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Cornelissen L.,Perioperative and Pain Medicine | Donado C.,Perioperative and Pain Medicine | Kim J.,Perioperative and Pain Medicine | Chiel L.,Program in Rheumatology | And 8 more authors.
Pediatric Rheumatology | Year: 2014

Background: Juvenile Idiopathic Arthritis (JIA) is the most common cause of non-infectious joint inflammation in children. Synovial inflammation results in pain, swelling and stiffness. Animal and adult human studies indicate that localized joint-associated inflammation may produce generalized changes in pain sensitivity. The aim was to characterize pain sensitivity in children with JIA to mechanical and thermal stimulus modalities using quantitative sensory testing (QST) at an affected inflamed joint, and compare to children in clinical remission. Generalized hypersensitivity was evaluated by comparing QST measures at the thenar eminence between JIA and healthy control children.Methods: 60 children aged 7-17 years with JIA participated. QST assessed sensory detection threshold and pain threshold at two sites: (1) affected joint (clinically active or inactive), (2) contralateral thenar eminence. Joint site included finger, wrist, knee and ankle. Clinical status was measured using objective and subjective markers of disease severity. Questionnaires assessed pain intensity and frequency, functional disability, anxiety, pain catastrophization and fatigue. QST data collected from joints were compared within JIA patients: active vs. inactive inflammation; and data from the contralateral thenar eminence were compared between JIA and healthy control cohorts in Europe [EU, (n = 151)] and the US (n = 92). Statistical analyses were performed using Kruskal-Wallis with Dunn's post-hoc comparison, Mann-Whitney or Fisher's exact test, where appropriate.Results: Overall, children with JIA reported low pain scores and low degrees of functional disability. Sensory detection thresholds and pain thresholds were similar in " active" compared to " inactive" joints. Despite this, children with JIA had generalized hypersensitivity at the thenar eminence when compared to healthy children for pressure (vs. EU p < 0.001), light touch (vs. EU p < 0.001), cold (vs EU, p < 0.01; vs US, p < 0.001) and heat pain (vs EU, p < 0.05; vs US p < 0.001).Conclusions: JIA is associated with increased sensitivity to painful mechanical and thermal stimuli, even in absence of pain reports, or markers of disease activity. Future research investigating mechanisms underlying pain hypersensitivity in JIA is warranted; this will in turn guide pharmacologic and non-pharmacologic interventions to prevent or reverse these processes. © 2014 Cornelissen et al.; licensee BioMed Central Ltd. Source


Hirschfeld G.,German Paediatric Pain Center | Hirschfeld G.,Witten/Herdecke University | Thielsch M.T.,University of Munster | Zernikow B.,German Paediatric Pain Center | Zernikow B.,Witten/Herdecke University
BioMed Research International | Year: 2013

Mental rotation tasks with objects and body parts as targets are widely used in cognitive neuropsychology. Even though these tasks are well established to study between-groups differences, the reliability on an individual level is largely unknown. We present a systematic study on the internal consistency and test-retest reliability of individual differences in mental rotation tasks comparing different target types and orders of presentations. In total n = 99 participants (n = 63 for the retest) completed the mental rotation tasks with hands, feet, faces, and cars as targets. Different target types were presented in either randomly mixed blocks or blocks of homogeneous targets. Across all target types, the consistency (split-half reliability) and stability (test-retest reliabilities) were good or acceptable both for intercepts and slopes. At the level of individual targets, only intercepts showed acceptable reliabilities. Blocked presentations resulted in significantly faster and numerically more consistent and stable responses. Mental rotation tasks - especially in blocked variants - can be used to reliably assess individual differences in global processing speed. However, the assessment of the theoretically important slope parameter for individual targets requires further adaptations to mental rotation tests. © 2013 Gerrit Hirschfeld et al. Source


Hirschfeld G.,Osnabruck University of Applied Sciences | Hirschfeld G.,German Paediatric Pain Center | von Glischinski M.,Witten/Herdecke University | Knop C.,Pediatric Diabetology and Endocrinology | And 7 more authors.
Diabetic Medicine | Year: 2015

Aims: To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children. Methods: A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the 'gold standard' for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods. Results: A total of 43 (49%) children (aged 6-18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%. Conclusion: The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence. © 2015 Diabetes UK. Source


Zernikow B.,Witten/Herdecke University | Zernikow B.,German Paediatric Pain Center | Wager J.,Witten/Herdecke University | Wager J.,German Paediatric Pain Center | And 4 more authors.
Anesthesiology | Year: 2015

This review aimed to synthesize the current evidence on the effectiveness of invasive treatments for complex regional pain syndrome in children and adolescents. Studies on children and adolescents with complex regional pain syndrome that evaluated the effects of invasive treatment were identified in PubMed (search March 2013). Thirty-six studies met the inclusion criteria. Articles reported on a total of 173 children and adolescents with complex regional pain syndrome. Generally, many studies lack methodological quality. The invasive treatments applied most often were singular sympathetic blocks, followed by epidural catheters and continuous sympathetic blocks. Rarely, spinal cord stimulation and pain-directed surgeries were reported. An individual patient frequently received more than one invasive procedure. Concerning outcome, for approximately all patients, an improvement in pain and functional disability was reported. However, these outcomes were seldom assessed with validated tools. In conclusion, the evidence level for invasive therapies in the treatment of complex regional pain syndrome in children and adolescents is weak. Copyright © 2014, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. Source


Hirschfeld G.,Osnabruck University of Applied Sciences | Wager J.,German Paediatric Pain Center | Wager J.,Witten/Herdecke University | Zernikow B.,German Paediatric Pain Center | Zernikow B.,Witten/Herdecke University
PeerJ | Year: 2015

Background. Recurrent pain is a common experience in childhood, but only few children with recurrent pain attend a physician. Previous studies yielded conflicting findings with regard to predictors of health care utilization in children with recurrent pain. Methods. The present study analyzes data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study comprising n = 2,149 children (3-10 years old) with recurrent pain to find robust predictors.We used multiple logistic regressions to investigate age, gender, socio-economic status (SES), migration background, pain intensity, pain frequency, pain-related disability, mental health problems, and health-related quality of life (HRQL) as predictors for visiting a doctor due to pain. Results. Overall, young girls with high pain-related disability, intensity, frequency, and migration background were more likely to attend a physician. Pain-related disability had the largest impact. Socioeconomic status, health-related quality of life and mental health problems were not systematically related to health care utilization. An analysis of the variability of these results indicated that several hundred participants are needed until the results stabilize. Conclusions. Our findings highlight the importance of pain-related disability and frequency in assessing the severity of recurrent pain. Generic predictors and demographic variables are of lesser relevance to children with recurrent pain. On a methodological level, our results show that large-scale studies are need to reliably identify predictors of health care utilization. © 2015 Hirschfeld et al. Source

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