Management of paediatric procedure-related cancer pain

Paediatric malignancy is not always painful in its own right; however, young patients with cancer undergo numerous painful procedures for diagnosis, therapy and supportive care, including lumbar puncture, bone marrow aspiration and biopsy. Children with cancer consider painful procedures to be the most difficult part of their illness and the frequent repetition of procedures does not desensitize them to the distress. This review provides a brief overview of the state of the art with regard to procedure-related pain in children, and presents some methods and strategies for assessing it and managing it effectively. The first section briefly identifies the dimensions of procedure-related pain and describes the most commonly used methods for its assessment. This followed by an examination of the pharmacological strategies for pain management, including local anaesthesia, conscious sedation and general anaesthesia. In the next section, psychological interventions for the management of procedure-related pain, such as preparation, cognitive–behavioural therapy and hypnosis, are reviewed. The review concludes with recommendations for clinical practice

Tracking daily fatigue fluctuations in multiple sclerosis : ecological momentary assessment provides unique insights

The preparation of this manuscript was supported by a UK Economic and Social Research Council (ESRC) PhD studentship (ES/1026266/1) awarded to DP. The study was funded by the Psychology Unit at the University of Southampton. The authors declare that they have no conflict of interest. The authors thank all participants of this study. Open access via Springer Compact Agreement.Peer reviewedPublisher PD

Attention toward interpersonal stimuli in individuals with and without chronic daily headache

Attentional capture of threat is a normal and adaptive process, although facilitated processing of mildly threatening stimuli irrelevant to current goals may result in attentional interference and compromised performance. In the field of chronic pain, attentional biases towards pain-related information have been commonly found. Pain is inexorably connected with emotion however, and a transdiagnostic approach elucidating similar mechanisms underlying pain and mood disorders has been advocated. One such mechanism may be repetitive thinking on negative themes, including worry and rumination. Attentional biases for threatening (e.g., angry faces) and negative (e.g., sad faces) information have been observed in anxious and depressed populations, although to date it has not been fully established whether biases for such information are heightened in individuals with chronic pain relative to healthy individuals. In this study, attentional biases for angry, sad and also happy facial expressions, at 500 and 1250 ms presentation times, were assessed via visual-probe task in chronic daily headache (n = 20) and healthy control (n = 26) groups. Results showed participants to demonstrate significant bias towards angry and sad expressions at 500 and 1250 ms, and happy expressions at 1250 ms. No significant differences in attentional bias were found between chronic daily headache and healthy control groups. These results suggest that attentional biases towards interpersonal threat are not specifically heightened in individuals with chronic daily headache. While similar mechanisms such as rumination may underlie biases in different disorders, this does not translate to heightened biases for the same specific content

Appearance related concerns across the general and clinical populations

This thesis explores appearance related concerns across the general and clinical populations. Section A briefly describes the different parts comprising this thesis and discusses the common themes emerged. In Section B, a survey of 300 young adults is reported which was conducted with an aim to identify the nature, extent and correlates of appearance dissatisfaction in this population. It was found that a surprisingly large percent of men and women were dissatisfied with their appearance and that this discontent was not limited to shape/size concerns in women and muscularity concerns in men as has been suggested by previous investigators. In terms of predictors of appearance dissatisfaction, appearance schemata, social support and psychological distress were the stronger with investment in appearance (appearance schemata) being the most significant. This survey was followed up by two qualitative studies aiming to identify and explore in more depth the factors that contribute to the development or not of appearance dissatisfaction. Themes such as parental modelling, self-esteem social support, media influence emerged in the participants' discourse as important in the development or not of their dissatisfaction with appearance. In Section C the consultation revised the existing measures of appearance (dis)satis faction and recommended the most developmentally appropriate and psychometrically rigorous for the assessment of individuals with cleft lip/palate condition. From the review of the relevant literature it became obvious that the assessment of appearance related aspects is still at an early stage. 'Me consultation also briefly summarizes the effects on body image, self-concept, and social interaction of cleft lip/palate condition. Finally in Section D, a review paper critically summarizes the literature on body image and quality of life in patients with head and neck cancer and makes recommendations for further developments in research and clinical practice in this area

Internet-delivered attentional bias modification training (iABMT) for the management of chronic musculoskeletal pain: A protocol for a randomised controlled trial

Introduction Chronic musculoskeletal pain is a complex medical condition that can significantly impact quality of life. Patients with chronic pain demonstrate attentional biases towards pain-related information. The therapeutic benefits of modifying attentional biases by implicitly training attention away from pain-related information towards neutral information have been supported in a small number of published studies. Limited research however has explored the efficacy of modifying pain-related biases via the internet. This protocol describes a randomised, double-blind, internet-delivered attentional bias modification intervention, aimed to evaluate the efficacy of the intervention on reducing pain interference. Secondary outcomes are pain intensity, state and trait anxiety, depression, pain-related fear, and sleep impairment. This study will also explore the effects of training intensity on these outcomes, along with participants' perceptions about the therapy. Methods and analysis The study is a double-blind, randomised controlled trial with four arms exploring the efficacy of online attentional bias modification training versus placebo training theorised to offer no specific therapeutic benefit. Participants with chronic musculoskeletal pain will be randomised to one of four groups: (1) 10-session attentional modification group; (2) 10-session placebo training group; (3) 18-session attentional modification group; or (4) 18-session placebo training group. In the attentional modification groups, the probe-classification version of the visual-probe task will be used to implicitly train attention away from threatening information towards neutral information. Following the intervention, participants will complete a short interview exploring their perceptions about the online training. In addition, a subgroup analysis for participants aged 16-24 and 25-60 will be undertaken. Ethics and dissemination This study has been approved by the University of Southampton Research Ethics Committee. Results will be published in peer-reviewed journals, academic conferences, and in lay reports for pain charities and patient support groups. Trial registration number NCT02232100; Pre-results

SCOTT AND THE LOGS: DESIGN AND DATA CAPTURE IN A PREPARATORY ONLINE PACKAGE FOR CHILDREN UNDERGOING GA FOR DENTAL PROCEDURES

This National Institute of Health Research project aims to test if children scheduled for anaesthesia benefit from an interactive online package. The project deals with the design and data capture (logs) of a prototype (alpha) online interactive cartoon created to answer the research question: “Will internet delivered information help children cope better with anaesthesia?” Following modification of the alpha package the resultant beta package will be compared to two control groups: standard care procedures and a non-medical computer game. An international academic audience provided positive feedback on the package design and data capture. The animation package sets an example of good practice in design for other similar healthcare scenarios

Barriers and facilitators to asthma self-management in adolescents:a systematic review of qualitative and quantitative studies

BACKGROUND: Many adolescents have poor asthma control and impaired quality of life despite the availability of modern pharmacotherapy. Research suggests that poor adherence to treatment and limited engagement in self-management could be contributing factors. OBJECTIVE: To conduct a systematic review of the barriers and facilitators to self-management of asthma reported by adolescents using a narrative synthesis approach to integrate the findings. DESIGN: MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for all types of study design. Full papers were retrieved for study abstracts that included data from participants aged 12-18 years referring to barriers or facilitators of asthma self-management behaviors. RESULTS: Sixteen studies (5 quantitative and 11 qualitative) underwent data extraction, quality appraisal, and thematic analysis. Six key themes were generated that encompassed barriers and/or facilitators to self-management of asthma in adolescents: Knowledge, Lifestyle, Beliefs and Attitudes, Relationships, Intrapersonal Characteristics, and Communication. CONCLUSIONS: There is a pressing need to prepare adolescents for self-management, using age-appropriate strategies that draw on the evidence we have synthesized. Current clinical practice should focus on ensuring adolescents have the correct knowledge, beliefs, and positive attitude to self-manage their illness. This needs to be delivered in a supportive environment that facilitates two-way communication, fosters adolescents' self-efficacy to manage their disease, and considers the wider social influences that impinge on self-management. Pediatr Pulmonol. 2016; 9999:XX-XX. © 2016 Wiley Periodicals, Inc

Pain assessment tools in paediatric palliative care: A systematic review of psychometric properties and recommendations for clinical practice

Background: Assessing pain in infants, children and young people with life-limiting conditions remains a challenge due to diverse patient conditions, types of pain and often a reduced ability or inability of patients to communicate verbally. Aim: To systematically identify pain assessment tools that are currently used in paediatric palliative care and examine their psychometric properties and feasibility and make recommendations for clinical practice. Design: A systematic literature review and evaluation of psychometric properties of pain assessment tools of original peer-reviewed research published from inception of data sources to April 2021. Data sources: PsycINFO via ProQuest, Web of Science Core, Medline via Ovid, EMBASE, BIOSIS and CINAHL were searched from inception to April 2021. Hand searches of reference lists of included studies and relevant reviews were performed. Results: From 1168 articles identified, 201 papers were selected for full-text assessment. Thirty-four articles met the eligibility criteria and we examined the psychometric properties of 22 pain assessment tools. Overall, the Faces Pain Scale-Revised (FPS-R) had high cross-cultural validity, construct validity (hypothesis testing) and responsiveness; while the Faces, Legs, Activity, Cry and Consolability (FLACC) scale and Paediatric Pain Profile (PPP) had high internal consistency, criterion validity, reliability and responsiveness. The number of studies per psychometric property of each pain assessment tool was limited and the methodological quality of included studies was low. Conclusion: Balancing aspects of feasibility and psychometric properties, the FPS-R is recommended for self-assessment, and the FLACC scale/FLACC Revised and PPP are the recommended observational tools in their respective age groups