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					                                             Relationship between Pain Intensity and Frequency
                                                       with Psychosocial Risk Factors
                              Katherine Simon1, Keri R. Hainsworth2, Renee J. Ladwig3, Kristen E. Jastrowski Mano2,
                                    Kimberly Anderson Khan2, W. Hobart Davies1,3, and Steven J. Weisman2,3
                                 University of Wisconsin-Milwaukee1, Medical College of Wisconsin2, & Children’s Hospital of Wisconsin3

  Introduction                                                                           Measures                                                                                                     Table II: Correlations
It is estimated that one in five U.S. children are affected by chronic               Demographic and Medical Information, including age, gender, ethnicity,                                                                 Best Pain      Worst Pain        Usual Pain
pain (Zeltzer & Schlank, 2005). Youth with chronic pain often have                  diagnosis, and pain intensity (worst, usual, best) and frequency, are                                                                     r p             r p               r p
decreased social functioning, increased school absenteeism, and                     collected upon arrival at the comprehensive pain center. The doctor or nurse
decreased quality of life (Eccleston, Wastell, Crombez, & Jordan,                   asked the primary caregiver and the youth for this information.
                                                                                                                                                                                                    Cumulative Risk          .03 (NS)        .07 (NS)        .16 (.004)***
2008). Research in adults has noted that daily stress is associated with                                                                                                                            Factors
headache severity (Cathcart & Pritchard, 2008); however, less is                     Clinician Interviews were conducted during the initial visit with the
known about the relationship between daily stressors and pain in                    family. The interviews include information regarding mental health history,
pediatric populations.                                                              current mental health symptoms, and coping attempts, among other factors.                                       *p < . 10. **p < .05. ***p < .01.
                                                                                    The number of risk factors were totaled and cumulative risk factors were                                         To Note: Best Pain was significantly correlated with Worst Pain (r =
                                                                                    used in subsequent analyses.                                                                                    .14, p = .018) and Usual Pain (r = .30, p = .000). Worst and Usual pain
                                                                                                                                                                                                    were also significant related (r = .35, p = .000).
  Hypothesis
 The current study aimed to explore the association between pain
                                                                                        Results
(intensity and frequency) and common psychosocial risk factors                       Pearson Correlations were used to explore the relationship between pain                                        Table III: T-tests
reported by youth seen in a multidisciplinary pain clinic.                          intensity, frequency and psychosocial risk factors.
                                                                                                                                                                                                                              M of Pain M of Pain         t(df)        p
 Hypothesis: Youth with fewer psychosocial risk factors will report                Independent t-tests were conducted to further describe the relationship
                                                                                                                                                                                                                              if Factor if Factor
lower pain intensity and frequency.                                                 between pain intensity and frequency with psychosocial risk factors                                                                       Endorsed     Not
                                                                                     See Table I for psychosocial risk factors, Table II for correlations, and                                                                         Endorsed
                                                                                    Table III for t-tests.                                                                                          Usual Pain
                                                                                                                                                                                                          Family Conflict       6.33        5.80        1.91(304)    .057*
  Methods                                                                                                                                                                                                                      N = 84      N = 222
                                                                                         Descriptive Statistics                                                                                                    Divorce      6.40        5.83        1.85(304)    .066*
 This study involved patients presenting to a multidisciplinary pain                                                                                                                                                          N = 62      N = 244
clinic at a large Midwestern children’s hospital.                                     Pain Locations (Top 3)                                                                                                         Abuse      6.89        5.88        1.96(304)    .051*
 At intake, mothers, fathers, and youth completed a packet of                                                                  Headache                             35.1%                                                     N = 19      N = 287
questionnaires that assess clinical, behavioral, and psychosocial                                                                                                                                      Financial Problems       7.11        5.74        4.05(304) .000***
                                                                                                                  Abdominal Pain                                     24.7%
variables related to pain.                                                                                                                                                                                                     N = 47      N = 259
                                                                                                              Lower Extremity Pain                                   17.1%                              School Transition       6.39        5.83        1.83(304)    .068*
 Based on an interview with the family, clinician’s also rate the
                                                                                      Cumulative Risk Factors                                         2.77 (SD = 2.39; R = 0-11)                                               N = 64      N = 242
occurrence of 23 psychosocial risk factors.
                                                                                                                                                                                                      Academic Problems         6.62        5.79        2.63(304) .009**
The current study includes youth 4 - 19 years old with chronic pain
                                                                                                                                                                                                                               N = 58      N = 248
(e.g., headache, gastrointestinal pain, musculoskeletal pain).                                                                                                                                      Best Pain
                                                                                        Table I: Top 10 Psychosocial Risk Factors                                                                    School Absenteeism         2.62        1.94        2.06(308) .040**
                                                                                                                                                                                                                               N = 95      N= 215
                                                                                              Psychosocial Risk Factors                                         % Reported                          Athletic Achievement        3.45        2.04        2.40(306) .017**
                                                                                                                                                                                                                               N = 22      N= 286
  Participant Demographics                                                                                      School Absenteeism                                  31.3%                           Worst Pain
                                             Youth                                                                                                                                                   School Absenteeism         8.80        8.37   2.02(314) .044**
                                                                                                                      Family Conflict                               28.5%                                                     N = 99       N = 217
                                             N = 351
                                                                                                                                                                                                    *p < . 10. **p < .05. ***p < .01.
         Gender                           67.5% female                                                                            Divorce                           19.9%
                                                                                                                                                                                                     Conclusions
           Age                           13.65 yrs (2.39)                                                           School Transition                               19.7%                            The data highlight the importance of assessing potential risk
                                                                                                                                                                                                    factors in the treatment of chronic pain in youth, especially
        Ethnicity                        77.9% Caucasian                                         Feeling Isolated/Not Fitting In                                    19.4%                           family and school factors.
                                                                                                                                                                                                     These results suggest that there is a relationship between
   Best Pain Intensity                      2.15 (2.69)                                    Academic or Learning Difficulties                                        18.8%
                                                                                                                                                                                                    pain ratings and identified school (i.e. transition, academic
                                                                                                                                                                                                    problems) and family stressors (i.e. divorce, abuse, financial
  Worst Pain Intensity                      8.49 (1.75)                                               Family Financial Problems                                     16.2%                           issues), which may indicate that youth identifying these
  Usual Pain Intensity                      5.59 (2.19)                                                                                                                                             stressors warrant more specific interventions directed at those
                                                                                                      Sibling Behavior Problems                                     16.0%                           problematic areas based on the fact that school and family are
                                                                                                                                                                                                    important components of development.
                                                                                                        Youth as a High Achiever                                    14.2%
                                                                                                                                                                                                     Future research should focus on determining if these
                                                                                                                          Peer Conflict                              9.7%                           psychosocial risk factors impact treatment strategies or the
                                                                                                                                                                                                    need for additional services.

                                                       The authors would like to acknowledge the families at the Children’s Hospital of Wisconsin Jane P. Pettit Pain and Palliative Care Center.
                                                                                     For more information, please contact Katherine Simon at simon@uwm.edu.

				
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posted:4/3/2013
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