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Brenda Golianu
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.

Systematic review
Published: 01 December 2019 in Medicine
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This aim of this study is to assess the effectiveness and safety of acupuncture for the treatment of patients with postoperative pain (PPP). We will carry out a systematic review of the published literature and will comprehensively search Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycINFO, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from inception to the present with no language restrictions. Randomized controlled trials comparing acupuncture with other interventions or sham acupuncture will be included. Two reviewers will independently conduct study selection, data collection, and study quality. A third reviewer will resolve any discrepancies. We will apply RevMan 5.3 software for statistical analysis. The protocol of this study will systematically assess the effectiveness and safety of acupuncture for patients with PPP. The primary outcome is postoperative pain intensity. The secondary outcomes comprise of: analgesic consumption, postoperative recovery parameters, vital signs, quality of life, and treatment related adverse events. This study will summarize the current evidence base for the effectiveness and safety of acupuncture for patients with PPP.

ACS Style

Qinhong Zhang; Jin-Huan Yue; Zhong-Ren Sun; Brenda Golianu. Effectiveness of acupuncture for the treatment of postoperative pain. Medicine 2019, 98, e17606 .

AMA Style

Qinhong Zhang, Jin-Huan Yue, Zhong-Ren Sun, Brenda Golianu. Effectiveness of acupuncture for the treatment of postoperative pain. Medicine. 2019; 98 (49):e17606.

Chicago/Turabian Style

Qinhong Zhang; Jin-Huan Yue; Zhong-Ren Sun; Brenda Golianu. 2019. "Effectiveness of acupuncture for the treatment of postoperative pain." Medicine 98, no. 49: e17606.

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.

Review
Published: 12 December 2018 in Children
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Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable bowel syndrome, acute and chronic pain, headache, and allergy, among others. In light of the growing prevalence of pediatric illnesses and patient complexity, it is crucial to emphasize the patient’s overall well-being. As academic centers around the world start to develop pediatric integrative medicine programs, the aim of this manuscript is to briefly highlight evidence of effective integrative treatments in pediatric subspecialties, to describe the establishment of our integrative medicine program, to summarize its early efforts, and to discuss potential barriers and keys to success.

ACS Style

Gautam Ramesh; Dana Gerstbacher; Jenna Arruda; Brenda Golianu; John Mark; Ann Ming Yeh. Pediatric Integrative Medicine in Academia: Stanford Children’s Experience. Children 2018, 5, 168 .

AMA Style

Gautam Ramesh, Dana Gerstbacher, Jenna Arruda, Brenda Golianu, John Mark, Ann Ming Yeh. Pediatric Integrative Medicine in Academia: Stanford Children’s Experience. Children. 2018; 5 (12):168.

Chicago/Turabian Style

Gautam Ramesh; Dana Gerstbacher; Jenna Arruda; Brenda Golianu; John Mark; Ann Ming Yeh. 2018. "Pediatric Integrative Medicine in Academia: Stanford Children’s Experience." Children 5, no. 12: 168.

Review
Published: 05 December 2018 in Children
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As awareness increases about the side effects of opioids and risks of misuse, opioid use and appropriate weaning of opioid therapies have become topics of significant clinical relevance among pediatric populations. Critically ill hospitalized neonates, children, and adolescents routinely receive opioids for analgesia and sedation as part of their hospitalization, for both acute and chronic illnesses. Opioids are frequently administered to manage pain symptoms, reduce anxiety and agitation, and diminish physiological stress responses. Opioids are also regularly prescribed to youth with chronic pain. These medications may be prescribed during the initial phase of a diagnostic workup, during an emergency room visit; as an inpatient, or on an outpatient basis. Following treatment for underlying pain conditions, it can be challenging to appropriately wean and discontinue opioid therapies. Weaning opioid therapy requires special expertise and care to avoid symptoms of increased pain, withdrawal, and agitation. To address this challenge, there have been enhanced efforts to implement opioid-reduction during pharmacological therapies for pediatric pain management. Effective pain management therapies and their outcomes in pediatrics are outside the scope of this paper. The aims of this paper were to: 1) Review the current practice of opioid-reduction during pharmacological therapies; and 2) highlight concrete opioid weaning strategies and management of opioid withdrawal.

ACS Style

Genevieve D’Souza; Anava A. Wren; Christina Almgren; Alexandra C. Ross; Amanda Marshall; Brenda Golianu. Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use. Children 2018, 5, 163 .

AMA Style

Genevieve D’Souza, Anava A. Wren, Christina Almgren, Alexandra C. Ross, Amanda Marshall, Brenda Golianu. Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use. Children. 2018; 5 (12):163.

Chicago/Turabian Style

Genevieve D’Souza; Anava A. Wren; Christina Almgren; Alexandra C. Ross; Amanda Marshall; Brenda Golianu. 2018. "Pharmacological Strategies for Decreasing Opioid Therapy and Management of Side Effects from Chronic Use." Children 5, no. 12: 163.

Journal article
Published: 22 August 2018 in Pediatric Neurology
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The negative effect of perceived stress on health and wellness has become a cultural epidemic. Despite many health implications, the clinical impact of stress on the nervous system is not well understood. This case series describes the symptom profiles of 80 children with nervous system dysregulation attributed to maladaptive neuroendocrine responses to stress. We performed a retrospective review of 80 children with nervous system dysregulation identified from a single, tertiary care pediatric neurology clinic. Included patients were between 5-17 years of age, with unexplained medical symptoms lasting ≥3-months affecting at least four out of six neurological domains: 1) somatization, 2) executive function, 3) autonomic function, 4) digestion, 5) sleep and 6) emotional regulation. Medical symptoms, diagnoses, and detailed social histories were collected. Out of 80 children, 57 were female (71%), 57 were Caucasian (71%), with median age 14 years. Symptoms had a mean duration of 32-months, and included: 100% somatic symptoms, 100% emotional dysregulation, 92.5% disrupted sleep, 82.5% autonomic dysregulation, 75% executive dysfunction, and 66% digestive problems. Overall, 94% reported chronic or traumatic stressors; adverse childhood experiences were present in 65%. Perceived stress impacts many functions of the neuroendocrine system through experience-dependent plasticity, with clinical consequences including a constellation of functional impairments we describe as nervous system dysregulation. The pathophysiology of these symptoms involves dysregulation of subcortical, hormonal and autonomic circuits, which remain largely untested. Recognition and understanding of maladaptive neurophysiology in stress-related symptoms has important implications for diagnosis, treatment and advances in health research.

ACS Style

Jorina Elbers; Safwan Jaradeh; Ann Ming Yeh; Brenda Golianu. Wired for Threat: Clinical Features of Nervous System Dysregulation in 80 Children. Pediatric Neurology 2018, 89, 39 -48.

AMA Style

Jorina Elbers, Safwan Jaradeh, Ann Ming Yeh, Brenda Golianu. Wired for Threat: Clinical Features of Nervous System Dysregulation in 80 Children. Pediatric Neurology. 2018; 89 ():39-48.

Chicago/Turabian Style

Jorina Elbers; Safwan Jaradeh; Ann Ming Yeh; Brenda Golianu. 2018. "Wired for Threat: Clinical Features of Nervous System Dysregulation in 80 Children." Pediatric Neurology 89, no. : 39-48.

Randomized controlled trial
Published: 01 August 2018 in Pediatric Critical Care Medicine
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The purpose of this pilot study was three-fold: 1) to evaluate the safety and feasibility of instituting massage therapy in the immediate postoperative period after congenital heart surgery, 2) to examine the preliminary results on effects of massage therapy versus standard of care plus three reading visits on postoperative pain and anxiety, and 3) to evaluate preliminary effects of opioid and benzodiazepine exposure in patients receiving massage therapy compared with reading controls. Prospective, randomized controlled trial. An academic children’s hospital. Sixty pediatric heart surgery patients between ages 6 and 18 years. Massage therapy and reading. There were no adverse events related to massage or reading interventions in either group. Our investigation found no statistically significant difference in Pain or State-Trait Anxiety scores in the initial 24 hours after heart surgery (T1) and within 48 hours of transfer to the acute care unit (T2) after controlling for age, gender, and Risk Adjustment for Congenital Heart Surgery 1 score. However, children receiving massage therapy had significantly lower State-Trait Anxiety scores after receiving massage therapy at time of discharge (T3; p = 0.0075) than children receiving standard of care plus three reading visits. We found no difference in total opioid exposure during the first 3 postoperative days between groups (median [interquartile range], 0.80 mg/kg morphine equivalents [0.29–10.60] vs 1.13 mg/kg morphine equivalents [0.72–6.14]). In contrast, children receiving massage therapy had significantly lower total benzodiazepine exposure in the immediate 3 days following heart surgery (median [interquartile range], 0.002 mg/kg lorazepam equivalents [0–0.03] vs 0.03 mg/kg lorazepam equivalents [0.02–0.09], p = 0.0253, Wilcoxon rank-sum) and number of benzodiazepine PRN doses (0.5 [0–2.5] PRN vs 2 PRNs (1–4); p = 0.00346, Wilcoxon rank-sum). Our pilot study demonstrated the safety and feasibility of implementing massage therapy in the immediate postoperative period in pediatric heart surgery patients. We found decreased State-Trait Anxiety scores at discharge and lower total exposure to benzodiazepines. Preventing postoperative complications such as delirium through nonpharmacologic interventions warrants further evaluation.

ACS Style

Sandra L. Staveski; Karen Boulanger; Lee Erman; Li Lin; Christina Almgren; Chloe Journel; Stephen J. Roth; Brenda Golianu. The Impact of Massage and Reading on Children’s Pain and Anxiety After Cardiovascular Surgery. Pediatric Critical Care Medicine 2018, 19, 725 -732.

AMA Style

Sandra L. Staveski, Karen Boulanger, Lee Erman, Li Lin, Christina Almgren, Chloe Journel, Stephen J. Roth, Brenda Golianu. The Impact of Massage and Reading on Children’s Pain and Anxiety After Cardiovascular Surgery. Pediatric Critical Care Medicine. 2018; 19 (8):725-732.

Chicago/Turabian Style

Sandra L. Staveski; Karen Boulanger; Lee Erman; Li Lin; Christina Almgren; Chloe Journel; Stephen J. Roth; Brenda Golianu. 2018. "The Impact of Massage and Reading on Children’s Pain and Anxiety After Cardiovascular Surgery." Pediatric Critical Care Medicine 19, no. 8: 725-732.

Journal article
Published: 23 April 2018 in Children
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It is widely recognized that burnout is prevalent in medical culture and begins early in training. Studies show pediatricians and pediatric trainees experience burnout rates comparable to other specialties. Newly developed Accreditation Council for Graduate Medical Education (ACGME) core competencies in professionalism and personal development recognize the unacceptably high resident burnout rates and present an important opportunity for programs to improve residents experience throughout training. These competencies encourage healthy lifestyle practices and cultivation of self-awareness, self-regulation, empathy, mindfulness, and compassion—a paradigm shift from traditional medical training underpinned by a culture of unrealistic endurance and self-sacrifice. To date, few successful and sustainable programs in resident burnout prevention and wellness promotion have been described. The University of Arizona Center for Integrative Medicine Pediatric Integrative Medicine in Residency (PIMR) curriculum, developed in 2011, was designed in part to help pediatric programs meet new resident wellbeing requirements. The purpose of this paper is to detail levels of lifestyle behaviors, burnout, and wellbeing for the PIMR program’s first-year residents (N = 203), and to examine the impact of lifestyle behaviors on burnout and wellbeing. The potential of the PIMR to provide interventions addressing gaps in lifestyle behaviors with recognized association to burnout is discussed.

ACS Style

Hilary McClafferty; Audrey J. Brooks; Mei-Kuang Chen; Michelle Brenner; Melanie Brown; Anna Esparham; Dana Gerstbacher; Brenda Golianu; John Mark; Joy Weydert; Ann Ming Yeh; Victoria Maizes. Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents. Children 2018, 5, 54 .

AMA Style

Hilary McClafferty, Audrey J. Brooks, Mei-Kuang Chen, Michelle Brenner, Melanie Brown, Anna Esparham, Dana Gerstbacher, Brenda Golianu, John Mark, Joy Weydert, Ann Ming Yeh, Victoria Maizes. Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents. Children. 2018; 5 (4):54.

Chicago/Turabian Style

Hilary McClafferty; Audrey J. Brooks; Mei-Kuang Chen; Michelle Brenner; Melanie Brown; Anna Esparham; Dana Gerstbacher; Brenda Golianu; John Mark; Joy Weydert; Ann Ming Yeh; Victoria Maizes. 2018. "Pediatric Integrative Medicine in Residency Program: Relationship between Lifestyle Behaviors and Burnout and Wellbeing Measures in First-Year Residents." Children 5, no. 4: 54.

Review
Published: 01 March 2018 in Medicine
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Several studies suggest that local warming therapy (LWT) may help to treat chronic wounds, such as pressure ulcers, venous ulcers, arterial ulcers, and diabetic foot ulcers. However, evidence supporting the efficacy of this treatment is still incomplete. This study aimed to assess the effects of LWT in treating chronic wounds. For this review, we searched the Cochrane Wounds Specialized Register (March 6, 2017); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2017 issue 3); Ovid MEDLINE (1946 to March 6, 2017); Ovid Embase (1974 to March 6, 2017); EBSCO CINAHL (1982 to March 6, 2017); Chinese Biomedical Literature Database (1980 to March 20, 2017); China National Knowledge Infrastructure (1980 to March 20, 2017); VIP Information (1980 to March 20, 2017) (Chinese Database); and Wanfang Data (1980 to March 20, 2017). We did not apply date or language restrictions. Published or unpublished randomized controlled trials (RCTs) analyzing the effects of LWT in the treatment of chronic wounds (pressure ulcers, venous ulcers, arterial ulcers, and diabetic foot ulcers) were screened and selected. Two review authors independently conducted study selection, we planned that 2 review authors would also assess risk of bias and extract study data. No studies (RCTs) met the inclusion criteria for this review. Thus, it was impossible to undertake a meta-analysis or a narrative description of studies. The effects of LWT for treating chronic wounds are unclear because we did not identify any studies that met the inclusion criteria for this review. Quality improvement for LWT trials is urgently needed.

ACS Style

Jin-Huan Yue; Shi-Jun Zhang; Qi Sun; Zhong-Ren Sun; Xin-Xin Wang; Brenda Golianu; Ying Lu; Qinhong Zhang. Local warming therapy for treating chronic wounds. Medicine 2018, 97, e9931 .

AMA Style

Jin-Huan Yue, Shi-Jun Zhang, Qi Sun, Zhong-Ren Sun, Xin-Xin Wang, Brenda Golianu, Ying Lu, Qinhong Zhang. Local warming therapy for treating chronic wounds. Medicine. 2018; 97 (12):e9931.

Chicago/Turabian Style

Jin-Huan Yue; Shi-Jun Zhang; Qi Sun; Zhong-Ren Sun; Xin-Xin Wang; Brenda Golianu; Ying Lu; Qinhong Zhang. 2018. "Local warming therapy for treating chronic wounds." Medicine 97, no. 12: e9931.

Journal article
Published: 07 December 2017 in Children
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Behavioral health interventions for pediatric chronic pain include cognitive-behavioral (CBT), acceptance and commitment (ACT), and family-based therapies, though literature regarding multi-family therapy (MFT) is sparse. This investigation examined the utility and outcomes of the Courage to Act with Pain: Teens Identifying Values, Acceptance, and Treatment Effects (CAPTIVATE) program, which included all three modalities (CBT, ACT, MFT) for youth with chronic pain and their parents. Program utility, engagement, and satisfaction were evaluated via quantitative and qualitative feedback. Pain-specific psychological, behavioral, and interpersonal processes were examined along with outcomes related to disability, quality of life, pain interference, fatigue, anxiety, and depressive symptoms. Participants indicated that CAPTIVATE was constructive, engaging, and helpful for social and family systems. Clinical and statistical improvements with large effect sizes were captured for pain catastrophizing, acceptance, and protective parenting but not family functioning. Similar effects were found for functional disability, pain interference, fatigue, anxiety, and depression. Given the importance of targeting multiple systems in the management of pediatric chronic pain, preliminary findings suggest a potential new group-based treatment option for youth and families. Next steps involve evaluating the differential effect of the program over treatment as usual, as well as specific CBT, ACT, and MFT components and processes that may affect outcomes.

ACS Style

Samantha E. Huestis; Grace Kao; Ashley Dunn; Austin T. Hilliard; Isabel A. Yoon; Brenda Golianu; Rashmi P. Bhandari. Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change. Children 2017, 4, 106 .

AMA Style

Samantha E. Huestis, Grace Kao, Ashley Dunn, Austin T. Hilliard, Isabel A. Yoon, Brenda Golianu, Rashmi P. Bhandari. Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change. Children. 2017; 4 (12):106.

Chicago/Turabian Style

Samantha E. Huestis; Grace Kao; Ashley Dunn; Austin T. Hilliard; Isabel A. Yoon; Brenda Golianu; Rashmi P. Bhandari. 2017. "Multi-Family Pediatric Pain Group Therapy: Capturing Acceptance and Cultivating Change." Children 4, no. 12: 106.

Review
Published: 01 December 2017 in Acupuncture in Medicine
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Objective To assess the effectiveness and safety of acupuncture for the treatment of chronic knee pain (CKP). Methods We searched the MEDLINE, EMBASE, Cochrane CENTERAL, CINAHL and four Chinese medical databases from their inception to June 2017. We included randomised controlled trials of acupuncture as the sole treatment or as an adjunctive treatment for CKP. The primary outcome was pain intensity measured by visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale and 11-point numeric rating scale. Secondary outcome measurements included the 36-Item Short Form Health Survey and adverse events. The quality of all included studies was evaluated using the Cochrane risk-of-bias criteria and the STRICTA (Standards for Reporting Interventions in Controlled Trials of Acupuncture) checklist. Results Nineteen trials were included in this systematic review. Of these, data from 17 studies were available for analysis. Regarding the effectiveness of acupuncture alone or combined with other treatment, the results of the meta-analysis showed that acupuncture was associated with significantly reduced CKP at 12 weeks on WOMAC pain subscale (mean difference (MD) −1.12, 95% confidence interval (CI) −1.98 to −0.26, I2=62%, 3 trials, 608 participants) and VAS (MD −10.56, 95% CI −17.69 to −3.44, I2=0%, 2 trials, 145 patients). As for safety, no difference was found between the acupuncture and control groups (risk ratio 1.08, 95% CI 0.54 to 2.17, I2=29%). Conclusion From this systematic review, we conclude that acupuncture may be effective at relieving CKP 12 weeks after acupuncture administration, based on the current evidence and our protocol. However, given the heterogeneity and methodological limitations of the included trials, we are currently unable to draw any strong conclusions regarding the effectiveness of acupuncture for chronic knee pain. In addition, we found that acupuncture appears to have a satisfactory safety profile, although further studies with larger numbers of participants are needed to confirm the safety of this technique. Strengths Systematic review without language restrictions. Limitations Only a few high-quality and consistent trials could be included in this review.

ACS Style

Qinhong Zhang; Jinhuan Yue; Brenda Golianu; Zhongren Sun; Ying Lu. Updated Systematic Review and Meta-Analysis of Acupuncture for Chronic Knee Pain. Acupuncture in Medicine 2017, 35, 392 -403.

AMA Style

Qinhong Zhang, Jinhuan Yue, Brenda Golianu, Zhongren Sun, Ying Lu. Updated Systematic Review and Meta-Analysis of Acupuncture for Chronic Knee Pain. Acupuncture in Medicine. 2017; 35 (6):392-403.

Chicago/Turabian Style

Qinhong Zhang; Jinhuan Yue; Brenda Golianu; Zhongren Sun; Ying Lu. 2017. "Updated Systematic Review and Meta-Analysis of Acupuncture for Chronic Knee Pain." Acupuncture in Medicine 35, no. 6: 392-403.

Journal article
Published: 15 November 2017 in Children
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Background: We report the prevalence of children with multiple medical symptoms in a pediatric neurology clinic, describe their symptom profiles, and explore their association with adverse childhood experiences (ACEs). Methods: We retrospectively reviewed 100 consecutive patients from an outpatient pediatric neurology clinic. Patients were included if they were ≥5 years old and reported ≥4 symptoms that were unexplained for ≥3-months. Symptom profiles across six functional domains were recorded: (1) executive dysfunction, (2) sleep disturbances, (3) autonomic dysregulation, (4) somatization, (5) digestive symptoms, and (6) emotional dysregulation. ACEs were scored for all patients. Results: Seventeen patients reported ≥4 medical symptoms. Somatization, sleep disturbances, and emotional dysregulation occurred in 100% patients, with executive dysfunction (94%), autonomic dysregulation (76%), and digestive problems (71%) in the majority. Forty-two children reported ≥1 ACE, but children with ≥4 symptoms were more likely to report ACEs compared to other children (88% vs. 33%; p < 0.0001) and had a higher median total ACE score (3 vs. 1; p < 0.001). Conclusions: Children with multiple medical symptoms should be screened for potential exposure to ACEs. A clinical profile of symptoms across multiple functional domains suggests putative neurobiological mechanisms involving stress and nervous system dysregulation that require further study.

ACS Style

Jorina Elbers; Cynthia R. Rovnaghi; Brenda Golianu; Kanwaljeet J. S. Anand. Clinical Profile Associated with Adverse Childhood Experiences: The Advent of Nervous System Dysregulation. Children 2017, 4, 98 .

AMA Style

Jorina Elbers, Cynthia R. Rovnaghi, Brenda Golianu, Kanwaljeet J. S. Anand. Clinical Profile Associated with Adverse Childhood Experiences: The Advent of Nervous System Dysregulation. Children. 2017; 4 (11):98.

Chicago/Turabian Style

Jorina Elbers; Cynthia R. Rovnaghi; Brenda Golianu; Kanwaljeet J. S. Anand. 2017. "Clinical Profile Associated with Adverse Childhood Experiences: The Advent of Nervous System Dysregulation." Children 4, no. 11: 98.

Review
Published: 23 June 2017 in Children
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Children must often endure painful procedures as part of their treatment for various medical conditions. Those with chronic pain endure frequent or constant discomfort in their daily lives, sometimes severely limiting their physical capacities. With the advent of affordable consumer-grade equipment, clinicians have access to a promising and engaging intervention for pediatric pain, both acute and chronic. In addition to providing relief from acute and procedural pain, virtual reality (VR) may also help to provide a corrective psychological and physiological environment to facilitate rehabilitation for pediatric patients suffering from chronic pain. The special qualities of VR such as presence, interactivity, customization, social interaction, and embodiment allow it to be accepted by children and adolescents and incorporated successfully into their existing medical therapies. However, the powerful and transformative nature of many VR experiences may also pose some risks and should be utilized with caution. In this paper, we review recent literature in pediatric virtual reality for procedural pain and anxiety, acute and chronic pain, and some rehabilitation applications. We also discuss the practical considerations of using VR in pediatric care, and offer specific suggestions and information for clinicians wishing to adopt these engaging therapies into their daily clinical practice.

ACS Style

Andrea Stevenson Won; Jakki Bailey; Jeremy Bailenson; Christine Tataru; Isabel A. Yoon; Brenda Golianu. Immersive Virtual Reality for Pediatric Pain. Children 2017, 4, 52 .

AMA Style

Andrea Stevenson Won, Jakki Bailey, Jeremy Bailenson, Christine Tataru, Isabel A. Yoon, Brenda Golianu. Immersive Virtual Reality for Pediatric Pain. Children. 2017; 4 (7):52.

Chicago/Turabian Style

Andrea Stevenson Won; Jakki Bailey; Jeremy Bailenson; Christine Tataru; Isabel A. Yoon; Brenda Golianu. 2017. "Immersive Virtual Reality for Pediatric Pain." Children 4, no. 7: 52.

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.

Exploratory study
Published: 17 April 2017 in Journal of Child & Adolescent Trauma
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This theoretical review aims to present the limited findings on traumatic stress and pain in children and adolescents, highlight recent discoveries regarding neurobiological processes, and suggest an alternative stress-health perspective in the future study and conceptualization of pediatric pain and traumatic stress based on results. Current literature highlights a positive correlation between pain and trauma symptoms in youth and suggests a complex relationship that may have mutually maintaining dynamics and intertwined physiological processes. Developmentally sensitive, longitudinal, process-oriented designs assessing neurobiological alterations and stress responses should be utilized in the examination of the trauma-pain relationship. Such investigations may provide a more unified explanation of the relationship between chronic pain and traumatic stress.

ACS Style

Grace S. Kao; Rashmi Parekh Bhandari; Samantha E. Huestis; Brenda Golianu. Traumatic Stress and Pediatric Pain: Towards a Neurobiological Stress-Health Perspective. Journal of Child & Adolescent Trauma 2017, 11, 249 -255.

AMA Style

Grace S. Kao, Rashmi Parekh Bhandari, Samantha E. Huestis, Brenda Golianu. Traumatic Stress and Pediatric Pain: Towards a Neurobiological Stress-Health Perspective. Journal of Child & Adolescent Trauma. 2017; 11 (2):249-255.

Chicago/Turabian Style

Grace S. Kao; Rashmi Parekh Bhandari; Samantha E. Huestis; Brenda Golianu. 2017. "Traumatic Stress and Pediatric Pain: Towards a Neurobiological Stress-Health Perspective." Journal of Child & Adolescent Trauma 11, no. 2: 249-255.

Review
Published: 03 April 2017 in Children
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Pediatric inflammatory bowel disease is an autoimmune disease that causes chronic inflammation of the gastrointestinal mucosa. There is emerging evidence that the brain–gut connection affects inflammatory bowel disease (IBD) patients more than previously thought. This is evidenced by comorbid mood disorders, irritable bowel symptoms concurrent with quiescent IBD, and the potential of psychosocial stressors to trigger IBD flares. Mind–body interventions such as psychotherapy, relaxation, mindfulness, biofeedback, yoga, and clinical hypnosis offer an adjunct to standard medical treatment for IBD. We will review the current evidence base for these mind–body interventions in the treatment of pediatric IBD, illustrate a case study, and offer suggestions for future research for this promising field.

ACS Style

Ann Ming Yeh; Anava Wren; Brenda Golianu. Mind–Body Interventions for Pediatric Inflammatory Bowel Disease. Children 2017, 4, 22 .

AMA Style

Ann Ming Yeh, Anava Wren, Brenda Golianu. Mind–Body Interventions for Pediatric Inflammatory Bowel Disease. Children. 2017; 4 (4):22.

Chicago/Turabian Style

Ann Ming Yeh; Anava Wren; Brenda Golianu. 2017. "Mind–Body Interventions for Pediatric Inflammatory Bowel Disease." Children 4, no. 4: 22.

Review
Published: 01 February 2017 in Acupuncture in Medicine
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Objectives To assess the effectiveness and safety of acupuncture for hiccups following stroke. Methods Medline, Embase, CENTRAL, CINAHL, and four Chinese medical databases were searched from their inception to 1 June 2015. The dataset included randomised controlled trials (RCTs) with no language restrictions that compared acupuncture as an adjunct to medical treatment (effectiveness) or acupuncture versus medical treatment (comparative effectiveness) in stroke patients with hiccups. The Cochrane risk of bias tool was used to assess the methodological quality of the trials. Results Out of 436 potentially relevant studies, five met the inclusion criteria. When acupuncture was compared with other interventions (as sole or adjunctive treatment), meta-analysis revealed a significant difference in favour of cessation of hiccups within a specified time period (CHWST) following intervention when used as an adjunct (risk ratio (RR) 1.59, 95% CI 1.16 to 2.19, I2=0%), but not when used alone (RR 1.40, 95% CI 0.79 to 2.47, I2=65%, ie, high heterogeneity). No safety information was reported in these studies. Conclusions Our systematic review and meta-analysis suggests that acupuncture may be an effective treatment for patients suffering from hiccups following stroke when used as an adjunct to medical treatment. However, due to the limited number of RCTs and poor methodology quality, we cannot reach a definitive conclusion, hence further large, rigorously designed trials are needed.

ACS Style

Jinhuan Yue; Ming Liu; Jun Li; Yuming Wang; E-Sing Hung; Xin Tong; Zhongren Sun; Qinhong Zhang; Brenda Golianu. Acupuncture for the Treatment of Hiccups following Stroke: A Systematic Review and Meta-Analysis. Acupuncture in Medicine 2017, 35, 2 -8.

AMA Style

Jinhuan Yue, Ming Liu, Jun Li, Yuming Wang, E-Sing Hung, Xin Tong, Zhongren Sun, Qinhong Zhang, Brenda Golianu. Acupuncture for the Treatment of Hiccups following Stroke: A Systematic Review and Meta-Analysis. Acupuncture in Medicine. 2017; 35 (1):2-8.

Chicago/Turabian Style

Jinhuan Yue; Ming Liu; Jun Li; Yuming Wang; E-Sing Hung; Xin Tong; Zhongren Sun; Qinhong Zhang; Brenda Golianu. 2017. "Acupuncture for the Treatment of Hiccups following Stroke: A Systematic Review and Meta-Analysis." Acupuncture in Medicine 35, no. 1: 2-8.

Review
Published: 02 July 2016 in Pediatric Anesthesia
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Children with chronic pain often undergo surgery and effective perioperative management of their pain can be challenging. Identification of the pediatric chronic pain patient preoperatively and development of a perioperative pain plan may help ensure a safer and more comfortable perioperative course. Successful management usually requires multiple different classes of analgesics, regional anesthesia, and adjunctive nonpharmacological therapies. Neuropathic and oncological pain can be especially difficult to treat and usually requires an individualized approach.

ACS Style

Meredith R. Brooks; Brenda Golianu. Perioperative management in children with chronic pain. Pediatric Anesthesia 2016, 26, 794 -806.

AMA Style

Meredith R. Brooks, Brenda Golianu. Perioperative management in children with chronic pain. Pediatric Anesthesia. 2016; 26 (8):794-806.

Chicago/Turabian Style

Meredith R. Brooks; Brenda Golianu. 2016. "Perioperative management in children with chronic pain." Pediatric Anesthesia 26, no. 8: 794-806.

Review
Published: 04 May 2016 in Systematic Reviews
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This study aims to investigate the efficacy and safety of acupuncture for patients with chronic neck pain. The MEDLINE, EMBASE, CENTRAL, CINAHL, and the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, VIP Information, and Wanfang Data databases will be searched from their inception to present. Randomised controlled trials (RCTs) of acupuncture (assessed as the sole treatment or as an adjunct treatment) for chronic neck pain will be included. The primary outcome is chronic neck pain measured by the visual analogue scale (VAS), McGill Pain Questionnaire, or short-form McGill Pain Questionnaire. The secondary outcomes will include the functional recovery, health-related quality of life, psychological improvements related to the reduction of pain, and adverse events. Two authors will perform the study selection, data extraction, and quality assessment independently. Any disagreements will be resolved through discussion with a third author. Methodological quality of the included trials will be evaluated by the Cochrane risk-of-bias criteria, and the Standards for Reporting Interventions in Controlled Trials of Acupuncture checklist will be used to assess completeness of reporting. The results of this systematic review will provide the latest evidence of the efficacy of acupuncture in treating chronic neck pain, which will benefit both practitioners and policymakers. PROSPERO CRD42015017178.

ACS Style

Qinhong Zhang; Jinhuan Yue; Xiangxin Zeng; Zhongren Sun; Brenda Golianu. Acupuncture for chronic neck pain: a protocol for an updated systematic review. Systematic Reviews 2016, 5, 76 .

AMA Style

Qinhong Zhang, Jinhuan Yue, Xiangxin Zeng, Zhongren Sun, Brenda Golianu. Acupuncture for chronic neck pain: a protocol for an updated systematic review. Systematic Reviews. 2016; 5 (1):76.

Chicago/Turabian Style

Qinhong Zhang; Jinhuan Yue; Xiangxin Zeng; Zhongren Sun; Brenda Golianu. 2016. "Acupuncture for chronic neck pain: a protocol for an updated systematic review." Systematic Reviews 5, no. 1: 76.