Psychosocial assessment and self-management of chronic pain

摘要: markdownabstractAbstract Chronic pain is prevalent in both children and adults has major negative consequences for their daily life, e.g. reduced participation activities depressive anxious feelings. Therefore, it important to early signal treat chronic pain. This thesis aimed provide answers two questions: 1. How improve signaling assessment of adolescents? 2. self-management adolescents adults? Psychosocial stress seems serve as an risk factor the occurrence In chapter 2 we examined if adversities, bullying, abuse, family conflict are factors adolescents. Additionally, described characteristics a community sample Dutch Participants present study were 15,220 adolescents, attending schools (grade 7 8) Rotterdam, Netherlands. Chronic was measured with newly developed questionnaire; Pain Barometer. Early adversities using single item questions from Rotterdam Youth Monitor, longitudinal youth health surveillance system. Cross-sectional associations between investigated logistic multilevel analysis, adjusted potential confounding. school year 2010-2011, 9.2% reported Physical abuse by others (OR=1.51, 95% CI=1.07-2.14), sexual (OR=1.46, CI=1.05-2.05), (OR=1.79, C=1.61-1.99), being bullied (OR=1.23, CI=1.17-1.29) more common (OR=1.28, CI=.95-1.71) parents parental divorce (OR=1.07, CI=.93-1.22) not significantly related The results suggest that may be these stressors might, prevent pain. In 3 determined whether associated specific aspects academic performance, i.e. lower grades, critical adolescent’s decreased emotional well-being attention problems. We hypothesized association grades mediated large cross-sectional study, collected data 2215 pupils, aged 12-13 years old. Pain, well-being, problems self-rating scale. Dutch, English, math taken index performance. Frequent (Dutch p = .02 .01). Both occasional frequent (p =< .01) self-reported <.01). Furthermore, partially (p-values show can explained intervention targeted at subjective could have positive effect on Behavioral migraine approaches effective reducing headache attacks. Availability treatment might increased patients trainers. Merelle colleagues evaluated home-based behavioral management training (BMT) lay maintenance effects long-term follow-up 4. Measurements pre-BMT (T0), post-BMT (T1), six-month (T2), follow-up, four after BMT (T3). Data 127 participants analyzed multi-level analyses. Short-term improvements attack frequency self-efficacy maintained ( DT0T3  = -.34  = .69, respectively). level internal control during  = .18). Quality life migraine-related disability improved gradually over time  = .45  = -.26, Although should interpreted caution because lack group inability gather information about additional treatments received period, findings beneficial long term. If so, this make widely available. Chapter 5 describes protocol promote skills pain, internet-based program: Move It Now. program includes cognitive techniques, including relaxation exercises thinking. objective ability cope In 6 Now evaluated. Because attrition loss apply originally proposed between-group design but had employ within-group design, comparing waiting list trajectory trajectory. Internet consisted seven weekly interactive modules, which worked through independently. therapist contacted them e-mail or telephone. Adolescents (N 69) assessed outcome measures coping, disability, catastrophizing, rewarding behavior parents, quality life. Measures weeks before treatment, pre-treatment, post-treatment, three months follow-up. Multi-level modelling used analysis data. intensity, sleep pre-treatment post-treatment Results coping mixed. No significant differences found pain-related catastrophizing. Contrary expectations, Internet-based difficult suffers indications decreasing problems. In conclusion, shows very important. highly among only negatively influences also grades. who experienced seem vulnerable experience Signaling Online reduce adolescent future, research done adherence online therapy. Since patient-therapist relation so important, strategies strengthen relationship studied. adults, provided trainers patients, even cost-effectiveness been proven, implemented would available.