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Children and Adolescents with Pain in Primary care: Biopsychosocial determinants and behavioral medicine treatment in a physical therapy framework
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotheraphy.
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Pain during childhood and adolescents is prevalent and longstanding pain can have severe consequences for children, their families and in the long run for the society. Persisting pain influences many aspects of life and pain-related disability is often associated with impairment, decreased health-related quality of life, school functioning, participation in social life, emotional well-being, and with increased healthcare utilization. The overall aim was to explore, with cross-sectional design, pain conditions, to identify biopsychosocial determinants and their association with pain-related disability, and to study the feasibility of applying a behavioral medicine treatment for adolescents experiencing musculoskeletal pain using randomized controlled design and multimethod approach. Samples of children and adolescents and their parents seeking primary care physical therapy for a pain condition, and a sample of treating physical therapists were included.

The results showed that some children had profiles of biopsychosocial determinants that could increase the risk for long-term pain-related disability. Many had long pain duration and multiple pain locations. Girls reported higher levels of catastrophizing compared to boys, who in turn used more behavioral distraction generally regarded as a positive coping strategy.

Behavioral medicine treatment, based on a biopsychosocial approach, targeting adolescents with pain was shown to be feasible for use in primary care, with promising outcomes. Tailoring of the treatment was suboptimal but the effect of behavioral medicine treatment in pain-related disability exceeded the effect of the control treatment. The satisfaction with treatment content and results were high for both the control- and experimental condition, significantly higher for the experimental condition as rated by participants. Learning and delivering the behavioral medicine intervention was perceived challenging but rewarding by the treating physical therapists. The biopsychosocial approach in tailoring the treatment, and dialogs with parents were identified as key aspects in the behavioral medicine treatment program.

In conclusion, in children seeking primary care for pain, the factors associated with pain-related disability were complex and interrelated. The findings highlight the importance for primary care health care providers to apply a biopsychosocial approach in assessment and treatment, for improvement of activities and participation, and thereby helping children and adolescents regain health.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. , 100 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 988
National Category
Physiotherapy
Identifiers
URN: urn:nbn:se:uu:diva-220957ISBN: 978-91-554-8920-5 (print)OAI: oai:DiVA.org:uu-220957DiVA: diva2:708562
Public defence
2014-05-23, Universitetshuset, sal IX, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-04-28 Created: 2014-03-24 Last updated: 2014-04-29
List of papers
1. Pain in children and adolescents in primary care: chronic and recurrent pain is common
Open this publication in new window or tab >>Pain in children and adolescents in primary care: chronic and recurrent pain is common
2012 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 12, 1246-1252 p.Article in journal (Refereed) Published
Abstract [en]

Aim: 

The aim of this study was to describe a paediatric primary care pain sample and examine associations between pain, health-related quality of life and disability.

Methods: 

The study design is descriptive and cross-sectional. One hundred and fifty-four consecutive children and adolescents between the ages of 8 and 16 seeking care for a pain-related conditions participated in this study. Pain characteristics, health-related quality of life and disability were investigated.

Results: 

Eighty-seven per cent of participants had a pain duration of 3 months or more, and almost half of the group studied had a pain duration of ≥ 12 months. The disability levels in the study group as a whole were low, with a mean FDI of 10.4 (SD 7.6). However, 35% of the study group had moderate disability levels and reported a mean FDI of 18.7 (SD 4.8). Single pain location was reported in 42%, whereas 58% had two or more pain locations. The children with multiple pain locations reported lower health-related quality of life and higher disability than children with single pain location.

Conclusion:

Paediatric pain patients in primary care consist partly of patients only slightly influenced by pain and partly of patients for whom pain has a great impact on their lives.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-187141 (URN)10.1111/j.1651-2227.2012.02829.x (DOI)000310868300029 ()22924888 (PubMedID)
Available from: 2012-12-03 Created: 2012-12-03 Last updated: 2017-12-07Bibliographically approved
2. How children and adolescents in primary care cope with pain and the biopsychosocial factors that correlate with pain-related disability
Open this publication in new window or tab >>How children and adolescents in primary care cope with pain and the biopsychosocial factors that correlate with pain-related disability
2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 10, 1021-1026 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To describe how children and adolescents cope with pain and to examine the biopsychosocial factors that correlate with pain-related disability (PRD) in a sample of primary care patients. Methods: This cross-sectional study included 133 patients, aged from eight to 16 years, who consulted primary care physiotherapy on a pain-related problem. Data were collected with the Functional Disability Inventory, the Pain Coping Questionnaire and a study-specific questionnaire. Linear multivariate regression analyses were applied to study the associations between PRD and (i) pain coping, (ii) individual-, pain-related and psychosocial variables. Results: Behavioural distraction, externalizing and catastrophizing explained 13% of the variance in PRD (regression model 1). In addition, pain intensity, worrying and the ability to reduce pain explained 21% of the variance in PRD (regression model 2). Conclusion: Variance in PRD was partly explained by pain intensity, worrying and ability to reduce pain and by behavioural distraction, externalizing and catastrophizing. Future prospective longitudinal studies are needed to identify possible additional variables explaining PRD, establish causality and the potential benefits of addressing these variables in interventions in primary care.

Keyword
Children, Pain coping, Pain-related disability, Primary care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-208633 (URN)10.1111/apa.12352 (DOI)000323886300032 ()
Available from: 2013-10-08 Created: 2013-10-07 Last updated: 2017-12-06Bibliographically approved
3. Treating youth in pain: A randomized controlled feasibility trial of a behavioral medicine approach in primary care
Open this publication in new window or tab >>Treating youth in pain: A randomized controlled feasibility trial of a behavioral medicine approach in primary care
Show others...
(English)Manuscript (preprint) (Other academic)
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-220953 (URN)
Available from: 2014-03-24 Created: 2014-03-24 Last updated: 2014-04-29
4. Feasibility of a tailored behavioral medicine intervention for adolescents’ with persistent pain – the views of adolescents, parents and physical therapists
Open this publication in new window or tab >>Feasibility of a tailored behavioral medicine intervention for adolescents’ with persistent pain – the views of adolescents, parents and physical therapists
(English)Manuscript (preprint) (Other academic)
National Category
Physiotherapy
Identifiers
urn:nbn:se:uu:diva-220956 (URN)
Available from: 2014-03-24 Created: 2014-03-24 Last updated: 2014-04-29

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