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Susan T. Tran
Department of Psychology, DePaul University, Chicago, IL 60614, USA

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Journal article
Published: 30 August 2021 in Children
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Emerging adulthood is often overlooked as a developmental time period critical to shaping future health outcomes. Recurrent pain is a commonly experienced health concern within this age group, particularly headaches and low back pain, and early experiences of recurrent pain are related to subsequent chronic pain and disability. Furthermore, adults from marginalized populations report more frequent and severe recurrent pain. Many studies have demonstrated the therapeutic effect of physical activity on pain relief; however, others have demonstrated that physical activity can also exacerbate pain symptoms. Therefore, the current study aimed to (1) assess a bidirectional relationship between reported pain and engagement in physical activity among an emerging adult sample (N = 265) and (2) determine whether sociodemographic factors moderate this relationship. Using longitudinal daily reported pain and ActiGraph monitor data collected over two weeks, a novel dynamic structural equation modeling approach was employed. Results indicated no significant cross-lagged relationships between pain and physical activity, and no significant moderation effects. These findings suggest that a bidirectional relationship does not exist among a diverse college sample of emerging adults even after considering sociodemographic moderators. Excellent retention and few missing data suggest that using accelerometers and daily diaries are feasible methods to collect data in this population. Sample considerations and future analytical approaches are discussed.

ACS Style

Helen Bedree; Steven A. Miller; Joanna Buscemi; Rachel Neff Greenley; Susan T. Tran. Using Technology to Assess Bidirectionality between Daily Pain and Physical Activity: The Role of Marginalization during Emerging Adulthood. Children 2021, 8, 756 .

AMA Style

Helen Bedree, Steven A. Miller, Joanna Buscemi, Rachel Neff Greenley, Susan T. Tran. Using Technology to Assess Bidirectionality between Daily Pain and Physical Activity: The Role of Marginalization during Emerging Adulthood. Children. 2021; 8 (9):756.

Chicago/Turabian Style

Helen Bedree; Steven A. Miller; Joanna Buscemi; Rachel Neff Greenley; Susan T. Tran. 2021. "Using Technology to Assess Bidirectionality between Daily Pain and Physical Activity: The Role of Marginalization during Emerging Adulthood." Children 8, no. 9: 756.

Journal article
Published: 04 January 2021 in Children
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Youth with chronic pain and youth who have experienced stressors are at risk for poor outcomes; however, little is known about the intersection of pain and stressors. This study aims to understand the prevalence of stressors among youth with chronic pain and the relationship between stressors and pain-related outcomes. Seven hundred and seventy youth with chronic pain aged 8–18 (Mage = 14.15 years, 70% female) reported pain characteristics, stressors, anxiety, disability, and quality of life. Most participants (82%) endorsed at least one stressor. A greater number of stressors was significantly related to greater anxiety and disability, and lower levels of quality of life. School stressors were significantly associated with functional disability; family, school, and peer stressors were significantly associated with anxiety and quality of life. Stressors are common in youth with chronic pain, and the presence of stressors is related to greater functional impairment. The results of this preliminary study using semi-structured clinical interviews suggest the importance of developing a validated measure that encompasses a wide variety of stressors for youth with pain. Future research on patient-reported stressors, relative intensity, and impact are needed.

ACS Style

Anjana Jagpal; Keri Hainsworth; Ratka Galijot; Katherine S. Salamon; Kim Anderson Khan; Susan T. Tran. The Relationship between Stressors and Pain-Related Clinical Outcomes in Pediatric Chronic Pain Patients. Children 2021, 8, 21 .

AMA Style

Anjana Jagpal, Keri Hainsworth, Ratka Galijot, Katherine S. Salamon, Kim Anderson Khan, Susan T. Tran. The Relationship between Stressors and Pain-Related Clinical Outcomes in Pediatric Chronic Pain Patients. Children. 2021; 8 (1):21.

Chicago/Turabian Style

Anjana Jagpal; Keri Hainsworth; Ratka Galijot; Katherine S. Salamon; Kim Anderson Khan; Susan T. Tran. 2021. "The Relationship between Stressors and Pain-Related Clinical Outcomes in Pediatric Chronic Pain Patients." Children 8, no. 1: 21.

Review
Published: 21 September 2020 in Children
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Ehlers–Danlos syndromes (EDS) are a group of connective tissue disorders that manifest with hyperextensibility of joints and skin, and general tissue fragility. While not a major criterion for clinical diagnosis, pain is a frequently endorsed symptom across subtypes of EDS. As such, the present review aims to summarize research to date on pain characteristics and management, and the relationship between such pain symptomatology and quality of life in pediatric EDS. Characteristics of pain, including theorized etiology, relative intensity and extent of pain are described, as well as descriptions of frequently endorsed pain sites (musculoskeletal, and non-musculoskeletal). Interventions related to the management of musculoskeletal (e.g., pharmaceutical intervention, physical therapy) and non-musculoskeletal pain (e.g., pharmaceutical and psychological interventions) are discussed, highlighting the need for additional research related to pediatric pain management in the context of hypermobility syndromes. In addition, the relationship between pain in pediatric EDS and quality of life is described. Finally, limitations of literature to date are described and recommendations for future lines of research are outlined.

ACS Style

Estée C. H. Feldman; Daniel P. Hivick; P. Maxwell Slepian; Susan T. Tran; Pradeep Chopra; Rachel Neff Greenley. Pain Symptomatology and Management in Pediatric Ehlers–Danlos Syndrome: A Review. Children 2020, 7, 146 .

AMA Style

Estée C. H. Feldman, Daniel P. Hivick, P. Maxwell Slepian, Susan T. Tran, Pradeep Chopra, Rachel Neff Greenley. Pain Symptomatology and Management in Pediatric Ehlers–Danlos Syndrome: A Review. Children. 2020; 7 (9):146.

Chicago/Turabian Style

Estée C. H. Feldman; Daniel P. Hivick; P. Maxwell Slepian; Susan T. Tran; Pradeep Chopra; Rachel Neff Greenley. 2020. "Pain Symptomatology and Management in Pediatric Ehlers–Danlos Syndrome: A Review." Children 7, no. 9: 146.

Research article
Published: 11 August 2020 in Psychology & Health
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Daily hassles and physical health complaints are common among undergraduate students, and both are related to negative academic and psychosocial outcomes. However, the extent to which hassles or health complaints persist from day to day is underexplored, and studies examining whether hassles predict health complaints or vice versa, are lacking. This study aimed to examine the temporal stability and to define the temporal relationship between daily hassles and health symptoms in undergraduate students. Participants (n = 255, mean age = 19.2 years, 69% female, 53% White) completed 14 consecutive daily diaries of hassles and health complaints. Daily reports of the Brief College Students Hassles Scale and the Patient Health Questionnaire-15. Hassles and health complaints demonstrated stability through autocorrelations. Hassles significantly predicted subsequent health complaints, but health complaints did not significantly predict subsequent hassles. However, the two paths did not differ significantly. Students reporting elevations in one or both domains may benefit from interventions aimed at reducing daily hassles, in order to promote better perceived health and well-being.

ACS Style

Susan T. Tran; Karolina Grotkowski; Steven A. Miller; Brandon W. Reed; Marissa L. Koven; Joanna Buscemi; Rachel Neff Greenley. Hassles predict physical health complaints in undergraduate students: a dynamic structural equation model analysis of daily diary data. Psychology & Health 2020, 1 -19.

AMA Style

Susan T. Tran, Karolina Grotkowski, Steven A. Miller, Brandon W. Reed, Marissa L. Koven, Joanna Buscemi, Rachel Neff Greenley. Hassles predict physical health complaints in undergraduate students: a dynamic structural equation model analysis of daily diary data. Psychology & Health. 2020; ():1-19.

Chicago/Turabian Style

Susan T. Tran; Karolina Grotkowski; Steven A. Miller; Brandon W. Reed; Marissa L. Koven; Joanna Buscemi; Rachel Neff Greenley. 2020. "Hassles predict physical health complaints in undergraduate students: a dynamic structural equation model analysis of daily diary data." Psychology & Health , no. : 1-19.

Journal article
Published: 01 January 2020 in The Journal of Pain
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Research in adult populations indicates that several sociodemographic and environmental variables increase risk for pain and poor outcomes. There is little research exploring the impact of household income, health insurance coverage, barriers to health care, neighborhood and school safety, violence experienced, and neighborhood isolation on pediatric chronic pain. Data from the Add Health Study, a longitudinal examination of a nationally-representative adolescent sample were analyzed. The relationships between demographic variables, risk factors, chronic pain, and long-term health outcomes were examined. Adolescents with chronic pain had lower income, more health care barriers, greater safety concerns, and experienced more violence compared to those without pain. In a model together, female sex, White race/ethnicity, and greater health care barriers, safety concerns, and violence exposure conferred significant risk for chronic pain. Additional analyses revealed nuances in the strength of risk factors between racial/ethnic groups. Systemic health care barriers were significantly associated with chronic pain and may delay symptom alleviation and return to functioning. Considering access to care is necessary in prevention efforts. Among adolescents with chronic pain, greater safety concerns predicted poor mental health outcomes, particularly for White females. The cumulative stress of environmental concerns, such as safety, and managing chronic pain may worsen functioning. PERSPECTIVE: Adolescents with chronic pain had lower income, and more health care barriers, safety concerns, and violence exposure compared to those without chronic pain. Access to care is a significant problem in youth with chronic pain. The relationships between race/ethnicity, risk factors, and health outcomes are complex and require additional research.

ACS Style

Susan T. Tran; Marissa L. Koven; Ashley S. Castro; Ana B. Goya Arce; Jocelyn S. Carter. Sociodemographic and Environmental Factors are Associated with Adolescents’ Pain and Longitudinal Health Outcomes. The Journal of Pain 2020, 21, 170 -181.

AMA Style

Susan T. Tran, Marissa L. Koven, Ashley S. Castro, Ana B. Goya Arce, Jocelyn S. Carter. Sociodemographic and Environmental Factors are Associated with Adolescents’ Pain and Longitudinal Health Outcomes. The Journal of Pain. 2020; 21 (1-2):170-181.

Chicago/Turabian Style

Susan T. Tran; Marissa L. Koven; Ashley S. Castro; Ana B. Goya Arce; Jocelyn S. Carter. 2020. "Sociodemographic and Environmental Factors are Associated with Adolescents’ Pain and Longitudinal Health Outcomes." The Journal of Pain 21, no. 1-2: 170-181.

Journal article
Published: 01 August 2019 in Journal of Child Health Care
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Hypermobile Ehlers–Danlos syndrome (hEDS), a genetic connective tissue disorder, involves several body systems which makes symptom management and functioning difficult. The aim of this study was to understand pediatric hEDS patients’ symptoms and primary complaints. Additionally, we examined the cumulative impact of symptoms on physical and psychological functioning. Thirty-four youth with hEDS were recruited from a genetics clinic and reported the hardest thing about having hEDS, their pain, fatigue, physical symptoms, functional disability, anxiety, and depression. Physical symptoms (pain and fatigue) and limitations (keeping up with friends) were reported as the most difficult parts of having hEDS. A higher number of somatic symptoms was the strongest predictor of disability, anxiety, and depression. Physical symptoms are subjectively distressing and significantly related to impairments in physical and psychological functioning. Thus, addressing these varied symptoms in treatment may yield better functioning in youth with hEDS.

ACS Style

Susan T Tran; Anjana Jagpal; Marissa L Koven; Carolyn E Turek; Julia S Golden; Brad T Tinkle. Symptom complaints and impact on functioning in youth with hypermobile Ehlers–Danlos syndrome. Journal of Child Health Care 2019, 24, 444 -457.

AMA Style

Susan T Tran, Anjana Jagpal, Marissa L Koven, Carolyn E Turek, Julia S Golden, Brad T Tinkle. Symptom complaints and impact on functioning in youth with hypermobile Ehlers–Danlos syndrome. Journal of Child Health Care. 2019; 24 (3):444-457.

Chicago/Turabian Style

Susan T Tran; Anjana Jagpal; Marissa L Koven; Carolyn E Turek; Julia S Golden; Brad T Tinkle. 2019. "Symptom complaints and impact on functioning in youth with hypermobile Ehlers–Danlos syndrome." Journal of Child Health Care 24, no. 3: 444-457.

Research paper
Published: 16 October 2018 in Pain
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Juvenile-onset fibromyalgia (JFM) is typically diagnosed in adolescence and characterized by widespread pain and marked functional impairment. The long-term impact of JFM into adulthood is poorly understood. The objectives of this study were to describe physical and psychosocial outcomes of youth diagnosed with JFM in early adulthood (∼8-year follow-up), examine longitudinal trajectories of pain and depressive symptoms from adolescence to young adulthood, and examine the impact of pain and depressive symptoms on physical functioning over time. Participants were 97 youth with JFM enrolled in a prospective longitudinal study in which pain symptoms, and physical and psychosocial functioning were assessed at 4 time points over approximately 8 years. At the time 4 follow-up (Mage = 24.2 years), the majority continued to suffer from pain and impairment in physical, social, and psychological domains. However, trajectories of pain and emotional symptoms showed varying patterns. Longitudinal analysis using growth mixture modeling revealed 2 pain trajectories (Steady Improvement and Rapid Rebounding Improvement), whereas depressive symptoms followed 3 distinct trajectories (Low-Stable, Improving, and Worsening). Membership in the Worsening Depressive symptoms group was associated with poorer physical functioning over time (P < 0.001) compared with the Low-Stable and Improving groups. This study offers evidence that although JFM symptoms persist for most individuals, pain severity tends to decrease over time. However, depressive symptoms follow distinct trajectories that indicate subgroups of JFM. In particular, JFM patients with worsening depressive symptoms showed decreasing physical functioning and may require more intensive and consistent intervention to prevent long-term disability.

ACS Style

Susmita Kashikar-Zuck; Natoshia Cunningham; James Peugh; William R. Black; Sarah Nelson; Anne M. Lynch-Jordan; Megan Pfeiffer; Susan T. Tran; Tracy V. Ting; Lesley M. Arnold; Adam Carle; Jennie Noll; Scott W. Powers; Daniel J. Lovell. Long-term outcomes of adolescents with juvenile-onset fibromyalgia into adulthood and impact of depressive symptoms on functioning over time. Pain 2018, 160, 433 -441.

AMA Style

Susmita Kashikar-Zuck, Natoshia Cunningham, James Peugh, William R. Black, Sarah Nelson, Anne M. Lynch-Jordan, Megan Pfeiffer, Susan T. Tran, Tracy V. Ting, Lesley M. Arnold, Adam Carle, Jennie Noll, Scott W. Powers, Daniel J. Lovell. Long-term outcomes of adolescents with juvenile-onset fibromyalgia into adulthood and impact of depressive symptoms on functioning over time. Pain. 2018; 160 (2):433-441.

Chicago/Turabian Style

Susmita Kashikar-Zuck; Natoshia Cunningham; James Peugh; William R. Black; Sarah Nelson; Anne M. Lynch-Jordan; Megan Pfeiffer; Susan T. Tran; Tracy V. Ting; Lesley M. Arnold; Adam Carle; Jennie Noll; Scott W. Powers; Daniel J. Lovell. 2018. "Long-term outcomes of adolescents with juvenile-onset fibromyalgia into adulthood and impact of depressive symptoms on functioning over time." Pain 160, no. 2: 433-441.

Journal article
Published: 04 July 2018 in Children
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Obesity negatively impacts the kinematics and kinetics of the lower extremities in children and adolescents. Although yoga has the potential to provide several distinct benefits for children with obesity, this is the first study to examine the benefits of yoga for gait (primary outcome) in youths with obesity. Secondary outcomes included health-related quality of life (HRQoL), physical activity, and pain. Feasibility and acceptability were also assessed. Nine youths (11–17 years) participated in an eight-week Iyengar yoga intervention (bi-weekly 1-h classes). Gait, HRQOL (self and parent-proxy reports), and physical activity were assessed at baseline and post-yoga. Pain was self-reported at the beginning of each class. Significant improvements were found in multiple gait parameters, including hip, knee, and ankle motion and moments. Self-reported and parent-proxy reports of emotional functioning significantly improved. Time spent in physical activity and weight did not change. This study demonstrates that a relatively brief, non-invasive Iyengar yoga intervention can result in improved malalignment of the lower extremities during ambulation, as well as in clinically meaningful improvements in emotional functioning. This study extends current evidence that supports a role for yoga in pediatric obesity.

ACS Style

Keri R. Hainsworth; Xue Cheng Liu; Pippa M. Simpson; Ann M. Swartz; Nina Linneman; Susan T. Tran; Gustavo R. Medrano; Bryant Mascarenhas; Liyun Zhang; Steven J. Weisman. A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning. Children 2018, 5, 92 .

AMA Style

Keri R. Hainsworth, Xue Cheng Liu, Pippa M. Simpson, Ann M. Swartz, Nina Linneman, Susan T. Tran, Gustavo R. Medrano, Bryant Mascarenhas, Liyun Zhang, Steven J. Weisman. A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning. Children. 2018; 5 (7):92.

Chicago/Turabian Style

Keri R. Hainsworth; Xue Cheng Liu; Pippa M. Simpson; Ann M. Swartz; Nina Linneman; Susan T. Tran; Gustavo R. Medrano; Bryant Mascarenhas; Liyun Zhang; Steven J. Weisman. 2018. "A Pilot Study of Iyengar Yoga for Pediatric Obesity: Effects on Gait and Emotional Functioning." Children 5, no. 7: 92.

Journal article
Published: 22 July 2016 in Pediatric Rheumatology
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Adolescents with juvenile fibromyalgia (JFM) tend to be very sedentary and avoid participation in physical activity. A prior study suggested that JFM patients show altered biomechanics compared to healthy adolescents which may make them more prone to pain/injury during exercise. A new intervention combining well established cognitive behavioral therapy (CBT) techniques with specialized neuromuscular exercise —Fibromyalgia Integrative Training for Teens (FIT Teens) was developed and shown to be promising in improving functioning in adolescents with JFM. In contrast to traditional exercise programs such as aerobic or resistance training, neuromuscular training is a tailored approach which targets gait, posture, balance and movement mechanics which form the foundation for safe exercise participation with reduced risk for injury or pain (and hence more tolerable by JFM patients). The aim of this pilot feasibility study was to establish whether objective biomechanical assessment including sophisticated 3-D motion analysis would be useful in measuring improvements in strength, balance, gait, and functional performance after participation in the 8-week FIT Teens program. Eleven female participants with JFM (ages 12–18 years) completed pre- and post-treatment assessments of biomechanics, including walking gait analysis, lower extremity strength assessment, functional performance, and dynamic postural stability. Descriptive data indicated that mechanics of walking gait and functional performance appeared to improve after treatment. Hip abduction strength and dynamic postural control also demonstrated improvements bilaterally. Overall, the results of this pilot study offer initial evidence for the utility of biomechanical assessment to objectively demonstrate observable changes in biomechanical performance after an integrated training intervention for youth with JFM. If replicated in larger controlled studies, findings would suggest that through the FIT Teens intervention, adolescents with JFM can progress towards normalized strength and biomechanics, which may enhance their ability to engage in physical exercise.

ACS Style

Susan T. Tran; Staci Thomas; Christopher Dicesare; Megan Pfeiffer; Soumitri Sil; Tracy V. Ting; Sara E. Williams; Gregory D. Myer; Susmita Kashikar-Zuck. A pilot study of biomechanical assessment before and after an integrative training program for adolescents with juvenile fibromyalgia. Pediatric Rheumatology 2016, 14, 1 -10.

AMA Style

Susan T. Tran, Staci Thomas, Christopher Dicesare, Megan Pfeiffer, Soumitri Sil, Tracy V. Ting, Sara E. Williams, Gregory D. Myer, Susmita Kashikar-Zuck. A pilot study of biomechanical assessment before and after an integrative training program for adolescents with juvenile fibromyalgia. Pediatric Rheumatology. 2016; 14 (1):1-10.

Chicago/Turabian Style

Susan T. Tran; Staci Thomas; Christopher Dicesare; Megan Pfeiffer; Soumitri Sil; Tracy V. Ting; Sara E. Williams; Gregory D. Myer; Susmita Kashikar-Zuck. 2016. "A pilot study of biomechanical assessment before and after an integrative training program for adolescents with juvenile fibromyalgia." Pediatric Rheumatology 14, no. 1: 1-10.

Pediatric rheumatology
Published: 22 June 2016 in Arthritis Care & Research
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Objective Cognitive–behavioral therapy (CBT) is effective in reducing disability among youth with juvenile fibromyalgia (FM); however, engagement in moderate to vigorous physical activity remains poor, even after CBT. The purpose of this study was to evaluate the feasibility and preliminary outcomes of an innovative program combining CBT with specialized neuromuscular exercise: the Fibromyalgia Integrative Training for Teens (FIT Teens) program. Methods Adolescents with juvenile FM (n = 22, all female, ages 12–18 years) from 2 urban children's hospitals participated in the 8‐week FIT Teens intervention. Participants completed measures of pain intensity, functional disability, depressive symptoms, pain catastrophizing, fear of movement, and readiness to change at baseline and after the intervention. Results The feasibility of the intervention across 2 sites was documented, including high retention rates (80%). Participants showed significant decreases in functional disability (P < 0.05), depression (P < 0.001), fear of movement (P < 0.01), and pain catastrophizing (P < 0.001) from pre‐ to postintervention. Results of the readiness to change measure indicated a significant decrease in precontemplation (P < 0.01) and increase in action/maintenance scores (P < 0.001). All results demonstrated medium to large effect sizes. Conclusion Adolescents with juvenile FM reported significant improvements in physical function and reduced fear of movement following the intervention. Improvement in physical function was achieved in a shorter time frame than in a prior trial of CBT without an exercise component. Further work is needed to compare the FIT Teens program with existing approaches and determine whether objective changes in exercise participation are achieved.

ACS Style

Susan T. Tran; Jessica Guite; Ashley Pantaleao; Megan Pfeiffer; Gregory D. Myer; Soumitri Sil; Staci M. Thomas; Tracy V. Ting; Sara E. Williams; Barbara Edelheit; Sylvia Ounpuu; Jennifer Rodriguez-MacClintic; Lawrence Zemel; William Zempsky; Susmita Kashikar-Zuck. Preliminary Outcomes of a Cross-Site Cognitive-Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia. Arthritis Care & Research 2016, 69, 413 -420.

AMA Style

Susan T. Tran, Jessica Guite, Ashley Pantaleao, Megan Pfeiffer, Gregory D. Myer, Soumitri Sil, Staci M. Thomas, Tracy V. Ting, Sara E. Williams, Barbara Edelheit, Sylvia Ounpuu, Jennifer Rodriguez-MacClintic, Lawrence Zemel, William Zempsky, Susmita Kashikar-Zuck. Preliminary Outcomes of a Cross-Site Cognitive-Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia. Arthritis Care & Research. 2016; 69 (3):413-420.

Chicago/Turabian Style

Susan T. Tran; Jessica Guite; Ashley Pantaleao; Megan Pfeiffer; Gregory D. Myer; Soumitri Sil; Staci M. Thomas; Tracy V. Ting; Sara E. Williams; Barbara Edelheit; Sylvia Ounpuu; Jennifer Rodriguez-MacClintic; Lawrence Zemel; William Zempsky; Susmita Kashikar-Zuck. 2016. "Preliminary Outcomes of a Cross-Site Cognitive-Behavioral and Neuromuscular Integrative Training Intervention for Juvenile Fibromyalgia." Arthritis Care & Research 69, no. 3: 413-420.

Journal article
Published: 01 April 2016 in The Journal of Pain
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Chronic pain is highly prevalent in pediatric populations with up to two thirds of these patients experiencing co-occurring anxiety disorders. A frequent treatment modality for these individuals is cognitive behavioral therapy (CBT). Referrals to CBT from pain management are often provided from a multidisciplinary care clinic where a psychologist serves as part of the team. While pain-focused CBT improves pain and disability, it remains ineffective for a significant portion of youth with chronic pain and it is unknown what factors drive treatment response. Despite the high prevalence of anxiety in pediatric pain populations, its role in treatment response to CBT has not been systematically investigated. Thus, the current study evaluated the role of clinically significant anxiety in treatment response to CBT (pain and disability) in a clinical sample of youth ages 8-18 with chronic pain. Measures of anxiety (The Screen for Anxiety Related Emotional Disorders), were given at an initial pain clinic evaluation and measures of pain and disability (Functional Disability Inventory) were completed at the initial evaluation and at the end of CBT. Of the 140 children recommended for CBT, 76 never initiated CBT, 34 initiated CBT, but then dropped out, and 30 completed CBT for chronic pain. Results indicated that youth with clinically significant anxiety were more likely to start and/or complete pain focused CBT (57.4%) compared to those with subclinical levels of anxiety (36.7%; X2 = 5.92, p < 0.05). Further, the non-anxious group exhibited a substantial reduction in pain intensity while the anxious group exhibited limited response to treatment (F = 8.75, p <0.01). Differences in reductions in functional disability between groups were non-significant. The findings suggest that anxiety drives treatment response in pediatric chronic pain and a more tailored approach to CBT for youth with chronic pain and comorbid anxiety may improve patient outcomes.

ACS Style

A. Jagpal; S. Nelson; S. Tran; S. Kashikar-Zuck; K. Goldschneider; A. Lynch-Jordan; R. Coghill; N. Cunningham. (515) The role of anxiety in youth with chronic pain undergoing cognitive behavioral therapy. The Journal of Pain 2016, 17, S103 .

AMA Style

A. Jagpal, S. Nelson, S. Tran, S. Kashikar-Zuck, K. Goldschneider, A. Lynch-Jordan, R. Coghill, N. Cunningham. (515) The role of anxiety in youth with chronic pain undergoing cognitive behavioral therapy. The Journal of Pain. 2016; 17 (4):S103.

Chicago/Turabian Style

A. Jagpal; S. Nelson; S. Tran; S. Kashikar-Zuck; K. Goldschneider; A. Lynch-Jordan; R. Coghill; N. Cunningham. 2016. "(515) The role of anxiety in youth with chronic pain undergoing cognitive behavioral therapy." The Journal of Pain 17, no. 4: S103.

Journal article
Published: 01 March 2016 in Clinical Practice in Pediatric Psychology
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ACS Style

Susan T. Tran; Kristen E. Jastrowski Mano; Kim Anderson Khan; W. Hobart Davies; Keri R. Hainsworth. Patterns of anxiety symptoms in pediatric chronic pain as reported by youth, mothers, and fathers. Clinical Practice in Pediatric Psychology 2016, 4, 51 -62.

AMA Style

Susan T. Tran, Kristen E. Jastrowski Mano, Kim Anderson Khan, W. Hobart Davies, Keri R. Hainsworth. Patterns of anxiety symptoms in pediatric chronic pain as reported by youth, mothers, and fathers. Clinical Practice in Pediatric Psychology. 2016; 4 (1):51-62.

Chicago/Turabian Style

Susan T. Tran; Kristen E. Jastrowski Mano; Kim Anderson Khan; W. Hobart Davies; Keri R. Hainsworth. 2016. "Patterns of anxiety symptoms in pediatric chronic pain as reported by youth, mothers, and fathers." Clinical Practice in Pediatric Psychology 4, no. 1: 51-62.

Journal article
Published: 12 February 2016 in The Journal of Pediatrics
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To evaluate whether clinical anxiety in children presenting to a pediatric pain management center is associated with a poorer treatment response for those who completed pain-focused cognitive behavioral therapy (CBT). The total sample consisted of 175 children, 40 of whom completed CBT for chronic pain. The Screen for Child Anxiety Related Emotional Disorders was completed at initial evaluation and outcome measures (average pain intensity and the Functional Disability Inventory) were collected during the initial evaluation and at the end of CBT. Group differences in outcomes were examined following CBT. The role of anxiety in CBT initiation and completion was also explored. Presence of clinical anxiety was associated with greater initiation and/or completion of pain-focused CBT but also a poorer treatment response. Specifically, the group with subclinical anxiety exhibited a substantial reduction in pain intensity, and the group with clinical anxiety exhibited a more limited response to treatment (F [1, 36] = 13.68 P < .01). A similar effect was observed for Functional Disability Inventory, such that the group with clinical anxiety had a significantly smaller response to treatment (F [1, 38] = 4.33 P < .05). The difference in pain and disability between groups following CBT suggest moderate effects (Cohen d = 0.77 and 0.78, respectively). Although youths with clinical anxiety are more likely to start and/or complete pain-focused CBT, anxiety has an adverse impact on CBT treatment response in children with chronic pain. Identification of patients with anxiety and use of tailored behavioral interventions may improve clinical outcomes.

ACS Style

Natoshia Raishevich Cunningham; Anjana Jagpal; Susan Tran; Susmita Kashikar-Zuck; Kenneth R. Goldschneider; Robert C. Coghill; Anne M. Lynch-Jordan. Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain. The Journal of Pediatrics 2016, 171, 227 -233.

AMA Style

Natoshia Raishevich Cunningham, Anjana Jagpal, Susan Tran, Susmita Kashikar-Zuck, Kenneth R. Goldschneider, Robert C. Coghill, Anne M. Lynch-Jordan. Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain. The Journal of Pediatrics. 2016; 171 ():227-233.

Chicago/Turabian Style

Natoshia Raishevich Cunningham; Anjana Jagpal; Susan Tran; Susmita Kashikar-Zuck; Kenneth R. Goldschneider; Robert C. Coghill; Anne M. Lynch-Jordan. 2016. "Anxiety Adversely Impacts Response to Cognitive Behavioral Therapy in Children with Chronic Pain." The Journal of Pediatrics 171, no. : 227-233.

Original articles
Published: 01 January 2016 in The Clinical Journal of Pain
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Objectives: Adolescents with juvenile fibromyalgia (JFM) are typically sedentary despite recommendations for physical exercise, a key component of pain management. Interventions such as cognitive-behavior therapy (CBT) are beneficial but do not improve exercise participation. The objective of this study was to obtain preliminary information about the feasibility, safety, and acceptability of a new intervention—Fibromyalgia Integrative Training for Teens (FIT Teens), which combines CBT with specialized neuromuscular exercise training modified from evidence-based injury prevention protocols. Materials and Methods: Participants were 17 adolescent females (aged 12 to 18 y) with JFM. Of these, 11 completed the 8-week (16 sessions) FIT Teens program in a small-group format with 3 to 4 patients per group. Patients provided detailed qualitative feedback via individual semistructured interviews after treatment. Interview content was coded using thematic analysis. Interventionist feedback about treatment implementation was also obtained. Results: The intervention was found to be feasible, well tolerated, and safe for JFM patients. Barriers to enrollment (50% of those approached) included difficulties with transportation or time conflicts. Treatment completers enjoyed the group format and reported increased self-efficacy, strength, and motivation to exercise. Participants also reported decreased pain and increased energy levels. Feedback from participants and interventionists was incorporated into a final treatment manual to be used in a future trial. Discussion: Results of this study provided initial support for the new FIT Teens program. An integrative strategy of combining pain coping skills via CBT enhanced with tailored exercise specifically designed to improve confidence in movement and improving activity participation holds promise in the management of JFM.

ACS Style

Susmita Kashikar-Zuck; Susan Tran; Kimberly Barnett; Maggie H. Bromberg; Daniel Strotman; Soumitri Sil; Staci M. Thomas; Naomi Joffe; Tracy V. Ting; Sara E. Williams; Gregory D. Myer. A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia. The Clinical Journal of Pain 2016, 32, 70 -81.

AMA Style

Susmita Kashikar-Zuck, Susan Tran, Kimberly Barnett, Maggie H. Bromberg, Daniel Strotman, Soumitri Sil, Staci M. Thomas, Naomi Joffe, Tracy V. Ting, Sara E. Williams, Gregory D. Myer. A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia. The Clinical Journal of Pain. 2016; 32 (1):70-81.

Chicago/Turabian Style

Susmita Kashikar-Zuck; Susan Tran; Kimberly Barnett; Maggie H. Bromberg; Daniel Strotman; Soumitri Sil; Staci M. Thomas; Naomi Joffe; Tracy V. Ting; Sara E. Williams; Gregory D. Myer. 2016. "A Qualitative Examination of a New Combined Cognitive-Behavioral and Neuromuscular Training Intervention for Juvenile Fibromyalgia." The Clinical Journal of Pain 32, no. 1: 70-81.

Original articles
Published: 01 October 2015 in The Clinical Journal of Pain
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Objectives: The relationships among chronic pain, anxiety, and school functioning are complex, and school functioning is often negatively impacted in youth with chronic pain. The objective of this study was to empirically test a model of associations between constructs predicting school functioning in youth with chronic pain to examine the direct effect of anxiety on school attendance and other indicators of school-related disability. Materials and Methods: Participants included 349 youth and their parents (311 mothers and 162 fathers) who attended a multidisciplinary pain clinic. Youth, mothers, fathers, and clinicians completed assessments of clinical outcomes important to family and clinician perceptions of school functioning; youth, mothers, and fathers completed an assessment of youth anxiety. Structural equation modeling was used to examine interrelations among predictors. Results: Measurement and structural models for predicting youth school functioning provided a very good fit of the data to the conceptual model. Anxiety was directly related to problems with school attendance and avoidance, concentration, and keeping up with schoolwork. Discussion: Anxiety was a robust predictor of school functioning across a range of domains. Evaluating anxiety symptoms in pediatric chronic pain will likely facilitate case conceptualization and treatment planning. This study supports a shift in focus from pain to anxiety as the driving force of school impairment in youth with chronic pain.

ACS Style

Kim Anderson Khan; Susan T. Tran; Kristen E. Jastrowski Mano; Pippa M. Simpson; Yumei Cao; Keri R. Hainsworth. Predicting Multiple Facets of School Functioning in Pediatric Chronic Pain. The Clinical Journal of Pain 2015, 31, 867 -875.

AMA Style

Kim Anderson Khan, Susan T. Tran, Kristen E. Jastrowski Mano, Pippa M. Simpson, Yumei Cao, Keri R. Hainsworth. Predicting Multiple Facets of School Functioning in Pediatric Chronic Pain. The Clinical Journal of Pain. 2015; 31 (10):867-875.

Chicago/Turabian Style

Kim Anderson Khan; Susan T. Tran; Kristen E. Jastrowski Mano; Pippa M. Simpson; Yumei Cao; Keri R. Hainsworth. 2015. "Predicting Multiple Facets of School Functioning in Pediatric Chronic Pain." The Clinical Journal of Pain 31, no. 10: 867-875.

Journal article
Published: 02 April 2015 in Journal of Pediatric Psychology
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Objectives Examine whether anxiety and pain catastrophizing are distinct constructs in relation to functional outcomes in pediatric chronic pain, and whether they differentially predict functional outcomes based on age. Methods In all, 725 youth (191 children, 534 adolescents) with chronic pain completed measures of pain characteristics, anxiety, pain catastrophizing, functional disability, and health-related quality of life (HRQOL). Structural equation modeling was used to examine interrelationships. Results Anxiety and pain catastrophizing were distinct. For both children and adolescents, pain catastrophizing predicted pain, functional disability, and HRQOL, and was a stronger predictor of pain intensity. For children, anxiety predicted HRQOL, and pain catastrophizing was a stronger predictor of functional disability. For adolescents, anxiety predicted functional disability and HRQOL, and anxiety was a stronger predictor of HRQOL. Conclusions There were age-related differences regarding whether anxiety or pain catastrophizing more strongly predicted specific functional outcomes. Assessment and intervention efforts should emphasize both anxiety and pain catastrophizing.

ACS Style

Susan T. Tran; Kristen E. Jastrowski Mano; Keri R. Hainsworth; Gustavo R. Medrano; PsyD Kimberly Anderson Khan; Steven J. Weisman; W. Hobart Davies. Distinct Influences of Anxiety and Pain Catastrophizing on Functional Outcomes in Children and Adolescents With Chronic Pain. Journal of Pediatric Psychology 2015, 40, 744 -755.

AMA Style

Susan T. Tran, Kristen E. Jastrowski Mano, Keri R. Hainsworth, Gustavo R. Medrano, PsyD Kimberly Anderson Khan, Steven J. Weisman, W. Hobart Davies. Distinct Influences of Anxiety and Pain Catastrophizing on Functional Outcomes in Children and Adolescents With Chronic Pain. Journal of Pediatric Psychology. 2015; 40 (8):744-755.

Chicago/Turabian Style

Susan T. Tran; Kristen E. Jastrowski Mano; Keri R. Hainsworth; Gustavo R. Medrano; PsyD Kimberly Anderson Khan; Steven J. Weisman; W. Hobart Davies. 2015. "Distinct Influences of Anxiety and Pain Catastrophizing on Functional Outcomes in Children and Adolescents With Chronic Pain." Journal of Pediatric Psychology 40, no. 8: 744-755.

Journal article
Published: 01 January 2015 in Clinical Practice in Pediatric Psychology
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ACS Style

Anne M. Lynch-Jordan; Soumitri Sil; Natoshia Raishevich Cunningham; Naomi Joffe; Shalonda K. Slater; Susan T. Tran; Lori E. Crosby. Measuring treatment response in an outpatient pediatric pain program. Clinical Practice in Pediatric Psychology 2015, 3, 1 -11.

AMA Style

Anne M. Lynch-Jordan, Soumitri Sil, Natoshia Raishevich Cunningham, Naomi Joffe, Shalonda K. Slater, Susan T. Tran, Lori E. Crosby. Measuring treatment response in an outpatient pediatric pain program. Clinical Practice in Pediatric Psychology. 2015; 3 (1):1-11.

Chicago/Turabian Style

Anne M. Lynch-Jordan; Soumitri Sil; Natoshia Raishevich Cunningham; Naomi Joffe; Shalonda K. Slater; Susan T. Tran; Lori E. Crosby. 2015. "Measuring treatment response in an outpatient pediatric pain program." Clinical Practice in Pediatric Psychology 3, no. 1: 1-11.

Research article
Published: 12 August 2013 in Journal of Child Health Care
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The purpose of this study is to examine prevalence rates of pain reports in youth with type 1 diabetes mellitus (T1DM) and potential predictors of pain. Pain is a common and debilitating symptom of diabetic polyneuropathies. There is currently little research regarding pain in youth with T1DM. It was predicted that self-care and general health factors would predict pain as suggested by the general pain literature. Participants ( N = 269) ranged in age from 13 to 17 years; youth had a mean time since diagnosis of 5.8 years. Data collected included diabetes self-management variables, ratings of the patient’s current functioning and pain intensity (‘current’), and information collected about experiences that occurred in the time preceding each appointment (‘interim’). About half of the youth ( n = 121, 49.0%) reported any interim pain across both appointments. Female adolescents and those individuals who were physically active and/or utilized health-care system more acutely were more likely to report interim central nervous system pain. Improved diabetes self-management and increased level of physical activity may reduce experiences of pain and increase the quality of life of youth with T1DM. Regular monitoring of both current and interim pain experiences of youth with T1DM is recommended.

ACS Style

Susan T Tran; Katherine S Salamon; Keri R Hainsworth; Jessica C Kichler; W Hobart Davies; Steven J Weisman; Ramin Alemzadeh. Pain reports in children and adolescents with type 1 diabetes mellitus. Journal of Child Health Care 2013, 19, 43 -52.

AMA Style

Susan T Tran, Katherine S Salamon, Keri R Hainsworth, Jessica C Kichler, W Hobart Davies, Steven J Weisman, Ramin Alemzadeh. Pain reports in children and adolescents with type 1 diabetes mellitus. Journal of Child Health Care. 2013; 19 (1):43-52.

Chicago/Turabian Style

Susan T Tran; Katherine S Salamon; Keri R Hainsworth; Jessica C Kichler; W Hobart Davies; Steven J Weisman; Ramin Alemzadeh. 2013. "Pain reports in children and adolescents with type 1 diabetes mellitus." Journal of Child Health Care 19, no. 1: 43-52.

Journal article
Published: 01 October 2012 in Journal Of Pediatric Psychology
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Objective The current study examined the associations between catastrophizing and pain intensity, psychological adjustment, functional ability, and community participation in youths with physical disability and chronic pain. Methods Participants consisted of 80 youths, aged 8–20 years, with cerebral palsy (n = 34), neuromuscular disease (n = 22), or spina bifida (n = 24). Measures from a cross-sectional survey included demographic, pain, and disability information, the Pain Catastrophizing Scale, the Child Health Questionnaire, and the Functional Disability Inventory. Results Results suggested that catastrophizing was significantly associated with pain intensity and psychological adjustment; however, catastrophizing did not demonstrate significant associations with functional ability or community participation. Conclusions The study extends previous findings of significant associations between catastrophizing and both pain intensity and psychological adjustment to samples of youths with chronic pain and disabilities not previously examined. Further research that examines the causal association between catastrophizing and outcomes in youths with chronic pain and physical disability is warranted.

ACS Style

Joyce M. Engel; Sylia Wilson; Susan T. Tran; Mark P. Jensen; Marcia Ciol. Pain Catastrophizing in Youths With Physical Disabilities and Chronic Pain. Journal Of Pediatric Psychology 2012, 38, 192 -201.

AMA Style

Joyce M. Engel, Sylia Wilson, Susan T. Tran, Mark P. Jensen, Marcia Ciol. Pain Catastrophizing in Youths With Physical Disabilities and Chronic Pain. Journal Of Pediatric Psychology. 2012; 38 (2):192-201.

Chicago/Turabian Style

Joyce M. Engel; Sylia Wilson; Susan T. Tran; Mark P. Jensen; Marcia Ciol. 2012. "Pain Catastrophizing in Youths With Physical Disabilities and Chronic Pain." Journal Of Pediatric Psychology 38, no. 2: 192-201.

Research article
Published: 21 August 2012 in Pain Research and Treatment
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Chronic and recurrent pain is experienced by many children and adolescents. Treatment of chronic pain using a multidisciplinary approach has been found to be effective for treatment of chronic pain. Parent satisfaction with treatment and treatment providers highly correlates to children’s treatment adherence. Parents of children treated at a multidisciplinary chronic pain clinic were interviewed following their initial appointment. Parents reported high satisfaction with treatment team members and with the treatment plan. Parents also reported appreciation of multidisciplinary structure, the high level of expertise of the team members, and the team members’ genuine interest in treating their children. This increase in satisfaction when compared to previous treatment is important since increases in satisfaction may correlate with a reduction in experiences of chronic pain. Parents reported high satisfaction with interactions with treatment team members and with the treatment plan provided for their children. Parents had appreciation of multidisciplinary team structure and the high level of expertise of the team members. This increase in satisfaction when compared to treatment from previous providers is important since increases in satisfaction may correlate with an increase in children’s treatment adherence and a reduction in experiences of chronic pain.

ACS Style

Ayala Y. Gorodzinsky; Susan Tran; Gustavo R. Medrano; Katie M. Fleischman; Kimberly J. Anderson-Khan; Renee J. Ladwig; Steven J. Weisman. Parents' Initial Perceptions of Multidisciplinary Care for Pediatric Chronic Pain. Pain Research and Treatment 2012, 2012, 1 -9.

AMA Style

Ayala Y. Gorodzinsky, Susan Tran, Gustavo R. Medrano, Katie M. Fleischman, Kimberly J. Anderson-Khan, Renee J. Ladwig, Steven J. Weisman. Parents' Initial Perceptions of Multidisciplinary Care for Pediatric Chronic Pain. Pain Research and Treatment. 2012; 2012 ():1-9.

Chicago/Turabian Style

Ayala Y. Gorodzinsky; Susan Tran; Gustavo R. Medrano; Katie M. Fleischman; Kimberly J. Anderson-Khan; Renee J. Ladwig; Steven J. Weisman. 2012. "Parents' Initial Perceptions of Multidisciplinary Care for Pediatric Chronic Pain." Pain Research and Treatment 2012, no. : 1-9.