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Item Open Access Identification of pain-related psychological risk factors for the development and maintenance of pediatric chronic postsurgical pain(Dove Medical Press Ltd., 04/03/2013) Pagé, M. Gabrielle; Stinson, Jennifer; Campbell, Fiona; Issac, Lisa; Katz, JoelBackground: The goals of this study were to examine the trajectory of pediatric chronic postsurgical pain (CPSP) over the first year after surgery and to identify acute postsurgical predictors of CPSP. Methods: Eighty-three children aged 8–18 years (mean 13.8, standard deviation 2.4) who underwent major orthopedic or general surgery completed pain and pain-related psychological measures at 48–72 hours, 2 weeks (pain anxiety and pain measures only), and 6 and 12 months after surgery. Results: Results showed that 1 year after surgery, 22% of children developed moderate to severe CPSP with minimal functional disability. Children who reported a Numeric Rating Scale pain-intensity score $ 3 out of 10 two weeks after discharge were more than three times as likely to develop moderate/severe CPSP at 6 months and more than twice as likely to develop moderate/severe CPSP at 12 months than those who reported a Numeric Rating Scale pain score , 3 (6-month relative risk 3.3, 95% confidence interval 1.2–9.0 and 12-month relative risk 2.5, 95% confidence interval 0.9–7.5). Pain unpleasantness predicted the transition from acute to moderate/severe CPSP, whereas anxiety sensitivity predicted the maintenance of moderate/severe CPSP from 6 to 12 months after surgery. Conclusions: This study highlights the prevalence of pediatric CPSP and the role played by psychological variables in its development/maintenance. Risk factors that are associated with the development of CPSP are different from those that maintain it.Item Open Access Pain-related psychological correlates of pediatric acute post-surgical pain(Dove Medical Press Ltd., 12/11/2012) Pagé, M. Gabrielle; Stinson, Jennifer; Campbell, Fiona; Issac, Lisa; Katz, JoelBackground: Post-surgical pain is prevalent in children, yet is significantly understudied. The goals of this study were to examine gender differences in pain outcomes and pain-related psychological constructs postoperatively and to identify pain-related psychological correlates of acute post-surgical pain (APSP) and predictors of functional disability 2 weeks after hospital discharge. Methods: Eighty-three children aged 8–18 (mean 13.8 ± 2.4) years who underwent major orthopedic or general surgery completed pain and pain-related psychological measures 48–72 hours and 2 weeks after surgery. Results: Girls reported higher levels of acute postoperative anxiety and pain unpleasantness compared with boys. In addition, pain anxiety was significantly associated with APSP intensity and functional disability 2 weeks after discharge, whereas pain catastrophizing was associated with APSP unpleasantness. Conclusion: These results highlight the important role played by pain-related psychological factors in the experience of pediatric APSP by children and adolescents.Item Open Access Parental risk factors for the development of pediatric acute and chronic postsurgical pain: a longitudinal study(Dove Medical Press Ltd., 27/09/2013) Pagé, M. Gabrielle; Campbell, Fiona; Issac, Lisa; Stinson, Jennifer; Katz, JoelBackground: The goal of this longitudinal study was to examine the associations among psychological factors and pain reports of children and their parents over the 12 month period after pediatric surgery. Materials and methods: Included in the study were 83 children aged 8–18 years undergoing major surgery. In each case, the child and one of their parents completed measures of pain intensity and unpleasantness, psychological function, and functional disability at 48–72 hours, 2 weeks (child only), 6 months, and 12 months after surgery. Results: The strength of the correlation coefficients between the psychological measures of the parent and their child increased significantly over time. There was a fair level of agreement between parent ratings of child acute and chronic pain (6 months after surgery) and the child’s actual ratings. Parent and child pain anxiety scores 48–72 hours after surgery interacted significantly to predict pain intensity, pain unpleasantness, and functional disability levels 2 weeks after discharge from hospital. Parent pain catastrophizing scores 48–72 hours after surgery predicted child pain intensity reports 12 months later. Conclusion: These results raise the possibility that as time from surgery increases, parents exert greater and greater influence over the pain response of their children, so that by 12 months postsurgery mark, parent pain catastrophizing (measured in the days after surgery) is the main risk factor for the development of postsurgical pain chronicity.Item Open Access Reliability and validity of the Child Pain Anxiety Symptoms Scale (CPASS) in a clinical sample of children and adolescents with acute postsurgical pain(Elsevier, 2011) Pagé, M. Gabrielle; Campbell, Fiona; Isaac, Lisa; Stinson, Jennifer; Martin-Pichora, Andrea L.; Katz, JoelPain anxiety refers to the cognitive, emotional, physiological, and behavioural reactions to the experience or anticipation of pain. The Child Pain Anxiety Symptoms Scale (CPASS) has recently been developed and validated in a pediatric community sample. The goal of the present study was to examine the psychometric properties of the CPASS in a sample of children and adolescents with acute postsurgical pain. Eighty-three children aged 8–18 years (mean 13.8 years, SD 2.4) completed measures of pain anxiety, anxiety sensitivity, pain catastrophizing, anxiety, depression, and pain intensity and unpleasantness 48–72 hours after major surgery; and pain intensity and unpleasantness, pain anxiety, and functional disability approximately 2 weeks after discharge from the hospital. The CPASS showed excellent internal consistency (α = 0.915). Stronger partial correlations of pain anxiety with anxiety sensitivity (r = 0.70) and pain catastrophizing (r = 0.73) compared to pain anxiety with anxiety (r = 0.53) and depression (r = 0.59) suggest excellent construct validity. Pain anxiety was significantly associated with pain intensity (r = 0.44) and unpleasantness (r = 0.32) 48–72 hours after surgery (concurrent validity) and with pain unpleasantness (r = 0.29) and functional disability (r = 0.50; but not pain intensity, r = 0.20) 2 weeks later (predictive validity). The CPASS showed adequate sensitivity to change over time (mean change = 9.52; effect size = 0.49) and good sensitivity and specificity. The results of the present study provide initial validity and reliability of the CPASS in a clinical sample of children and adolescents after major surgery.Item Open Access Validation of the numerical rating scale for pain intensity and unpleasantness in pediatric acute postoperative pain: sensitivity to change over time(Elsevier, 2012) Pagé, M. Gabrielle; Katz, Joel; Stinson, Jennifer; Isaac, Lisa; Martin-Pichora, Andrea L.; Campbell, FionaThis study evaluates the construct validity (including sensitivity to change) of the numerical rating scale (NRS) for pain intensity (I) and unpleasantness (U) and participant pain scale preferences in children/adolescents with acute postoperative pain. Eighty-three children aged 8 to 18 years (mean = 13.8, SD = 2.4) completed 3 pain scales including NRS, Verbal Rating Scale (VRS), and faces scales (Faces Pain Scale-Revised [FPS-R] and Facial Affective Scale [FAS], respectively) for pain intensity (I) and unpleasantness (U) 48 to 72 hours after major surgery, and the NRS, VRS and Functional Disability Index (FDI) 2 weeks after surgery. As predicted, the NRSI correlated highly with the VRSI and FPS-R and the NRSU correlated highly with the VRSU and FAS 48 to 72 hours after surgery. The FDI correlated moderately with the NRS at both time points. Scores on the NRSI and NRSU at 48 to 72 hours were significantly higher than at 2 weeks after surgery. Children found the faces scales the easiest to use while the VRS was liked the least and was the hardest to use. The NRS has adequate evidence of construct validity including sensitivity for both pain intensity and unpleasantness. This study further supports the validity of the NRS as a tool to measure both intensity and unpleasantness of acute pain in children.