The journal of pain : official journal of the American Pain Society
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Traumatic brain injury (TBI) is a leading cause of pediatric disability. Although persistent pain has been recognized as a significant postinjury complication, there is a paucity of data concerning the postinjury pain experience of youth. This study aimed to examine the prevalence of persistent pain in adolescents after TBI, identify risk factors for pain, and evaluate the impact of pain on adolescent health-related quality of life. Participants included 144 adolescents with mild to severe TBI who were followed over 36 months after injury. At 3-, 12-, 24-, and 36-month assessments, measures of pain intensity, depression, posttraumatic stress disorder, and health-related quality of life were completed by adolescents. Findings demonstrated that 24.3% of adolescents reported persistent pain (defined as usual pain intensity ≥3/10) at all assessment points after TBI. Female sex (odds ratio = 2.73, 95% confidence interval = 1.12-6.63) and higher levels of depressive symptoms at 3 months after injury (odds ratio = 1.26, 95% confidence interval = 1.12-1.43) were predictors of persistent pain at 36 months. Furthermore, mixed linear models indicated that early pain experience at 3 months following TBI was associated with a significantly poorer long-term health-related quality of life. ⋯ This is the first study to examine the prevalence of persistent pain over long-term follow-up in adolescents after TBI and its impact on health-related quality of life. These findings indicate that adolescents with TBI may benefit from timely evaluation and intervention to minimize the development and impact of pain.
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Randomized Controlled Trial
Developmental data supporting simplification of self-report pain scales for preschool-age children.
Claims regarding the ability of preschool-age children to provide accurate self-reports using standard pain scales are not well supported by age-specific evidence. Responses of children younger than 5 years are often idiosyncratic and subject to biases. Simplifying the task of self-report of pain would make it more developmentally appropriate for 3- to 5-year-olds. A binary question is asked: "Does it hurt?" or an equivalent. If yes, a simplified scale is presented, comprising 3 categories representing low, medium, and high pain severity. Children aged 3 to 5 years (N = 184) were recruited from preschools and day care centers. Following parental consent and child assent, children were randomly assigned to use either the Faces Pain Scale-Revised or a 3-face scale preceded by a yes-no question to rate pain in 9 picture stories from the Charleston Pediatric Pain Pictures portraying no pain, moderate pain, and severe pain. The simplified pain rating task made no difference for 5-year-olds, whose mean scores were nearly identical using the 2 approaches. However, discrimination of the 3 levels of Charleston Pediatric Pain Pictures items was significantly better in 3- and 4-year-olds with the simplified task than with the Faces Pain Scale-Revised. Simplifying the task improved preschool-age children's ability to estimate pain intensity. ⋯ Standard self-report pain scales with 6 faces are confusing for many 3- and 4-year-olds. In basic preparatory research for future development of a preschool self-report pain scale, we simplified the task. This simplification made no difference for 5-year-olds but improved the performance of 3- and 4-year-olds.
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Little is known about how far opioid shoppers travel or how often they cross state lines to fill their opioid prescriptions. This retrospective cohort study evaluated these measures for opioid shoppers and nonshoppers using a large U.S. prescription database. Patients with ≥3 opioid dispensings were followed for 18 months. A subject was considered a shopper when he or she filled overlapping opioid prescriptions written by >1 prescriber at ≥3 pharmacies. A heavy shopper had ≥5 shopping episodes. Outcomes assessed were distance traveled among pharmacies and number of states visited to fill opioid prescriptions. A total of 10,910,451 subjects were included; .7% developed any shopping behavior and their prescriptions accounted for 8.6% of all opioid dispensings. Shoppers and heavy shoppers were younger than the nonshoppers. Shoppers traveled a median of 83.8 miles, heavy shoppers 199.5 miles, and nonshoppers 0 miles. Almost 20% of shoppers or heavy shoppers, but only 4% of nonshoppers, visited >1 state. Shoppers traveled greater distances and more often crossed state borders to fill opioid prescriptions than nonshoppers, and their dispensings accounted for a disproportionate number of opioid dispensings. Sharing of data among prescription-monitoring programs will likely strengthen those programs and may decrease shopping behavior. ⋯ This study shows that opioid shoppers travel greater distances and more often cross state borders to fill opioid prescriptions than nonshoppers, and their dispensings accounted for a disproportionate number of opioid dispensings. The findings support the need for data sharing among prescription-monitoring programs to deter opioid shopping behavior.
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In this study, effects of chronic pain and pain-related fear on orienting and maintenance of attention toward pain stimuli were evaluated by tracking eye movements within a dot-probe paradigm. The sample comprised matched chronic pain (n = 24) and pain-free (n = 24) groups, each of which included lower and higher fear of pain subgroups. Participants completed a dot-probe task wherein eye movements were assessed during the presentation of sensory pain-neutral, health catastrophe-neutral, and neutral-neutral word pairs. Higher fear of pain levels were associated with biases in 1) directing initial gaze toward health catastrophe words and, among participants with chronic pain, 2) subsequent avoidance of threat as reflected by shorter first fixation durations on health catastrophe words compared to pain-free cohorts. As stimulus word pairs persisted for 2,000 ms, no group differences were observed for overall gaze durations or reaction times to probes that followed. In sum, this research identified specific biases in visual attention related to fear of pain and chronic pain during early stages of information processing that were not evident on the basis of later behavior responses to probes. ⋯ Effects of chronic pain and fear of pain on attention were examined by tracking eye movements within a dot-probe paradigm. Heightened fear of pain corresponded to biases in initial gaze toward health catastrophe words and, among participants with chronic pain, subsequent gaze shifts away from these words. No reaction time differences emerged.
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Review Meta Analysis
Primary somatosensory cortex function in complex regional pain syndrome: a systematic review and meta-analysis.
That complex regional pain syndrome (CRPS) is associated with functional reorganization in the primary somatosensory cortex (S1) is widely accepted and seldom questioned. Despite more than a decade of research, there has been no systematic review of the CRPS literature concerning the changes in S1 function, and therefore the extent of these changes is unclear. Here we conduct a systematic review and meta-analysis to quantify the spatial and temporal aspects of S1 function in CRPS. A comprehensive search strategy identified functional neuroimaging studies of S1 in CRPS. We adhered to a rigorous systematic review protocol when extracting data and appraising risk of bias. Outcomes were grouped into spatial representation; activation levels, including disinhibition; peak latency of activation; and glucose metabolism. Meta-analysis was conducted where possible. Fifteen studies were included, all investigating upper-extremity CRPS. In patients with CRPS, the S1 spatial representation of the affected hand is smaller than that of the unaffected hand and that of non-CRPS controls; however, this evidence comes from only a few studies. There is no difference in activation, disinhibition, or latency of peripherally evoked S1 responses in CRPS. The risk of bias was high across studies, mainly from unclear sampling methods and unblinded analysis of outcomes. ⋯ The evidence for a difference in function of the primary somatosensory cortex in CRPS compared with controls is clouded by high risk of bias and conflicting results, but reduced representation size seems consistent.