Maria Pavlova1, Tatiana Lund1, Jenny Sun2, Joel Katz3, Mary Brindle4, Melanie Noel1,5,6,7,8. 1. Department of Psychology, University of Calgary, Calgary, Alberta, Canada. 2. Icahn School of Medicine at Mount Sinai, New York, New York, USA. 3. Department of Psychology, York University, Toronto, Ontario, Canada. 4. Department of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada. 5. Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada. 6. Hotchkiss Brain Institute, Calgary, Canada. 7. Owerko Centre, Calgary, Canada. 8. Mathison Centre for Mental Health Research & Education, Calgary, Alberta, Canada.
Abstract
Background: Three to 22% of youth undergoing surgery develop chronic postsurgical pain (CPSP). Negative biases in pain memories (i.e., recalling higher levels of pain as compared to initial reports) are a risk factor for CPSP development. Children's memories for pain are modifiable. Existing memory-reframing interventions reduced negatively biased memories associated with procedural pain and pain after minor surgery. However, not one study has tested the feasibility and acceptability of the memory-reframing intervention in youth undergoing major surgery. Aims: The current pilot randomized clinical trial (RCT; NCT03110367; clinicaltrials.gov) examined the feasibility and acceptability of, as well as adherence to, a memory reframing intervention. Methods: Youth undergoing a major surgery reported their baseline and postsurgery pain levels. Four weeks postsurgery, youth and one of their parents were randomized to receive control or memory-reframing instructions. Following the instructions, parents and youth reminisced about the surgery either as they normally would (control) or using the memory-reframing strategies (intervention). Six weeks postsurgery, youth completed a pain memory interview; parents reported intervention acceptability. Four months postsurgery, youth reported their pain. Results: Seventeen youth (76% girls, Mage = 14.1 years) completed the study. The intervention was feasible and acceptable. Parents, but not youth, adhered to the intervention principles. The effect sizes of the intervention on youth pain memories (ηp 2 = 0.22) and pain outcomes (ηp 2 = 0.23) were used to inform a larger RCT sample size. Conclusions: Memory reframing is a promising avenue in pediatric pain research. Larger RCTs are needed to determine intervention efficacy to improve pain outcomes.
Background: Three to 22% of youth undergoing surgery develop chronic postsurgical pain (CPSP). Negative biases in pain memories (i.e., recalling higher levels of pain as compared to initial reports) are a risk factor for CPSP development. Children's memories for pain are modifiable. Existing memory-reframing interventions reduced negatively biased memories associated with procedural pain and pain after minor surgery. However, not one study has tested the feasibility and acceptability of the memory-reframing intervention in youth undergoing major surgery. Aims: The current pilot randomized clinical trial (RCT; NCT03110367; clinicaltrials.gov) examined the feasibility and acceptability of, as well as adherence to, a memory reframing intervention. Methods: Youth undergoing a major surgery reported their baseline and postsurgery pain levels. Four weeks postsurgery, youth and one of their parents were randomized to receive control or memory-reframing instructions. Following the instructions, parents and youth reminisced about the surgery either as they normally would (control) or using the memory-reframing strategies (intervention). Six weeks postsurgery, youth completed a pain memory interview; parents reported intervention acceptability. Four months postsurgery, youth reported their pain. Results: Seventeen youth (76% girls, Mage = 14.1 years) completed the study. The intervention was feasible and acceptable. Parents, but not youth, adhered to the intervention principles. The effect sizes of the intervention on youth pain memories (ηp 2 = 0.22) and pain outcomes (ηp 2 = 0.23) were used to inform a larger RCT sample size. Conclusions: Memory reframing is a promising avenue in pediatric pain research. Larger RCTs are needed to determine intervention efficacy to improve pain outcomes.
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