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Virtual psychoeducation for improvement of pain catastrophizing in pediatric presurgical patients and caregivers: a proof-of-concept study

La psychoéducation virtuelle pour l’amélioration de la dramatisation de la douleur chez la patientèle préchirurgicale pédiatrique et les soignant·es : une étude de preuve de concept

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Canadian Journal of Anesthesia/Journal canadien d'anesthésie Aims and scope Submit manuscript

Abstract

Purpose

Pain catastrophizing (PC) is the tendency to magnify the threat value of pain sensations and is associated with greater postsurgical pain intensity, functional disability, and pain chronicity. Higher parental PC predicts higher chronic postsurgical pain in youth. Treating PC in caregivers and youth prior to surgery may improve recovery and surgical outcomes. We developed and evaluated a psychoeducational workshop addressing PC for presurgical youth and their parents/caregivers. We hypothesized that parent/caregiver and youth PC scores would decrease over time. We also explored preintervention levels of youth anxiety and depression as moderators of outcome.

Methods

Youth (n = 43) and caregivers (n = 41) attended a virtual, group-based single-session intervention (SSI). Single-session intervention content addressed pain neuroscience, PC, and adaptive coping strategies for managing pain and PC drawn from cognitive-behavioural, acceptance and commitment, and dialectical behaviour therapy approaches. Participants completed questionnaires assessing PC at preintervention, postintervention, and two weeks postsurgery. Youth mood and anxiety were assessed at preintervention.

Results

Caregiver PC scores decreased from pre- to postintervention (P = 0.006), and this was maintained at postsurgery (P = 0.002). Youth PC scores decreased from preintervention to postsurgery, but only for those with higher preintervention anxiety (P = 0.01).

Conclusion

Our results provide proof-of-concept support for a virtual SSI targeting caregivers and youth PC during the perioperative period. The present findings highlight the possible need to screen presurgical candidates for symptoms of anxiety. Replication with larger and more diverse samples, and a more robust design are warranted.

Résumé

Objectif

Le terme de dramatisation de la douleur décrit la tendance à amplifier la valeur de menace des sensations de douleur et est associée à une plus grande intensité de la douleur postopératoire, à une incapacité fonctionnelle et à une chronicité de la douleur. Une dramatisation parentale plus élevée de la douleur prédit une douleur postopératoire chronique plus élevée chez les jeunes. Le traitement de la dramatisation de la douleur chez les soignant·es et les jeunes avant la chirurgie peut améliorer le rétablissement et les devenirs chirurgicaux. Nous avons mis au point et évalué un atelier psychoéducatif sur la dramatisation de la douleur destiné aux jeunes en période préchirurgicale et à leurs parents/soignant·es. Nous avons émis l’hypothèse que les scores de dramatisation de la douleur des parents/soignant·es et des jeunes diminueraient avec le temps. Nous avons également exploré les niveaux d’anxiété et de dépression des jeunes avant l’intervention en tant qu’éléments modérateurs des résultats.

Méthode

Des jeunes (n = 43) et les personnes en prenant soin (n = 41) ont participé à une seule intervention virtuelle en groupe. Le contenu de l’intervention unique portait sur les neurosciences de la douleur, la dramatisation de la douleur et les stratégies d’adaptation pour la prise en charge de la douleur et la dramatisation de la douleur tirées des approches cognitivo-comportementales, d’acceptation et d’engagement, et de thérapie comportementale dialectique. Les participant·es ont rempli des questionnaires évaluant la dramatisation de la douleur avant l’intervention, après l’intervention et deux semaines après la chirurgie. L’humeur et l’anxiété des jeunes ont été évaluées avant l’intervention.

Résultats

Les scores de dramatisation de la douleur des soignant·es ont diminué de la période précédant à la période suivant l’intervention (P = 0,006), et cela s’est maintenu après la chirurgie (P = 0,002). Les scores de dramatisation de la douleur des jeunes ont diminué de la période précédant l’intervention à la période postchirurgie, mais seulement chez les jeunes présentant une anxiété pré-intervention plus élevée (P = 0,01).

Conclusion

Nos résultats appuient la preuve de concept pour une intervention virtuelle unique ciblant la dramatisation de la douleur chez les soignant·es et les jeunes en période périopératoire. Ces résultats soulignent la nécessité potentielle de dépister les symptômes d’anxiété chez les candidat·es avant la chirurgie. La réplication avec des échantillons plus grands et plus diversifiés et une conception plus robuste est justifiée.

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Author contributions

Fotini Zachariades conceptualized and developed the first iteration of the workshop, contributed to the study design and data interpretation, cofacilitated the workshop, and reviewed the final draft. Danijela Maras contributed to workshop development, contributed to data interpretation, cofacilitated the workshop, wrote the first draft of the manuscript, and edited the final draft. Deborah Mervitz gave feedback on the initial content development, facilitated patient recruitment, and reviewed the final draft. Brenda Martelli cofacilitated the workshop and reviewed the final draft. Audrey Prayal-Brown contributed to writing and reviewed the final draft. Lamia Hayawi and Nick Barrowman designed and conducted the data analysis, prepared tables and figures, contributed to the interpretation of results, and reviewed the final draft. Christine Lamontagne contributed to the conceptualization of the study and study design as well as grant application, patient recruitment, data interpretation, writing the preliminary draft, and editing the final draft.

Acknowledgements

The authors thank Ashley Sokalski and Laura Arsenault-Perera for supporting project coordination and data collection, all surgical administration assistants and staff for supporting patient recruitment/referrals, and the patients and parents/caregivers for participating.

Disclosures

The authors report there are no competing interests to declare.

Funding statement

University of Ottawa Anesthesiology and Pain Medicine Research (UOAPM) Grants competition: Amount awarded: CAD 11,000.

Prior conference presentations

Portions of the current findings have been presented at two conferences: 1) Poster presented at the 2022 International Symposium on Pediatric Pain (March 24–27, Auckland, New Zealand; virtual conference); 2) Poster presented at the 2021 Canadian Pain Society’s Annual Scientific Meeting (April 28–30; virtual meeting).

Editorial responsibility

This submission was handled by Dr. Philippe Richebé, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Government of Canada, Ottawa, ON, Canada

    Fotini Zachariades PhD, CPsych

  2. Mental Health Service, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Danijela Maras PhD

  3. Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada

    Deborah Mervitz MD, FRCPC, Brenda Martelli BScN, BEd, MEd, RN-EC, Audrey Prayal-Brown MD & Christine Lamontagne MDCM, FRCPC

  4. Acute Pain Service, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Deborah Mervitz MD, FRCPC & Brenda Martelli BScN, BEd, MEd, RN-EC

  5. Clinical Research Unit, Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada

    Lamia Hayawi MSc & Nick Barrowman PhD

  6. Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada

    Nick Barrowman PhD

  7. Chronic Pain Services at the Children’s Hospital of Eastern Ottawa, Ottawa, ON, Canada

    Christine Lamontagne MDCM, FRCPC

  8. Children’s Hospital of Eastern Ontario, 401 Symth Rd., Ottawa, ON, K1H 8L1, Canada

    Christine Lamontagne MDCM, FRCPC

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  1. Fotini Zachariades PhD, CPsych
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  8. Christine Lamontagne MDCM, FRCPC
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Correspondence to Christine Lamontagne MDCM, FRCPC.

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Zachariades, F., Maras, D., Mervitz, D. et al. Virtual psychoeducation for improvement of pain catastrophizing in pediatric presurgical patients and caregivers: a proof-of-concept study. Can J Anesth/J Can Anesth 70, 1753–1764 (2023). https://doi.org/10.1007/s12630-023-02583-3

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