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The Pivotal Role of Pediatric Psychology in Chronic Pain: Opportunities for Informing and Promoting New Research and Intervention in a Shifting Healthcare Landscape

  • Sarah Nelson
  • Rachael Coakley
Psychological and Behavioral Aspects of Headache and Pain (D Buse, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Psychological and Behavioral Aspects of Headache and Pain

Abstract

Purpose of Review

In the context of new efforts to formulate more comprehensive diagnostic and treatment processes for chronic pain conditions, this review aims to provide an overview of some of the most salient developments in the diagnosis and clinical treatment of pediatric chronic pain and to delineate the current and future role of clinical pediatric psychologists in these efforts.

Recent Findings

The acceptance and promotion of the multidisciplinary approach to pediatric pain management has had an especially significant impact on the field of pediatric psychology. Though chronic pain was historically conceptualized as a biomedical problem, psychology is increasingly viewed as a routine, integral, and component part of treatment. With this evolving biopsychosocial paradigm, pediatric psychology is poised to help shape the development of this field, contributing to emerging conceptual and diagnostic frameworks via consultation, research, clinical care, and education.

Summary

This review discusses the role of pediatric psychologists as collaborators in emerging diagnostic and assessment frameworks, leaders in pain-related research, drivers of clinical care, and educators for providers, patients, and the lay public. With increased opportunities to enhance the conceptualization and treatment of pediatric pain, pediatric psychologists have an important role to play in reducing the prevalence and persistence of pediatric pain.

Keywords

Pediatric psychology Pediatric pain Current practice Healthcare 

Notes

Compliance with Ethical Standards

Conflict of Interest

Sarah Nelson and Rachael Coakley declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L, et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152(12):2729–38.CrossRefPubMedGoogle Scholar
  2. 2.
    Logan DE, Claar RL, Guite JW, Kashikar-Zuck S, Lynch-Jordan A, Palermo TM, et al. Factor structure of the children’s depression inventory in a multisite sample of children and adolescents with chronic pain. J Pain. 2013;14(7):689–98.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lynch-Jordan AM, Kashikar-Zuck S, Szabova A, Goldschneider KR. The interplay of parent and adolescent catastrophizing and its impact on adolescents' pain, functioning, and pain behavior. Clin J Pain. 2013;29(8):681–8.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581–624.CrossRefPubMedGoogle Scholar
  5. 5.
    Kashikar-Zuck S, Sil S, Lynch-Jordan AM, Ting TV, Peugh J, Schikler KN, et al. Changes in pain coping, catastrophizing, and coping efficacy after cognitive-behavioral therapy in children and adolescents with juvenile fibromyalgia. J Pain. 2013;14(5):492–501.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lynch-Jordan AM, Sil S, Peugh J, Cunningham N, Kashikar-Zuck S, Goldschneider KR. Differential changes in functional disability and pain intensity over the course of psychological treatment for children with chronic pain. Pain. 2014;155(10):1955–61.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Sil S, Arnold LM, Lynch-Jordan A, Ting TV, Peugh J, Cunningham N, et al. Identifying treatment responders and predictors of improvement after cognitive-behavioral therapy for juvenile fibromyalgia. Pain. 2014;155(7):1206–12.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Kashikar-Zuck S, Carle A, Barnett K, Goldschneider KR, Sherry DD, Mara CA, et al. Longitudinal evaluation of patient-reported outcomes measurement information systems (PROMIS) measures in pediatric chronic pain. Pain. 2016;157(2):339–47.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Hechler T, et al. Inpatient-based intensive interdisciplinary pain treatment for highly impaired children with severe chronic pain: randomized controlled trial of efficacy and economic effects. PAIN®. 2014;155(1):118–28.CrossRefGoogle Scholar
  10. 10.
    Eccleston C, Palermo TM, de Williams C, Lewandowski AC, Morley S, Fisher E, Law E. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database Syst Rev. 2014.  https://doi.org/10.1002/14651858.
  11. 11.
    Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain—United States, 2016. Jama. 2016;315(15):1624–45.CrossRefPubMedGoogle Scholar
  12. 12.
    Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol. 2014;69(2):153–66.CrossRefPubMedGoogle Scholar
  13. 13.
    Turk DC, Monarch ES. Biopsychosocial perspective on chronic pain. In: Turk DC, Gatchel RJ, editors. Psychological approaches to pain management: A practitioner's handbook. New York, NY, US: Guilford Press; 2002. p. 3–9.Google Scholar
  14. 14.
    Simons LE, Logan DE, Chastain L, Cerullo M. Engagement in multidisciplinary interventions for pediatric chronic pain: parental expectations, barriers, and child outcomes. Clin J Pain. 2010;26(4):291–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Ernst MM, O'brien HL, Powers SW. Cognitive-behavioral therapy: how medical providers can increase patient and family openness and access to evidence-based multimodal therapy for pediatric migraine. Headache. 2015;55(10):1382–96.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    McGrath PJ, et al. Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. J Pain. 2008;9(9):771–83.CrossRefPubMedGoogle Scholar
  17. 17.
    Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features, and Rome IV. Gastroenterology. 2016;150(6):1262–1279. e2.CrossRefGoogle Scholar
  18. 18.
    Ting TV, et al. 2010 American College of Rheumatology Adult Fibromyalgia Criteria for use in an adolescent female population with juvenile fibromyalgia. J Pediatr. 2016;169:181–7.e1.CrossRefPubMedGoogle Scholar
  19. 19.
    Olesen J. Headache Classification Committee of the International Headache Society (IHS) the international classification of headache disorders, Asbtracts. Cephalalgia. 2018;38(1):1–211.CrossRefGoogle Scholar
  20. 20.
    Dhroove G, Chogle A, Saps M. A million-dollar work-up for abdominal pain: is it worth it? J Pediatr Gastroenterol Nutr. 2010;51(5):579–83.CrossRefPubMedGoogle Scholar
  21. 21.
    Subcommittee, A.A.o.N.Q.S. and P.C.o.t.C.N. Society. Pharmacological treatment of migraine headache in children and adolescents. Pediatrics. 2005;115(4):1107.CrossRefGoogle Scholar
  22. 22.
    Yarnitsky D. Conditioned pain modulation (the diffuse noxious inhibitory control-like effect): its relevance for acute and chronic pain states. Curr Opin Anesthesiol. 2010;23(5):611–5.CrossRefGoogle Scholar
  23. 23.
    Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity. J Pain. 2009;10(9):895–926.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain. 2011;152(3 Suppl):S2–15.CrossRefPubMedGoogle Scholar
  25. 25.
    •• Dworkin RH, et al. Multidimensional diagnostic criteria for chronic pain: introduction to the ACTTION–American Pain Society Pain Taxonomy (AAPT). J Pain. 2016;17(9):T1–9. Important article outlining steps taken to improve the diagnosis of chronic pain. CrossRefPubMedGoogle Scholar
  26. 26.
    Fillingim RB, Bruehl S, Dworkin RH, Dworkin SF, Loeser JD, Turk DC, et al. The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions. J Pain. 2014;15(3):241–9.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, (beta version). Cephalalgia, 2013;33(9):629–808.Google Scholar
  28. 28.
    Cunningham NR, Kashikar-Zuck S. Nonpharmacological treatment of pain in rheumatic diseases and other musculoskeletal pain conditions. Curr Rheumatol Rep. 2013;15(2):306.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Logan DE, Carpino EA, Chiang G, Condon M, Firn E, Gaughan VJ, et al. A day-hospital approach to treatment of pediatric complex regional pain syndrome: initial functional outcomes. Clin J Pain. 2012;28(9):766–74.CrossRefPubMedGoogle Scholar
  30. 30.
    Schechter NL. Functional pain: time for a new name. JAMA Pediatr. 2014;168(8):693–4.CrossRefPubMedGoogle Scholar
  31. 31.
    Ross AC, Simons LE, Feinstein AB, Yoon IA, Bhandari RP. Social risk and resilience factors in adolescent chronic pain: Examining the role of parents and peers. J Pediatr Psychol. 2017;43(3):303–13.CrossRefGoogle Scholar
  32. 32.
    American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5™. 5th ed. Arlington, VA, US: American Psychiatric Publishing, Inc.; 2013.  https://doi.org/10.1176/appi.books.9780890425596.
  33. 33.
    • Coakley R, Wihak T, Kossowsky J, Iversen C, Donado C. The comfort ability pain management workshop: A preliminary, nonrandomized investigation of a brief, cognitive, biobehavioral, and parent training intervention for pediatric chronic pain. J Pediatr Psychol. 2017;43(3):252–265. A new and effective psychological approach to pain management outside of traditional cognitive-behavioral therapy. CrossRefGoogle Scholar
  34. 34.
    Kite DM, Gullifer J, Tyson GA. Views on the diagnostic labels of autism and Asperger’s disorder and the proposed changes in the DSM. J Autism Dev Disord. 2013;43(7):1692–700.CrossRefPubMedGoogle Scholar
  35. 35.
    Cunningham NR, Jagpal A, Tran ST, Kashikar-Zuck S, Goldschneider KR, Coghill RC, et al. Anxiety adversely impacts response to cognitive behavioral therapy in children with chronic pain. J Pediatr. 2016;171:227–33.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth. 2013;111(1):52–8.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Boerner KE, Eccleston C, Chambers CT, Keogh E. 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. Pain. 2017;158(4):569–82.CrossRefGoogle Scholar
  38. 38.
    Chow ET, Otis JD, Simons LE. The longitudinal impact of parent distress and behavior on functional outcomes among youth with chronic pain. J Pain. 2016;17(6):729–38.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Logan DE, Simons LE, Carpino EA. Too sick for school? Parent influences on school functioning among children with chronic pain. Pain. 2012;153(2):437–43.CrossRefPubMedGoogle Scholar
  40. 40.
    Noel M, Palermo TM, Essner B, Zhou C, Levy RL, Langer SL, et al. A developmental analysis of the factorial validity of the parent-report version of the adult responses to Children’s symptoms in children versus adolescents with chronic pain or pain-related chronic illness. J Pain. 2015;16(1):31–41.CrossRefPubMedGoogle Scholar
  41. 41.
    Palermo TM, Law EF, Bromberg M, Fales J, Eccleston C, Wilson AC. Problem-solving skills training for parents of children with chronic pain: a pilot randomized controlled trial. Pain. 2016;157(6):1213–23.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Levy RL, Langer SL, Walker LS, Romano JM, Christie DL, Youssef N, et al. Twelve-month follow-up of cognitive behavioral therapy for children with functional abdominal pain. JAMA Pediatr. 2013;167(2):178–84.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Kashikar-Zuck S, Tran ST, Barnett K, Bromberg MH, Strotman D, Sil S, et al. A qualitative examination of a new combined cognitive-behavioral and neuromuscular training intervention for juvenile fibromyalgia. Clin J Pain. 2016;32(1):70–81.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Kashikar-Zuck S, Ting TV, Arnold LM, Bean J, Powers SW, Graham TB, et al. Cognitive behavioral therapy for the treatment of juvenile fibromyalgia: a multisite, single-blind, randomized, controlled clinical trial. Arthritis Rheum. 2012;64(1):297–305.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Levy RL, Langer SL, Walker LS, Romano JM, Christie DL, Youssef N, et al. Cognitive-behavioral therapy for children with functional abdominal pain and their parents decreases pain and other symptoms. Am J Gastroenterol. 2010;105(4):946–56.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Powers SW, Kashikar-Zuck SM, Allen JR, LeCates SL, Slater SK, Zafar M, et al. Cognitive behavioral therapy plus amitriptyline for chronic migraine in children and adolescents: a randomized clinical trial. JAMA. 2013;310(24):2622–30.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Bethell C, et al. Complementary and conventional medicine use among youth with recurrent headaches. Pediatrics. 2013;132:e1173–83.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Simons LE, Basch MC. State of the art in biobehavioral approaches to the management of chronic pain in childhood. Pain Manag. 2016;6(1):49–61.CrossRefPubMedGoogle Scholar
  49. 49.
    Blume HK, Brockman LN, Breuner CC. Biofeedback therapy for pediatric headache: factors associated with response. Headache. 2012;52(9):1377–86.CrossRefPubMedGoogle Scholar
  50. 50.
    Stern MJ, Guiles RA, Gevirtz R. HRV biofeedback for pediatric irritable bowel syndrome and functional abdominal pain: a clinical replication series. Appl Psychophysiol Biofeedback. 2014;39(3–4):287–91.CrossRefPubMedGoogle Scholar
  51. 51.
    Henin A, et al. Cognitive behavioral therapy with children and adolescents. In: The Massachusetts general hospital handbook of cognitive behavioral therapy. Springer; 2016. p. 259–75.Google Scholar
  52. 52.
    Cunningham NR, Tran ST, Lynch-Jordan AM, Ting TV, Sil S, Strotman D, et al. Psychiatric disorders in young adults diagnosed with juvenile fibromyalgia in adolescence. J Rheumatol. 2015;42(12):2427–33.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Logan DE, Williams SE, Carullo VP, Claar RL, Bruehl S, Berde CB. Children and adolescents with complex regional pain syndrome: more psychologically distressed than other children in pain? Pain Res Manag. 2013;18(2):87–93.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Coyne LW, McHugh L, Martinez ER. Acceptance and commitment therapy (ACT): advances and applications with children, adolescents, and families. Child Adolesc Psychiatr Clin N Am. 2011;20(2):379–99.CrossRefPubMedGoogle Scholar
  55. 55.
    Veehof M, et al. Acceptance-and mindfulness-based interventions for the treatment of chronic pain: a meta-analytic review. Cogn Behav Ther. 2016;45(1):5–31.CrossRefPubMedGoogle Scholar
  56. 56.
    Pielech M, Vowles KE, Wicksell R. Acceptance and commitment therapy for pediatric chronic pain: theory and application. Children. 2017;4(2):10.CrossRefPubMedCentralGoogle Scholar
  57. 57.
    McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol. 2014;69(2):178–87.CrossRefPubMedGoogle Scholar
  58. 58.
    Lovas DA, Pajer K, Chorney JML, Vo DX, Howlett M, Doyle A, et al. Mindfulness for adolescent chronic pain: a pilot feasibility study. J Child Adolesc Ment Health. 2017;29(2):129–36.CrossRefPubMedGoogle Scholar
  59. 59.
    Kabat-Zinn J. Full catastrophe living: The program of the stress reduction clinic at the University of Massachusetts Medical Center. New York: Delta; 1990.Google Scholar
  60. 60.
    Waelde LC, et al. A pilot study of mindfulness meditation for pediatric chronic pain. Children. 2017;4(5):32.CrossRefPubMedCentralGoogle Scholar
  61. 61.
    Ladwig RJ, Weisman SJ. A randomized, controlled pilot study of mindfulness-based stress reduction for pediatric chronic pain. Altern Ther Health Med. 2013;19(6):8.PubMedGoogle Scholar
  62. 62.
    Coakley R. When your child hurts: effective strategies to increase comfort, reduce stress, and break the cycle of chronic pain. Yale University Press; 2016.Google Scholar
  63. 63.
    Simons LE, Sieberg CB, Pielech M, Conroy C, Logan DE. What does it take? Comparing intensive rehabilitation to outpatient treatment for children with significant pain-related disability. J Pediatr Psychol. 2013;38(2):213–23.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Simons LE, Sieberg CB, Conroy C, Randall ET, Shulman J, Borsook D, et al. Children with chronic pain: response trajectories after intensive pain rehabilitation treatment. J Pain. 2018;19(2):207–18.CrossRefPubMedGoogle Scholar
  65. 65.
    Mittinty MM, Vanlint S, Stocks N, Mittinty MN, Moseley GL. Exploring effect of pain education on chronic pain patients’ expectation of recovery and pain intensity. Scand J Pain. 2018;18:211–9.CrossRefPubMedGoogle Scholar
  66. 66.
    Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain. 2015;16(9):807–13.CrossRefPubMedGoogle Scholar
  67. 67.
    Chambers C. It doesn’t have to hurt: development and preliminary evaluation of a YouTube video for parents with information about how to help children with shots and needles. In: Medicine 2.0 conference. toronto: JMIR publications Inc; 2014.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesia, Critical Care, and Pain MedicineBoston Children’s HospitalBostonUSA
  2. 2.Department of PsychiatryHarvard Medical SchoolBostonUSA

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