PRISM :: Browsing by Author "Noel, Melanie"

Browsing by Author "Noel, Melanie"

Now showing 1 - 20 of 38

Open Access
A 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, Wanrudee
Abstract 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.
Open Access
A 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, Sherry
ObjectiveChronic 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.
Open Access
Adverse Childhood Experiences and Intimate Partner Violence: A Meta-Analysis
(2022-08) Zhu, Jenney; Madigan, Sheri; Dobson, Keith; Wells, Lana; Noel, Melanie
Background: 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.
Open Access
The 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 Marie
Background: 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.
Open Access
Characterization of (In)Validation in Adolescent Chronic Pain Care: Pain Intensity, Pain Disability, and Psychological Correlates
(2024-08-28) Li, Queenie Kwan Wing; Noel, Melanie; Exner-Cortens, Deinera; Orr, Serena
BACKGROUND. Pediatric chronic pain is associated with significant personal, familial, and societal burden. The dearth of effective treatments for chronic pain in youth suggests that there may be neglected socioenvironmental determinants in its etiology and occurrence. (In)validation (i.e., communicating that an individual’s feelings, thoughts, or actions are [not] understandable or legitimate) during chronic pain treatment is a patient-identified priority; further, individuals with marginalized identities overwhelmingly report experiences of invalidation in healthcare. Research has yet to systematically describe (in)validation in the clinical encounter. This study aimed to: (1) characterize to what extent physicians (in)validate adolescents with chronic pain (AWCP) and their parents during four distinct sections of a clinical encounter; (2) investigate whether (in)validation differs by AWCP sociodemographic factors; and (3) explore preliminary associations between (in)validation during the clinical encounter and pain correlates at followup. METHOD. Video recordings of 39 AWCP and their parents who presented to a tertiary pediatric pain clinic were coded and analyzed. Separate validation and invalidation scores were assigned using a behavioural coding scheme drawn from the psychopathology field. A subset of 24 participants who completed follow-up questionnaires were included in an exploratory analysis of (in)validation and pain correlates. RESULTS. Physicians were most invalidating towards AWCP and their parents at the beginning of the clinical encounter (i.e., history taking) and least validating towards AWCP during physical examination. Boys and their parents were more invalidated throughout the encounter than girls and their parents. Parents of white AWCP were significantly more invalidated during history taking than the rest of the encounter, whereas invalidation towards parents of racialized AWCP did not differ significantly across encounter sections. Finally, invalidation was associated with worse AWCP pain disability at follow-up. CONCLUSIONS. There is opportunity for physicians to be mindful of invalidation towards patients from the outset of their pain treatment. (In)validation towards AWCP and their families differed depending on demographic characteristics, indicating the need for equity considerations to improve clinical encounters. Invalidation was associated with worse pain disability over time; thus, there is early justification for developing interventions that minimize physician invalidation of families seeking chronic pain care.
Open Access
Characterizing 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.
Open Access
The 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, Gerald
Introduction: 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.
Open Access
Co-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.
Open Access
Disentangling 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, Melanie
Background. 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.
Open Access
Disentangling 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, Melanie
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.
Open Access
Early childhood risk factors for later onset of pediatric chronic pain: a multi-method longitudinal study
(2024-08-08) Pavlova, Maria; Noel, Melanie; Orr, Serena L.; Walker, Andrew; Madigan, Sheri; McDonald, Sheila W.; Tough, Suzanne C.; Birnie, Kathryn A.
Abstract Background Pediatric chronic pain (i.e., pain lasting ≥ 3 months) is prevalent, disabling, and costly. It spikes in adolescence, interrupts psychosocial development and functioning, and often co-occurs with mental health problems. Chronic pain often begins spontaneously without prior injuries and/or other disorders. Prospective longitudinal cohort studies following children from early childhood, prior to chronic pain onset, are needed to examine contributing factors, such as early pain experiences and mental health. Using data from a longitudinal community pregnancy cohort (All Our Families; AOF), the present study examined the associations between early developmental risk factors, including early childhood pain experiences and mental health symptoms, and the onset of pediatric chronic pain at ages 8 and 11 years. Methods Available longitudinal AOF data from child age 4 months, as well as 1, 2, 3, 5, 8, and 11 years, were used. Mothers reported their child’s pain experiences (e.g., hospitalizations, vaccinations, gut problems) at each timepoint from 4 months to 8 years, child chronic pain at age 8, and child mental health symptoms at ages 5 and 8 years. Children reported their chronic pain frequency and interference at age 11. Adaptive least absolute shrinkage and selection operator (LASSO) regressions were used to select predictor variables. Complete case analyses were complemented by multiple imputation using chained equation (MICE) models. Results Gut problems, emergency room visits, frequent pain complaints, and headaches at age 5 or earlier, as well as female sex, were associated with increased risk of maternal reported child chronic pain at age 8. Maternal reported chronic pain at age 8 was associated with higher levels of child-reported pain frequency and pain interferences at age 11. Boys self-reported lower levels of pain interference at age 11. Conclusions Some, but not all, painful experiences (e.g., gut problems, ER visits, pain complaints) in early life contribute to pediatric chronic pain onset and should be considered for screening and early intervention.
Open Access
Examining 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.
Open Access
Examining 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.
Open Access
Executive Functioning in Children with Chronic Pain
(2020-07-06) Jones, Kailyn Maria; Nordstokke, David W.; Wilcox, Gabrielle; Noel, Melanie; Schroeder, Meadow
Objective: 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.
Open Access
Functional 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, Melanie
Post-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.
Open Access
Heat, cold, and pressure pain thresholds following a sport-related concussion
(2020-07-07) Johnstone, Corson; Schneider, Kathryn J.; Debert, Chantel Teresa; Noel, Melanie
Concussions 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.
Open Access
Insomnia During Pregnancy
(2020-07-16) Sedov, Ivan; Tomfohr-Madsen, Lianne M.; Dobson, Keith; Noel, Melanie; Green, Sheryl; Kopala-Sibley, Daniel
The 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.
Open Access
Investigating 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.
Open Access
Language and Social Competence in Childhood: Synthesizing Existing Literature and Examining Developmental Pathways
(2024-07-29) Wieczorek, Karolina Marta; Graham, Susan; Madigan, Sheri; Noel, Melanie; Climie, Emma; Charest, Monique
In this dissertation, I examined the connections between language and social competence in children. These associations were examined in children ranging from 2 to 12 years of age, and who demonstrated diverse language abilities ranging from clinical difficulties to those showcasing typical language development. Associations were examined using two approaches: 1) via systematic review and meta-analysis of existing literature, while assessing for moderators, and 2) via drawing on a large prospective cohort to examine longitudinal mediation pathways. In Chapter Two, I conducted a systematic review and meta-analysis to examine the association between language and social competence in children with Developmental Language Disorder (DLD) and assessed relevant moderators of this association. Merging results from 21 studies and 6,830 children, a significant association was found between language and social competence in children with DLD (r = .18; 95% confidence interval = .12–.24; p < .001), that was small in magnitude. The association was moderated by language aspect, with no other moderators significantly influencing the association of interest. In Chapter Three, I completed a systematic review and three meta-analyses to explore links between social competence and three types of language skills (i.e., overall, receptive, and expressive) in typically developing children. In combining the results from 130 studies and 62,120 children, significant associations were found were between social competence and overall language (r = .27, 95% confidence interval [.21, .32], p <.001), receptive language (r = .23, 95% confidence interval [.20, .27], p <.001) and expressive language (r = .20, 95% confidence interval [.16, .24], p <.001), that were medium in magnitude. Associations were moderated by study design (i.e., overall language, expressive language), social type (i.e., overall language), geographic region (i.e., expressive language), and publication status (i.e., receptive language). No other moderators significantly impacted the associations of interest. In Chapter Four, I facilitated a longitudinal mediation analysis to explore developmental pathways between language and social skills in a large, prospective cohort called All Our Families (AOF). Specifically, I drew on a sample of 3,387 children to examine pathways between expressive language in toddlerhood, to social skills in middle childhood, via core language and pragmatic language around the time of school entry (i.e., examining pathways from 2 to 5 to 8 years of age). Several covariates known to impact language development were controlled for in the analyses. Via examining indirect effects, it was found that pragmatic language, but not core language, partially mediated the pathway of interest. In Chapter Five, I integrate the findings from the three studies, discuss implications and highlight limitations of my dissertation research. Together, my dissertation provides support for the longstanding notion that language and social competence are related during childhood, and enhances the knowledge base regarding the nuances of these relations in children with varying language skills.
Open Access
Mild 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.