Tonya M Palermo

University of Washington Seattle | UW · Department of Anesthesiology and Pain Medicine

Background: Pain is the most common symptom of acute pancreatitis (AP), and opioids have been utilized as the cornerstone of treatment. Despite the adverse effects of opioids, data on effective analgesia in children with AP is lacking. We aimed to evaluate analgesia prescribing patterns in pediatric AP, identify factors associated with opioid admi...

Background: Engagement predicts benefits from self-managed treatments. However, engagement is an important concern in digital interventions, with over 50% of patients being nonadherent to interventions in chronic conditions such as chronic pain. Little is known about the individual characteristics that contribute to engagement with a digital self-...

Tonya M Palermo,1 Karen Deborah Davis,2 Didier Bouhassira,3 Robert W Hurley,4 Joel D Katz,5 Francis J Keefe,6 Michael E Schatman,7,8 Dennis C Turk,1 David Yarnitsky9 1Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA; 2Department of Surgery and Institute of Medical Science, Krembil Brain Institute, Uni...

During adolescence and puberty, alterations in pain, both experimental and clinical, are observed. In addition, adolescents undergo extensive biopsychosocial changes as they transition from childhood to adulthood. However, a better understanding of how the biopsychosocial changes during adolescence impact pain is needed to improve pain management a...

This study aimed to determine the prevalence of pediatric chronic pain by household food sufficiency status and examine whether food insufficiency would be associated with greater risk for chronic pain. We analyzed data from the 2019–2020 National Survey of Children’s Health of 48,410 children (6–17 years) in the United States. Across the sample, 2...

Quantitative sensory testing (QST) is increasingly used in pediatric chronic pain; however, assessment in youth with acute musculoskeletal (MSK) pain is limited. This study evaluated the feasibility, reliability, and sources of variability of a brief QST protocol in two clinical samples of youth with acute MSK pain. Participants were 277 youth (Mag...

Background Migraine is a major pediatric health problem impacting 10–12% of youth. About 1 in 3 youth with migraine are diagnosed with insomnia. Sleep and migraine share a cyclical relationship, and data indicate that insomnia symptoms increase migraine severity. CBT for insomnia (CBT-I) has demonstrated efficacy for improving insomnia in adults wi...

Background Dysmenorrhea is suggested to increase the risk of chronic pain by enhancing central sensitization. However, little is known about whether emotional and cognitive responses induced by dysmenorrhea contribute to chronic pain interference. This study examined the association between catastrophizing specific to dysmenorrhea and both dysmenor...

Background: Pain science education is commonly integrated into treatments for childhood-onset chronic pain. A core component of pain science education is learning about, and often reconceptualizing, the biology of chronic pain. Yet, few interventions have been developed specifically for young adults and little is known about how young adults conce...

Background/objectives: Current treatments for chronic pancreatitis focus on symptom management and therapeutics targeting disease reversal are lacking. Given the role of the cyclooxygenase-2 (COX-2) enzyme in producing prostaglandin E2 (PGE2), a key component in the inflammatory pathway of chronic pancreatitis, this study evaluates the physiologic...

Background Pain is a predominant symptom of inflammatory bowel disease (IBD), and is influenced by cognitive, emotional, and behavioral factors. The cognitive-affective model of symptom appraisal (CAMSA) has been used to understand how youth view symptoms in chronic conditions. We sought to (1) determine how youth with IBD and their parents apprais...

Background: The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed. Objective: To present comprehensive and short-form adaptations of Axis I and II of the DC/TMD for adults that are appropriate for use with children in clinical and research set...

Background: Pain communication should be an integral part of clinical consultations, particularly in paediatric rheumatology where children and adolescents frequently present with chronic musculoskeletal pain. To date, literature exploring the nature of and extent to which pain communication occurs has focused on healthcare professionals as respon...

Introduction: Pain is a cardinal symptom of chronic pancreatitis (CP). Using PROMIS measures, we characterized physical and mental health and symptom profiles of a well-defined cohort of individuals with CP and compared them to controls. Among patients with CP, we also examined associations between pain (intensity, temporal nature) and PROMIS symp...

Promoting Resilience in Stress Management (PRISM) is a well-established resilience coaching program for youth with chronic illness. It is a one-on-one intervention targeting skills in stress management, goal-setting, cognitive reframing, and meaning-making. We aimed to (i) assess the feasibility and acceptability of PRISM and (ii) explore PRISM’s i...

Serving as Editor-in-Chief of the Journal of Pediatric Psychology (JPP) from 2018 to 2022 has been an enormous privilege. Each editor of JPP over the past 30 years (Brown, 2007; Drotar, 2012; Holmbeck, 2017; Kazak, 2002; La Greca, 1997; Roberts, 1992) has prepared a Vale Dictum. I follow in their footsteps in this editorial which provides a summary...

BACKGROUND Engagement predicts benefits from self-managed treatments. However, engagement is an important concern in digital interventions, with over 50% of patients being nonadherent to interventions in chronic conditions such as chronic pain. Little is known about the individual characteristics that contribute to engagement with a digital self-ma...

Objective: Female chronic pelvic pain (CPP) has multiple pain generators and significant psychosocial sequalae. Biopsychosocial-based phenotyping could help identify clinical heterogeneity that may inform tailored patient treatment. This study sought to identify distinct CPP profiles based on routinely collected clinical information and evaluate t...

Recurrent acute pancreatitis and chronic pancreatitis represent high morbidity diseases, which are frequently associated with chronic abdominal pain, pancreatic insufficiencies, and reduced quality of life. Currently, there are no therapies to reverse or delay disease progression, and clinical trials are needed to investigate potential intervention...

Background Sickle cell disease (SCD) is characterized by severe acute pain episodes as well as risk for chronic pain. Digital delivery of SCD pain self-management support may enhance pain self-management skills and accessibility for youth. However, little is known about how youth with SCD and their caregivers engage with digital health programs. iC...

BACKGROUND Sickle cell disease (SCD) is characterized by severe acute pain episodes as well as risk for chronic pain. Developing pain self-management skills early in the disease trajectory can support improved pain coping. Digital delivery of SCD pain self-management support may enhance accessibility for youth. However, little is known about how yo...

Background Multi-disciplinary teams (MDTs) are common in paediatric rheumatology where UK standards of care state that all children/young people should have access to a paediatric rheumatologist, nurse, physiotherapist, occupational therapist and a psychologist. MDTs in paediatric rheumatology regularly meet for the broader purpose of discussing th...

Background : The Adolescent Insomnia Questionnaire (AIQ), English version, is the only validated screening measure developed specifically to identify insomnia symptoms in adolescents. To date, no specific screening tool for adolescent insomnia is present in Danish language. The aim of this study was to translate and validate the AIQ in a sample of...

The COVID-19 pandemic and its associated disruptions have been shown to increase rates of childhood depression, anxiety, obesity, and insomnia. Thus far, the epidemiological impact of the pandemic on the national prevalence of pediatric chronic in the United States has not been systematically addressed. We aimed to compare the national prevalence o...

Background Opioids provide effective pain relief for many adolescents following sports-injury surgery. However, a subgroup experiences poor pain relief with significant risk of developing iatrogenic problematic opioid use behaviors, such as persistent opioid use and opioid misuse (use in a way other than prescribed: e.g. longer duration, higher dos...

Background Subthreshold exercise, defined as aerobic exercise below the level that causes symptoms, has been utilized as a treatment for youth with persistent postconcussive symptoms (PPCS), but there is currently little evidence to guide use. In addition, prior studies of exercise for PPCS have all required multiple in-person visits. We developed...

Background : The Adolescent Insomnia Questionnaire (AIQ), English version, is the only validated screening measure developed specifically to identify insomnia symptoms in adolescents. To date, no specific screening tool for adolescent insomnia is present in Danish language. The aim of this study was to translate and validate the AIQ in a sample of...

Background Health-related quality of life (HRQOL) is an important outcome among children with Hirschsprung Disease (HD), but there are challenges in interpreting findings in previous studies owing to the choice of a comparator group and informant. We compared parent-proxy versus child self-report HRQOL in children with HD to children with functiona...

Data are equivocal on the consequences of COVID-19 pandemic on pain and well-being for individuals with chronic pain. Furthermore, little is known regarding its impact on the health of young adults with chronic pain. We conducted a longitudinal study to compare pain, psychological functioning, and substance use before and during the pandemic of 196...

Sleep is interrelated with the experience of chronic pain and represents a modifiable lifestyle factor that may play an important role in the treatment of children and adolescents with chronic pain. This is a topical review of assessment and treatment approaches to promote sleep health in children and adolescents with chronic pain, which summarizes...

Over 50% of adolescents with chronic pain report comorbid sleep disturbances (e.g., difficulties with falling asleep), which is associated with increased pain-related disability and poorer quality of life. However, limited longitudinal data are available to understand how sleep disturbance may impact response to psychological treatment. Our primary...

Chronic pain extends from childhood to adulthood for many young people. The transition from pediatric to adult care is a critical, yet understudied, healthcare task facing young adults with chronic pain. The aims of this observational, sequential mixed methods study were to 1) document the healthcare transition status of young adults with chronic p...

Children and adolescents have unique needs that should be considered in the assessment and management of pain. This chapter reviews the considerations in managing pediatric chronic pain, including a discussion of its impact; a description of clinical evaluation and evidence‐based management approaches. Chronic or recurrent pain in children may be a...

Objectives: Abdominal pain, emergency department visits and hospitalizations impact lives of children with acute recurrent pancreatitis (ARP) and chronic pancreatitis (CP). However, data on health-related quality of life (HRQOL) in this population remains limited. We aimed to evaluate HRQOL in children with ARP or CP; and test biopsychosocial risk...

Background Unlike the psychosocial assessment established for adults in the diagnostic criteria for temporomandibular disorders (DC/TMD), a standardized psychosocial assessment for children and adolescents with TMD complaints has not yet been established. Objectives To develop a new standardized instrument set to assess the psychosocial functionin...

Background Spinal fusion surgery is a common and painful musculoskeletal surgery performed in the adolescent population. Despite the known risk for developing chronic post-surgical pain, few perioperative psychosocial interventions have been evaluated in this population, and none have been delivered remotely (via the Internet) to improve accessibil...

Prior systematic reviews have summarized the prevalence and impact of chronic pain in "average" pediatric (i.e., school-age) and adult (i.e., middle-age) age groups. To our knowledge, this is the first study to describe the prevalence of chronic pain in the subgroup of individuals that fall in between established boundaries of "childhood" and "adul...

Objective: Neighborhood socioeconomic status (SES) is linked to self-reported pain severity and disability but its association with evoked pain responsiveness in individuals with chronic pain remains unclear. The present study examined relations between neighborhood SES, assessed through the area deprivation index (ADI), and static and dynamic pai...

Background: Sickle cell disease (SCD) is the most common genetic disorder in the United States, seen in 100,000 Americans. SCD complications include pain episodes, chronic anemia and long-term end organ damage, leading to significant impairment in health-related quality of life (HRQOL) across the lifespan. Hydroxyurea (HU) reduces morbidity and mor...

Study objective: Concussion is highly prevalent in adolescents and associated with a higher risk of substance use. With the rising use of opioids among adolescents, one form of substance use of concern is the misuse of prescription opioids. This study aimed to examine the association between a history of sports-related concussion in the past year...

Background : The Adolescent Insomnia Questionnaire (AIQ), English version, is the only validated screening measure developed specifically to identify insomnia symptoms in adolescents. To date, no specific screening tool for adolescent insomnia is present in Danish language. The aim of this study was to translate and validate the AIQ in a sample of...

A workshop was sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases to focus on research gaps and opportunities in pancreatic pain. The event was held on July 21, 2021, and structured into 4 sessions: (1) pathophysiology; (2) biomarkers, mediators, and pharmacology of pain; (3) pain assessment; and (4) pain treatment ch...

Background: Spinal fusion surgery is associated with severe acute postsurgical pain and high rates of chronic postsurgical pain in adolescents. Psychological distress, sleep disturbance, and low pain self-efficacy predict higher acute pain and likelihood of developing chronic postsurgical pain. Interventions targeting baseline psychosocial risk fa...

Objectives: Youth with functional abdominal pain (FAP) experience significant pain-related distress and functional impairment. Although quantitative sensory testing protocols have identified alterations in pain modulatory systems that distinguish youth with FAP from healthy controls, the extent to which evoked pain responses predict subsequent tra...

Purpose of review: Management of abdominal pain in patients with chronic pancreatitis is often suboptimal. We review recent data on the epidemiology and new approaches for managing pain in chronic pancreatitis. Recent findings: Chronic pancreatitis duration does not appear to affect the pain experience. Pain pattern in chronic pancreatitis patie...

Introduction: Severe abdominal pain is a cardinal symptom of chronic pancreatitis (CP) associated with a high economic and societal burden. In other chronic pain conditions, cognitive-behavioral therapy (CBT) has demonstrated efficacy in improving patient outcomes (e.g., pain-related disability and depression). However, CBT has not yet been evalua...

The purpose of this chapter is to provide an overview of sleep assessment and evidence-based treatment of sleep difficulties in children and adolescents with chronic pain. We begin with a review of sleep measures in a number of domains, providing recommendations of well-established subjective measures that have demonstrated reliability and validity...

This chapter reviews the measurement of health-related quality of life (HRQoL) and physical function in pediatric pain populations, including details about questionnaire and performance-based measures, and recommendations for their use. Because many children and adolescents with pain report impairment in participation in physical activities, physic...

Study objectives: The aim of this study was to estimate the association between insufficient sleep and prescription opioid misuse among US high school students. Methods: Participants were 6,884 high school students who self- reported on sleep duration and prescription opioid misuse in the 2019 Youth Risk Behavior Survey (YRBS). Sleep duration wa...

Background Pain education resources for children using appropriate language and illustrations remain scarce. Objectives We aimed to summarize the development process and testing for face and content validity of a structured comic book about pain education for children. Methods A first draft of a comic book was developed (Portuguese and English) b...

Background: Concussion is common, and up to 30% of youth develop persistent symptoms. Preliminary data suggests treatment with rehabilitative exercise is beneficial, but most programs require frequent in-person visits, which is challenging for youth in rural areas, and has been made more difficult for all youth during the COVID-19 pandemic. We have...

Objectives: To characterize the types of multisite pain experienced by children with functional abdominal pain disorders (FAPDs) and to examine differences in psychosocial distress, functional disability and health-related quality of life in children with multisite pain vs. abdominal pain alone. Study design: Cross-sectional study of children ag...

The novel coronavirus disease (COVID-19) has caused prolonged disruptions in daily life for many communities. Little is known about the impact of the COVID-19 pandemic on the health and well-being of youth with chronic pain and their families. We conducted a longitudinal, mixed-methods study to characterize early adaptation to the COVID-19 pandemic...

Inconsistent results of psychological treatments for pediatric functional abdominal pain (FAP) may be due to heterogeneity of patients’ pain-related psychological characteristics. This randomized controlled trial tested whether statistically derived patient subgroups (high pain dysfunctional [HPD], high pain adaptive [HPA], and low pain adaptive [L...

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To identify and assess the effects of digital behavioural interventions focused on behavioural change in people with SCD on:. medication adherence or disease management (such as managing acute and chronic pain), or both, on health- and other-related...

Musculoskeletal pain is common in the general pediatric population and is a challenge to youth, their parents, and society. The majority of children experiencing musculoskeletal pain will recover; however, a small subgroup of youth develops chronic pain. There is limited understanding of the factors that affect the transition from acute to chronic...

The COVID-19 pandemic has led to major disruptions in the clinical research enterprise. Investigators and staff at the University of Washington and Seattle Children’s Research Institute (SCRI) were surveyed to determine the impact of the pandemic restrictions on their non-COVID-19 clinical research studies. Enrollment and study visits were stopped...

Appropriate outcome measures and high-quality intervention trials are critical to advancing care for children with chronic pain. Our aim was to update a core outcome set for pediatric chronic pain interventions. The first phase involved collecting providers', patients', and parents' perspectives about treatment of pediatric chronic pain to understa...

Headaches are among the world’s leading causes of disability for children and adults.¹ Clinical samples of youth with headache report frequent school absences, poorer school performance, and lower quality of life than youth with other chronic conditions.² However, little is known about the association of headache with school functioning at the popu...

Background Chronic pain is associated with significant physical and psychological impairments across the adult lifespan. However, there is a relative gap in knowledge on individual differences that predict pain‐related functioning. The current study highlights one important source of individual variation: age. Methods Using cross‐sectional data fr...

Objective Upwards of 14% of late adolescents and young adults (AYAs) experience chronic pain; however, limited research has focused on factors specifically influencing late AYAs as they transition to adulthood. In this topical review, we propose a conceptual model of multidomain pain resilience (MDPR) in late AYAs with chronic pain that extends exi...

Background An estimated 12.8% of children and adolescents experience chronic health conditions that lead to poor quality of life, adjustment and coping issues, and concurrent mental health problems. Digital health deployment of psychosocial interventions to support youth with chronic illness has become increasingly popular with the advent of the te...

Acute and chronic pain are highly prevalent and impactful consequences of surgery across the lifespan, yet a comprehensive conceptual model encompassing biopsy-chosocial factors underlying acute to chronic pain transition is lacking, particularly in youth. Building on prior chronic postsurgical pain models, we propose a new conceptual model of biop...

Study objective: The main aim of this study was to estimate the association between sleep deficiency in adolescence and subsequent prescription opioid misuse in adulthood using United States nationally representative longitudinal data. Methods: Self-reported data captured in the National Longitudinal Study of Adolescent to Adult Health at baseli...