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Objective: We aimed to examine factors associated with frequent headache remission in schoolchildren aged 10–18 years. Background: Frequent headache is a common health problem in adolescence, and some individuals in this population experience remission. Factors preceding headache remission as opposed to ongoing headache, and their development over time, have not been examined extensively. Methods: Data were derived from a large school sample (N = 2280). Over the course of 1 year, n = 156 adolescents experienced remission from frequent headaches, while n = 125 adolescents continued to have frequent headaches throughout the year. In this longitudinal case–control study, we predicted headache remission using demographic, pain, psychosocial, sleep, and physiological characteristics. Additionally, we sought to explore the development of psychosocial, sleep, and physiological characteristics in relation to remitted versus ongoing headache over the 1‐year period. Results: A model containing the variables sex (odds ratio [OR] = 0.43, 95% confidence interval [CI] = 0.248–0.76, p = 0.003), headache intensity (OR = 0.85, 95% CI = 0.73–0.99, p = 0.035), anxiety score (OR = 0.92, 95% CI = 0.85–1.01, p = 0.071), and depression score (OR = 0.94, 95% CI = 0.89–1.00, p = 0.041) predicted the outcome variable (remitted vs. non‐remitted headache), explaining 17% of the variance in group membership. Schoolchildren reporting remitted headache at the end of the year exhibited lower depression (F[1, 557.01] = 45.77, p < 0.001) and anxiety scores (F[1, 557.01] = 21.72, p < 0.001), higher school satisfaction (F[1, 209.46] = 7.15, p = 0.008), and fewer difficulties falling asleep (F[1, 856.52] = 41.21, p < 0.001) or sleeping through the night (F[1, 731.12] = 26.42, p < 0.001) throughout the year compared to those with non‐remitted headache. Depression scores declined significantly over the year in the group with remitted headache, whereas these scores remained constant in the group with non‐remitted headache. Conclusion: Our results suggest a correlation between headache remission and male sex, improved mental health, and reduced pain‐related burden. Moreover, there was an observed decline in symptoms of depression during headache remission. Psychotherapy may be a promising treatment strategy for addressing frequent headaches reported by children and adolescents. Plain Language Summary: Our goal was to find out why some kids aged 10–18 years stop having frequent headaches, which is why we asked 2280 schoolchildren to fill out a survey five times during the school year. Kids who stopped having frequent headaches were more often boys, had better mental health, and were not bothered as much by pain. The results suggest that psychotherapy might help kids and teens who get a lot of headaches. [ABSTRACT FROM AUTHOR]

Objectives: Anxiety and depression are internalizing mental disorders often commencing in childhood and manifesting in adolescence. The Revised Anxiety and Depression Scale (RCADS) is an internationally widely used standardized diagnostic tool, but the German version has only been validated in a pediatric chronic pain sample; normative data are not available. The aim of this study is to test its reliability (internal consistency) and validity (factorial, convergent, known‐groups) in a representative German school sample and to provide norm data. Methods: Data were collected from N = 1562 German schoolchildren (Mage = 12.2; SDage = 2.33; range 8–17 years; 52.4% girls). Results: Cronbach's α ranged from 0.73 to 0.96 for the total and the six subscales (five anxiety and one depression). Confirmatory factor analysis showed the 6‐factor model had acceptable to good model fit with CFI = 0.93, TLI = 0.93, RMSEA = 0.05, SRMR = 0.05, which was better than 1‐ and 2‐factor models. The (sub)scales correlated moderate to high negatively with health‐related quality of life (−0.31 ≤ τ ≤ −0.51; p < 0.001) and positively with functional impairment (0.31 ≤ τ ≤ 0.48; p < 0.001). Mean scores of anxiety and depression scales were significantly higher in girls and partly in adolescents. Conclusion: Findings provide support for the good psychometric properties of the German RCADS in a community sample. [ABSTRACT FROM AUTHOR]

Summary: Children and adolescents with complex chronic conditions, including those with life‐threatening or life‐limiting conditions, are a heterogeneous population. Many individuals exhibit sleep abnormalities that are measurable by proxy questionnaires. No suitable instrument to assess the wide range of different complex chronic conditions is currently available. The aim of the present study was to develop a screening tool—the Sleep Screening for Children and Adolescents with Complex Chronic Conditions—to effectively obtain sleep behaviour information in this population. Following a mixed‐method design, potential items for the Sleep Screening for Children and Adolescents with Complex Chronic Conditions questionnaire were defined through literature research and expert meetings. In a pre‐test with N = 60 family and professional caregivers, the items' relevance and comprehensibility as well as the instrument's overall design were assessed. For the main test, N = 315 participants were recruited in three tertiary paediatric hospitals. A principal components analysis detected the questionnaire's scales. Item analysis focused on mean values, range, difficulty and discriminatory power. Convergent validation of the Sleep Screening for Children and Adolescents with Complex Chronic Conditions was assessed via correlations between scale items. Most patients had neurological or neuromuscular diseases. Four scales ("Falling and staying asleep", "Sleep‐associated respiration and arousal", "Daytime sleepiness" and "Sleep‐associated movements") emerged. The item analysis showed satisfactory discriminative power. In the preliminary validation, all scales correlated positively with a child's care level and with various sleep circumstances items. Three scales additionally correlated with the number of complex chronic condition diagnoses. This newly developed questionnaire can provide clinicians with first indications of possible sleep problems in a growing paediatric population. [ABSTRACT FROM AUTHOR]

Background: For paediatric chronic pain patients, intensive interdisciplinary pain treatment (IIPT) is a well‐established treatment. The treatment's short‐term effectiveness can be improved by an additive psychosocial aftercare (PAC). However, neither the program's long‐term effectiveness nor the patients in particular need have been investigated yet. Methods: This study aimed at determining the long‐term effects of PAC and detecting predictors of treatment outcome within a multicentre randomized controlled trial measured at five time points up to 12 months after discharge. At inpatient admission to IIPT, patients (N = 419, 14.3 years of age, 72.3% female) were randomly assigned to intervention or control group. After IIPT discharge, the intervention group received PAC, whereas the control group received treatment as usual (TAU). Patient‐reported outcomes included pain and emotional characteristics. Clinicians assessed potential psychosocial risk factors and their prognosis of treatment outcome. Statistical analyses included mixed‐models and univariable logistic regressions. Results: Data at the 12‐month follow‐up (n = 288) showed a significant benefit of PAC compared with TAU; the majority (59.0%) of patients in the PAC‐group reported no chronic pain compared to 29.2% of TAU‐patients (p < 0.001). Patients with a single parent specifically benefited from PAC compared to TAU. Clinicians were able to make a reliable prognosis of treatment outcome, but did not successfully predict which patients would benefit the most from PAC. Conclusions: Study results suggest that PAC is highly effective irrespective of patient characteristics, but particularly for patients with single parents. Its broad implementation could help to improve the long‐term outcomes of youth with severely disabling chronic pain. Significance: A psychosocial aftercare following paediatric IIPT leads to significantly better pain and emotional outcomes compared to treatment as usual up to 12 months after discharge, especially for patients with single parents. [ABSTRACT FROM AUTHOR]

Aim: Multidrug‐resistant organisms (MDRO) deserve special attention in health‐care facilities for children with life‐limiting conditions because these children have an increased risk for colonisation. To avoid nosocomial transmissions to other inpatients, single‐room isolation is usually recommended. In the context of paediatric palliative care (PPC), such isolation counters the aim of participation in social activities for the patients. This study aimed to determine the prevalence of MDRO, the predictive value of risk factors and the incidence of nosocomial infections and nosocomial colonisations on a PPC inpatient unit applying a special hygiene concept that enables participation in social activities through risk‐adaption and barrier nursing. Methods: Two‐year surveillance with MDRO screening of all intakes (N = 386) of a PPC unit on the day of admission and discharge. To determine the predictive value of pre‐defined risk factors, logistic regression analyses were calculated. Receiver operating characteristic analyses were performed to determine the predictive power of the number of risk factors on the presence of MDRO. Results: The rate of MDRO colonisation at admission was 12.7%; previous positive MDRO screening was the only significant individual risk factor. Over the 2‐year period, no MDRO‐related nosocomial infections occurred; nosocomial colonisation incidence density was 0.6. Conclusion: Results demonstrate that patients with at least one risk factor have to be cared for by barrier nursing until MDRO screening results are negative. Following these guidelines prevents nosocomial MDRO transmission. [ABSTRACT FROM AUTHOR]

Objective: Chronic pain in children and adolescents gives rise to high healthcare costs. Successful treatment is supposed to reduce the economic burden. The objective of this study was to determine the changes in healthcare utilization and expenditures from 1 year before (Pre) intensive interdisciplinary pain treatment (IIPT) to the first (Post 1) and second (Post 2) years after discharge in a sample of paediatric chronic pain patients. Methods: Claims data from one statutory health insurance company were analysed for 119 children and adolescents (mean age = 15.3, 68.9% female) who sought IIPT at the German Paediatric Pain Centre. Costs incurred for inpatient treatment, outpatient treatment, medication, remedies and aids were compared before treatment and 2 years after discharge. Healthcare utilization was compared using Wilcoxon signed‐rank test, and expenditures using trimmed means and the Yuen's t‐test. Results: Overall costs were significantly lower in the 2 years after IIPT compared to before IIPT (Pre: 3,543€, Post 1:2,681€, Post 2:1937€ (trimmed means)). Healthcare utilization changed significantly; hospitalizations decreased in the years after discharge, while psychotherapies stayed stable in the year after discharge but lessened in the second year. Conclusion: The results of this study support prior findings on the high economic burden of paediatric chronic pain. IIPT may contribute to a transition in healthcare utilization from somatic‐focused treatments to more psychological treatments. Overall costs were reduced as soon as the first year after discharge and decreased even further in the second year. Significance: This study analyses original claims data from paediatric chronic pain patients in the year before and up to 2 years after intensive interdisciplinary pain treatment in a specialized paediatric pain centre. The analysis of long‐term data reveals a continuous cost reduction after intensive interdisciplinary pain treatment and a change in the subsequent outpatient treatment. [ABSTRACT FROM AUTHOR]

Background: Chronic pain in children is a serious issue, therefore calling for effective prevention/intervention measures. This study aimed to evaluate the efficacy of an educational movie on pain knowledge in school children in general and on pain‐related behaviours and pain intensity in those who are affected by chronic pain. Regarding those affected, the association between pain knowledge and intensity, as well as the potential mediating effect of pain‐related behaviours, were investigated. Methods: Recruited from four schools, N = 381 students (51.7% female; Mage = 11.4, SD = 0.95) participated, of which n = 108 reported chronic pain. Each school was randomly allocated to the intervention or control group (cluster‐randomization). At two time points spaced 4–5 weeks apart, students provided information on their pain knowledge, pain‐related behaviour (passive pain coping, pain‐related disability, missed school days, medication use) and pain intensity. After the first assessment, students in the intervention group watched an educational movie. Multilevel linear models for all outcomes were calculated as well as a mediation analysis. Results: Pain knowledge increased significantly in the intervention group (β = 2.76 [95% CI 2.20, 3.31]). However, no significant time‐by‐group interactions were found for pain‐related behaviour or pain intensity. The mediation model identified that the indirect effect of pain knowledge on pain intensity was mediated by pain‐related behaviour (β = −0.18, p = 0.014 and β = 0.38, p < 0.001, respectively). Conclusions: Educational movies may be an effective tool for educating students about pain management. However, the knowledge gained may not be sufficient to improve pain behaviour and intensity overall. Significance: A 10‐min educational movie on chronic pain management was tested in school children (N = 381). Following the intervention, knowledge of chronic pain concepts was statistically greater in the intervention group compared to the control group not watching the movie. Furthermore, a mediation model theoretically determined whether an association between pain knowledge and pain intensity exists, and whether this is explained by level of dysfunctional pain‐related behaviorisms. Full mediation was confirmed. [ABSTRACT FROM AUTHOR]

Background: Findings on the short‐ and long‐term effectiveness of intensive interdisciplinary pain treatment (IIPT) for children with severe chronic functional pain are promising. However, a definitive appraisal of long‐term effectiveness cannot be made due to a lack of comparison groups. The aim of the present study was to compare the health status of former patients with the health status of an age‐ and sex‐matched comparison group from the community. Methods: Data from two samples, a clinical sample of former patients (n = 162; aged 14 to 26) and an age‐ and sex‐matched community sample (n = 162), were analysed. Former patients provided data 7 years after IIPT. Pain characteristics, physical and mental health status, autonomy, coping and health care utilisation were compared between the two samples. Results: Seven years after treatment, the majority (58%) of the clinical sample were completely pain‐free. Compared to the community sample, the clinical sample demonstrated worse physical and mental health and continued to seek more frequent health care, irrespective of whether or not they experienced ongoing chronic pain. However, the clinical sample reported better coping strategies and a comparable level of autonomy. Conclusion: Patients experiencing severe chronic pain in childhood who engage in IIPT are likely to have recovered from their pain in early adulthood. Long‐term treatment effects may manifest in better coping strategies. However, reduced mental and physical health status may indicate a negative long‐term effect of early chronic pain experiences or a general vulnerability in people developing a chronic pain condition in childhood. Significance: The majority of severely impaired paediatric chronic pain patients no longer suffer from chronic pain seven years after intensive interdisciplinary pain treatment. However, former patients have worse physical and mental health status than a community sample, and continue to seek out more frequent health care utilisation, irrespective of whether or not they continue to experience chronic pain. Therefore, potential negative long‐term effects of childhood chronic pain experiences need specific attention early on. [ABSTRACT FROM AUTHOR]

Background: Although paediatric chronic pain is common, it is not yet clear which individuals with chronic pain are likely to seek health care for their pain. The aims of this study were to summarize the current evidence of the characteristics of children and adolescents with chronic pain who consult a physician or use medication for their pain. Additionally, we aimed to expand knowledge by further investigating key and promising, factors in a large community sample of adolescents.Methods: First, using scoping review methodology, studies on health care utilisation in paediatric chronic pain were identified by the systematic literature search. Out of 1,158 articles, 12 were included for data extraction. Second, in a population-based cross-sectional survey, data of N = 2,280 adolescents (10-18 years) and their parents (N = 1,464), were analysed. Univariable logistic and multivariable LASSO regression models were calculated for adolescents with chronic pain (n = 749) to identify predictors of physician visits or analgesics intake due to pain, controlling for acute illness and injury.Results: The scoping review identified higher pain intensity, frequency, severity and pain-related disability as significant individual factors associated with physician consultation. Female sex and higher pain intensity were associated with medication consumption. Multivariable analyses with cross-sectional data revealed only pain-related school absence to be associated with physician consultation; analgesic medication use was associated with school absence and higher pain intensity.Conclusion: Original data from this study support prior findings. School absence and pain intensity, plausible surrogates for pain severity, are the most relevant factors in health care utilisation due to chronic pain.Significance: A scoping summary of existing research on predictors for physician consultation and medication use in children and adolescents with chronic pain is provided. Furthermore, the role of potential predictors for health care utilisation-sociodemographic, pain, school, psychological and parent-related characteristics-is analysed in a population-based cross-sectional survey. Controlling for illness and injuries, and using a strict chronic pain definition, the cross-sectional survey allows conclusions on healthcare utilisation specific to chronic pain in adolescents. [ABSTRACT FROM AUTHOR]

Background: Chronic pain is a common issue in adolescents. Prevalence of pain and associated factors present differently in sex and age subgroups; however, the interaction of sex and age combined has not been thoroughly assessed. This study aimed to identify psychosocial and health factors associated with chronic pain in younger and older adolescent girls and boys.Methods: Students from five schools in grades 5-10 self-completed a pain survey. Participants were 2,280 adolescents (52% girls) aged 10-18 years (M = 12.95, SD = 1.84). Data were analysed using multivariate logistic regression models.Results: Chronic pain was present in 33% of participants. The risk of chronic pain increased by 29% in girls, compared to 16% in boys, per year of age (p = .039). Overall, depression (OR = 2.05, p < .001), anxiety (OR = 1.51, p < .001), lower school satisfaction (OR = 1.41, p = .034) and sleep issues (OR = 2.34, p < .001) were associated with chronic pain. Stratified analyses identified unique significant associations between chronic pain and psychosocial factors. In boys aged 10-13 years, higher socioeconomic status (OR = 1.76, p = .024) and poorer school performance (OR = 1.60, p = .027) were uniquely important; in girls aged 10-13 years, lower school satisfaction (OR = 2.92, p = .003) was associated with pain, and in older girls aged 14-18 years, anxiety (OR = 1.74, p = .009) was significantly associated with pain. When these differences were assessed statistically, only lower school satisfaction had significant differences between subgroups (p = .049).Conclusions: Many psychosocial and health factors are similarly important, with few differences, for chronic pain in girls and boys at different stages of adolescence.Significance: We report evidence that negative psychosocial and health factors are related to a higher prevalence of chronic pain in adolescents. Furthermore, the relationships between anxiety, socioeconomic status, lower school satisfaction and lower school performance with pain may vary between adolescents of differing sexes and ages. Understanding how possible risk factors for chronic pain contribute differently to the pain experience of adolescent girls and boys is an important step towards lowering the prevalence of this common health condition. [ABSTRACT FROM AUTHOR]

Background: Medically unexplained pain in children and adolescents is a common and increasing health care problem. Primary care is usually the first point of contact for these patients. It is the overall objective of this study to investigate treatment outcome of medically unexplained pain in paediatric primary care and to identify predictors of treatment failure.Method: In a prospective observational cohort study with three assessments over 6 months, N = 266 children (6-17 years) presenting to paediatric primary care due to medically unexplained pain were included. The primary outcome is treatment failure after 6 months defined as disabling chronic pain. Risk factors for treatment failure were identified by means of logistic regression analyses.Results: At the 6-months follow-up, treatment proved unsuccessful in 22.6% of patients. In patients with headaches, high functional impairment and strong emotional pain burden at study inclusion, the risk for treatment failure was increased. However, when also including data on the initial treatment response, pain location and functional impairment were no longer significant. Patients who did not respond to treatment within the first 3 months were more likely to experience treatment failure (OR = 203.7 ; p < 0.001) at 6 months, as were children with a higher emotional pain burden at study inclusion (OR = 1.3; p = 0.007; R2  = 0.781).Conclusions: This study indicates that paediatric primary care is not sufficient for nearly one-quarter of the children with medically unexplained pain. Individuals without a positive treatment response after 3 months are at increased risk for treatment failure.Significance: This study investigates the treatment outcome of medically unexplained pain in paediatric primary care. Individuals with a higher emotional pain burden at the first visit and those without positive treatment response after 3 months are at increased risk for treatment failure. Therefore, a stepped-care approach seems warranted. After an insufficient primary care trial of 3 months, patients should be transferred to pain specialists for a more intense treatment. [ABSTRACT FROM AUTHOR]

Objective.- The aim of this study was to investigate the utility of pain descriptors (pain quality, pain intensity) assessed in a questionnaire to discriminate tension-type headache (TTH) from TTH plus migraine in a sample of adolescents. Background.- Epidemiological studies assess pain characteristics via questionnaire and estimate prevalence rates based on these pain descriptions. According to International Headache Society criteria, the subjective pain quality and intensity for TTH and migraine differs and therefore should be able to discriminate the 2 diagnoses. The discriminative ability between TTH and TTH plus migraine may be a special challenge. Design and methods.- One hundred twenty-two adolescents with pure TTH and 110 adolescents with TTH plus migraine aged 11-18 years presenting to a tertiary pediatric pain clinic were included in the study. Questionnaire reports of pain intensity and quality were compared with physician's diagnosis as the gold standard. Mean differences as well as receiver operating characteristics were analyzed. Results.- Adolescents with TTH plus migraine reported more pulsating and less intense pain compared with pure TTH. Receiver operating characteristic analysis indicated that pain descriptors did not discriminate between groups. Diagnostic utility of descriptors was similarly low for older adolescents and parental proxy reports. Conclusions.- Pain intensity and quality assessed by questionnaires are not suitable to discriminate TTH from TTH plus migraine. This may lead to inaccurate prevalence estimates in epidemiological studies and may mislead practitioners in forming diagnostic hypotheses. The exclusion of these pain descriptors in questionnaires should be considered. More research systematically assessing the diagnostic utility of verbal pain descriptors in primary care and epidemiological samples is needed. [ABSTRACT FROM AUTHOR]

Abstract: Preliminary evidence suggests that parental catastrophizing about their child’s pain may be important in understanding both parental responses to their child’s pain and the child’s pain experience. However, little is known about potential differences between mothers and fathers. There were three aims of the present study addressing this lack of knowledge: (i) to investigate the three-factor structure of the German version of the Parental Pain Catastrophizing Scale (PCS-P) () in mothers and fathers of children with chronic pain, (ii) to explore differences between mothers and fathers in parental catastrophizing, (iii) to investigate the contribution of parental catastrophizing on the child’s chronic pain problem and pain-related parent behavior. In a sample of 128 mothers and fathers of paediatric chronic pain patients, the invariance of the PCS-P was evaluated. Results replicated the previously established three-factor structure (i.e. rumination, magnification and helplessness) in both groups. Mothers reported higher levels of catastrophizing as compared to fathers. Specifically, mothers and fathers differed on levels of rumination; the two groups did not differ in magnification and helplessness. Maternal but not paternal catastrophizing contributed significantly in explaining the child’s pain intensity whereas neither mothers’ nor fathers’ catastrophizing were significantly related to the child’s disability. Both maternal and paternal catastrophizing contributed significantly to heightened parental solicitous responses. Fathers’ but not mothers’ catastrophizing also contributed to heightened distracting responses. The present findings attest to the importance of maternal and paternal catastrophizing for the child’s pain characteristics and pain-related parent behavior, which are both relevant for treatment conceptualization. [Copyright &y& Elsevier]