domingo, 6 de mayo de 2012

Dolor crónico en niños


Factores sociodemográficos en una clínica pediátrica de dolor crónico: papel de la edad, sexo y estado minoritario en las características del dolor y la salud 
Sociodemographic factors in a pediatric chronic pain clinic: The roles of age, sex and minority status in pain and health characteristics.
Evans S, Taub R, Tsao JC, Meldrum M, Zeltzer LK.
Pediatric Pain Program, Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America.
J Pain Manag. 2010 Jul;3(3):273-281.
Abstract
Little is known about how sociodemographic factors relate to children's chronic pain. This paper describes the pain, health, and sociodemographic characteristics of a cohort of children presenting to an urban tertiary chronic pain clinic and documents the role of age, sex and minority status on pain-related characteristics. A multidisciplinary, tertiary clinic specializing in pediatric chronic pain. Two hundred and nineteen patients and their parents were given questionnaire packets to fill out prior to their intake appointment which included demographic information, clinical information, Child Health Questionnaire - Parent Report, Functional Disability Index - Parent Report, Child Somatization Index - Parent Report, and a Pain Intensity Scale. Additional clinical information was obtained from patients' medical records via chart review. This clinical sample exhibited compromised functioning in a number of domains, including school attendance, bodily pain, and health compared to normative data. Patients also exhibited high levels of functional disability. Minority children evidenced decreased sleep, increased somatization, higher levels of functional disability, and increased pain intensity compared to Caucasians. Caucasians were more likely to endorse headaches than minorities, and girls were more likely than boys to present with fibromyalgia. Younger children reported better functioning than did teens. The results indicate that sociodemographic factors are significantly associated with several pain-related characteristics in children with chronic pain. Further research must address potential mechanisms of these relationships and applications for treatment.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3113686/pdf/nihms266164.pdf  
Asociación entre dolor y funcionamiento padres y niños en una muestra de dolor crónico pediátrico: un abordaje con métodos mixtos 
Associations between parent and child pain and functioning in a pediatric chronic pain sample: A mixed methods approach.
Evans S, Meldrum M, Tsao JC, Fraynt R, Zeltzer LK.
Int J Disabil Hum Dev. 2010 Nov 1;9(1):11-21.
Abstract
This study employed a mixed-method design to test sex-specific parent-child pain associations. Subjects were 179 chronic pain patients aged 11-19 years (mean = 14.34; 72% female) presenting for treatment at a multidisciplinary, tertiary clinic. Mothers and children completed questionnaires prior to their clinic visit, including measures of children's pain, functioning and psychological characteristics. Mothers also reported on their own pain and psychological functioning. Interviews were conducted with a sub-sample of 34 mothers and children prior to the clinic visit and analyzed using a grounded theory approach. The quantitative data suggest stronger mother-daughter than mother-son pain relationships. The qualitative data suggest that girls' pain and pain-related disability is related to an overly enmeshed mother-daughter relationship and the presence of maternal models of pain, while boys' pain and disability is linked to male pain models and criticism and to maternal worry and solicitousness. Boys and girls appear to have developmentally incongruous levels of autonomy and conformity to maternal expectations. The mixed-method data suggest distinct trajectories through which mother and father involvement may be linked to chronic pain in adolescent boys and girls.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105525/pdf/nihms263123.pdf 
 
Relación del la percepción del niño del dolor materno al dolor infantil del y fuera del laboratorio 
Relationship of child perceptions of maternal pain to children's laboratory and non-laboratory pain.
Evans S, Tsao JC, Zeltzer LK.
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90024, USA. suevans@mednet.ucla.edu
Pain Res Manag. 2008 May-Jun;13(3):211-8.
Abstract
Previous research has established links between parent and child pain. However, little is known about sex-specific parent-child pain relationships in a nonclinical population. A sample of 186 children aged eight to 18 years (49% female) provided information on maternal and self bodily pain, assessed by asking children about the presence and location of bodily pain experienced. Children also completed three laboratory pain tasks and reported on cold pressor pain intensity, pressure pain intensity and heat pain intensity. The presence of child-reported maternal pain was consistently correlated with daughters' bodily and laboratory pain, but not with sons' pain in bivariate analyses. Multivariate analyses controlling for child age and maternal psychological distress indicated that children of mothers with bodily pain reported more total bodily pain sites as well as greater pressure and cold pain intensity, relative to children of mothers without bodily pain. For cold pain intensity, these results differed for boys versus girls, in that daughters reporting maternal pain evidenced significantly higher cold pain intensity compared with daughters not reporting maternal pain. No such differences were found for boys. The findings suggest that children's perceptions of maternal pain may play a role in influencing children's own experience of pain, and that maternal pain models may affect boys and girls differently.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642517/pdf/prm13211.pdf  

 

Atentamente
Dr. Enrique Hernández-Cortez
Anestesiología y Medicina del Dolor

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