Chambers, Christine
Permanent URI for this collectionhttps://hdl.handle.net/10222/27712
Christine Chambers
Professor
Canada Research Chair: Pain and Child Health
Email: christine.chambers@dal.ca
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Item Open Access Sex differences in experimental pain among healthy children: A systematic review and meta-analysis(Lippincott Williams & Wilkins, 2014) Boerner, Katelynn Elizabeth; Birnie, Kathryn A; Caes, Line; Schinkel, Meghan; Chambers, ChristineSex differences in response to experimental pain are commonly reported in systematic reviews in the adult literature. The objective of the present research was to conduct a systematic review and meta-analysis of sex differences in healthy children’s responses to experimental pain (e.g., cold pressor, heat pain, pressure pain) and, where possible, to conduct analyses separately for children and adolescents. A search was conducted of electronic databases for published papers in English of empirical research using experimental pain tasks to examine pain-related outcomes in healthy boys and girls between 0 and 18 years of age. Eighty articles were eligible for inclusion and were coded to extract information relevant to sex differences. The systematic review indicated that, across different experimental pain tasks, the majority of studies reported no significant differences between boys and girls on pain-related outcomes. However, the meta-analysis of available combined data found that girls reported significantly higher pain intensity compared to boys in studies where the mean age of participants was greater than 12 years. Additionally, a meta-analysis of heat pain found that boys had significantly higher tolerance than girls overall, and boys had significantly higher heat pain threshold than girls in studies where the mean age of participants was 12 years or younger. These findings suggest that developmental stage may be relevant for understanding sex differences in pain.Item Open Access Impact of threat level, task instruction, and individual characteristics on cold pressor pain and fear among children and their parents(John Wiley & Sons, 2015) Boerner, Katelynn Elizabeth; Noel, Melanie Elizabeth; Birnie, Kathryn A; Caes, Line; Petter, Mark; Chambers, ChristineThe cold pressor task (CPT) is increasingly used to induce experimental pain in children, but the specific methodology of the CPT is quite variable across pediatric studies. This study examined how subtle variations in CPT methodology (e.g., provision of low- or high-threat information regarding the task; provision or omission of maximum immersion time) may influence children’s and parents’ perceptions of the pain experience. Forty-eight children (8-14 years) and their parents were randomly assigned to receive information about the CPT that varied on two dimensions, prior to completing the task: (1) Threat level: High-threat (task described as very painful, high pain expressions depicted) or low-threat (standard CPT instructions provided, low pain expressions depicted); (2) Ceiling: Informed (provided maximum immersion time) or uninformed (information about maximum immersion time omitted). Parents and children in the high-threat condition expected greater child pain, and these children reported higher perceived threat of pain and state pain catastrophizing. For children in the low-threat condition, an informed ceiling was associated with less state pain catastrophizing during the CPT. Pain intensity, tolerance, and fear during the CPT did not differ by experimental group, but were predicted by child characteristics. Findings suggest that provision of threatening information may impact anticipatory outcomes, but experienced pain was better explained by individual child variables.Item Open Access The epidemiology of chronic pain in children and adolescents revisited: A systematic review(Wolters Kluwer, 2011) King, Sara; Chambers, Christine; Huguet, Anna; MacNevin, Rebecca; McGrath, Patrick; Parker, Lousie; McDonald, AmandaChronic and recurrent pain not associated with a disease are very common in childhood and adolescence, but studies of pain prevalence have yielded inconsistent findings. This systematic review examined studies of chronic and recurrent pain prevalence to provide updated aggregated prevalence rates. The review also examined correlates of chronic and recurrent pain such as age, sex, and psychosocial functioning. Studies of pain prevalence rates in children and adolescents published in English or French between 1991 and 2009 were identified using EMBASE, Medline, CINAHL, and PsycINFO databases. Of 185 published papers yielded by the search, 58 met inclusion criteria and were reviewed and 41 were included in the review. Two independent reviewers screened papers for inclusion, extracted data and assessed the quality of studies. The range and median prevalence rates for specific types of pain were as follows: Headache: Median = 23%; Abdominal Pain: Median 19%; Back Pain: Median = 21%; Musculoskeletal Pain: Median = 29%; Multiple Pains: Median = 11%; Other Pains: Median = 38%. Pain prevalence rates were generally higher in girls and increased with age for most pain types. Lower socioeconomic status was associated with higher pain prevalence especially for headache). Most studies did not meet quality criteria.Item Open Access Cognitive Behavioural Therapy for Pediatric Chronic Pain: The Problem, Research, and Practice(Springer, 2012) Noel, Melanie Elizabeth; Petter, Mark; Parker, Jennifer; Chambers, ChristineThe purpose of this paper is to outline the rationale and use of cognitive-behavioural therapy (CBT) for the treatment of pediatric chronic pain. The paper begins by demonstrating the scope and impact of the problem of pediatric chronic pain. It then provides an overview of the framework of CBT for pediatric chronic pain and standard treatment components are outlined. A summary of the current state of research and its efficacy is provided. The paper concludes by providing outcome data from a specific example of a CBT group for pediatric recurrent abdominal pain. Future directions for research in this area are discussed.Item Open Access “Pain is not over when the needle ends”: A review and preliminary model of acute pain memory development in childhood(Future Medicine Ltd, 2012) Noel, Melanie Elizabeth; Chambers, Christine; Petter, Mark; McGrath, Patrick; Klein, Raymond M.; Stewart, Sherry H.Over the past several decades, the field of pediatric pain has made impressive advances in our understanding of the pain experience of the developing child, as well as the devastating impact of inadequately managed pain early in life. It is now well recognized that, from infancy, children are capable of developing implicit memories of pain that can influence their subsequent reactions to pain. The present review provides a synthesis of selected studies that made a significant impact on this field of inquiry, with particular emphasis on recent clinical and laboratory-based experimental research examining children’s explicit autobiographical memories for acute pain. Research has begun to move toward improving the precision with which children at risk for developing negatively estimated pain memories can be identified, given the adverse influence these memories can have on subsequent pain experience. As such, several fear- and anxiety-related child and parent variables implicated in this process are discussed and avenues for future research and clinical intervention are identified throughout. Finally, a preliminary empirically-and theoretically-derived model of acute pain memory development in childhood is presented to parsimoniously summarize the evidence accumulated to date and guide future investigation in this area.Item Open Access Remembering the Pain of Childhood: Applying a Developmental Perspective to the Study of Pain Memories(Lippincott Williams & Wilkins, 2015) Noel, Melanie Elizabeth; Palermo, Tonya; Chambers, Christine; Taddio, Anna; Hermann, ChristianeItem Open Access The Acceptability of Deception in Pediatric Research(Wolters Kluwer, 2015) Noel, Melanie Elizabeth; Boerner, Katelynn Elizabeth; Birnie, Kathryn A; Caes, Line; Parker, Jennifer; Chambers, Christine; Fernandez, Conrad; Lee, KangObjective: Deception has been used to investigate the role of developmental and behavioral factors in child health; however, its acceptability for use in pediatric research has received little empirical attention. This study examined the acceptability of deception in a pediatric pain research study as assessed via participating children’s and parents’ long-term perceptions of its use. Method: Ninety-four children (52 boys; Mage = 12.77 years) and their parents (86 mothers, 8 fathers) completed a structured interview that assessed perceptions of various aspects of deception in a pediatric pain study, two and a half years after participating. Results: A minority of parents (25.5%) and children (13.8%) spontaneously recalled that deception was used. Overall, parents and children reported positive experiences with research participation, felt comfortable with the debriefing process, and deemed the research to be of societal importance. Opinions about researchers and psychologists were not negatively impacted and most reported willingness to participate in research involving deception again. Conclusion: When thoughtfully planned and disclosed, deception in pediatric research appears to be acceptable to parents and children. Future research should further examine the acceptability of deception and alternatives (e.g., authorized deception) among pediatric samples.Item Open Access When does pain matter? Acknowledging the subjectivity of clinical significance.(Lippincott Williams & Wilkins, 2012) Birnie, Kathryn A; McGrath, Patrick; Chambers, ChristineItem Open Access Lost in translation: A cautionary note about presentation of non-English measures in English language journals(Wolters Kluwer Health, 2013) Chambers, Christine; Birnie, Kathryn AItem Open Access Dyadic analysis of child and parent trait and state pain catastrophizing in the process of children's pain communication(Lippincott Williams & Wilkins, 2016) Birnie, Kathryn A; Chambers, Christine; Chorney, Jill MacLaren; Fernandez, Conrad; McGrath, PatrickExplored separately, child and parent catastrophic thoughts about child pain show robust negative relations with child pain. The objective of this study was to conduct a dyadic analysis to elucidate intra- and inter-personal influences of child and parent pain catastrophizing on aspects of pain communication, including observed behaviours and perceptions of child pain. A community sample of 171 dyads including a child aged 8-12 years (89 girls) and parent (135 mothers) rated pain catastrophizing (PCS-C and PCS-P trait and state versions), and child pain intensity and unpleasantness following a cold pressor task (CPT). Child pain tolerance was also assessed. Parent-child interactions during the CPT were coded for parent attending, non-attending, and other talk, and child symptom complaints and other talk. Data was analyzed using the actor-partner interdependence model and hierarchical multiple regressions. Children reporting higher state pain catastrophizing had greater symptom complaints regardless of level of parent state pain catastrophizing. Children reporting low state pain catastrophizing had similar high levels of symptom complaints, but only when parents reported high state pain catastrophizing. Higher child and parent state and/or trait pain catastrophizing predicted their own ratings of higher child pain intensity and unpleasantness, with child state pain catastrophizing additionally predicting parent ratings. Higher pain tolerance was predicted by older child age and lower child state pain catastrophizing. These newly identified interpersonal effects highlight the relevance of the social context to children’s pain expressions and parent perceptions of child pain. Both child and parent pain catastrophizing warrant consideration when managing child pain.Item Open Access The role of trait mindfulness in the pain experience of adolescents(Elsevier, 2013) Petter, Mark; Chambers, Christine; McGrath, Patrick; Dick, BruceTrait mindfulness appears to mitigate pain among adult clinical populations, and has a unique relationship with pain catastrophizing. However, little is understood about this phenomenon among adolescents. The association between trait mindfulness and pain in both real-world and experimental contexts was examined among a community sample of adolescents. Participants were 198 adolescents who completed measures of trait mindfulness, pain catastrophizing, and pain interference, as well as an interview on daily pain before undergoing an acute experimental pain task. Following the task they provided ratings of pain intensity and state catastrophizing. Results showed that in relation to daily pains, mindfulness was a significant and unique predictor of pain interference and this relationship was partially mediated by pain catastrophizing. Mindfulness also had an indirect relationship with experimental pain intensity and tolerance. These associations were mediated by catastrophizing during the pain task. These findings highlight the association between trait mindfulness and both daily and experimental pain and offer insight into how mindfulness may affect pain among youth. Findings are discussed in the context of current psychological models of pediatric pain and future avenues for research.Item Open Access When “Don’t Worry” Communicates Fear: Children’s Perceptions of Parental Reassurance and Distraction during a Painful Medical Procedure(Wolters Kluwer, 2010) McMurtury, Megan; Chambers, Christine; McGrath, Patrick; Asp, Elissahildren's distress during painful medical procedures is strongly influenced by adult behavior. Adult reassurance (e.g., "it's okay") is associated with increased child distress whereas distraction is associated with increased child coping. It is unknown why reassurance shows this counterintuitive relationship with child distress. The present research investigated whether children perceive their parents as fearful when they reassure using complementary observational and experimental methodologies. One hundred children (40 boys, 60 girls) 5-10years old (M=8.02, SD=1.69) and their parents (86 mothers, 14 fathers) participated. First, spontaneous parent-child interactions during pediatric venipuncture were captured and used for a video-mediated recall task in which the children viewed instances of parental reassurance and distraction and rated their parents' fear and happiness. Second, the children were asked to rate the intensity of parental fear and happiness for 12 video vignettes showing an actor posing as a parent during venipuncture. To determine whether the children's perceptions varied with the qualities of the behavior, the vignettes manipulated: facial expression (happy vs. fearful), vocal tone (rising vs. falling), and content (informative reassurance vs. uninformative reassurance vs. distraction). For both tasks, the children provided higher ratings of fear during reassurance than distraction. In response to the vignettes, the children gave higher ratings of parental fear for a fearful facial expression, but the influence of vocal tone differed with the verbal content of the utterance. The results provide insight into the complexity of adult reassurance and highlight the important role of parental facial expression, tone, and verbal content during painful medical procedures.Item Open Access Children’s Fear during Procedural Pain: Preliminary Investigation of the Children’s Fear Scale(American Psychological Association, 2011-08-01) McMurtry, Meghan; Noel, Melanie Elizabeth; Chambers, Christine; McGrath, PatrickMany children consider getting a needle to be one of their most feared and painful experiences. Differentiating between a child’s experience of fear and pain is critical to appropriate intervention. There is no gold standard one-item self-report measure of fear for use with children. Objective: To conduct an initial investigation of the psychometric properties of the Children’s Fear Scale (CFS; based on the adult Faces Anxiety Scale) with young school-aged children. Methods: Children and their parents were filmed during venipuncture and completed pain and fear ratings immediately after the procedure (n = 100) and 2 weeks later (n = 48). Behavioral coding of the procedures was conducted. Results: Support was found for inter-rater reliability (time 1: rs = .51, p < .001) and test-retest reliability (rs = .76, p < .001) of the CFS for measuring children’s fear during venipuncture. Assessment of construct validity revealed high concurrent convergent validity with another self-report measure of fear (time 1: rs = .73, p < .001) and moderate discriminant validity (e.g., time 1: rs = -.30, p < .005 with child coping behavior; rs = .41, p < .001 with child distress behavior). Conclusions: The CFS holds promise for measuring pain-related fear in children. In addition to further investigation into the psychometric properties of the CFS during acute pain with a wider age range, future research could validate this measure in other contexts. The utility of a one-item measure of fear extends beyond the field of pediatric pain to other contexts including intervention for anxiety disorders and children in hospital.Item Open Access Contemporary Use of the Cold Pressor Task in Pediatric Pain Research: A Systematic Review of Methods(Sciene Direct, 2012) Birnie, Kathryn; Petter, Mark; Boerner, Katelynn; Noel, Melanie; Chambers, ChristineThe cold pressor task (CPT) is an ethical experimental pain task widely used by pediatric pain researchers to examine a variety of important theoretical and clinical questions. The purpose of this systematic review was to describe contemporary use of the CPT in pediatric pain research to identify possible methodological and procedural inconsistencies and inform future research. All papers using the CPT to examine pain-related outcomes in children ≤18 years old published after 2005 were identified, 2005 being when published pediatric CPT studies were last reviewed and guidelines for pediatric use of the CPT were published. Information related to samples, CPT methodology, and pain outcomes was recorded. Thirty-six published papers, involving 2,242 children (aged 3–18 years) from both healthy and clinical samples, met review inclusion criteria. Several aspects of CPT methodology with significant potential to impact pain outcomes were found to be inconsistently implemented and reported, including water temperature, use of informed versus uninformed ceilings, and the presence of observers during the CPT. Self-report child pain intensity and pain tolerance were common outcomes. A number of refinements for use of the CPT in pediatric pain research are suggested.Item Open Access Caregiver accuracy in detecting deception in facial expressions of pain in children(Elsevier, 2013) Boerner, Katelynn; Chambers, Christine; Craig, Kenneth; Pillai Riddell, Rebecca; Parker, JenniferFacial expressions provide a primary source of inference about a child’s pain. Although facial expressions typically appear spontaneous, children have some capacity to fake or suppress displays of pain, thereby potentially misleading caregiver judgments. The present study was designed to compare accuracy of different groups of caregivers in detecting deception in children’s facial expressions of pain when voluntarily controlled. Caregivers (15 pediatricians, 15 pediatric nurses, and 15 parents) viewed 48 video clips of children, 12 in each of 4 conditions (genuine pain, faked pain, suppressed pain, neutral baseline), and judged which condition was apparent to them. A 3 (group: pediatrician vs pediatric nurse vs parent) × 4 (condition: genuine vs faked vs suppressed vs neutral) mixed analysis of variance (ANOVA) of judgment accuracies revealed a significant main effect of group, with nurses demonstrating higher overall accuracy scores than parents, and pediatricians not differing from either group. As well, all caregivers, regardless of group, demonstrated the lowest accuracy when viewing the genuine condition, relative to the faked and suppressed conditions, with accuracy for the neutral condition not differing significantly from the other conditions. Overall, caregivers were more successful at identifying faked and suppressed than genuine expressions of pain in children, and pediatric nurses fared better overall in judgment accuracy than parents.Item Open Access Sex differences in parent and child pain ratings during an experimental child pain task(Pulsus Group, 2008-05) Moon, Erin C.; Chambers, Christine T.; Larochette, Anne-Claire; Hayton, Kelly; Craig, Kenneth D.; McGrath, Patrick J.No abstract available.Item Open Access The effects of mindful attention on cold pressor pain in children(2013-01) Petter, Mark; Chambers, Christine T.; Chorney, Jill MacLarenNo abstract available.Item Open Access A randomized trial of yoga for adolescents with irritable bowel syndrome(Pulsus Group, 2006) Kuttner, Leora; Chambers, Christine T.; Hardial, Janine; Israel, David M.; Jacobson, Kevan; Evans, KathyNo abstract available.Item Open Access Measurement of pain in children(Pulsus Group, 2009-01) McGrath, Patrick J.; Latimer, Margot; Finley, G. A.; Chambers, Christine T.No abstract available.Item Open Access Social functioning and peer relationships in children and adolescents with chronic pain: A systematic review(Pulsus Group, 2010-01) Forgeron, Paula A.; King, Sara; Stinson, Jennifer N.; McGrath, Patrick J.; MacDonald, Amanda J.; Chambers, Christine T.No abstract available.