Mindfulness Meditation for Pediatric Chronic Pain

Waelde, L.C. et al (2017) Children. 4, 32.

Despite advances in psychological interventions for pediatric chronic pain, there has been little research examining mindfulness meditation for these conditions. This study presents data from a pilot clinical trial of a six-week manualized mindfulness meditation intervention offered to 20 adolescents aged 13–17 years.

Mindfulness meditation shows promise as a feasible and acceptable intervention for youth with chronic pain. Future research should optimize intervention components and determine treatment efficacy

The full article is available to download here

Parents’ reactions can lessen or worsen pain for injured kids

New research (yet to be published) has looked at family coping and distress during a dressing change following a burn injury in kids | The Conversation

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The 18-month study observed 92 families during their young child’s (one to six years) first burn dressing change at a Brisbane hospital.

Parents who reported they were more anxious or distressed were less able to support their child during the procedure. This decreased the child’s ability to cope and increased the child’s distress, which was measured by their ability to be distracted by toys and conversation, compared to crying or screaming during the dressing change.

Ratings of child anxiety and pain during the dressing change were also greater for children of parents who were less able to support their child during the dressing change.

Read the full blog post by  Erin Brown & Justin Kenardy here

Low Back Pain in Children and Adolescents

Moreno, M. (2017) JAMA Pediatrics. 171(3):312

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Image source: H – – J – Flickr // CC BY-NC-ND 2.0

Low back pain is often thought of as an adult condition. However, it is relatively common as children grow older.

At 7 years of age, about 1% of children will have experienced low back pain; at 10 years of age, about 6% of children will have experienced low back pain; and at 14 to 16 years of age, about 18% of adolescents will have experienced low back pain.

Unfortunately, having low back pain as a child or adolescent is a significant risk factor for having low back pain as an adult.

Read the full article here

Childhood & adolescent risk and prognostic factors for musculoskeletal pain

Huguet, A. et al. (2016) Pain. 157(12) pp. 2640–2656

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Image source: Tim Ellis – Wellcome Images // CC BY-NC-ND 4.0

A variety of factors may be involved in the development and course of musculoskeletal (MSK) pain.

We undertook a systematic review with meta-analysis to synthesize and evaluate the quality of evidence about childhood and adolescent factors associated with onset and persistence of MSK pain, and its related disability.

No study was identified that examined prognostic factors for MSK pain–related disability. High-quality evidence suggests that low socioeconomic status is a risk factor for onset of MSK pain in studies exploring long-term follow-up. Moderate-quality evidence suggests that negative emotional symptoms and regularly smoking in childhood or adolescence may be associated with later MSK pain. However, moderate-quality evidence also suggests that high body mass index, taller height, and having joint hypermobility are not risk factors for onset of MSK pain. We found other risk and prognostic factors explored were associated with low or very low quality of evidence.

Additional well-conducted primary studies are needed to increase confidence in the available evidence, and to explore new childhood risk and prognostic factors for MSK pain.

Read the full abstract here

Intrapartum care for healthy women and babies

NICE has updated its clinical guideline Intrapartum care for healthy women and babies (CG190). This guideline covers the care of healthy women and their babies during labour and immediately after the birth.  NICE has reviewed the evidence on the effectiveness of midwife-led continuity models and other models of care and deleted a recommendation about team midwifery.

This guideline includes recommendations on:nice-logo

  • choosing place of birth
  • the latent first stage of labour
  • initial and ongoing assessment
  • transfer of care
  • pain relief and monitoring during labour
  • care in the first, second and third stages of labour
  • care of the baby and woman after the birth

Young children’s ability to report on past, future, and hypothetical pain states: a cognitive-developmental perspective

Jaaniste, T. et al. (2016) Pain. 157(11). pp. 2399–2409

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Children are at times asked by clinicians or researchers to rate their pain associated with their past, future, or hypothetical experiences. However, little consideration is typically given to the cognitive-developmental requirements of such pain reports. Consequently, these pain assessment tasks may exceed the abilities of some children, potentially resulting in biased or random responses. This could lead to the over- or under-treatment of children’s pain.

This review provides an overview of factors, and specifically the cognitive-developmental prerequisites, that may affect a child’s ability to report on nonpresent pain states, such as past, future, or hypothetical pain experiences. Children’s ability to report on past pains may be influenced by developmental (age, cognitive ability), contextual (mood state, language used by significant others), affective and pain-related factors.

The ability to mentally construct and report on future painful experiences may be shaped by memory of past experiences, information provision and learning, contextual factors, knowledge about oneself, cognitive coping style, and cognitive development. Hypothetical pain reports are sometimes used in the development and validation of pain assessment scales, as a tool in assessing cognitive-developmental and social-developmental aspects of children’s reports of pain, and for the purposes of training children to use self-report scales. Rating pain associated with hypothetical pain scenarios requires the ability to recognize pain in another person and depends on the child’s experience with pain.

Enhanced understanding of cognitive-developmental requirements of young children’s pain reports could lead to improved understanding, assessment, and treatment of pediatric pain.

Read the abstract here

Nurses’ Beliefs Regarding Pain in Critically Ill Children

LaFond, C.M. et al. Journal of Pediatric Nursing. Published online: September 3 2016

Highlights

  • Nurses’ beliefs regarding critically ill children’s pain was described and compared.
  • Most beliefs were consistent with effective pain management practices.
  • Inaccurate beliefs included pharmacokinetics and use of behavior to verify pain.
  • Divergent and conflicting beliefs related to the legitimacy of a child’s pain report.
  • Nurses believe that unrelieved pain is harmful but also concerned about use of opioids.

Abstract

Purpose: The purpose of this study was to provide a current and comprehensive evaluation of nurses’ beliefs regarding pain in critically ill children.

Design and Methods: A convergent parallel mixed-methods design was used. Nurse beliefs were captured via questionnaire and interview and then compared.

Results: Forty nurses participated. Most beliefs reported via questionnaire were consistent with effective pain management practices. Common inaccurate beliefs included the need to verify pain reports with physical indicators and the pharmacokinetics of intravenous opioids. Beliefs commonly shared during interviews concerned the need to verify pain reports with observed behavior, the accuracy of pain reports, the need to respond to pain, concerns regarding opioid analgesics, and the need to “start low” with interventions. Convergent beliefs between the questionnaire and interview included the use of physical indicators to verify pain, the need to take the child’s word when pain is described, and concerns regarding negative effects of analgesics. Divergent and conflicting findings were most often regarding the legitimacy of a child’s pain report.

Conclusions: Findings from this study regarding the accuracy of nurses’ pain beliefs for critically ill children are consistent with past research. The presence of divergent and conflicting responses suggests that nurses’ pain beliefs are not static and may vary with patient characteristics.

Practice Implications: While most nurses appreciate the risks of unrelieved pain in children, many are concerned about the potential adverse effects of opioid administration. Interventions are needed to guide nurses in minimizing both of these risks.

Read the abstract here