Getting a grip on pain : a model on pain and quality of life in adolescents with chronic pain

Chronic pain in children and adolescents is increasingly recognized to occur. It often results in considerable functional disability and is a cause for health services utilisation. Chronic pain is known to have substantial impact on the quality of life of adolescents and their families. The maintenance of chronic pain in the absence of a defined organic diagnosis has led researchers to seek for psychosocial explanations. This thesis evaluates a model on the adjustment of adolescents to chronic pain, in which psychosocial factors are incorporated. Examined are two issues in relation to this model. The first issue concerns the influence of psychosocial factors on chronic pain and quality of life of adolescents. The second issue concerns the evaluation of a cognitive-behavioral intervention program for adolescents with chronic pain. Before presenting studies on these issues, this introductory chapter starts with a description of the background of these studies. After presenting information on chronic pain and quality of life in adolescents, the reader is acquainted with the issue of psychosocial factors related to chronic pain and quality of life. Additionally, the background of the cognitive-behavioral intervention program is addressed. Finally, an overview of the various chapters in this thesis is presented

Development and psychometric properties of a pain-related problem list for adolescents (PPL)

Instruments for measuring pain-related problems in adolescents with chronic pain are sparse, especially those based on the personal experiences of these adolescents. This study aimed to develop and test such an instrument, the pain-related problem list for adolescents (PPL). A sample of 129 adolescents with chronic pain without documented physiological etiology completed the 57-item problem list, which was based on interviews with a similar group of adolescents with chronic pain. Principal components analysis yielded four domains: problems related to (1) concentration; (2) mobility; (3) adaptability; and (4) mood. The questionnaire was shortened to 18 items and has good reliability (total α = 0.82; concentration α = 0.86; mobility α = 0.77; adaptability α = 0.71; and mood α = 0.78); the validity also proved to be adequate, especially in the general population sample. The PPL provides a tool to assess the impact of chronic pain in adolescents. Future research should focus on further validation of the PPL in a large clinical population and establishing its test-retest reliability

A cognitive-behavioural program for adolescents with chronic pain - A pilot study

The purpose of this pilot study is to evaluate the feasibility of a cognitive-behavioural training program for adolescents with chronic pain irrespective of pain localisation. A secondary aim was to give an impression of the effect of the program on pain and quality of life. Eight adolescents (14-18 years) with chronic non-organic pain recruited from the general population (and their parents) participated in this pilot study. The intervention included five group meetings alternated with four telephone contacts (during the self-management weeks) over a period of 9 weeks. The training aimed to change pain behaviour through pain education, relaxation strategies, problem-solving techniques, assertiveness training, cognitive restructuring and by stimulating the adolescent's physical activity level. The training further addresses the social context of pain by inviting parents to attend two meetings for the parents only, and by asking the adolescents to bring a peer to one of the meetings. Adolescents and their parents were positive about the program. Adolescents felt they were more in control of their pain and parents valued the support they experienced in helping their children to master the pain. The training was considered to be feasible in daily life. Further, the preliminary data showed an effect on pain and quality of life in the expected direction. The results underline the need for a definitive study with a larger sample size and a random controlled design