Sex differences in the efficacy of psychological therapies for the management of chronic and recurrent pain in children and adolescents:a systematic review and meta-analysis

Sex differences in chronic pain are reported to emerge during adolescence, although it is unclear if this includes responses to treatment. We conducted a meta-analysis to examine whether sex differences were present on outcome variables at pre-treatment, and whether the efficacy of psychological therapies for pediatric chronic pain differs between boys and girls at post-treatment and follow-up time points. Searches were conducted, extending two existing Cochrane reviews of randomized-controlled trials examining the efficacy of psychological therapies for chronic and recurrent pain in children and adolescents. Forty-six articles were eligible for inclusion, and data were extracted regarding pain, disability, anxiety, and depression in boys and girls at pre-treatment, post-treatment, and follow-up time points. No published study reported outcome data separately by sex, so authors of all studies were contacted and 17 studies provided data. Twice as many girls (n =1760) were enrolled into clinical trials of psychological therapies for pediatric chronic pain than boys (n = 828). Girls reported higher depression and anxiety at pre-treatment than boys. Girls with headache also reported significantly greater pre-treatment pain severity. Treatment gains were consistent across the sexes. One exception was for post-treatment disability in children with non-headache pain conditions; girls exhibited a significant effect of treatment relative to control condition (SMD= -0.50[-0.80,-0.20], p &lt; .01), but no such effect was observed for boys (SMD= -0.08[-0.44,0.28], p = .66). Future research should examine whether mechanisms of treatment efficacy differ between boys and girls, and consider the impact of pre-treatment sex differences on response to treatment.</p

Adult judgments of children’s pain and fear during venipuncture: The impact of adult and child sex

Background: Low levels of agreement between caregiver and child reports of acute pain are well documented. Aims: This study builds on prior research through exploring factors that may contribute to low caregiver–child concordance. Specifically, the study examined the influence of adult and child sex on adult judgments of children’s pain and fear during venipuncture and examined whether trait parental pain catastrophizing, empathy, and anxiety predicted judgment accuracy. Methods: Using a judgment study paradigm, 160 participants (82 women) viewed 20 10-s video clips of children (10 boys, 10 girls) undergoing venipuncture and rated each child’s pain and fear. Adults’ ratings were compared to the children’s own ratings. Adults completed measures of trait parental pain catastrophizing, dispositional empathy, and trait anxiety. Results: Adults accurately judged boys’ pain and fear significantly more often than that of girls. Further, adults underestimated and overestimated girls’ pain and overestimated girls’ fear significantly more frequently than that of boys. No effects of adult sex or adult by child sex interactions emerged. Parental pain catastrophizing significantly predicted underestimation of girls’ pain, with adults who engaged in more catastrophizing being less likely to underestimate girls’ pain. The variables did not predict adult judgment of child pain for women and men separately and did not predict adult judgment of child fear when examined by adult sex, child sex, or both combined. Conclusions: Child sex influences adult pain and fear judgments, with girls being more vulnerable to inaccurate assessment than boys. Higher levels of parental pain catastrophizing may buffer against adults’ propensities to underestimate girls’ pain

Sex differences in experimental pain among healthy children: A systematic review and meta-analysis

Sex differences in response to experimental pain are commonly reported in systematic reviews in the adult literature. The objective of the present research was to conduct a systematic review and meta-analysis of sex differences in healthy children's responses to experimental pain (eg, cold pressor, heat pain, pressure pain) and, where possible, to conduct analyses separately for children and adolescents. A search was conducted of electronic databases for published papers in English of empirical research using experimental pain tasks to examine pain-related outcomes in healthy boys and girls between 0 and 18 years of age. Eighty articles were eligible for inclusion and were coded to extract information relevant to sex differences. The systematic review indicated that, across different experimental pain tasks, the majority of studies reported no significant differences between boys and girls on pain-related outcomes. However, the meta-analysis of available combined data found that girls reported significantly higher cold pressor pain intensity compared to boys in studies where the mean age of participants was greater than 12 years. Additionally, a meta-analysis of heat pain found that boys had significantly higher tolerance than girls overall, and boys had significantly higher heat pain threshold than girls in studies where the mean age of participants was 12 years or younger. These findings suggest that developmental stage may be relevant for understanding sex differences in pain

Impact of Threat Level, Task Instruction, and Individual Characteristics on Cold Pressor Pain and Fear among Children and Their Parents

The cold pressor task (CPT) is increasingly used to induce experimental pain in children, but the specific methodology of the CPT is quite variable across pediatric studies. This study examined how subtle variations in CPT methodology (eg. provision of low- or high-threat information regarding the task; provision or omission of maximum immersion time) may influence children's and parents' perceptions of the pain experience. Forty-eight children (8 to 14 years) and their parents were randomly assigned to receive information about the CPT that varied on 2 dimensions, prior to completing the task: (i) threat level: high-threat (task described as very painful, high pain expressions depicted) or low-threat (standard CPT instructions provided, low pain expressions depicted); (ii) ceiling: informed (provided maximum immersion time) or uninformed (information about maximum immersion time omitted). Parents and children in the high-threat condition expected greater child pain, and these children reported higher perceived threat of pain and state pain catastrophizing. For children in the low-threat condition, an informed ceiling was associated with less state pain catastrophizing during the CPT. Pain intensity, tolerance, and fear during the CPT did not differ by experimental group, but were predicted by child characteristics. Findings suggest that provision of threatening information may impact anticipatory outcomes, but experienced pain was better explained by individual child variables. &copy; 2015 World Institute of Pain

Acceptability by parents and children of deception in pediatric research

OBJECTIVE: Deception has been used to investigate the role of developmental and behavioral factors in child health; however, its acceptability for use in pediatric research has received little empirical attention. This study examined the acceptability of deception in a pediatric pain research study as assessed through participating children's and parent's long-term perceptions of its use.&nbsp; METHOD: Ninety-four children (52 boys; meanage = 12.77 yr) and their parents (86 mothers, 8 fathers) completed a structured interview that assessed perceptions of various aspects of deception in a pediatric pain study, 2.5 years after participating.&nbsp; RESULTS: A minority of parents (25.5%) and children (13.8%) spontaneously recalled that deception was used. Overall, parents and children reported positive experiences with research participation, felt comfortable with the debriefing process, and deemed the research to be of societal importance. Opinions about researchers and psychologists were not negatively impacted, and most reported willingness to participate in research involving deception again.&nbsp; CONCLUSION:&nbsp;When thoughtfully planned and disclosed, deception in pediatric research seems to be acceptable to parents and children. Future research should further examine the acceptability of deception and alternatives (e.g., authorized deception) among pediatric samples

A comprehensive categorical and bibliometric analysis of published research articles on pediatric pain from 1975 to 2010

The field of pediatric pain research began in the mid-1970s and has undergone significant growth and development in recent years as evidenced by the variety of books, conferences, and journals on the topic and also the number of disciplines engaged in work in this area. Using categorical and bibliometric meta-trend analysis, this study offers a synthesis of research on pediatric pain published between 1975 and 2010 in peer-reviewed journals. Abstracts from 4256 articles, retrieved from Web of Science, were coded across 4 categories: article type, article topic, type and age of participants, and pain stimulus. The affiliation of the first author and number of citations were also gathered. The results suggest a significant increase in the number of publications over the time period investigated, with 96% of the included articles published since 1990 and most research being multiauthored publications in pain-focused journals. First authors were most often from the United States and affiliated with a medical department. Most studies were original research articles; the most frequent topics were pain characterization (39.86%), pain intervention (37.49%), and pain assessment (25.00%). Clinical samples were most frequent, with participants most often characterized as children (6-12 years) or adolescents (13-18 years) experiencing chronic or acute pain. The findings provide a comprehensive overview of contributions in the field of pediatric pain research over 35 years and offers recommendations for future research in the area. &copy; 2015 International Association for the Study of Pain

Simple psychological interventions for reducing pain from common needle procedures in adults: Systematic review of randomized and quasi-randomized controlled trials

Background: This systematic review evaluated the effectiveness of simple psychological interventions for managing pain and fear in adults undergoing vaccination or related common needle procedures (ie, venipuncture/venous cannulation). Design/Methods: Databases were searched to identify relevant randomized and quasi-randomized controlled trials. Self-reported pain and fear were prioritized as critically important outcomes. Data were combined using standardized mean difference (SMD) or relative risk (RR) with 95% confidence intervals (CI). Results: No studies involving vaccination met inclusion criteria; evidence was drawn from 8 studies of other common needle procedures (eg, venous cannulation, venipuncture) in adults. Two trials evaluating the impact of neutral signaling of the impending procedure (eg, ready? ) as compared with signaling of impending pain (eg, sharp scratch ) demonstrated lower pain when signaled about the procedure (n=199): SMD=-0.97 (95% CI, -1.26, -0.68), after removal of 1 trial where self-reported pain was significantly lower than the other 2 included trials. Two trials evaluated music distraction (n=156) and demonstrated no difference in pain: SMD=0.10 (95% CI, -0.48, 0.27), or fear: SMD= -0.25 (95% CI, -0.61, 0.10). Two trials evaluated visual distraction and demonstrated no difference in pain (n=177): SMD= -0.57 (95% CI, -1.82, 0.68), or fear (n=81): SMD= -0.05 (95% CI, -0.50, 0.40). Two trials evaluating breathing interventions found less pain in intervention groups (n=138): SMD= -0.82 (95% CI, -1.21, -0.43). The quality of evidence across all trials was very low. Conclusions: There are no published studies of simple psychological interventions for vaccination pain in adults. There is some evidence of a benefit from other needle procedures for breathing strategies and neutral signaling of the start of the procedure. There is no evidence for use of music or visual distraction

State versus Trait: Validating State Assessment of Child and Parental Catastrophic Thinking about Child Pain

Pain catastrophizing has emerged as one of the most robust predictors of child pain outcomes. Although assessments of state (i.e., situation-specific) pain catastrophizing in children and parents are often used, their psychometric properties are unknown. This study aimed to assess factor structure, reliability and predictive validity of state versions of Pain Catastrophizing Scales for children (PCS-C State) and parents (PCS-P State) relative to corresponding trait versions for child and parental pain-related outcomes. Data were pooled from 8 experimental pain studies wherein child and/or parent state catastrophizing (measured immediately before application of a pain stimulus) and trait catastrophizing were assessed in community-based samples of children aged 8&ndash;18 years (N=689) and their parents (N=888) in Dutch or English. Exploratory factor analyses were conducted to examine the underlying factor structure of the PCS-P/PCS-C State, revealing a single factor solution that explained 55.53% of the variance for children and 49.72% for parents. Hierarchical linear regression analyses were used to examine relative influence of state versus trait catastrophizing on child and parent pain-related outcomes. Child and parent state catastrophizing were significantly associated with child pain intensity, child state anxiety and parental distress. State catastrophizing scores showed stronger associations than trait scores for most outcomes