Rashmi Bhandari, Postdoctoral Faculty Sponsor
INTRODUCTION: Up to 17%-20% of pediatric patients with chronic pain are prescribed opioid pharmacotherapy and face an increased risk of opioid misuse in adulthood. Little is known about the way clinical presentation may influence which children with chronic pain are prescribed opioids. This study examines the associations between child's and caregiver's report of child's pain, physical function, and socioemotional indices with opioid prescriptions in pediatric patients initiating treatment for chronic pain.METHODS: Participants were 1,155 pediatric patients (71.26% female, n=823) aged 8-17 years and 1 of their caregivers (89% mothers) who presented for evaluation at a tertiary care pediatric pain clinic. Data were collected from 2015 to 2019 and analyzed in 2020.RESULTS: Binary logistic regression analyses investigated the relative contribution of child's demographic, pain, and Patient-Reported Outcome Measurement Information System measures to opioid prescription status; separate models were conducted for child's and caregiver's report. Across child and caregiver models, findings were that child's age (older), pain duration (longer; child's report only), and increased physical limitations (mobility challenges and pain interference; caregiver's report only) were the most salient clinical correlates of positive opioid status. Contrary to the existing literature on adults with chronic pain, socioemotional indices (anxiety, depression, peer functioning) were nonsignificant.CONCLUSIONS: A greater understanding of how clinical presentation may relate to prescribed opioid pharmacotherapy informs the field's conceptualization of the sequelae of opioid use and misuse in the context of pediatric chronic pain.
View details for DOI 10.1016/j.amepre.2020.08.026
View details for PubMedID 33160799
Research in adult populations indicates that several sociodemographic and environmental variables increase risk for pain and poor outcomes. There is little research exploring the impact of household income, health insurance coverage, barriers to health care, neighborhood and school safety, violence experienced, and neighborhood isolation on pediatric chronic pain. Data from the Add Health Study, a longitudinal examination of a nationally-representative adolescent sample were analyzed. The relationships between demographic variables, risk factors, chronic pain, and long-term health outcomes were examined. Adolescents with chronic pain had lower income, more health care barriers, greater safety concerns, and experienced more violence compared to those without pain. In a model together, female sex, White race/ethnicity, and greater health care barriers, safety concerns, and violence exposure conferred significant risk for chronic pain. Additional analyses revealed nuances in the strength of risk factors between racial/ethnic groups. Systemic health care barriers were significantly associated with chronic pain and may delay symptom alleviation and return to functioning. Considering access to care is necessary in prevention efforts. Among adolescents with chronic pain, greater safety concerns predicted poor mental health outcomes, particularly for White females. The cumulative stress of environmental concerns, such as safety, and managing chronic pain may worsen functioning. PERSPECTIVE: Adolescents with chronic pain had lower income, and more health care barriers, safety concerns, and violence exposure compared to those without chronic pain. Access to care is a significant problem in youth with chronic pain. The relationships between race/ethnicity, risk factors, and health outcomes are complex and require additional research.
View details for DOI 10.1016/j.jpain.2019.06.007
View details for Web of Science ID 000553361300014
View details for PubMedID 31255798
Perfectionistic self-presentation (PSP) has been identified as a vulnerability factor in the development of depressive disorders during early adolescence. The Perfectionism Social Disconnection Model (PSDM) offers a theoretical framework suggesting PSP leads to depressive symptoms via interpersonal problems and social disconnection. Previous studies have supported the role of social disconnection as a mediator in the relation between PSP and suicidal ideation, but have not evaluated interpersonal problems in the model. Furthermore, the generalizability of the model has not been established for community and ethnic minority samples. Using cross-sectional data, the present study addresses these gaps by evaluating the PSDM and including social anxiety and loneliness as indicators of interpersonal problems and social disconnection, respectively, as predictors of youth depressive symptoms. The sample includes 289 (51.2% females) predominately low income and Latino and African American youth in fifth through seventh grade in three public schools. As predicted, social anxiety mediates the relationship between both PSP and loneliness and PSP and depressive symptoms. Moreover, mediational analyses indicate that social anxiety accounts for the relation between PSP and depression. Consistent with the PSDM model, the relationship between PSP and youth depressive symptoms is mediated sequentially through both social anxiety and loneliness, but primarily among the Latino sample.
View details for DOI 10.1007/s10802-016-0240-y
View details for Web of Science ID 000406185000011
View details for PubMedID 27917458
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