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Amanda B. Feinstein
Department of Anesthesiology, Perioperative, and Pain Medicine Stanford University School of Medicine Stanford, CA United States

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Journal article
Published: 23 November 2020 in JMIR Rehabilitation and Assistive Technologies
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Background In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. Objective We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. Methods We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. Results This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (P<.001), fear (P=.003), avoidance (P=.004), and functional limitations (P=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. Conclusions The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun.

ACS Style

Anya Griffin; Luke Wilson; Amanda B Feinstein; Adeline Bortz; Marissa S Heirich; Rachel Gilkerson; Jenny Fm Wagner; Maria Menendez; Thomas J Caruso; Samuel Rodriguez; Srinivas Naidu; Brenda Golianu; Laura E Simons. Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study. JMIR Rehabilitation and Assistive Technologies 2020, 7, e22620 .

AMA Style

Anya Griffin, Luke Wilson, Amanda B Feinstein, Adeline Bortz, Marissa S Heirich, Rachel Gilkerson, Jenny Fm Wagner, Maria Menendez, Thomas J Caruso, Samuel Rodriguez, Srinivas Naidu, Brenda Golianu, Laura E Simons. Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study. JMIR Rehabilitation and Assistive Technologies. 2020; 7 (2):e22620.

Chicago/Turabian Style

Anya Griffin; Luke Wilson; Amanda B Feinstein; Adeline Bortz; Marissa S Heirich; Rachel Gilkerson; Jenny Fm Wagner; Maria Menendez; Thomas J Caruso; Samuel Rodriguez; Srinivas Naidu; Brenda Golianu; Laura E Simons. 2020. "Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study." JMIR Rehabilitation and Assistive Technologies 7, no. 2: e22620.

Preprint content
Published: 17 July 2020
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BACKGROUND In the field of pain, virtual reality (VR) technology has been increasingly common in the context of procedural pain management. As an interactive technology tool, VR has the potential to be extended beyond acute pain management to chronic pain rehabilitation with a focus on increasing engagement with painful or avoided movements. OBJECTIVE We outline the development and initial implementation of a VR program in pain rehabilitation intervention to enhance function in youth with chronic pain. METHODS We present the development, acceptability, feasibility, and utility of an innovative VR program (Fruity Feet) for pediatric pain rehabilitation to facilitate increased upper and lower extremity engagement. The development team was an interdisciplinary group of pediatric experts, including physical therapists, occupational therapists, pain psychologists, anesthesiologists, pain researchers, and a VR software developer. We used a 4-phase iterative development process that engaged clinicians, parents, and patients via interviews and standardized questionnaires. RESULTS This study included 17 pediatric patients (13 female, 4 male) enrolled in an intensive interdisciplinary pain treatment (IIPT) program, with mean age of 13.24 (range 7-17) years, completing a total of 63 VR sessions. Overall reports of presence were high (mean 28.98; max 40; SD 4.02), suggestive of a high level of immersion. Among those with multisession data (n=8), reports of pain (P<.001), fear (P=.003), avoidance (P=.004), and functional limitations (P=.01) significantly decreased. Qualitative analysis revealed (1) a positive experience with VR (eg, enjoyed VR, would like to utilize the VR program again, felt VR was a helpful tool); (2) feeling distracted from pain while engaged in VR; (3) greater perceived mobility; and (4) fewer clinician-observed pain behaviors during VR. Movement data support the targeted impact of the Fruity Feet compared to other available VR programs. CONCLUSIONS The iterative development process yielded a highly engaging and feasible VR program based on qualitative feedback, questionnaires, and movement data. We discuss next steps for the refinement, implementation, and assessment of impact of VR on chronic pain rehabilitation. VR holds great promise as a tool to facilitate therapeutic gains in chronic pain rehabilitation in a manner that is highly reinforcing and fun.

ACS Style

Anya Griffin; Luke Wilson; Amanda B Feinstein; Adeline Bortz; Marissa S Heirich; Rachel Gilkerson; Jenny Fm Wagner; Maria Menendez; Thomas J Caruso; Samuel Rodriguez; Srinivas Naidu; Brenda Golianu; Laura E Simons. Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study (Preprint). 2020, 1 .

AMA Style

Anya Griffin, Luke Wilson, Amanda B Feinstein, Adeline Bortz, Marissa S Heirich, Rachel Gilkerson, Jenny Fm Wagner, Maria Menendez, Thomas J Caruso, Samuel Rodriguez, Srinivas Naidu, Brenda Golianu, Laura E Simons. Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study (Preprint). . 2020; ():1.

Chicago/Turabian Style

Anya Griffin; Luke Wilson; Amanda B Feinstein; Adeline Bortz; Marissa S Heirich; Rachel Gilkerson; Jenny Fm Wagner; Maria Menendez; Thomas J Caruso; Samuel Rodriguez; Srinivas Naidu; Brenda Golianu; Laura E Simons. 2020. "Virtual Reality in Pain Rehabilitation for Youth With Chronic Pain: Pilot Feasibility Study (Preprint)." , no. : 1.

Review
Published: 21 February 2019 in Children
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Opioid therapy is the cornerstone of treatment for acute procedural and postoperative pain and is regularly prescribed for severe and debilitating chronic pain conditions. Although beneficial for many patients, opioid therapy may have side effects, limited efficacy, and potential negative outcomes. Multidisciplinary pain management treatments incorporating pharmacological and integrative non-pharmacological therapies have been shown to be effective in acute and chronic pain management for pediatric populations. A multidisciplinary approach can also benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids. The aims of this paper are to: (1) provide a brief overview of a multidisciplinary pain management approach for pediatric patients with acute and chronic pain, (2) highlight the mechanisms of action and evidence base of commonly utilized integrative non-pharmacological therapies in pediatric multidisciplinary pain management, and (3) explore the opioid sparing effects of multidisciplinary treatment for pediatric pain.

ACS Style

Anava Wren; Alexandra Ross; Genevieve D’Souza; Christina Almgren; Amanda Feinstein; Amanda Marshall; Brenda Golianu. Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. Children 2019, 6, 33 .

AMA Style

Anava Wren, Alexandra Ross, Genevieve D’Souza, Christina Almgren, Amanda Feinstein, Amanda Marshall, Brenda Golianu. Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids. Children. 2019; 6 (2):33.

Chicago/Turabian Style

Anava Wren; Alexandra Ross; Genevieve D’Souza; Christina Almgren; Amanda Feinstein; Amanda Marshall; Brenda Golianu. 2019. "Multidisciplinary Pain Management for Pediatric Patients with Acute and Chronic Pain: A Foundational Treatment Approach When Prescribing Opioids." Children 6, no. 2: 33.

Journal article
Published: 01 December 2018 in The Clinical Journal of Pain
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Both pediatric and parent pain catastrophizing and pain acceptance are key factors associated with pediatric pain outcomes; however, the interactive effects of these factors within the parent-child dyad have yet to be tested. The aims of this study were to examine: (1) the mediating role of child catastrophizing between parent catastrophizing and child outcomes (pain interference and mobility), (2) the mediating role of child acceptance between parent acceptance and child outcomes, and (3) whether child acceptance buffers the relation between parent catastrophizing and child catastrophizing, which in turn impacts child outcomes. Cross-sectional data from 324 youth with chronic pain ages 10 to 17 years (M age=14.72, (SD=2.12); 73.1% female; 59% Caucasian) and their parents were collected. Participants completed measures assessing pediatric PROMIS domains (mobility and pain interference), pain catastrophizing, pain acceptance, and child pain intensity. Mediation was conducted via 1000-draw bootstrap-adjusted analyses in Mplus. Parent pain catastrophizing was indirectly associated with child pain interference via child catastrophizing but was not associated with mobility difficulties in the mediation model. Parent pain acceptance was indirectly associated with both child pain interference and mobility via child acceptance. We did not find evidence of child acceptance buffering parent and child pain catastrophizing. The findings of this study highlight the need for caregiver involvement in multidisciplinary treatments to mitigate risk and enhance resilience in youth with chronic pain.

ACS Style

Amanda B. Feinstein; John Sturgeon; Rashmi P. Bhandari; Isabel A. Yoon; Alexandra C. Ross; Samantha E. Huestis; Anya T. Griffin; Laura E. Simons. Risk and Resilience in Pediatric Pain. The Clinical Journal of Pain 2018, 34, 1096 -1105.

AMA Style

Amanda B. Feinstein, John Sturgeon, Rashmi P. Bhandari, Isabel A. Yoon, Alexandra C. Ross, Samantha E. Huestis, Anya T. Griffin, Laura E. Simons. Risk and Resilience in Pediatric Pain. The Clinical Journal of Pain. 2018; 34 (12):1096-1105.

Chicago/Turabian Style

Amanda B. Feinstein; John Sturgeon; Rashmi P. Bhandari; Isabel A. Yoon; Alexandra C. Ross; Samantha E. Huestis; Anya T. Griffin; Laura E. Simons. 2018. "Risk and Resilience in Pediatric Pain." The Clinical Journal of Pain 34, no. 12: 1096-1105.

Journal article
Published: 23 September 2017 in Journal Of Pediatric Psychology
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ObjectiveThe current study focuses on social risk and resilience in an adolescent population with chronic pain. Prior research identifies parental cognitions and behaviors as influential in youths’ experiences of chronic pain and pain-related disability. Adolescent development is characterized by greater autonomy from parents and an increased emphasis on peer relationships. Study aims explore the potential protective effect of high-quality adolescent peer relationships on associations between parent and adolescent cognitive and behavioral responses to pain.Method238 adolescents with mixed-etiology chronic pain and their parents completed Pediatric Collaborative Health Outcomes Information Registry (Peds-CHOIR) electronic questionnaires prior to their initial visit to a tertiary pediatric pain clinic. Variables in this study include parent catastrophizing, parent protective behavior, adolescent peer relationship quality, adolescent catastrophizing, adolescent functional impairment, and demographic and pain characteristics.ResultsAs expected, associations between parent and adolescent cognitive and behavioral pain responses were moderated by peer relationship quality. Contrary to expectations, for adolescents endorsing low-quality peer relationships, maladaptive adolescent outcomes were elevated across levels of parental cognitions and behaviors. For adolescents endorsing high-quality peer relationships, adolescent and parent pain responses were linearly related.ConclusionsThis study highlights the salience of both family and peer processes in functional outcomes among adolescents with chronic pain. Results suggest that adolescents’ adaptive responses to chronic pain may be best supported by the simultaneous presence of adaptive parenting and high-quality peer relationships. Understanding the larger social context in which an adolescent exists is informative in specifying models that predict adaptive outcomes or magnify risks.

ACS Style

Alexandra C. Ross; Laura E. Simons; Amanda B. Feinstein; Msc Isabel A. Yoon; Rashmi P. Bhandari. Social Risk and Resilience Factors in Adolescent Chronic Pain: Examining the Role of Parents and Peers. Journal Of Pediatric Psychology 2017, 43, 303 -313.

AMA Style

Alexandra C. Ross, Laura E. Simons, Amanda B. Feinstein, Msc Isabel A. Yoon, Rashmi P. Bhandari. Social Risk and Resilience Factors in Adolescent Chronic Pain: Examining the Role of Parents and Peers. Journal Of Pediatric Psychology. 2017; 43 (3):303-313.

Chicago/Turabian Style

Alexandra C. Ross; Laura E. Simons; Amanda B. Feinstein; Msc Isabel A. Yoon; Rashmi P. Bhandari. 2017. "Social Risk and Resilience Factors in Adolescent Chronic Pain: Examining the Role of Parents and Peers." Journal Of Pediatric Psychology 43, no. 3: 303-313.

Journal article
Published: 26 April 2017 in Children
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Despite advances in psychological interventions for pediatric chronic pain, there has been little research examining mindfulness meditation for these conditions. This study presents data from a pilot clinical trial of a six-week manualized mindfulness meditation intervention offered to 20 adolescents aged 13–17 years. Measures of pain intensity, functional disability, depression and parent worry about their child’s pain were obtained at baseline and post-treatment. Results indicated no significant changes in pain or depression, however functional disability and frequency of pain functioning complaints improved with small effect sizes. Parents’ worry about child’s pain significantly decreased with a large effect size. Participants rated intervention components positively and most teens suggested that the number of sessions be increased. Three case examples illustrate mindfulness meditation effects and precautions. Mindfulness meditation shows promise as a feasible and acceptable intervention for youth with chronic pain. Future research should optimize intervention components and determine treatment efficacy.

ACS Style

Lynn C. Waelde; Amanda B. Feinstein; Rashmi Bhandari; Anya Griffin; Isabel A. Yoon; Brenda Golianu. A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain. Children 2017, 4, 32 .

AMA Style

Lynn C. Waelde, Amanda B. Feinstein, Rashmi Bhandari, Anya Griffin, Isabel A. Yoon, Brenda Golianu. A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain. Children. 2017; 4 (5):32.

Chicago/Turabian Style

Lynn C. Waelde; Amanda B. Feinstein; Rashmi Bhandari; Anya Griffin; Isabel A. Yoon; Brenda Golianu. 2017. "A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain." Children 4, no. 5: 32.

Original report
Published: 04 November 2016 in The Journal of Pain
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Pain catastrophizing is one of the most powerful predictors of poor outcomes in youth and adults with pain; however, little is known about differential effects of pain catastrophizing on outcomes as a function of age. The current study examined the predictive value of pain catastrophizing on pain interference and pain intensity across children, adolescents, and 2 age groups of young adults with chronic pain. Cross-sectional data are presented from the adult and pediatric Collaborative Health Outcomes Information Registry (CHOIR), including measures of pain catastrophizing, pain intensity, pain interference, and emotional distress from 1,028 individuals with chronic pain. Results revealed that age moderated the relation between pain catastrophizing and pain interference, with the strength of these effects declining with age. The effect of pain catastrophizing on pain interference was strongest in adolescents and relatively weak in all 3 other groups. Emotional distress was the strongest predictor of pain interference for children, whereas pain intensity was the strongest predictor for both adult groups. Pain catastrophizing was found to predict pain intensity and, although age was a significant moderator, statistical findings were weak. Developmental considerations and clinical implications regarding the utility of the construct of pain catastrophizing across age groups are discussed. Perspective This article explores differences in pain catastrophizing as predictors of pain interference and pain intensity across cohorts of children, adolescents, and 2 age groups of young adults. This work may stimulate further research on chronic pain from a developmental perceptive and inform developmentally tailored treatment interventions that target catastrophizing, emotional distress, and pain intensity.

ACS Style

Amanda B. Feinstein; John Sturgeon; Beth D. Darnall; Ashley L. Dunn; Tom Rico; Ming C. Kao; Rashmi P. Bhandari. The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain. The Journal of Pain 2016, 18, 144 -154.

AMA Style

Amanda B. Feinstein, John Sturgeon, Beth D. Darnall, Ashley L. Dunn, Tom Rico, Ming C. Kao, Rashmi P. Bhandari. The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain. The Journal of Pain. 2016; 18 (2):144-154.

Chicago/Turabian Style

Amanda B. Feinstein; John Sturgeon; Beth D. Darnall; Ashley L. Dunn; Tom Rico; Ming C. Kao; Rashmi P. Bhandari. 2016. "The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain." The Journal of Pain 18, no. 2: 144-154.