers after the removal of duplicates, with 42 papers included in the full review. The majority of papers investigated peer relationships (86%). Fewer papers investigated autonomy (43%) and identity (21%) development. Included papers were mostly quantitative (64%), with fewer qualitative (34%) and mixed-methods papers (2%). Overall, we found bidirectional relationships between chronic pain in young people, their social development, and a range of functional outcomes. However, the mechanisms underlying these relationships remain relatively unexplored. CONCLUSIONS: Review results are mapped onto the model proposed by Palermo et al. (2014). Guided by this model, clinical treatment for young people with chronic pain should consider social development. The model also sets out a future research agenda focused on exploring: (a) identity development, (b) the mechanisms underlying the relationships between social-developmental domains, pain, and outcomes, (c) a variety of participants and populations, and (d) a variety of methods, including longitudinal study designs

A practical guide and perspectives on the use of experimental pain modalities with children and adolescents

Use of experimental pain is vital for addressing research questions that would otherwise be impossible to examine in the real world. Experimental induction of pain in children is highly scrutinized given the potential for harm and lack of direct benefit to a vulnerable population. However, its use has critically advanced our understanding of the mechanisms, assessment and treatment of pain in both healthy and chronically ill children. This article introduces various experimental pain modalities, including the cold pressor task, the water load symptom provocation test, thermal pain, pressure pain and conditioned pain modulation, and discusses their application for use with children and adolescents. It addresses practical implementation and ethical issues, as well as the advantages and disadvantages offered by each task. The incredible potential for future research is discussed given the array of experimental pain modalities now available to pediatric researchers

Influence de traitements thermo-mécaniques sur les performances en fluage et en fatigue d'aciers martensitiques à 9% Cr

National audienceLe développement des réacteurs nucléaires de génération IV et des réacteurs à fusion nucléaire requiert l'utilisation de matériaux possédant de bonnes propriétés mécaniques au-delà de 550 °C. En service, ces matériaux seront soumis à du fluage à haute température couplé à des sollicitations cycliques de fatigue. Les aciers martensitiques à 9-12 % Cr sont pressentis pour ces applications; cependant leur comportement en fatigue et fatigue-fluage à haute température est encore insuffisant : la microstructure martensitique grossit et l'acier s'adoucit rapidement. Afin de stabiliser sa microstructure, l'acier commercial P91 a subi un traitement thermo-mécanique incluant du laminage à 600 °C suivi d'un revenu d'une heure à 700 °C. Les observations microstructurales confirment que le traitement thermo-mécanique a conduit à une martensite plus fine, émaillée de nombreux et fins précipités de type MX. Les divers essais mécaniques réalisés prouvent que ces changements ont un effet positif sur les propriétés de l'acier : sa dureté est plus élevée de 100 Hv par rapport à l'acier P91 à réception, et sa limite d'élasticité conventionnelle est supérieure de 430 MPa à 20 °C et de 220 MPa à 550 °C. La durée de vie du P91 optimisé en fluage à 650 °C sous 120 MPa est plus de 14 fois supérieure à celle du P91; et l'essai de fatigue à 650 °C et 0,7 % de déformation totale montre un adoucissement légèrement moins rapide

Editorial: Coping With the Pediatric Coping Literature: Innovative Approaches to Move the Field Forward

First paragraph: Chronic illnesses, injuries, and other health conditions (herein “conditions”) such as sickle cell disease, chronic pain, and burns are life-disrupting challenges for children and their families. Coping strategies can be defined as “cognitive and behavioral efforts to manage specific external or internal demands that are appraised as taxing or exceeding the resources of a person” (Lazarus, 1991, p. 112). In the context of chronic pediatric health concerns, children and their caregivers/parents must cope with the management of the condition itself, its indirect impact and associated treatment on their daily life (e.g., effect on school engagement), in addition to unrelated “everyday” stressors (e.g., parenting, peer conflict) (Turner-Cobb, 2013). Despite a substantive body of literature exploring coping strategies and quality of life in children living with a chronic condition, several theoretical and empirical gaps remain, including a large number and variable application of coping frameworks or models together with vague and inconsistent operationalization of coping strategies. For instance, Rudolph et al. (1995) proposed a conceptualization of coping that distinguishes between coping responses, goals, and outcomes. Coping responses are actions initiated in relation to a perceived stressor, while the goals are the reasons behind the engagement in a coping response, and the outcomes are the consequences of the coping response. Yet, these different components of coping have been used interchangeably in the context of pediatric chronic health conditions, with assessment or conceptualization of each aspect of coping varying substantially within and across health concerns. Consequently, the goal of this Research Topic “Coping with the Pediatric Coping Literature: Innovative Approaches to Move the Field Forward” was to bundle innovative and cutting-edge research that increases our understanding of coping strategies and their underlying mechanisms within pediatric chronic health conditions

Which passengers are on your bus? A taxonomy of the barriers adolescents with chronic pain face in achieving functional recovery

Background: Despite evidence that intensive interdisciplinary pain treatment (IIPT) is effective in facilitating functional recovery in adolescents with chronic pain, engagement with IIPT is suboptimal amongst adolescents. A key aspect of IIPT is to support functional recovery via (re)engagement with age-appropriate daily activities. The aim of this study was to gain a comprehensive insight into adolescents' perceptions of the barriers they need to overcome to engage with age-appropriate activities in order to achieve functional recovery. Methods: Forty-one adolescents who were starting an IIPT program completed the 'passenger-on-the-bus metaphor', an exercise in which they identify and describe their perceived barriers (i.e., 'passengers' on their bus) that prevent them from engaging with age-appropriate activities. The responses were analysed using inductive thematic analyses to generate a taxonomy of perceived barriers to functional recovery. Results: We generated a taxonomy of seven different barriers that participants described facing on their road to functional recovery: physical constraints, being 'fed up', low self-confidence and self-esteem, perfectionism, avoidance of engagement with pain, feelings (such as sadness, anger, guilt, anxiety), and social barriers (received from a range of sources such as parents, friends, school, and wider society). Conclusion: The findings reveal a variety of barriers that were perceived to hinder functional recovery through reduced engagement with age-appropriate activities and thereby hamper progress within IIPT. The passenger-on-the-bus metaphor can be used to identify similar barriers faced by adolescents in an individualized treatment approach, thereby making it possible for clinicians to target their IIPT more precisely. Additional Information: Question Response Significance Below please give a paragraph entitled "Significance", indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. The signifiance statement should be short, attention-grabbing,non-redundant with the conclusions and rigorously in line with the contents of the full article. It should not exceed 80 words and will be added to the end of the abstract at the time of typesetting. This paragraph will NOT Explicit identification of adolescents' individual barriers towards obtaining functional could be critical to enhance the adolescents' motivation to engage with and adhere to recovery intensive interdisciplinary pain treatment

An analysis on history of childhood adversity, anxiety, and chronic pain in adulthood and the influence of inflammatory biomarker C-reactive protein

Despite a link between adverse childhood experiences (ACEs) and anxiety, the role of anxiety in the pathway to chronic pain is unclear. Potentially, inflammatory biomarkers such as C-reactive protein (CRP) are involved. Objectives were to (1) examine relationships between reported ACEs, anxiety, and chronic pain, and (2) assess associations between ACEs, anxiety, and CRP levels and between CRP and chronic pain. Data from 24,172 adults who participated in the UK Biobank were used to conduct Poisson regressions to assess relationships between ACEs, anxiety, and chronic pain. For participants with CRP data who met the inclusion criteria (n = 2007), similar models were run between ACEs, anxiety, and CRP, and CRP and chronic pain. For objective 1, three statistically significant interactions were found to predict pain: frequency of physical abuse x reported muscular symptoms during anxiety (p = 0.01); frequency in which they felt hated x having discussed anxiety with a professional (p = 0.03), and reported frequency of sexual abuse x difficulties relaxing during anxiety attacks (p = 0.03). For objective 2, frequency of sexual abuse and informing a professional about anxiety significantly interacted to predict elevated CRP. For correlations, the largest was between CRP and the number of times pain was reported over the years (p = 0.01). Finally, ACEs (physical abuse, sexual abuse, and whether taken to a doctor) significantly interacted with CRP to predict pain. This study suggests mechanisms of the impact of ACEs on chronic pain may include inflammation and anxiety, which warrants further study

Anxiety, history of childhood adversity, and experiencing chronic pain in adulthood: A systematic literature review and meta-analysis

Background: When considering factors that may impact chronic pain experiences in adulthood, adverse childhood experiences (ACEs) and anxiety should be considered. The literature on the associations between these 3 variables remains unclear. Objective: To summarize the existing literature on the relationship between ACEs and anxiety on chronic pain experience in adults, and examine the association between ACEs and anxiety. Methods: A systematic literature review (SLR) and meta-analysis was used to examine adults (≥18) with a reported history of ACEs, self-reported and/or diagnosed anxiety, and chronic pain. The SLR included quality appraisal according to the Joanna Briggs Institute tool. Results: The narrative summary indicated a significant association between ACEs, anxiety, and chronic pain experiences in adults. Of 52 selected studies, 79% reported a moderate-strong association. For ACE prevalence, the majority reported experiencing sexual abuse (50% [SD 16.01]), followed by physical abuse (46% [SD 20.7]). Other ACEs included emotional abuse (33% [SD 17.17]), emotional neglect (25% [SD 21.02]), and physical neglect (23% [SD 22.44]). Meta-analyses showed moderate associations between anxiety and chronic pain (r = 0.30; 95% CI = [0.14, 0.45], p < 0.01) and between ACEs and anxiety (r = 0.26; 95% CI = [0.15, 0.36], p < 0.01), and that participants who experienced ACEs are around twice as likely to present chronic pain during adulthood (OR = 1.99; 95% CI = [1.53, 2.60], p < 0.01). Conclusion: The results of the SLR and meta-analysis indicated that ACEs and anxiety influence chronic pain experience in adults. Given the relationship between ACEs and anxiety, there would be value in exploring this as a potential mediator in future studies. Significance: There was an unmet need to summarize the existing literature on the relationship between ACEs and anxiety on chronic pain experience in adults and the association between ACEs and anxiety. The results of this systematic review and meta-analysis indicated that both ACEs and anxiety influenced chronic pain experience in adults and helped to inform the diverse literature on these potential relationships to date

Offspring of parents with chronic pain: A systematic review and meta-analysis of pain, health, psychological, and family outcomes

Offspring of parents with chronic pain may be at risk for poorer outcomes than offspring of healthy parents. The objective of this research was to provide a comprehensive mixed-methods systematic synthesis of all available research on outcomes in offspring of parents with chronic pain. A systematic search was conducted for published articles in English examining pain, health, psychological, or family outcomes in offspring of parents with chronic pain. Fifty-nine eligible articles were identified (31 population-based, 25 clinical, 3 qualitative), including offspring from birth to adulthood and parents with varying chronic pain diagnoses (eg, mixed pain samples, arthritis). Meta-analysis was used to synthesize the results from population-based and clinical studies, while meta-ethnography was used to synthesize the results of qualitative studies. Increased pain complaints were found in offspring of mothers and of fathers with chronic pain and when both parents had chronic pain. Newborns of mothers with chronic pain were more likely to have adverse birth outcomes, including low birthweight, preterm delivery, caesarian section, intensive care admission, and mortality. Offspring of parents with chronic pain had greater externalizing and internalizing problems and poorer social competence and family outcomes. No significant differences were found on teacher-reported externalizing problems. The meta-ethnography identified 6 key concepts (developing independence, developing compassion, learning about health and coping, missing out, emotional health, and struggles communicating with parents). Across study designs, offspring of parents with chronic pain had poorer outcomes than other offspring, although the meta-ethnography noted some constructive impact of having a parent with chronic pain. &copy; 2015 International Association for the Study of Pain

Overview of ¹⁴C release from irradiated zircaloys in geological disposal conditions

Carbon-14 (radiocarbon, 14C) is a long-lived radionuclide (5730 yr) of interest regarding the safety for the management of intermediate level wastes (ILW). The present study gives an overview of the release of 14C from irradiated Zircaloy cladding in alkaline media. 14C is found either in the alloy part of Zircaloy cladding due to the neutron activation of 14N impurities by 14N(n,p)14C reaction, or in the oxide layer (ZrO2) formed at the metal surface by the neutron activation of 17O from UO2 or (U-Pu)O2 fuel and water from the primary circuit in the reactor by 17O(n,α)14C reaction. Various irradiated and unirradiated Zircaloys have been studied. The total 14C inventory has been determined both experimentally and by calculations. The results seem to be in good agreement. Leaching experiments were conducted in alkaline media for several time durations. 14C was mainly released as carboxylic acids. Further, corrosion measurements were performed by using both hydrogen measurements and electrochemical measurements. The corrosion rate (CR) ranges from a few nm/yr to 100 nm/yr depending on the surface conditions and the method used for measurement. From a safety assessment point of view, the instant release fraction (IRF) was determined on irradiated Zircaloy-2. The results showed that the 14C inventory in the oxide was significantly below the 20% commonly used in safety case assessments