Browsing by Author "Noel, Melanie"
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- ItemOpen AccessA cluster randomized clinical trial to evaluate the effectiveness of the Implementation of Infant Pain Practice Change (ImPaC) Resource to improve pain practices in hospitalized infants: a study protocol(2020-01-06) Bueno, Mariana; Stevens, Bonnie; Barwick, Melanie A; Riahi, Shirine; Li, Shelly-Anne; Lanese, Alexa; Willan, Andrew R; Synnes, Anne; Estabrooks, Carole A; Chambers, Christine T; Harrison, Denise; Yamada, Janet; Stinson, Jennifer; Campbell-Yeo, Marsha; Noel, Melanie; Gibbins, Sharyn; LeMay, Sylvie; Isaranuwatchai, WanrudeeAbstract Background Hospitalized infants undergo multiple painful procedures daily. Despite the significant evidence, procedural pain assessment and management continues to be suboptimal. Repetitive and untreated pain at this vital developmental juncture is associated with negative behavioral and neurodevelopmental consequences. To address this knowledge to practice gap, we developed the web-based Implementation of Infant Pain Practice Change (ImPaC) Resource to guide change in healthcare professionals’ pain practice behaviors. This protocol describes the evaluation of the intervention effectiveness and implementation of the Resource and how organizational context influences outcomes. Methods An effectiveness-implementation hybrid type 1 design, blending a cluster randomized clinical trial and a mixed-methods implementation study will be used. Eighteen Neonatal Intensive Care Units (NICUs) across Canada will be randomized to intervention (INT) or standard practice (SP) groups. NICUs in the INT group will receive the Resource for six months; those in the SP group will continue with practice as usual and will be offered the Resource after a six-month waiting period. Data analysts will be blinded to group allocation. To address the intervention effectiveness, the INT and SP groups will be compared on clinical outcomes including the proportion of infants who have procedural pain assessed and managed, and the frequency and nature of painful procedures. Data will be collected at baseline (before randomization) and at completion of the intervention (six months). Implementation outcomes (feasibility, fidelity, implementation cost, and reach) will be measured at completion of the intervention. Sustainability will be assessed at six and 12 months following the intervention. Organizational context will be assessed to examine its influence on intervention and implementation outcomes. Discussion This mixed-methods study aims to determine the effectiveness and the implementation of a multifaceted online strategy for changing healthcare professionals’ pain practices for hospitalized infants. Implementation strategies that are easily and effectively implemented are important for sustained change. The results will inform healthcare professionals and decision-makers on how to address the challenges of implementing the Resource within various organizational contexts. Trial registration ClinicalTrials.gov, NCT03825822. Registered 31 January 2019.
- ItemOpen AccessA Longitudinal Examination of Attentional Biases in Pediatric Chronic Pain: Nature, Theorized Antecedents, and Consequences(2020-07-03) Soltani, Sabine; Noel, Melanie; Yeates, Keith; Sears, Christopher; Giesbrecht, Gerry; Stewart, SherryObjectiveChronic pain is common in childhood and adolescence, and is associated with significant functional impairment, lower quality of life, and high psychiatric comorbidities. Theoretical models of chronic pain suggest a key role for attentional biases in the development, maintenance, and progression of chronic pain and co-occurring psychiatric symptoms. Despite their prominence in theoretical models, attentional biases for pain remain understudied and poorly understood, particularly in youth. The objective of this dissertation was to assess the nature of attentional bias for pain-related information in a clinical sample of youth with chronic pain and to examine its relationship with theorized antecedents and pain and mental health symptoms. MethodsParticipants consisted of a sample of 102 youth aged 10-18 years with chronic pain (71% female) and 53 youth without chronic pain (the control group; 50% female). Participants completed a questionnaire battery assessing pain characteristics, mental health symptoms, theorized antecedents of pediatric chronic pain, and attentional control. To assess attentional bias for pain, participants completed an eye-tracking task in which they viewed pairs of images of children depicting pain expressions of varying intensity and a neutral facial expression. Participants also completed a behavioural measure of attentional control. Pain outcomes and mental health symptoms in youth with chronic pain were assessed again at 3-month follow-up.ResultsAcross the sample, youth exhibited attentional bias for pain expressions, regardless of chronic pain status. Within-group differences in attending to varying levels of pain expressiveness were found. Attentional bias was not significantly associated with theorized antecedents, pain-related outcomes, or mental health symptoms at baseline or 3-month follow-up in youth with chronic pain. There was no evidence in support of a moderating effect of attentional control. ConclusionsThe results of this dissertation support the existence of an attentional bias for pain facial expressions in both youth with chronic pain and youth without chronic pain. Unexpectedly, attentional bias was not associated with key theorized antecedents or pain-related outcomes. These findings have significant implications for future research examining the theoretical and clinical utility of attentional biases in pediatric chronic pain.
- ItemOpen AccessAdverse Childhood Experiences and Intimate Partner Violence: A Meta-Analysis(2022-08) Zhu, Jenney; Madigan, Sheri; Dobson, Keith; Wells, Lana; Noel, MelanieBackground: Intimate partner violence (IPV) represents a significant public health concern that impacts individuals globally. Exposure to adverse childhood experiences (ACEs) represents one risk factor for IPV involvement. However, the results of existing research on the association between ACEs and IPV have demonstrated somewhat mixed results. Given the heterogeneity of existing findings, the overall effect size of the association between ACEs and IPV was examined, to in turn inform policy, knowledge translation, prevention, and intervention efforts. Objectives: The present research sought to meta-analytically examine the association between ACEs and (1) IPV perpetration and (2) IPV victimization. Additionally, moderator analyses were conducted to determine demographic factors and study characteristics that may impact the association between ACEs and IPV involvement Method: Electronic searches were conducted in MEDLINE, Embase, and PsycINFO in August of 2021. One-hundred and twenty-three records were screened for inclusion. All studies must have included a measure of ACEs (i.e., 8-item, 10-item, or other composite measure) and a measure of IPV victimization or perpetration (e.g., physical, sexual, or psychological abuse). Results: Among the 27 studies and 41 samples included in the present meta-analysis, 65,330 participants were included. Across all included studies, 33.84% of participants identified as male and the mean age was 32.10 years (age range, 14-56.9). The results of the meta-analyses demonstrated that ACEs were positively associated with IPV perpetration [k = 15, r = .172, (95% CI: .119, .223), p < .001], and victimization [k = 26, r = .200, (95% CI: .143, .255) p < .001]. Results of the moderator analysis demonstrated that the association between ACEs and IPV perpetration and victimization was stronger among studies that examined mixed IPV (i.e., more than one type of IPV) compared to physical IPV exclusively. The association between ACEs and IPV victimization was also stronger among studies that included younger participants and among more recently published studies. Conclusions: The present meta-analyses demonstrate a need for trauma-informed and early approaches to IPV screening, prevention, and intervention. Further, significant moderators identified in the present meta-analyses contribute to a stronger understanding of factors that amplify or attenuate risk for IPV among individuals with ACEs exposure. Future research should build upon these results to help inform resiliency factors that may mitigate risk for IPV.
- ItemOpen AccessThe AMBIANCE-brief: An observational assessment tool of disruptive caregiving for use in applied settings with families at high social risk(2019-08-27) Cooke, Jessica Elizabeth; Madigan, Sheri L.; Graham, Susan A.; Noel, Melanie; Benzies, Karen MarieBackground: A community-identified need has emerged for a well-validated indicator of caregiving difficulties for use in practice settings. Thus, a brief form of the Atypical Maternal Behavior Instrument for Assessment and Classification System (AMBIANCE) was developed for use as a screening instrument. Prior to its dissemination in practice settings, further evidence of the feasibility and validity of the AMBIANCE-Brief must be established. Objectives: The current study aims to: assess feasibility of coding disrupted caregiving in real-time; establish the convergent validity of the AMBIANCE-Brief with the full AMBIANCE, as well as its postdictive validity in relation to maternal unresolved states of mind, and its concurrent validity with infant attachment disorganization; examine if the relation between maternal unresolved states of mind and infant attachment disorganization is mediated by maternal disrupted caregiving as assessed by the AMBIANCE-Brief. Method: Adolescent mothers and their infants (N = 69 dyads) participated when infants were 6 and 12 months of age. At 6 months of age, mothers completed the Adult Attachment Interview (AAI). Dyads completed the Strange Situation Procedure (SSP), as well as play sessions with toys and without toys when infants were 12 months of age. Maternal disrupted caregiving was coded from the play sessions using the full AMBIANCE and AMBIANCE-Brief. Results: The AMBIANCE-Brief demonstrated strong convergent validity with the full AMBIANCE, postdictive validity with maternal unresolved states of mind, and concurrent validity with infant attachment disorganization in both play sessions. However, maternal disrupted caregiving, as assessed by the AMBIANCE-Brief, did not significantly mediate the association between maternal unresolved states of mind and infant attachment disorganization. Conclusions: The current work represents an initial step in the development of shorter protocols which are more efficient for practitioners to use in practice settings. Future studies are needed to establish evidence of validity and feasibility of the AMBIANCE-Brief in community agencies.
- ItemOpen AccessCharacterizing Pain in Long-Term Survivors of Childhood Cancer(2020-08-04) Patton, Michaela; Schulte, Fiona S.M.; Noel, Melanie; Carlson, Linda E.; Birnie, Kathryn A.Many long-term survivors of childhood cancer (LTSCCs) experience late- and long-term effects from their treatments, including pain. Yet, pain is poorly understood among LTSCCs. The current study aims to 1a) identify rates and patterns of chronic pain 1b) describe multiple dimensions of pain, and 2) test predictors of chronic pain in LTSCCs. Survivors [n=140; 48.6% male, Mage=17.3 years (SD=4.9)] were recruited from across Canada. Participants completed the Pain Questionnaire, Pain Catastrophizing Scale, Pediatric Quality of Life Inventory, Patient Reported Outcome Measurement Information System (PROMIS) – Pain Interference, Anxiety, and Depression scales, Child Posttraumatic Stress Scale, the Posttraumatic Stress Disorder Checklist for the DSM-V, and the Cancer Worry Scale. It was found that 26% of LTSCCs reported experiencing chronic pain. An exploratory cluster analysis revealed that 20% of survivors had a moderate to severe chronic pain problem based on measures of pain intensity and interference. The combination of anxiety, depression, PTSS, cancer worry, current age, age at diagnosis, pain catastrophizing, and sex significantly predicted the presence of chronic pain, χ2(8, N = 123) = 27.87, p < .001. Higher pain catastrophizing (OR = 1.09; 95% CI = 1.03-1.15) and older current age (OR = 1.13; 95% CI = 1.01-1.27) were significant predictors of chronic pain. LTSCCs should be screened for the presence and magnitude of chronic pain during their long-term follow-up visits so appropriate interventions can be discussed. Future research should investigate pain interventions tailored for this population.
- ItemOpen AccessThe Chemo-Gut Project: Investigating the Effects of Cancer Treatment on Gut Microbiota, Gastrointestinal and Psychosocial Health in Cancer Survivors(2022-04) Deleemans, Julie; Carlson, Linda; Reimer, Raylene; Schulte, Fiona; Noel, Melanie; Giesbrecht, GeraldIntroduction: Cancer treatments such as chemotherapy adversely affect the gut microbiota, gastrointestinal (GI) and psychosocial health. However, it is unknown whether changes in the gut microbiota persist in the long-term, and if this may be related to GI and psychosocial symptoms. This work investigated the longer-term effects of cancer treatments on the gut microbiota, psychosocial and GI symptoms, and explored potential prebiotic and probiotic treatment options. Methods: A cross-sectional survey study with 317 cancer survivors examined characteristics of GI, physical and mental health outcomes, whether GI symptoms were associated with mental and physical health, and relationships between type of cancer treatment and these outcomes. A cross-sectional pilot study with 17 cancer survivors and 18 healthy volunteers investigated relationships between cancer treatment-related factors, gut microbiota, GI and psychosocial symptoms. A systematic review then evaluated the current literature on prebiotic and probiotic interventions used to treat GI and/or psychosocial symptoms in cancer patients and survivors. Results: Survivors in the survey study reported persistent GI symptoms, and 52% rated their GI symptom severity as moderate to extreme. Survivors reported poorer mental and physical health compared to PROMIS normative scores, and higher GI symptom severity was associated with worse mental and physical health. Survivors in the pilot study had more GI symptoms, poorer psychosocial health, and significantly greater abundance of Selenomondales, Veilloneliaceae, and Intestinibacter. In survivors, Lachnospiraceae, Ruminococcaceae and Intestinibacter correlated with psychosocial symptoms. Survivors ≤6 months post-treatment had lower alpha diversity than survivors >6 months post-treatment and healthy controls. Our systematic review found that probiotics were associated with improvements in several GI symptoms, especially diarrhea. However, improvements in anxiety, depression, fatigue, and QOL were only found in cancer survivors who received probiotic intervention. Conclusion: GI symptoms may persist for years after anti-cancer therapies have ended, and are associated with poorer physical and psychosocial health. In the first 6 months after cancer treatment gut microbiota alpha diversity is lowest, and specific bacteria may impact survivors’ psychosocial symptoms. Probiotics may help to alleviate some GI and psychosocial symptoms. Interventions combining dietary treatment with psychosocial interventions may be crucial for optimizing patient outcomes.
- ItemOpen AccessCo-constructing the Past: Examining Mother- and Father-Child Narratives About Past Events Involving Pain versus Sadness(2019-08-26) Pavlova, Maria; Noel, Melanie; Graham, Susan A.; Madigan, Sheri L.; McMorris, Carly A.Background. Parent-child reminiscing about past events creates an influential sociolinguistic context within which children’s development occurs. Parents differ dramatically in their reminiscing styles, whereas some parents are highly elaborative (i.e., they use open-ended detailed questions) and focus on talking about emotions, other parents are repetitive and emphasize factual information. Elaborative reminiscing has been linked to more optimal developmental outcomes. No studies have examined how parent-children reminiscing about past pain compares to other stressful experiences (i.e., sadness, fear), and how parent-children reminiscing about past pain might be linked to children’s socio-emotional skills. This study was the first to examine the association between parent-child reminiscing about past pain and children’s prosocial acts to pain-related distress in others as well as overall children’s socio-emotional functioning. Methods. One hundred and sixteen 4-year old children (54% girls) and their parents (49% mothers) completed a structured narrative elicitation task wherein they reminisced about a unique past event involving pain, fear, and sadness. Children then witnessed a confederate pretending to be in pain (i.e., hurt fingers and a knee). Children’s prosocial responses and parent-child narratives about past pain were coded using established coding schemes based on the developmental psychology literature. Results. Parent-children narratives about pain were characterized by less emotion-laden and more coping and pain-related words as compared to sadness or fearful narratives. Parents, who used open-ended questions, provided new information, and talked about emotions and coping when talking about past events involving pain, had children who exhibited more prosocial acts and concern in response to other’s pain and had higher parent-reported levels of empathy. Discussion. Parent-children reminiscing about past pain differs from reminiscing about other types of distressing events (e.g., involving sadness or fear) and is linked to children’s socio-emotional skills. This highlights a possibility of differential socialization of pain. Parent-child reminiscing is amenable to intervention and offers a promising avenue for pediatric pain management interventions.
- ItemOpen AccessDisentangling the Sleep-Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms(Hindawi, 2017) Pavlova, Maria; Ference, Jennifer; Hancock, Megan; Noel, MelaniePediatric chronic pain often emerges in adolescence and cooccurs with internalizing mental health issues and sleep impairments. Emerging evidence suggests that sleep problems may precede the onset of chronic pain as well as anxiety and depression. Studies conducted in pediatric populations with pain-related chronic illnesses suggest that internalizing mental health symptoms may mediate the sleep-pain relationship; however, this has not been examined in youth with primary pain disorders.
- ItemOpen AccessDisentangling the Sleep-Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms(2017-11-16) Pavlova, Maria; Ference, Jennifer; Hancock, Megan; Noel, MelanieBackground. Pediatric chronic pain often emerges in adolescence and cooccurs with internalizing mental health issues and sleep impairments. Emerging evidence suggests that sleep problems may precede the onset of chronic pain as well as anxiety and depression. Studies conducted in pediatric populations with pain-related chronic illnesses suggest that internalizing mental health symptoms may mediate the sleep-pain relationship; however, this has not been examined in youth with primary pain disorders. Objective. To examine whether anxiety and depressive symptoms mediated relationships between sleep quality and pain outcomes among youth with chronic pain. Methods. Participants included 147 youth (66.7% female) aged 8–18 years who were referred to a tertiary-level chronic pain program. At intake, the youth completed psychometrically sound measures of sleep quality, pain intensity, pain interference, and anxiety and depressive symptoms. Results. As hypothesized, poor sleep quality was associated with increased pain intensity and pain interference, and anxiety and depressive symptoms mediated these sleep-pain relationships. Discussion. For youth with chronic pain, poor sleep quality may worsen pain through alterations in mood and anxiety; however, prospective research using objective measures is needed. Future research should examine whether targeting sleep and internalizing mental health symptoms in treatments improve pain outcomes in these youth.
- ItemOpen AccessExamining the Effect of Category-Training on 11-Month-Olds’ Property Generalizations(2018-08-08) Zepeda, Michelle Stephanie; Graham, Susan A.; Noel, Melanie; Curtin, Suzanne; Drefs, Michelle A.The ability to form category-property links allows infants to generalize a property from one category member to another. In the present studies, I examined whether orienting infants to the demands of the task, through categorization training, would facilitate 11-month-old infants’ property extensions when familiarized with a single exemplar of a novel animal category. In Experiment 1, 11-month-olds (N = 32) were trained with two familiar animal-sound pairings (i.e., dog-bark, cat-meow), and tested on their learning and generalization of novel animal-sound associations. Across two conditions, Experiment 2 familiarized 11-month-olds (N = 58) to one familiar (i.e., dog-bark) and one novel animal-sound pairing. Conditions differed in their presentation of familiarization trials (i.e., random or blocked). Infants were also tested on their learning and extension of the animal-sound associations. In both studies, infants did not demonstrate learning of the original animal sound pairing, nor generalization of the sound property to new members of the animal categories. These results indicate that categorization training did not facilitate 11-month-olds’ ability to learn or generalize a novel animal-sound association, when familiarized with a single exemplar.
- ItemOpen AccessExamining the Intergenerational Cascade from Parent Adverse Childhood Experiences to Child Chronic Pain: The Mediating Roles of Parent Chronic Pain and PTSD Symptoms(2020-09-19) Beveridge, Jaimie; Noel, Melanie; Madigan, Sheri L.; Yeates, Keith Owen; Giesbrecht, Gerald F.Introduction: Adverse childhood experiences (ACEs; exposure to abuse, neglect, household dysfunction as a child) are common and associated with poor mental and physical health outcomes in adolescence and adulthood. Emerging research suggests ACEs can also confer risk for the next generation. Indeed, parent ACEs have been found to relate to children’s general health, development, and psychosocial functioning. Research has yet to examine ACEs among parents of youth with chronic pain. Parent ACEs may play an important role in pediatric chronic pain, given their association with physical (e.g., parent chronic pain) and mental (e.g., parent PTSD) health conditions that are related to the functioning of youth with chronic pain. The current study sought to examine the relation between parent ACEs and child chronic pain as well as the potential mediating roles of parent chronic pain and PTSD symptoms in this relation. Methods: Parent-child dyads were recruited from tertiary-level pediatric chronic pain clinics in Canada. At baseline, parents completed self-report measures of exposure to ACEs, chronic pain status, and current PTSD symptoms. At 3-month follow-up, youth completed self-report measures of pain intensity and pain interference. The final sample included 195 youth with chronic pain (75.9% female, Mage = 14.39 years) and one of their parents (92.3% female, Mage = 44.91 years). Results: Over two-thirds (67.7%) of parents reported one or more ACEs and almost one-quarter (22.1%) reported four or more ACEs. Parent ACEs (total score, maltreatment score, and household dysfunction score) were related to parent chronic pain status but not parent PTSD symptoms. Moreover, parent ACEs were not related to youth pain outcomes either directly or indirectly through parent chronic pain or PTSD symptoms. Conclusions: These findings suggest that ACEs are prevalent among parents of youth seeking treatment for their chronic pain but are not directly related to the youth’s pain or impairment. Further research that examines the role of parent ACEs in the development of child chronic pain as well as other potential mediators of this association is needed to inform interventions that prevent the intergenerational transmission of risk for chronic pain.
- ItemOpen AccessExecutive Functioning in Children with Chronic Pain(2020-07-06) Jones, Kailyn Maria; Nordstokke, David W.; Wilcox, Gabrielle; Noel, Melanie; Schroeder, MeadowObjective: School serves as a crucial site for youth development and the potential consequences of poor school functioning are extensive. Limited school functioning is well documented in youth with chronic pain; however, variables that may explain poor school functioning are not adequately understood. Preliminary research suggests differences in executive functioning (EF) to possibly play a role, yet little research specifically examining EF in youth with chronic pain is available. Given the critical role of EF in learning, problem-solving, school functioning, and coping, the overall aim of this dissertation was to examine potential differences in EF between youth with and without chronic pain. A subsequent aim was to explore associations between EF and school functioning in youth with chronic pain and to investigate relationships between performance-based measures and behaviour ratings of EF in a mixed sample of youth. Method: A series of studies examining school functioning in youth with chronic pain in direct relation to one or more additional variables were synthesized and a preliminary conceptual model of school functioning in youth with chronic pain was proposed. A total of 26 youth with chronic pain (80.8% girls) and their parents were recruited from two tertiary-care pain clinics and a comparison group of 30 youth without chronic pain and their parents were recruited from the community. Participants completed ratings of pain; physical, emotional, social, and school functioning; sleep quality; medication; and a brief measure of general intelligence. Standardized neuropsychological tests were used to examine EF with a focus on working memory, divided and alternating attention, inhibition, flexibility, incidental memory, and planning. A parent- and self- report behaviour rating of EF was also administered. Results: Participants with chronic pain had significantly lower scores on performance-based tests of working memory, divided and alternating attention, inhibition, and flexibility compared to the non-chronic pain group. Poorer behaviour ratings of overall emotion and cognitive regulation as well as global EF were also found for youth with chronic pain. Several of these observed group differences remained after controlling for covariates. Performance-based measures of EF were not found to be significant predictors of school functioning. In contrast, parent- and self-report behaviour rating scales of EF showed a statistically significant result; however, subsequent analysis found only the self-report cognitive regulation scale to be a significant predictor of school functioning. Performance-based and parent- and self-report scales evaluating the same EF domains showed some weak correlations and several non-significant associations. Conclusion: This empirical work offers one of few multidimensional examinations of EF in youth with chronic pain, using a comprehensive neuropsychological test battery combined with behaviour ratings of EF. It offers several novel and pertinent findings, and demonstrates EF differences in youth with chronic pain. It also raises potential implications for the evaluation of EF in youth with chronic pain, lending evidence to the use of both performance-based measures and behaviour ratings when evaluating, remediating, and accommodating EF. This dissertation highlights the need for multidisciplinary healthcare and education teams to achieve collaborative and integrated services within individualized pain management for youth.
- ItemOpen AccessFunctional Connectivity of the Anterior Cingulate Cortex in Children with Post-traumatic Headache(2020-05-19) Ofoghi, Zahra; Barlow, Karen Maria; Dewey, Deborah; Yeates, Keith Owen; Bray, Signe L.; Noel, MelaniePost-traumatic headache (PTH) is among the most common persistent post-concussion symptoms following mild traumatic brain injury (mTBI). Investigating structural and functional neuroimaging correlates of pain or headache can help to understand biological mechanisms behind persistent PTH. In this dissertation, a systematic review was conducted to examine the neuroimaging correlates of headache or pain following mTBI. Here, in the adult populations with PTH, there was evidence to suggest alterations in descending pain modulatory mechanisms but there was a lack of research in the pediatric populations with PTH. The remainder of this thesis addresses this knowledge gap by investigating alterations in central pain processing networks with a focus on the anterior cingulate cortex (ACC). To do this, functional connectivity (FC) between the ACC and other pain-related regions was explored in children with PTH and compared to those without PTH following mTBI and uninjured healthy controls. The influence of a pre-injury headache history on ACC FC was then investigated. As other cognitive and affective symptoms are also common in children with PTH, the associations between attention problems and anxiety and ACC FC were studied. Functional connectivity of the perigenual ACC-cerebellum and the subgenual ACC-DLPFC were different in children with PTH compared to healthy controls. No significant differences, however, were found in children with and without PTH. Functional connectivity between the ventral ACC areas (rostral and perigenual) and cerebellum was significantly affected by a past history of headache problems; children with PTH and a history of headache having decreased negative FC. In children with PTH, better attention performance was associated with stronger subgenual ACC-cerebellum FC. Anxiety, however, was not associated with the ACC FC and pain-related regions. Taken together, this dissertation provides evidence of alterations in descending modulatory pain processing mechanisms in children with PTH following mTBI. Further, for the first time, neuroimaging evidence supported the effect of pre-injury headaches on connectivity between pain-related regions in children with PTH. Future studies should explore FC of other pain-related regions (e.g. periaqueductal regions, cerebellum) in central pain processing networks and their relationship with recovery.
- ItemOpen AccessHeat, cold, and pressure pain thresholds following a sport-related concussion(2020-07-07) Johnstone, Corson; Schneider, Kathryn J.; Debert, Chantel Teresa; Noel, MelanieConcussions are among the most common sport and recreational injuries. Head and neck pain are commonly reported symptoms following concussion, but pain may also occur at regions secondary to the region of primary injury suggesting central sensitization. Central sensitization may be assessed using quantitative sensory testing (QST) to quantify heat (HPT), cold (CPT), and pressure pain thresholds (PPT). Pain thresholds have shown to predict worse prognosis of whiplash associated disorder. However, changes in pain thresholds as a consequence of SRC have not been well evaluated despite acute and persistent pain commonly occurring following SRC. Here we discuss the feasibility of QST among a consecutive sample of patients aged 13-60 that were seen at the Acute Sport Concussion Clinic (ASCC) and local sport medicine clinics in Calgary, Alberta, Canada, and diagnosed with SRC. Pain thresholds in patients with SRC were compared against orthopaedic injured (OI) and uninjured (UI) controls. There were no adverse reactions to QST in patients with SRC. There were no significant differences in heat, cold, and pressure pain thresholds across groups. Of interest, when looking at the data descriptively, patients with SRC had lower median HPTs and higher median CPTs than OI and UI controls as well as higher PPTs than OI controls. Further research including prospective cohort design is warranted to better understand how heat, cold, and pressure pain thresholds may be altered in patients with SRC.
- ItemOpen AccessInsomnia During Pregnancy(2020-07-16) Sedov, Ivan; Tomfohr-Madsen, Lianne M.; Dobson, Keith; Noel, Melanie; Green, Sheryl; Kopala-Sibley, DanielThe problem: Sleep has long been noted to be disturbed during pregnancy; however, investigations of insomnia as it occurs during the prenatal period have been limited. The goal of this dissertation was to develop the existing knowledge base of prenatal insomnia prevalence, course, and risk factors.Methods: A meta-analysis of prenatal insomnia literature was conducted to establish a prevalence of insomnia and moderating variables including trimester, gestational age, maternal age, depression, and anxiety. Additionally, 142 women were recruited in early-pregnancy and followed until early-postpartum. Measures of insomnia symptoms as well as mental health variables were taken every 10 weeks for a total of 40 weeks. Semiparametric group-based modeling was used to construct trajectories of insomnia symptomology over the course of pregnancy. Cross-lagged panel analysis was used to test the strength of the relationship between generalized anxiety and insomnia symptoms.Results: The results of the meta-analysis indicated that 36.7% of pregnant women reported clinically significant insomnia symptoms. Trimester moderated the prevalence such that the prevalence of insomnia symptoms was higher during the third relative to the second trimester. The trajectory analysis resulted in three groups: stable-low (42.2%), dynamic-medium (44.3%), and decreasing-high (13.4%). Women in the decreasing-high group reported clinically elevated symptoms through the course of pregnancy which decreased slightly in the postpartum. The stable-low group demonstrated consistently low insomnia symptoms. The dynamic-medium group demonstrated sub-clinical insomnia symptoms that worsened in the third trimester before decreasing in the postpartum. Anxiety and depression symptoms at baseline were predictive of trajectory membership. Additionally, experiencing consistently high insomnia symptoms throughiiithe course of pregnancy was related to higher symptoms of anxiety and depression in the postpartum. The cross-lagged panel analysis indicated that generalized anxiety symptoms predicted subsequent insomnia symptoms but not vice versa. Anxiety symptoms in late-pregnancy were not predictive of insomnia symptoms in early-postpartum.General conclusion: Insomnia symptoms are prevalent during pregnancy and characterized by several different trajectory patterns. Generalized anxiety symptoms are an important predictor of subsequent insomnia symptoms. This body of work helps to develop the current understanding of insomnia as it occurs during pregnancy.
- ItemOpen AccessInvestigating Intranasal Oxytocin as a Treatment for Women's Chronic Pelvic Pain: A Feasibility Study(2018-09-14) Flynn, Michelle Jacqueline; Campbell, Tavis S.; Noel, Melanie; Bergeron, Sophie; McGrath, Daniel S.Chronic pelvic pain (CPP) affects approximately 5.7-26.6% of women in the general population and has limited treatment options. Administration of oxytocin (OT) has been associated with reductions in pain in other chronic pain conditions. The current feasibility study was the first to investigate the OT-pain association in women with CPP. The aims were: 1) determine if a clinically significant change in pain intensity (1-centimeter improvement on a 10-centimeter visual analogue scale) could be detected following intranasal OT administration; 2) identify challenges in treatment and study protocol implementation. Women with CPP (N=18) were recruited from chronic pain and gynecology clinics for this randomized, double-blind, within-subject crossover trial (Registration#NCT02888574). Exclusion criteria included pregnancy, primary diagnosis of endometriosis, dysmenorrhea, interstitial cystitis, functional bowel disorder, fibromyalgia, or neuropathic pain. Currently, 11 women have completed the trial (2-weeks OT, 2-weeks washout, 2-weeks placebo, with random order of OT and placebo). Women recorded symptoms of pain at baseline and in daily diaries. One participant dropped out due to headaches following placebo administration, one did not complete daily diaries, and two were randomized despite having pain only during intercourse, leaving seven women in the analyses. Clinically significant change was reported for average and current pain following OT and placebo administration. Self-reported treatment adherence was near perfect. Participants viewed the treatment as credible, anticipating improved pain. Daily diary adherence was good. Challenges with protocol implementation highlight the need for more systematic eligibility assessments and recruitment strategies, and moving daily diaries to an online platform. Overall, a clinically significant change was detected on pain and the treatment protocol was feasible, though some adjustments to the study protocol are warranted before a subsequent trial is completed.
- ItemOpen AccessMild Traumatic Brain Injury, Sleep, and Pain in Adolescence(2018-11-14) Christensen, Jennaya; Mychasiuk, Richelle; Antle, Michael C.; Noel, Melanie; Lebel, Catherine A.The child and adolescent age group exhibit the highest rates of traumatic brain injury (TBI), with mild TBI (mTBI) and repetitive mild TBI (RmTBI) accounting for a large proportion of these injuries. Adolescents represent a particularly high risk cohort for experiencing long-term post-traumatic deficits. During this critical development phase, dramatic changes in brain structure and organization coincide with important shifts in the sleep cycle, which predispose adolescents to sleep deprivation. Similarly, mTBI often leads to reports of varying levels of sleep problems, yet the role of post-traumatic sleep in post-concussive symptomology remains unclear. Therefore, it is possible that sleep deprivation in the post-traumatic period could be further exacerbating the deleterious effects of mTBI. The glymphatic system is the central nervous system’s (CNS) macroscopic waste clearance system. Importantly, this system removes neurotoxic waste, such as Tau and β-amyloid, from the CNS. Recent developments have determined that the glymphatic system is 90% more active during sleep states while being dramatically suppressed during wakefulness. Given that Tau and β-amyloid protein aggregates are pathological trademarks of the neurodegenerative disorders that are associated with RmTBI and that mTBI patients commonly report sleep problems, one would reason that a reduced glymphatic clearance function may play an imperative role in the development of the neurological deficits related to RmTBI. Chronic pain and sleep deprivation represent major health issues that plague adolescence. A bidirectional relationship exists between sleep and pain; however, emerging evidence suggests that sleep disturbances have a stronger influence on subsequent pain than vice versa. The neurobiological underpinnings of this relationship, particularly during adolescence, are poorly understood. Given the high prevalence of these health issues during adolescence and the debilitating effects they inflict on nearly every domain of development, it is crucial that we determine the neurobiological mechanisms fundamental to this relationship and identify potential therapeutic strategies.
- ItemOpen AccessPain and Cerebral Blood Flow in Children Shortly After Mild Traumatic Brain Injury Compared to Orthopedic Injury(2022-09) Kwan, Vivian; Yeates, Keith; Lebel, Marc; Noel, Melanie; Miller, Jillian Vinall; Esopenko, CarrieAims: The aims of the current study are to: (1) examine pain ratings in children following mild traumatic brain injury (mild TBI) compared to a control group of orthopedic injury (OI), (2) compare cerebral blood flow (CBF) approximately 10 days post-injury between the two injury groups, and (3) investigate the association between children’s pain ratings and CBF to determine whether the association may vary depending on the type of injury (mild TBI vs OI). Methods: This was a prospective study of children and adolescents ages 8-16 years following mild TBI (n = 374) or OI (n = 202) recruited from emergency departments across five sites in Canada (Calgary, Edmonton, Montreal, Ottawa, Vancouver). They were assessed at a post-acute follow-up approximately 7 days post-injury. They rated pain intensity (“Over the past week, how much hurt do you have?”) from 0 (no pain) to 10 (worst pain possible) and pain unpleasantness (“how much do aches or pains bother you?”) from 0 (not at all) to 4 (very much). CBF was measured using arterial spin labeling (ASL) with a pseudo-continuous (Calgary, Montreal GE, Vancouver) or pulsed approach (Edmonton, Montreal Siemens, Ottawa). Results: Children with mild TBI reported significantly higher pain intensity (M = 4.77, SD = 2.38 versus M = 4.01, SD = 2.26, η2 = 0.015) and unpleasantness (M = 1.78, SD = 1.02 versus M = 1.30, SD = 0.89, η2 = 0.029) compared to children with OI. Final CBF analyses were focused on data from Calgary and Vancouver, given quality concerns with data from other scanners. Absolute CBF, but not relative CBF, was significantly lower in the mild TBI than OI group (η2 ranged from 0.017 to 0.041) across all seven regions of interest (ROI) and global grey matter, after correcting for multiple comparisons. Relative CBF in four ROIs in the parietal lobe (intraparietal sulcus, inferior parietal lobe, primary somatosensory cortex, and superior parietal lobe) were significant predictors of children’s pain intensity ratings, but only in the OI group, and not the mild TBI group. Conclusions: Absolute CBF was decreased in the mild TBI compared to OI group. There was no clear association between children’s pain ratings and absolute or relative CBF after mild TBI. More research is needed to better understand the pathophysiology of vascular changes following mild TBI, and how these changes may be related to pain, post-concussive symptoms, and other aspects of functioning.
- ItemOpen AccessPain in Children Following Mild Traumatic Brain Injury: A Longitudinal Analysis in Association with Post-Concussive Symptoms(2017) Kwan, Vivian; Yeates, Keith; Noel, Melanie; Barlow, Karen; Kirton, AdamUp to 57% of youth report pain 3 to 36 months after a mild traumatic brain injury (TBI; Tham et al., 2013). Importantly, pain may be related to post-concussive symptoms (PCS). Thus our objective was to examine pain as a time-varying covariate of PCS. The current study recruited children ages 8 to 16 following mild TBI (n = 112) or orthopedic injury (OI; n = 67) at the time of injury and up to 6 months post-injury. Participants provided weekly ratings of their pain intensity and PCS frequency. Results showed that children with mild TBI and OI do not have significantly different trajectories of pain decline over time. However, relative increases in an individual’s pain ratings were related to increases in cognitive and somatic PCS, and this relationship was stronger in children with mild TBI than OI. Future research to better understand this closer association after mild TBI is warranted.
- ItemOpen AccessParent-Child Reminiscing in the Context of Procedural and Postsurgical Pediatric Pain(2023-06) Pavlova, Maria; Noel, Melanie; Orr, Serena L.; Graham, Susan; Yeates, Keith O.Objective. Children experience pain often and remember it long after painful experiences are over. Up to 25% of children remember past pain in a negatively-biased way (i.e., recalling higher levels of pain as compared to the initial pain reports) and are at risk of experiencing higher levels of pain in the future. Pain memories are malleable and can be reframed through conversations. Recent evidence demonstrated that the way parents reminisce about past pain with their children influenced how children remembered their past pain. Yet, no interventions have used parental reminiscing to change children’s memories for pain. The present dissertation aimed to develop a parent-led memory-reframing intervention that harnesses parent-child reminiscing about past pain and to examine the intervention’s efficacy to change children’s memories for pain. Methods. Three randomized controlled trials investigated whether parents can be taught to reminisce about past pain optimally to, in turn, change children’s memories for pain to be more accurate/positively-biased (i.e., recalling lower levels of pain compared to the initial reports). Additionally, the dissertation examined whether optimal parent-child reminiscing would result in lower levels of future needle pain. Parental beliefs regarding reminiscing about past pain were investigated to optimize the intervention and increase parental motivation to engage in reminiscing about past pain. Results. The parent-led memory-reframing intervention resulted in young children remembering their past post-surgical, but not needle, pain in a more accurate/positively-biased way. The intervention also changed parental reminiscing style to include optimal strategies for reframing past painful experiences. Parents rated the intervention to be feasible and highly acceptable in the context of post-surgical and needle pain. Results also demonstrated that some parental beliefs regarding reminiscing about past painful experiences may be a barrier that prevents parents from engaging in reminiscing about past pain. Conclusions. This dissertation developed and examined the efficacy of a parent-led memory-reframing intervention, a new avenue in pediatric pain management that targets children’s pain memories. The intervention was efficacious in changing how children remember their past post-surgical pain. The preliminary results warrant future large-scale trials to further examine the intervention’s potential to change children’s pain and health trajectories.