Department of Psychology

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Open Access
A cross-sectional examination of the relationships between caregiver proximal soothing and infant pain over the first year of life
(Pain, 2013) Campbell, Lauren; Pillai Riddell, Rebecca; Greenberg, Saul; Garfield, Hartley
Although previous research has examined the relationships between caregiver proximal soothing and infant pain, there is a paucity of work taking infant age into account, despite the steep developmental trajectory that occurs across the infancy period. Moreover, no studies have differentially examined the relationships between caregiver proximal soothing and initial infant pain reactivity and pain regulation. This study examined how much variance in pain reactivity and pain regulation was accounted for by caregiver proximal soothing at four routine immunizations (2, 4, 6, 12 months) across the first year of life, controlling for pre-needle distress. One latent growth model was replicated at each of the four infant ages, using a sample of 760 caregiver-infant dyads followed longitudinally. Controlling for pre-needle infant distress, caregiver proximal soothing accounted for little to no variance in infant pain reactivity or regulation at all four ages. Pre-needle distress and pain reactivity accounted for the largest amount of variance in pain regulation, with this increasing after 2- months. It was concluded that, within each immunization appointment across the first year of life, earlier infant pain behavior is a stronger predictor of subsequent infant pain behavior than caregiver proximal soothing. Given the longer-term benefits that have been demonstrated for proximal soothing during distressing contexts, caregivers are still encouraged to use proximal soothing during infant immunizations.
Open Access
A Double-blind, Placebo-controlled Trial of Transdermal Fentanyl after Abdominal Hysterectomy Analgesic, Respiratory, and Pharmacokinetic Effects
(Lippincott, Williams and Wilkins, 1994) Sandler, Alan N.; Baxter, Alan; Katz, Joel; Norman, Peter; Koren, Gideon; Roger, Sandra; Hull, Kathryn; Samson, Benoit; Friedlander, Mark; Klein, Julia
Background: A randomized, double-blind, placebo-controlled trial was conducted to assess the analgesic, pharmacokinetic, and clinical respiratory effects of 72-h application of two transdermal fentanyl (TTSF) patch sizes in patients undergoing abdominal hysterectomy. Methods: TTSV patches releasing 50 [mu]g/h (TTSF-50) or 75 [mu]g/h (TTSF-75) fentanyl or placebo patches were applied to 120 women 2 h before abdominal hysterectomy under general anesthesia. Postoperatively, all patients had access to supplemental morphine using patient-controlled analgesia pumps. Each patient was attended continuously by a research nurse for 8 h on the night before surgery and for 84 h after patch application. The following data were collected: visual analog scale pain scores, supplementary analgesia, fentanyl plasma concentration (4-h intervals), continuous hemoglobin saturation (pulse oximetry), respiratory pattern (continuous respiratory inductive plethysmography), and adverse effects (nausea, vomiting, pruritus). Data analysis included analysis of variance, Kruskal-Wallis, and chi-squared. P < 0.05 was considered significant. Results: There were no demographic differences among groups. Visual analog scale pain scores were significantly lower for the TTSF-75 group, and supplemental morphine was significantly decreased in the TTSF-75 group in the postanesthesia care unit and for both the TTSF-50 and the TTSF-75 group for 8-48 h postoperatively. Between 5 and 36 h, the TTSF groups had significantly increased abnormal respiratory pattern including apneic episodes (tidal volume of less than 100 ml for more than 15 s) and episodes of slow respiratory rate (less than 8 breaths/min persisting for more than 5 min) and significantly increased requirement for oxygen supplementation. Nine patients in the TTSF groups were withdrawn because of severe respiratory depression compared to none in the placebo group. No significant between-group differences were present in the incidence of nausea, vomiting, or pruritus. Although fentanyl plasma concentration was higher in the TTSF-75 group than in the TTSF-50 group, the differences were not significant. Fentanyl plasma concentration decreased significantly 48 h after patch application. Conclusions: Application of TTSF patches 2 h preoperatively is associated with moderate supplementary opioid requirements for analgesia in the early postoperative period and ongoing opioid supplementation for at least 72 h. Although good analgesia is the result of this combination therapy, it is associated with a high incidence of respiratory depression requiring Intensive monitoring, oxygen supplementation, removal of the TTSF patches in approximately 11% of the patients, and opioid reversal with naloxone in approximately 8% of the patients.
Open Access
A heteroscedastic, rank-based approach for analyzing 2 x 2 independent groups designs
(JMASM, Inc., 2009) Mills, L.; Cribbie, Robert; Luh, Wei-ming
The ANOVA F is a widely used statistic in psychological research despite its shortcomings when the assumptions of normality and variance heterogeneity are violated. A Monte Carlo investigation compared Type I error and power rates of the ANOVA F, Alexander-Govern with trimmed means and Johnson transformation, Welch-James with trimmed means and Johnson Transformation, Welch with trimmed means, and Welch on ranked data using Johansen’s interaction procedure. Results suggest that the ANOVA F is not appropriate when assumptions of normality and variance homogeneity are violated, and that the Welch/Johansen on ranks offers the best balance of empirical Type I error control and statistical power under these conditions.
Open Access
A longitudinal analysis of the development of infant facial expressions in responses to acute pain: Immediate and regulatory expressions
(Pain, 2012) Ahola Kohut, Sara; Pillai Riddell, Rebecca; Flora, David; Oster, Harriet
Facial expressions during infancy are important to examine as infants do not have the language skills to describe their experiences. This is particularly vital in the context of pain where infants depend solely on their caregivers for relief. The objective of the current study was to investigate the development of negative infant facial expressions in response to immunization pain over the first year of life. Infant facial expressions were examined longitudinally using a subsample of 100 infants that were each videotaped during their 2-, 4-, 6-, and 12-month routine immunization appointments. Infant facial expressions were coded using BabyFACS for the first minute after a painful needle prick. Facial expressions were examined with a catalogue of the most commonly occurring facial expressions. Results demonstrated that clear differences were seen over ages. Infants display a variety of facial expressions with some of the components of adult pain expressions immediately after the needle and abate shortly after. However, infants did not display adult expressions of discrete negative emotions. Instead, infants display a variety of generalized pain and distress faces aimed at gaining caregiver aid. The development of non-verbal communication in infants, particular facial expressions, remains an important area of inquiry. Further study into accurately measuring infant negative emotions, pain, and distress is warranted.
Open Access
A longitudinal examination of verbal reassurance during infant immunization: Occurrence and examination of emotional availability as a potential moderator
(Journal of Pediatric Psychology, 2012) Racine, Nicole; Pillai Riddell, Rebecca; Flora, David; Garfield, Hartley; Greenberg, Saul
OBJECTIVE: This study investigated the associations between caregiver verbal reassurance and infant pain-related distress during immunization over the first year of life. The relationships between verbal reassurance and caregiver emotional availability (EA) were also examined. Finally, EA was investigated as a moderator of the relationship between verbal reassurance and infant pain. METHODS: A cross-sectional analysis was conducted with 606 infants (and their parents) at 4 different ages (n = 376 at 2 months, n = 455 at 4 months, n = 484 at 6 months, and n = 407 at 12 months). RESULTS: Verbal reassurance was positively associated with infant distress across all four ages. EA was only negatively related to verbal reassurance at 12 months of age. EA was not a significant moderator at any age. CONCLUSION: Findings demonstrate consistent but small relationships between verbal reassurance and infant pain over the first year of life.
Open Access
A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain
(Elsevier, 2007) Goldberg, Robert J.; Katz, Joel
Between 40% and 60% of Americans use complementary and alternative medicine to manage medical conditions, prevent disease, and promote health and well-being. Omega-3 polyunsaturated fatty acids (ω-3 PUFAs) have been used to treat joint pain associated with several inflammatory conditions. We conducted a meta-analysis of 17 randomized, controlled trials assessing the pain relieving effects of ω-3 PUFAs in patients with rheumatoid arthritis or joint pain secondary to inflammatory bowel disease and dysmenorrhea. Meta-analysis was conducted with Cochrane Review Manager 4.2.8. for six separate outcomes using standardized mean differences (SMDs) as a measure of effect size: (1) patient assessed pain, (2) physician assessed pain, (3) duration of morning stiffness, (4) number of painful and/or tender joints, (5) Ritchie articular index, and (6) nonselective nonsteroidal anti-inflammatory drug consumption. Supplementation with ω-3 PUFAs for 3–4 months reduces patient reported joint pain intensity (SMD: −0.26; 95% CI: −0.49 to −0.03, p = 0.03), minutes of morning stiffness (SMD: −0.43; 95% CI: −0.72 to −0.15, p = 0.003), number of painful and/or tender joints (SMD: −0.29; 95% CI: −0.48 to −0.10, p = 0.003), and NSAID consumption (SMD: −0.40; 95% CI: −0.72 to − 0.08, p = 0.01). Significant effects were not detected for physician assessed pain (SMD: −0.14; 95% CI: −0.49 to 0.22, p = 0.45) or Ritchie articular index (SMD: 0.15; 95% CI: − 0.19 to 0.49, p = 0.40) at 3–4 months. The results suggest that ω-3 PUFAs are an attractive adjunctive treatment for joint pain associated with rheumatoid arthritis, inflammatory bowel disease, and dysmenorrhea.
Open Access
A microhistory in letters: What happened to I. Huang’s research reports on size-weight illusion
(Chinese Academy of Sciences, 2017) Gao, Zhipeng
In the recent development of history and sociology of science, peer review practice has been scrutinized. However, historians have not paid any attention to this important topic in the history of Chinese psychology. Primarily based on thirteen recently discovered letter correspondences among leading scholars such as I. Huang, Siegen K. Chou, and Wu Youxun, this paper studies the complicated stories behind I. Huang’s two publications on the size-weight illusion using a microhistory approach. I. Huang (1903-1944) was an important Chinese psychologist who received trainings in child psychology and Gestalt psychology from Arnold Gesell and Kurt Koffka in the USA. A few years after returning to China, Huang’s research was severely impeded by the Sino-Japanese War, poverty, and terminal cancer. Nonetheless, Huang persevered in conducting research in hopes of delivering two research reports to international colleagues. Unexpectedly, in 1941 and again in 1943, the only two state-run international outlets both invited the same reviewer, Wang Jingxi, a physiological psychologist heading the Psychology Institute of Academia Sinica, who kept criticizing Huang’s reports. Unconvinced by Wang’s criticisms, Huang wrote letters to the editors in defense of his reports as well to his old classmate and colleague, psychologist Siegen K. Chou, for support. These correspondences discussed a number of core issues in the peer review practice: evaluation criteria, the composition and qualifications of reviewer (s), dispute resolution, and institutional and social factors that shape research activities. For example, various evaluation criteria – originality, theoretical contribution, methodological rigor, sample size, experimenter effects, the suitability of the statistics used, replicability, referencing, and language style – were brought up and discussed. In Huang’s view, Wang nitpicked about language style while downplaying other more important criteria, failed to appreciate that high reliability and statistical significance can overcome the limitation of the small sample size, and did not possess appropriate expertise to evaluate his research. When Wang criticized Huang’s study as repetitive of extant literature, Huang argued, first, that successful replication is not entirely useless, and, moreover, that his research was mainly aimed at theoretical integration rather than empirical findings. Huang admitted that his reports did indeed have certain shortcomings but argued that the wartime scarcity of literature and research equipment had made these inevitable. For instance, such scarcity had led to Huang’s lack of awareness of extant literature resembling his independent theoretical innovation. In order to resolve the disagreements, Huang contended that his methodological and language choices were no different than those of authoritative psychologists. When Huang called upon Siegen K. Chou to mediate the dispute, Chou delicately voiced his support of Huang, his intimate friend and colleague, while paying due respect to Wang, the leading figure in Chinese psychology. Chou echoed Huang’s proposal of recruiting additional reviewers, and offered further suggestions to improve the peer review process. Finally, Huang refused the two state-run outlets’ sympathetic offers of acceptance of the articles along with remuneration. He instead submitted the articles to The Journal of General Psychology based in the USA. Unfortunately, Huang soon passed away in extraordinary hardship before his articles were published. It is worth noting that the published papers include editorial footnotes about their having been accepted by Arnold Gesell, who deeply respected and mourned his former student.
Open Access
A Qualitative Systematic Review of the Role of N-Methyl-D-Aspartate Receptor Antagonists in Preventive Analgesia
(Lippincott, Williams and Wilkins, 2004) McCartney, Colin J. L.; Sinha, Avinash; Katz, Joel
We evaluated in a qualitative systematic review the effect of N-methyl-D-aspartate (NMDA) receptor antagonists on reducing postoperative pain and analgesic consumption beyond the clinical duration of action of the target drug (preventive analgesia). Randomized trials examining the use of an NMDA antagonist in the perioperative period were sought by using a MEDLINE (1966–2003) and EMBASE (1985–2003) search. Reference sections of relevant articles were reviewed, and additional articles were obtained if they evaluated postoperative analgesia after the administration of NMDA antagonists. The primary outcome was a reduction in pain, analgesic consumption, or both in a time period beyond five half-lives of the drug under examination. Secondary outcomes included time to first analgesic request and adverse effects. Forty articles met the inclusion criteria (24 ketamine, 12 dextromethorphan, and 4 magnesium). The evidence in favor of preventive analgesia was strongest in the case of dextromethorphan and ketamine, with 67% and 58%, respectively, of studies demonstrating a reduction in pain, analgesic consumption, or both beyond the clinical duration of action of the drug concerned. None of the four studies examining magnesium demonstrated preventive analgesia.
Open Access
A randomised, controlled study of peri-operative low dose s(+)-ketamine in combination with postoperative patient-controlled s(+)-ketamine and morphine after radical prostatectomy
(Lippincott, Williams and Wilkins, 2004) Snijdelaar, Dirk G.; Cornelisse, H.B.; Schmid, R. L.; Katz, Joel
In a randomised, double-blind prospective study we compared the effects on postoperative pain and analgesic consumption of intra-operative s(+)-ketamine (100 μg.kg−1 bolus and a continuous infusion of 2 μg.kg−1.min−1) followed by postoperative patient-controlled analgesia with morphine (1 mg per bolus) plus s(+)-ketamine (0.5 mg per bolus), or intra-operative saline followed by postoperative patient-controlled analgesia morphine (1 mg per bolus) alone. A total of 28 male patients undergoing radical prostatectomy were studied. Morphine consumption, pain scores, pressure algometry and adverse effects were recorded for 48 h after surgery. Cumulative morphine consumption was significantly lower in the ketamine/morphine group (47.9 ± 26.2 mg) than in the saline/morphine group (73.4 ± 34.8 mg; p = 0.049). Pain scores at rest were significantly lower in the ketamine/morphine group across the 48-h study period (p = 0.01). No significant differences were found in pressure algometry measurements or the occurrence of adverse effects.
Open Access
A Randomized, Double-blind Comparison of Lumbar Epidural and Intravenous Fentanyl Infusions for Postthoracotomy Pain Relief: Analgesic, Pharmacokinetic, and Respiratory Effects
(Lippincott, Williams and Wilkins, 1992) Sandler, Alan N.; Stringer, David; Panos, Larry; Koren, Gideon; Friedlander, Mark; Klein, Julia; Katz, Joel; Badner, Neal
Although epidural opioids frequently are used to provide postoperative analgesia, several articles have suggested that the analgesia after epidural fentanyl is similar to that after an equal dose of fentanyl given intravenously. To address this issue further, 29 postthoracotomy patients were studied in a randomized, double-blinded trial comparing a lumbar epidural fentanyl infusion with an intravenous fentanyl infusion for analgesia, plasma fentanyl pharmacokinetics, and respiratory effects for 20 h postoperatively. In all patients in both groups, good analgesia was achieved (pain score < 3, maximum 10) over a similar time course, although the patients receiving epidural infusion required a significantly larger fentanyl infusion dose than did the patients receiving intravenous infusion (group receiving epidural fentanyl infusion: 1.95 +/- 0.45 [micro]g [middle dot] kg-1 [middle dot] h-1; group receiving intravenous fentanyl infusion: 1.56 +/- 0.36 [micro]g [middle dot] kg-1 [middle dot] h-1; P = 0.0002). The time course for the plasma fentanyl concentrations was similar in the two groups, and plasma fentanyl concentrations were not significantly different at any sampling period (T7-T20; group receiving epidural fentanyl infusion:1.8 +/- 0.5 ng/ml; group receiving intravenous fentanyl infusion: 1.6 +/- 0.6 ng/ml; P = 0.06). Similarly, calculated clearance values for the two groups were not significantly different (group receiving epidural fentanyl infusion: 0.95 +/- 0.26 l [middle dot] kg-1 [middle dot] h-1; group receiving intravenous fentanyl infusion: 0.87 +/- 0.25 l [middle dot] kg-1 [middle dot] h-1; P = 0.3). Both groups demonstrated a similar degree of mild to moderate respiratory depression postoperatively, which was assessed with continuous respiratory inductance plethysmography and sequential arterial blood gas analysis. Side effects (nausea, vomiting, pruritus) were mild and did not differ between groups. The authors conclude that lumbar epidural fentanyl infusions are equivalent to intravenous fentanyl infusions for postthoracotomy analgesia and that the mode of action of a lumbar epidural fentanyl infusion is primarily through systemic absorption.
Open Access
A Randomized-controlled Trial of Parent-led Tactile Stimulation to Reduce Pain During Infant Immunization Injections
(Lippincott, Williams & Wilkins, 2014-03) Hogan, Mary-Ellen; Probst, Janet; Wong, Karen; Pillai Riddell, Rebecca; Katz, Joel; Taddio, Anna
Objective: To determine the effectiveness of parent-led tactile stimulation for pain reduction when added to a combination of evidence-based pain-reducing interventions in infants undergoing immunization injections. Methods: Healthy infants aged 4 to 6 months undergoing routine immunization at a primary care practice were eligible. Infants were randomized to tactile stimulation by a parent or usual care. Parents in the tactile stimulation group rubbed the ipsilateral thigh distal to the site for 15 seconds before, during, and after injections. In addition, all infants received evidence-based pain-relieving interventions including: sucrose solution, holding by a parent, and intramuscular injection without aspiration. The primary outcome was pain, measured by a validated tool, the Modified Behavioral Pain Scale (MBPS), by an observer unaware of treatment allocation using videotapes of the procedure. MBPS scores could range from 0 (no pain) to 10 (maximum pain). Parents, unaware of the study hypothesis, also rated infant pain in real time using a 100mm visual analogue scale. Results: One hundred twenty infants participated. Infant characteristics did not differ (P>0.05) between the tactile stimulation and control groups. Mean MBPS scores and parent visual analogue scale scores did not differ between groups (8.2 [1.1] vs. 8.0 [1.3]; P=0.57) and (60 [20] vs. 53 [22] mm; P=0.10), respectively. Discussion: Parent-led tactile stimulation did not reduce pain in infants undergoing immunization injections when combined with other pain-relieving interventions. Potential reasons for the lack of effectiveness are discussed. Investigation of the effectiveness of clinician-led tactile stimulation in this population is recommended.
Open Access
A Review of Emergency Visits made by Youth and Adults with Autism Spectrum Disorder from the Parent Perspective
(Emerald Publishing, 2018) Lunsky, Yona; Tint, Ami; Weiss, Jonathan; Palucka, Anna; Bradley, Elspeth
Purpose: Past research has shown individuals with autism spectrum disorder (ASD) visit hospital emergency departments (ED) at high rates. In order to assist individuals with ASD, their families and health care providers to improve ED care, it is important to understand these encounters in greater detail. This study aimed to provide a descriptive summary of the ED experiences of adolescents and adults with ASD, from the perspective of their families. Design/Methodology/Approach: A subset of data from a larger prospective cohort study was used. Specifically, 46 parents of adolescents and adults with ASD provided details concerning 49 ED visits over a 12-month period. Findings: Results suggest a range of presentations requiring ED use, and also diverse profiles of those with ASD who visited the ED, in terms of age, gender, and ASD severity. While overall degree of satisfaction with care received in the ED was high, parents provided recommendations to improve the ED experiences for their family members with ASD. Originality/value: This is the first study to provide detailed accounts of ED visits from the perspective of parents of adolescents and adults with ASD. Families play an important role in the lives of individuals with ASD across the lifespan and it is important to include their perspective to improve hospital- based care for those with ASD.
Open Access
A Systematic Literature Review of Emotion Regulation Measurement in Individuals With Autism Spectrum Disorder
(International Society for Autism Research, Wiley Periodicals, Inc., 2014-12) Weiss, Jonathan; Thomson, Kendra; Chan, Lisa
Emotion regulation (ER) difficulties are a potential common factor underlying the presentation of multiple emotional and behavioral problems in individuals with Autism Spectrum Disorder (ASD). To provide an overview of how ER has been studied in individuals with ASD, we conducted a systematic review of the past 20 years of ER research in the ASD population, using established keywords from the most comprehensive ER literature review of the typically developing population to date. Out of an initial sampling of 305 studies, 32 were eligible for review. We examined the types of methods (self-report, informant report, naturalistic observation/ behavior coding, physiological, and open-ended) and the ER constructs based on Gross and Thompson’s modal model (situation selection, situation modification, attention deployment, cognitive change, and response modulation). Studies most often assessed ER using one type of method and from a unidimensional perspective. Across the 32 studies, we documented the types of measures used and found that 38% of studies used self-report, 44% included an informant report measure, 31% included at least one naturalistic observation/behavior coding measure, 13% included at least one physiological measure, and 13% included at least one open-ended measure. Only 25% of studies used more than one method of measurement. The findings of the current review provide the field with an in-depth analysis of various ER measures and how each measure taps into an ER framework. Future research can use this model to examine ER in a multicomponent way and through multiple methods.
Open Access
The ABCDs of Pain Management: A Double-Blind Randomized Controlled Trial Examining the Impact of a Brief Educational Video on Infants’ and Toddlers’ Pain Scores and Parent Soothing Behavior
(Journal of Pediatric Psychology, 2017-11) Pillai Riddell, Rebecca; O'Neill, Monica C; Campbell, Lauren; Taddio, Anna; Greenberg, Saul; Garfield, Hartley
Objectives To test the efficacy of a brief behavioral pain management strategy (The ABCDs of Needle Pain Management), delivered via video, on infants’ and toddlers’ pain scores and on parental soothing behavior. Methods This was a double-blind, parallel trial design. Parent–child dyads (N = 128) were recruited before their child’s 6-month (infant) or 18-month (toddler) vaccination in a pediatric clinic and randomly assigned to watch a 5-min treatment video or a placebo video. The primary outcome was the Modified Behavior Pain Scale (Taddio et al., Journal of Pain and Symptom Management, 10, pp. 456–463, 1995), coded during four epochs (Pain Reactivity, Pain Regulation 1 min, Pain Regulation 2 min, and Pain Regulation 3 min) after the last vaccination needle. Secondary analyses examined parental use of distraction, rocking, and physical comforting over this same time period. Results Results demonstrated a treatment effect for toddlers (18-month-olds) for the Pain Regulation 1 (d = 0.84) and Pain Regulation 2 (d = 0.76) postvaccination scores. Secondary analyses found differences in parental rocking and physical comforting between treatment conditions and between age-groups (d’s = 0.37–0.54). Conclusions The ABCD pain management strategy delivered via video was an effective way to reduce toddler pain after vaccination and increase parental use of rocking and physical comforting. The treatment effect was not demonstrated with infants.
Open Access
Acceptability of a cognitive behavior therapy intervention to implantable cardioverter defibrillator recipients
(Springer, 2010) Irvine, J.; Stanley, J.; Ong, L.; Cribbie, Robert; Ritvo, Paul; Katz, Joel; Dorian, Paul; O' Donnell, S.; Harris, L.; Cameron, D.; Hill, Ann; Newman, D.; Johnson, S. N.; Bilanovic, A.; sears, samuel
We aimed to assess cardiac patients, acceptance of cognitive behavior therapy (CBT); determine if gender was associated with treatment engagement (session attendance and utilization of intervention strategies); and relate engagement to outcome. Of 193 patients receiving an implantable cardioverter defibrillator (ICD) who agreed to participate in a randomized controlled trial, 96 were randomized to CBT. Measures of treatment acceptance indicated that most participants rated counseling as “very to extremely helpful.” Gender was associated with only one treatment engagement index. Symptoms of depression and post-traumatic stress improved from baseline to 6- and 12-month follow-up. Number of counseling session attendance was not associated with outcome. Reported utilization of two of the six CBT strategies (modifying faulty thinking, correcting cognitive distortions) was associated with a better treatment outcome. In conclusion, a CBT intervention was well received by ICD patients. There was some indication that treatment engagement related to better treatment outcomes.
Open Access
Access barriers to services by immigrant mothers of children with autism in Canada
(17/01/2017) Khanlou, Nazilla; Haque, Nasim; Mustafa, Nida; Vazquez, Luz Maria; Mantini, Anne; Weiss, Jonathan
Equal access for autism services remains suboptimal for diverse groups. In Canada,little is known about the barriers immigrant mothers face accessing services and support for their children with developmental disabilities. In this qualitative study, 21 immigrant mothers of children with Autism, from a diverse ethno cultural background, were interviewed inToronto, Canada. We apply House’s (1981) four domains of social support to analyze findings.Structural support challenges, such as delays in diagnosis, fragmented and dispersed services were common, followed by instrumental challenges due to loss of social ties and stigma. Lack of expected support from partners, and negative perceptions of services, were identified as emotional and perceptive challenges. Focused attention is required to address inequalities within the context of current access pathways for autism.
Open Access
Accuracy of children’s and parent’s memory for a novel painful experience
(Pain and Research Management, 2000) Badali, Melanie; Pillai Riddell, Rebecca; Craig, Kenneth; Giesbrecht, Kelly; Chambers, Christine
BACKGROUND: Despite recent progress in understanding memory of pain in adults, the validity of the assumption that these findings extend to children has not been established. Because treatment often is evaluated on the basis of pain recall, it is crucial that the accuracy of pain memories in children be established. OBJECTIVES: To examine children’s ability to recall pain intensity and contextual details associated with a novel painful experience. Furthermore, children’s memories were compared with those of their parents. SUBJECTS AND METHODS: Twenty-three parent-child dyads were recruited from a sample participating in an earlier study investigating children’s responses to the cold pressor test and parents’ characterization of the children’s responses. Children (age five to 12 years) and parents independently had rated the child’s pain using a seven-point Faces Pain Scale. Approximately one year later, they were asked to recall the experience and rate the pain again. Memory for contextual details associated with the event also was assessed through a series of open-ended questions. RESULTS: A 2 (rater) × 2 (time period) repeated measures ANOVA examined the reliability of ratings and differences between parent and child ratings of pain, both recorded at the time of the cold pressor and recalled one year later. There were no significant differences in ratings over time or between parent and child. CONCLUSIONS: The findings indicate that children’s memories of a novel painful experience can be consistent over a long interval. Moreover, parents’ ratings also reflect good recall and can be in agreement with those of their children.
Open Access
Acute and chronic post-surgical pain after living liver donation: Incidence and predictors
(Wiley, 2014-11) Holztman, S.; Clarke, Hance; McCluskey, S.; Turcotte, K.; Grant, David; Katz, Joel
Despite its prominence as a concern among potential surgical candidates, there is little information in the literature regarding the short- and long-term pain experience after living liver donation. We undertook a prospective study to examine (1) the nature and incidence of acute and chronic pain after living donor hepatectomy and (2) the factors associated with an increased or decreased risk of adverse pain outcomes. Before donation, a comprehensive assessment of potential predictors of acute and chronic pain outcomes was conducted; this included donors’ pain expectations, psychosocial factors, medical histories, and demographic factors. Detailed data regarding pain outcomes were collected postoperatively (days 1 and 2) and again during 6- and 12-month follow-up telephone interviews. Sixty-five adults (32 females and 33 males) scheduled for donor hepatectomy participated. Substantial proportions of the donors reported a moderate-to-severe level of pain intensity (4 on a 0-10 scale) at rest and after movement on day 1 (42% and 74%, respectively) and day 2 (33% and 32%, respectively). Persistent postsurgical pain was reported by 31% of the donors at the 6-month follow-up and by 27% of the donors at the 12-month follow-up. Generally, this pain was mild, and pain-related life interference was minimal. Female sex, a younger age, and several predonation measures of pain-related anxiety were associated with a significantly greater risk of developing persistent postsurgical pain. In conclusion, this study has identified a subset of patients who experience persistent pain after living liver donation. Additional prospective research using larger samples of liver donors is needed to replicate this work, to obtain a more detailed account of the acute and long-term pain experience, and to determine whether targeted interventions can minimize the frequency and severity of chronic pain.
Open Access
Acute pain after thoracic surgery predicts long-term post-thoracotomy pain
(Lippincott, Williams and Wilkins, 1996) Katz, Joel; Jackson, Marla.; Kavanagh, Brian P.; Sandler, Alan N.
Objective: Long-term pain is a common sequela of thoracotomy, occurring in approximately 50% of patients 2 years after thoracic surgery. Despite this alarming statistic, little is known about the factors responsible for the transition of acute to chronic pain. The aim of the present study is to identify predictors of long-term post-thoracotomy pain. Design: Follow-up was for 1.5 years for patients who had participated in a prospective, randomized, controlled trial of preemptive, multimodal analgesia. Setting: Subjects were recruited from a tertiary care center. Patients: Thirty patients who had undergone lateral thoracotomy were followed up by telephone, administered a structured interview, and classified according to long-term pain status. Main Outcome Measures: Present pain status was measured by a verbal rating scale (VAS). Measures obtained within the first 48 h after surgery were compared between patients with and without pain 1.5 years later. These include VAS pain scores at rest and after movement, McGill Pain Questionnaire data, patient-controlled morphine consumption (mg), and pain thresholds to pressure applied to a rib contralateral to the thoracotomy incision. Results: Fifty-two percent of patients reported long-term pain. Early post-operative pain was the only factor that significantly predicted long-term pain. Pain intensity 24 h after surgery, at rest, and after movement was significantly greater among patients who developed long-term pain compared with pain-free patients. A significant predictive relationship was also found at 24 and 48 h using the McGill Pain Questionnaire. Cumulative morphine was comparable for the two groups. Pain thresholds to pressure applied to a rib contralateral to the incision did not differ significantly between the groups. Conclusion: Aggressive management of early postoperative pain may reduce the likelihood of long-term post-thoracotomy pain.
Open Access
Acute pain after total hip arthroplasty does not predict the development of chronic postsurgical pain 6 months later
(Springer Verlag, 2010) Clarke, Hance; Kay, Joseph; Mitsakakis, Nicholas; Katz, Joel
Purpose Much remains unknown about the relationship between acute postoperative pain and the development of pathologic chronic postsurgical pain (CPSP). The purpose of this project was to identify the extent to which maximum pain scores on movement over the first two days after total hip arthroplasty predicted the presence of chronic pain 6 months later after controlling for potentially important covariates. Methods The sample comprised 82 of 114 patients who participated in a double-blinded randomized controlled trial in which all patients received acetaminophen 1 g p.o., celecoxib 400 mg p.o., and dexamethasone 8 mg i.v., 1–2 h preoperatively. In addition, patients received gabapentin (GBP) 600 mg (G2) or placebo (G1 and G3) 2 h prior to surgery [G1: placebo/placebo (n = 38); G2: GBP/placebo (n = 38); G3: placebo/GBP (n = 38)]. In the PACU, patients received gabapentin 600 mg (G3) or placebo (G1 and G2). Follow-up data from the 82 patients who were contacted by telephone 6 months postsurgery were used for the current study. Results Maximal movement-evoked pain intensity over the first two postoperative days (P = 0.38) failed to predict the presence of CPSP 6 months later after controlling for age (P = 0.09), treatment group (P = 0.91), and cumulative morphine consumption (P = 0.8) (multivariate logistic regression likelihood ratio test against the intercept only model P = 0.59). Conclusion Neither maximum movement-evoked acute pain, nor any other factor measured, predicted the presence of CPSP at 6 months. Further research is needed to identify risk factors for CPSP after total hip arthroplasty.