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Pain Management in Children During the COVID-19 Pandemic

Authors:
Patricia A Richardson at Michigan State University
Patricia A Richardson
Anjana Kundu
Anjana Kundu
Anjana Kundu
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Abstract

Purpose of Review For many children, the SARS-CoV-2 pandemic has impacted the experience and treatment of their pain. This narrative review draws from the pain literature and emerging findings from COVID-19 research to highlight potentially meaningful directions for clinical consideration and empirical inquiry in the months and years to come. Recent Findings COVID-19 has been linked to diffuse acute pains as well as chronic pain sequelae. Contextual factors known to increase vulnerability for pain and associated functional disability have been exacerbated during the pandemic. Beyond these salient concerns has been the remarkable resilience demonstrated by patients and providers as healthcare systems have sought to harness creativity and innovative digital solutions to support optimal child wellbeing throughout this crisis. Summary Ongoing research is needed to elucidate the short- and long-term effects of the pandemic on children’s pain and to consider how the delivery of treatment via digital technology has impacted existing paradigms of pain management.
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PEDIATRIC ANESTHESIA (R AGARWAL, SECTION EDITOR)
Pain Management in Children During the COVID-19 Pandemic
Patricia A. Richardson
1,2
&Anjana Kundu
3,4
Accepted: 28 June 2021
#Springer Science+Business Media, LLC, part of Springer Nature 2021
Abstract
Purpose of Review For many children, the SARS-CoV-2 pandemic has impacted the experience and treatment of their pain. This
narrative review draws from the pain literature and emerging findings from COVID-19 research to highlight potentially mean-
ingful directions for clinical consideration and empirical inquiry in the months and years to come.
Recent Findings COVID-19 has been linked to diffuse acute pains as well as chronic pain sequelae. Contextual factors known to
increase vulnerability for pain and associated functional disability have been exacerbated during the pandemic. Beyond these
salient concerns has been the remarkable resilience demonstrated by patients and providers as healthcare systems have sought to
harness creativity and innovative digital solutions to support optimal child wellbeing throughout this crisis.
Summary Ongoing research is needed to elucidate the short- and long-term effects of the pandemic on children’s pain and to
consider how the delivery of treatment via digital technology has impacted existing paradigms of pain management.
Keywords COVID-19 .Pediatric .Pain .Acutepain .Chronic pain .MIS-C .Telehealth .Sleep .Abuse .Neglect .Virtualcare .
School .Psychosocial .Behavioral
Introduction
There have been over 27 million documented cases of severe
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in
the USA and over 108 million cases worldwide. Although the
impact of the coronavirus disease 2019 (COVID-19) pandem-
ic has been felt by all, there are special considerations to make
for children experiencing pain. The pandemic has had a pro-
found effect on the way that pain is experienced by children
and families. Not only are headache and diffuse pains
symptoms of the virus [1•], but a unique presentation among
older children, multisystem inflammatory syndrome (MIS-C),
has manifested as severe abdominal pain, joint swelling, and
pain [2]. Furthermore, contextual factors known to in-
crease vulnerability for pain and associated functional
disability have been higher within the context of the
pandemic (e.g., stress, anxiety, depression, social isola-
tion, sleep disturbance, reduced activities of daily living,
physical deconditioning) [3•,4,5].
COVID-19 has also impacted optimal pain management
for children due to safety and logistical challenges.
Depending on location of residence, there were weeks to
months at the outset of the pandemic when healthcare profes-
sionals, inpatient and outpatient, were unable to see patients.
During this period, healthcare systems rapidly developed safe-
ty protocols and digital technology infrastructure to support
virtual visits. Across many healthcare systems, restrictions
were placed on elective, routine, and nonemergency interven-
tional procedures, postponing them unless considered essen-
tial. Some pain professionals were redistributed from primary
domains of practice to assist with the urgent need to evaluate
and treat patients with COVID-19. Given that many emergen-
cy departments have gone through periods of being inundated
with COVID-19 patients, some children with significant pain
were either unable to access emergency care or faced delays in
This article is part of the Topical Collection on Pediatric Anesthesia
*Patricia A. Richardson
panri@msu.edu
1
Departments of Pediatric Psychology and Pediatric Pain and
Palliative Medicine, Helen DeVos Children’s Hospital, 35 Michigan
St. NE., Grand Rapids, MI 49503, USA
2
Department of Pediatrics and Human Development, Michigan State
University College of Human Medicine, East Lansing, MI, USA
3
Department of Pediatric Anesthesiology, Dayton Children’s
Hospital, Dayton, OH, USA
4
Department of Pediatrics, Wright State University Boonshoft School
of Medicine, Dayton, OH, USA
https://doi.org/10.1007/s40140-021-00475-0
/ Published online: 26 July 2021
Current Anesthesiology Reports (2021) 11:214–222
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... A survey carried out in Japan showed that the increase in the frequency and intensity of pain, as well as the prevalence of CP syndrome, were reported with the increase in the time of social isolation due to the pandemic 29 . Thus, being physically isolated from others constitutes a social threat that can perpetuate and exacerbate pain and the associated disability, leading to depression, discouragement, a feeling of loss of purpose and personal value, and a lack of ideals 24,30 . These changes in daily life during the COVID-19 pandemic have been closely associated with the intensity of pain and mental suffering 19 . ...
... In this way, the absence of therapeutic sessions and the postponement of appointments have fostered feelings of abandonment, social injustice and inequality, and thus increased psychological suffering, especially in patients with pain 26,27 . Another damaging factor was the redeployment of healthcare professionals, as shown in a study 36 , which found that 28% of nurses were forced to change their usual roles during the pandemic; these nurses shared many different experiences, and their roles were affected by the pandemic, in addition to the redeployment of materials to emergency services and intensive care units dedicated to COVID-19 patients 23,30 . These were some of the main causes of concern for patients receiving opioid therapy, of whom 21.4% reported fear of running out of their medication, and 19.7% reported having difficulties accessing prescribed opioids due to COVID-19 37 . ...
... And one of the mechanisms behind this decline may be due to reduced exposure to CP risk factors, such as stress, bullying or aversion to school in general 20 . However, during social isolation, social support and the use of effective coping strategies led to an improvement in patients' quality of life and mental health, which may lead to the conclusion that patients with stronger pre-pandemic connections adapted better to the virtual environment, feeling less loss; while those who previously had greater feelings of loneliness with the whole family together, felt more comfort and security and more attention with the closeness of family members 20,24,25,28,30 . ...
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... A survey carried out in Japan showed that the increase in the frequency and intensity of pain, as well as the prevalence of CP syndrome, were reported with the increase in the time of social isolation due to the pandemic 29 . Thus, being physically isolated from others constitutes a social threat that can perpetuate and exacerbate pain and the associated disability, leading to depression, discouragement, a feeling of loss of purpose and personal value, and a lack of ideals 24,30 . These changes in daily life during the COVID-19 pandemic have been closely associated with the intensity of pain and mental suffering 19 . ...
... In this way, the absence of therapeutic sessions and the postponement of appointments have fostered feelings of abandonment, social injustice and inequality, and thus increased psychological suffering, especially in patients with pain 26,27 . Another damaging factor was the redeployment of healthcare professionals, as shown in a study 36 , which found that 28% of nurses were forced to change their usual roles during the pandemic; these nurses shared many different experiences, and their roles were affected by the pandemic, in addition to the redeployment of materials to emergency services and intensive care units dedicated to COVID-19 patients 23,30 . These were some of the main causes of concern for patients receiving opioid therapy, of whom 21.4% reported fear of running out of their medication, and 19.7% reported having difficulties accessing prescribed opioids due to COVID-19 37 . ...
... And one of the mechanisms behind this decline may be due to reduced exposure to CP risk factors, such as stress, bullying or aversion to school in general 20 . However, during social isolation, social support and the use of effective coping strategies led to an improvement in patients' quality of life and mental health, which may lead to the conclusion that patients with stronger pre-pandemic connections adapted better to the virtual environment, feeling less loss; while those who previously had greater feelings of loneliness with the whole family together, felt more comfort and security and more attention with the closeness of family members 20,24,25,28,30 . ...
Possibilities of the nurse’s action in front of the effects of social isolation on the patient with chronic pain: integrative review
Article
Full-text available
  • Oct 2023
BACKGROUND AND OBJECTIVES Social isolation, as experienced in the context of the COVID-19 pandemic, has triggered psychological and neuropsychiatric problems; these conditions can aggravate chronic pain crises. It is also known that social relationships play an important role in pain and emotions. Chronic pain (CP) is a challenging disease, especially in terms of its multifaceted mechanisms and treatment. Thus, the aim of this study was to provide a better understanding of nurses’ work with patients with CP and the impact of social isolation resulting from the COVID-19 pandemic. CONTENTS This is an integrative review, carried out in the Virtual Health Library (Biblioteca Virtual em Saúde - BVS) and Medline via Pubmed databases of the National Library of Medicine. To select the articles, the following descriptors in health sciences and Medical Subject Headings (DeCS/MeSh) were considered: “Social isolation”, “Chronic pain”, “COVID-19”, “Nursing care” and “Patient care planning”, with their synonyms/alternative terms. A total of 45,703 articles were found; based on the inclusion and exclusion criteria, 27 articles were selected. This study hoped to answer the following guiding questions: “how do nurses work with individuals with CP during the social isolation caused by COVID-19?”, and “what are the consequences of social isolation for this population due to the COVID-19 pandemic?”. Of the 27 articles, most were published in North America and Europe, and three in Brazil. The population most affected by CP are seniors, women and people on low incomes. In terms of profession, only three of the 27 articles were published by nurses. The data was discussed considering the work of nurses with individuals with CP, especially through telehealth, as well as the impacts that people with CP have suffered from social isolation during the coronavirus pandemic. CONCLUSION There is a significant gap in the literature regarding the role of nurses with individuals with CP in social isolation, suggesting the need for further studies in this area, mainly at the national level. From the studies found, it was evidenced that individuals who live with CP have the multiple dimensions of the human being affected, but that in this moment of social isolation due to the COVID-19 pandemic, the worst commitment was the emotional one. Thus, with the continued rise of telehealth and the possibility of future pandemics, it is recommended to move the existing guidelines for the formal development of telehealth competencies towards relevant curricular content and clinical experience for all nursing programs. Keywords Chronic pain; COVID-19; Nursing care; Patient care planning; Social isolation
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... Beginning in March 2020, the world saw pediatric pain management clinics abruptly changing their delivery of care owing, in part, to social-distancing requirements. Depending on the location, some healthcare professionals (HCPs) were unable to see patients for varying periods of time because of clinic shutdowns or redeployment, whereas others were able to rapidly pivot to a virtual model of care delivery [11][12][13]. Fortunately, across Canada, all 13 pediatric pain clinic sites were able to successfully transition to virtual care, where the largest program in Canada (The Hospital for Sick Children) transitioned over the course of 2 weeks at the onset of the pandemic [11,14]. ...
... Further, given that the optimal paradigm for chronic pain management involves psychological, physical, and pharmacological approaches, the transition from in-person care to a full-scale virtual model was no easy feat [15,16]. Multidisciplinary treatment (MDT) teams consisting of physicians (e.g., anesthesiologist, pain doctor, or pediatrician), physical therapists, nurse practitioners, psychologists and/or psychiatrists, occupational therapists, and/or social workers began to rapidly navigate virtual technology to ensure that patients received safe and quality care [13,17]. While some HCPs had prior knowledge of and practice delivering occasional telemedicine appointments, very few had experience delivering full-time remote services (e.g., videoconference, telephone consultation) [12,18,19]. ...
... While some HCPs had prior knowledge of and practice delivering occasional telemedicine appointments, very few had experience delivering full-time remote services (e.g., videoconference, telephone consultation) [12,18,19]. HCPs faced many administrative, logistical (i.e., infrastructure, setting up virtual care), and technological (i.e., internet connection, technological literacy) challenges, but they demonstrated resilience in meeting the demands of the unprecedented circumstances [13,17]. Now, nearly 3 years since the initial shift in modality of care, it is apparent that virtual healthcare has endured beyond needing to meet social-distancing requirements [20][21][22]. ...
“Working Together”: Perspectives of Healthcare Professionals in Providing Virtual Care to Youth with Chronic Pain during the COVID-19 Pandemic
Article
Full-text available
Background: The onset of the coronavirus disease in 2019 necessitated a rapid transition to virtual care for chronic pain treatment. Methods: A mixed methods design was implemented using qualitative interviews and quantitative satisfaction surveys. Interviews were conducted in February 2021 with a sample of healthcare professionals (HCPs; n = 6) who had provided multidisciplinary treatment (MDT) through an outpatient hospital pediatric chronic pain program. Satisfaction surveys were distributed to all MDT professionals employed by the clinic in April 2021 (n = 13 of 20 eligible; 65% response rate). Participants represented medicine, rehabilitation, and mental health professionals. Results: Analysis of interviews generated five themes: (1) adaptation to virtual care, (2) benefits of virtual care, (3) limitations of virtual care, (4) shifting stance on virtual care over time, and (5) considerations for implementing virtual care. The satisfaction survey data revealed that respondents were able to effectively provide appropriate diagnoses, recommendations, and/or care plans for pediatric chronic pain via virtual care (n = 12, 92.3%). Detailed survey responses are presented by discipline. Conclusions: This study provides a rich exploration of HCPs' experiences in providing MDT for pediatric chronic pain within a virtual care model. The current results may contribute to the future development of guidelines for virtual care delivery with pediatric chronic pain populations.
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... 27 These results can directly inform adaptations and considerations when implementing care options in practice, but more evidence is required around how treatment modalities and exams can reliably be transitioned to virtual care, as well as accessibility and safety as compared to in-person care. 32 Research using head-to-head comparisons and RCTs remains necessary to address these factors as they are a robust approach to making meaningful recommendations regarding care delivery. ...
A systematic review of in‐person versus remotely delivered interventions for youth with chronic pain
Article
Full-text available
  • May 2024
The COVID‐19 pandemic prompted a rapid shift from in‐person to virtually‐delivered care. Many youth with chronic pain have the ability to access care virtually; however, little is known about the efficacy of pain care for youth with chronic pain delivered virtually when compared to in‐person. Such evidence is essential to guide youth in making decisions about their care, but also to inform what options health professionals present to youth. The purpose of this systematic review and meta‐analysis was to examine the efficacy of interventions that are delivered in‐person versus virtually for youth with chronic pain. Five databases (i.e., CINAHL, EMBASE, MEDLINE, APA PsycINFO, and Web of Science) were searched in October 2022 to identify randomized controlled trials that compare single/multimodal interventions for pediatric chronic pain delivered in‐person versus virtually. A total 3638 unique studies were identified through database and other searching, two of which satisfied established criteria for inclusion in this review. Both studies compared psychological interventions delivered virtually versus in‐person for youth with chronic pain and showed comparable efficacy across modalities. The planned meta‐analyses could not be conducted due to different outcomes within each study that could not be combined. This systematic review highlights a critical gap in the evidence regarding the efficacy of virtually delivered interventions for youth with chronic pain. This evidence is necessary to inform treatment decisions for youth, and further research is required to develop the evidence to inform clinical interventions, especially as virtual treatments continue to be offered.
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... Moreover, school participation and in-person social interactions were limited, while greater numbers of families experienced financial strain and increased stress [8]. Given these changes, the COVID-19 pandemic was hypothesized to cause a global threat to chronic pain management, yet these concerns have not widely born out [9,10,45]. Studies with youth who had received care for chronic pain before the pandemic suggest an overall stability or improvement in pain-related symptoms during the early stages of the pandemic [23,26,35,40,49,52]. A study from Germany also found an overall decrease in chronic pain prevalence in a school-based sample from October/November 2019 to June/July 2020 [44]. ...
Comparing the prevalence of chronic pain in school-aged children in the United States from 2019 to 2020: a nationally representative study examining differences associated with the COVID-19 pandemic
Article
  • Aug 2023
  • PAIN
The coronavirus disease 19 (COVID-19) pandemic negatively affected children's health in the United States (US), with more severe disruption for marginalized groups. However, potential impact on pediatric chronic pain has not been assessed at the population level. This study aimed to (1) estimate differences in the US national prevalence of pediatric chronic pain during the first year of the COVID-19 pandemic (2020), relative to one year earlier (2019); (2) determine whether differences in prevalence varied across sociodemographic groups; and (3) explore changes in child, caregiver, and family factors associated with chronic pain prevalence. Using data of children 6 to 17 years from the National Survey of Children's Health 2019 and 2020 (n = 50,518), we compared weighted percentages of sample characteristics by year and conducted a series of directed-acyclic graph-informed survey-weighted Poisson regressions. The estimated national prevalence (95% CI) of pediatric chronic pain was 10.8% (9.9, 11.9%) in 2019, decreasing to 7.6% (6.9, 8.3%) in 2020. Contrary to hypotheses, the adjusted prevalence of chronic pain was 31% lower in 2020 than in 2019 (aPR = 0.69, 95% CI: 0.61, 0.79), adjusting for child age, sex, race or ethnicity, caregiver education, neighborhood park or playground, and census region. The 2019 to 2020 change in chronic pain prevalence was similar by age (P = 0.34), sex (P = 0.94), race or ethnicity (P = 0.41), caregiver education (P = 0.49), neighborhood park or playground (P = 0.22), and census region (P = 0.20). Exploratory analyses identified 3 potential contributors to the unexpected decrease in the national prevalence of pediatric chronic pain: lower prevalence of bullying, more frequent family meals, and higher family resilience.
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... Loss of loved ones and grief can be complicated in the context of COVID-19 and contribute to psychological and emotional morbidity, causing increased susceptibility of the patient to present with chronic pain. This should be assessed in all patients and their families and interventions should be initiated early to alleviate suffering [10][11][12][13] . Patients with chronic pain must be treated with clinical decisions regarding the post-COVID perspective, requiring changes in the clinical and organizational point of view for patients who cannot discontinue care or still need the care to control multiple comorbidities that require regular monitoring. ...
Role of palliative care and telemedicine in patients with chronic pain during the COVID-19 pandemic: integrative review
Article
Full-text available
  • Feb 2023
BACKGROUND AND OBJECTIVES Pain was distributed differently in the population during the pandemic due to characteristics such as advanced age, population density, socioeconomic status, smoking, presence of chronic diseases, availability of tests to diagnose COVID-19, and access to health care, which negatively affected the quality of life of the infected population. This article aims to describe information about patients with chronic pain and the interventions received in the scenario of the advent of telemedicine during the COVID -19 pandemic. METHODS An integrative literature review was developed. The search was conducted in the Pubmed database in January 2022, and articles between 2019 and 2022 were selected, for a total of 18 articles, of which 8 were used. RESULTS New challenges directly related to COVID-19 infection have led to a paradigm in the management of patients with chronic pain, from chronic use of inappropriate current drugs to socioeconomic impacts that negatively affect pain modulation. Loss and bereavement can be complicated in the context of COVID -19 and contribute to psychological and emotional morbidity that increases patients vulnerability to chronic pain. CONCLUSIONS Palliative care is vital in the management of chronic pain in all individuals affected by the pandemic. Therefore, there is a need for public policies to recognize, strengthen, and guarantee access to palliative care in the population affected by COVID-19, as well as in those with physical and emotional sequelae of this illness. Keywords Chronic pain; COVID-19; Palliative care; Palliative medicine
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Pain, mental health and healthcare utilization: Impact of the COVID-19 pandemic on youth with chronic pain, parents and siblings
Article
  • Jul 2023
  • EUR J PAIN
Background: Paediatric chronic pain was a public health emergency before the novel coronavirus (COVID-19) pandemic, and this problem is predicted to escalate. Pain tends to occur intergenerationally in families, and youth with chronic pain and their parents have high rates of mental health issues, which can further exacerbate pain. Siblings of youth with chronic pain have been largely overlooked in research, as well as the impact of the pandemic on posttraumatic stress disorder (PTSD) symptoms and healthcare utilization. Methods: This cross-sectional study examined pain, mental health and healthcare utilization in three groups: youth with chronic pain (n = 357), parents of youth with chronic pain (n = 233) and siblings of youth with chronic pain (n = 156) during the COVID-19 pandemic in Canada. Results: More so than with pain symptoms, the results revealed high levels of mental health symptoms (i.e. anxiety, depressive, and PTSD), particularly in individuals more personally impacted by the pandemic. The largest effect was seen on PTSD symptoms for all groups. For parents with chronic pain, greater personal COVID-19 impact was related to worse pain interference. Reported rates of healthcare utilization were strikingly high, with youth with chronic pain, parents (reporting on behalf of their children with chronic pain), and siblings of youth with chronic pain reporting that most consultations were due to pain. Conclusions: Longitudinal research assessing these outcomes across continued waves of the pandemic is needed to ensure timely, tailored and equitable access to pain and mental health assessment and treatment. Significance: This study examined pain, mental health, substance use and healthcare utilization in youth with chronic pain, siblings and parents during the COVID-19 pandemic. Greater personal impact of the pandemic was not largely associated with poorer pain outcomes; however, it was associated with mental health, with the largest effect on PTSD symptoms. The high rates and significant association of COVID-19 impact with PTSD symptoms underscore the importance of including PTSD assessment as part of routine screening practices in pain clinics.
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Impact of the COVID-19 pandemic on the pharmacological, physical, and psychological treatments of pain: Findings from the Chronic Pain & COVID-19 Pan-Canadian Study
Article
Full-text available
  • Feb 2021
Abstract Introduction: Multimodal treatment is recognized as the optimal paradigm for the management of chronic pain (CP). Careful balance between pharmacological and physical/psychological approaches is thus desirable but can be easily disrupted. Objectives: This study aimed at exploring the impact of the COVID-19 pandemic on pharmacological and physical/psychological treatments of CP. Methods: A Pan-Canadian cross-sectional web-based study was conducted between April 16th and May 31st 2020 among adults living with CP when the country was in the ascending slope of the first COVID-19 pandemic wave. Results: A total of 2864 participants shared their treatment experience (mean age: 49.7 years and women: 83.5%). Among medication users (n 5 2533), 38.3% reported changes in their pharmacological pain treatment. The main reasons were as follows: (1) changes in pain symptoms, (2) lack of access to prescribers/cancellation of medical appointments, and (3) increased medication intake in compensation for stopping physical/psychological treatments because of the pandemic. Among participants who used physical/psychological pain management approaches before the pandemic (n 5 2467), 68.3% had to modify their treatments or self-management strategies. Common reasons were lack of access to clinics/exercise facilities and the need to compensate for having to stop another type of physical/psychological treatment because of the pandemic-related public health safety measures. Conclusions: Our study underlines the negative impact of the COVID-19 pandemic on access to pain relief, which is considered a fundamental human right. Results will help to justify resource allocation and inform the development of interventions to be better prepared for waves to come and future health crises.
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Adverse effects of COVID-19-related lockdown on pain, physical activity and psychological well-being in people with chronic pain
Article
Full-text available
  • Nov 2020
Countries across the world imposed lockdown restrictions during the COVID-19 pandemic. It has been proposed that lockdown conditions, including social and physical distancing measures, may disproportionately impact those living with chronic pain and require rapid adaptation to treatment and care strategies. Using an online methodology, we investigated how lockdown restrictions in the United Kingdom impacted individuals with chronic pain (N = 431) relative to a healthy control group (N = 88). Data were collected during the most stringent period of lockdown in the United Kingdom (mid-April to early-May 2020). In accordance with the fear-avoidance model, we hypothesised lockdown-related increases in pain and psychological distress, which would be mediated by levels of pain catastrophising. Responses indicated that people with chronic pain perceived increased pain severity, compared to their estimation of typical pain levels prior to lockdown (p < .001). They were also more adversely affected by lockdown conditions compared to pain-free individuals, demonstrating greater self-perceived increases in anxiety and depressed mood, increased loneliness and reduced levels of physical exercise (p ⩽ .001). Hierarchical regression analysis revealed that pain catastrophising was an important factor relating to the extent of self-perceived increases in pain severity during lockdown (β = .27, p < .001) and also mediated the relationship between decreased mood and pain. Perceived decreases in levels of physical exercise also related to perceptions of increased pain (β = .15, p < .001). Interestingly, levels of pain intensity (measured at two time points at pre and during lockdown) in a subgroup (N = 85) did not demonstrate a significant change. However, individuals in this subgroup still reported self-perceived pain increases during lockdown, which were also predicted by baseline levels of pain catastrophising. Overall, the findings indicate that people with chronic pain suffer adverse effects of lockdown including self-perceived increases in their pain. Remote pain management provision to target reduction of pain catastrophising and increase health behaviours including physical activity could be beneficial for this vulnerable population.
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Characteristics of pediatric multi-system inflammatory syndrome (PMIS) associated with COVID-19: a meta-analysis and insights into pathogenesis
Article
Full-text available
  • Nov 2020
  • INT J INFECT DIS
Objectives There was an outbreak of pediatric multisystem inflammation syndrome (PMIS) was observed in multiple countries recently, and this syndrome was suspected to be associated with SARS-CoV-2 infection. At present, there is still no standardized diagnostic criteria and treatment regimen for PMIS, while the etiology and pathogenesis still remain unclear. Methods We performed a systematic review on PubMed and Embase from the time of inception to June 24th 2020 in order to find relevant cases. Results There are seven studies included, and 80% of patients suffered persistent fever and 90% appeared gastrointestinal symptoms. IgG antibody against SARS-CoV-2 was positive on 81% of patients, while 37% of the patients were nucleic acid positive. C-reactive protein, IL-6 and PCT were elevated and intravenous immunoglobulin was a routine treatment for PMIS. There were more than half of patients required inotropic supports and mechanical ventilation were applied to 33% of patients. The median length of hospital stay was 10.66 days and 74% had admitted to accept intensive care. Conclusions Our study documented three common types of PMIS clinical presentation: persistent fever and gastrointestinal symptoms, shocked with heart dysfunction and Kawasaki disease-like syndrome. PMIS patients proved with a marked inflammatory state were possibly associated with SARS-CoV-2 infection.
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Stress, Resilience, and Well-Being in Italian Children and Their Parents during the COVID-19 Pandemic
Article
Full-text available
The novel coronavirus (COVID-19) outbreak has forced parents and children to adopt significant changes in their daily routine, which has been a big challenge for families, with important implications for family stress. In this study, we aimed to analyze the potential risk and protective factors for parents’ and children’s well-being during a potentially traumatic event such as the COVID-19 quarantine. Specifically, we investigated parents’ and children’s well-being, parental stress, and children’s resilience. The study involved 463 Italian parents of children aged 5–17. All participants completed an online survey consisting of the Psychological General Well Being Index (PGWB) to assess parental well-being, the Strengths and Difficulties Questionnaire (SDQ) to measure children’s well-being, the Parent Stress Scale (PSS) to investigate parental stress, and the Child and Youth Resilience Measure (CYRM-R) to measure children’s resilience. The results show that confinement measures and changes in daily routine negatively affect parents’ psychological dimensions, thus exposing children to a significant risk for their well-being. Our results also detect some risk factors for psychological maladjustments, such as parental stress, lower levels of resilience in children, changes in working conditions, and parental psychological, physical, or genetic problems. In this study, we attempted to identify the personal and contextual variables involved in the psychological adjustment to the COVID-19 quarantine to identify families at risk for maladjustment and pave the way for ad hoc intervention programs intended to support them. Our data show promising results for the early detection of the determinants of families’ psychological health. It is important to focus attention on the needs of families and children—including their mental health—to mitigate the health and economic implications of the COVID-19 pandemic.
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Adverse childhood experiences and chronic pain among children and adolescents in the United States
Article
Full-text available
  • Aug 2020
Objective: To evaluate the association between adverse childhood experiences (ACEs) and chronic pain during childhood and adolescence. Methods: Cross-sectional analysis of the 2016-2017 National Survey of Children's Health, including 48,567 child participants of 6 to 17 years of age. Parents of children reported on 9 ACEs. Chronic pain was defined as parents reporting that their children had "frequent or chronic difficulty with repeated or chronic physical pain, including headache or other back or body pain during the past 12 months." Multivariate logistic regression analysis adjusted for sociodemographic and health-related factors. Results: In this nationally representative sample, 49.8% of children were exposed to one or more ACEs during their lifetime. Children with exposure to 1 or more ACEs had higher rates of chronic pain (8.7%) as compared to those with no reported ACEs (4.8%). In multivariate analysis, children with ACEs had increased odds for chronic pain (adjusted odds ratio [aOR]: 1.6, 95% confidence interval [CI]: 1.3-2.2, for 0 vs 1 ACE and aOR: 2.7, 95% CI: 2.1-3.4 for 0 vs 4+ ACEs). The strongest associations of individually measured ACEs with chronic pain included financial instability (aOR: 1.9, 95% CI: 1.6-2.2), living with a mentally ill adult (aOR: 1.8, 95% CI: 1.5-2.2), and having experienced discrimination based on race (aOR: 1.7, 95% CI: 1.3-2.2). Conclusions: Children and adolescents with ACEs had increased risk for chronic pain, and this association increased in a dose-dependent fashion.
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The social threats of COVID-19 for people with chronic pain
Article
Full-text available
  • Jul 2020
The COVID-19 (SARS-CoV-2) pandemic has changed the social environment in which people live and work, as well as the social systems they rely on. To contain the spread of coronavirus and to prepare for a dramatic increase in demand for limited hospital/medical facilities and resources, societies have enforced physical distancing measures. Consequently, there have been limitations on the use of public transportation, public spaces, and work, education, and recreational facilities. Furthermore, access to vital, but nonurgent, healthcare services (including pain management services) has been restricted. These changes have affected the way people connect with each other, manage their health and wellbeing, and fulfil their social roles. For some, these changes may present opportunities (eg, increased time with family, normalisation of flexible working, and reduced demand for travel). For others, however, these social changes can also represent significant threats to health and wellbeing. The negative impact of social changes prompted by the COVID-19 crisis may disproportionately affect individuals living with long-term painful conditions. Living with chronic pain can threaten an individuals' fundamental social needs for autonomy (agency or independence), belonging (social connection), and justice (fairness). In turn, for some, experiencing heightened social threat can maintain and exacerbate chronic pain. In this review, we draw attention to the potential for social and systemic changes associated with attempts to contain the spread of COVID-19 to precipitate, maintain, and exacerbate pain by increasing the social threats faced by individuals with chronic pain (Fig. 1). We also suggest strategies for mitigating the social impact of COVID-19 on those living with chronic pain, for instance by learning from the resilience demonstrated by people in pain who have found ways to deal with social threat. Finally, we suggest several time-critical, high-impact research questions for further investigation (Fig. 1).
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Suffering in silence: How COVID-19 school closures inhibit the reporting of child maltreatment
Article
  • Oct 2020
  • J PUBLIC ECON
To combat the spread of COVID-19, many primary and secondary schools in the United States canceled classes and moved instruction online. This study examines an unexplored consequence of COVID-19 school closures: the broken link between child maltreatment victims and the number one source of reported maltreatment allegations—school personnel. Using current, county-level data from Florida, we estimate a counterfactual distribution of child maltreatment allegations for March and April 2020, the first two months in which Florida schools closed. While one would expect the financial, mental, and physical stress due to COVID-19 to result in additional child maltreatment cases, we find that the actual number of reported allegations was approximately 15,000 lower (27%) than expected for these two months. We leverage a detailed dataset of school district staffing and spending to show that the observed decline in allegations was largely driven by school closures. Finally, we discuss policy implications of our findings for the debate surrounding school reopenings and suggest a number of responses that may mitigate this hidden cost of school closures.
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