Clinical Assistant Professor, Anesthesiology, Perioperative and Pain Medicine
Fellowship: Stanford University Child Psychology Postdoctoral Fellowship (2022) CA
Internship: Boston Children's Hospital Dept of Psychiatry (2019) MA
PhD Training: DePaul University Registrar (2019) IL
Comparison of pain and psychosocial correlates among Hispanic and Non-Hispanic White youth with chronic pain.
2022; 7 (4): e1020
Despite well-documented pain disparities among adults from non-White and Hispanic groups, less is known about pain disparities in non-White and Hispanic pediatric populations.We compare pain and related psychosocial factors at the individual (pain intensity, pain interference, pain catastrophizing, co-occurring symptoms), social (peer relations), and systemic (health insurance) levels among Hispanic and Non-Hispanic White (NHW) youth with chronic pain.Eight hundred thirty-seven (71.4% female) Hispanic (n = 268, 32%) and NHW (n = 569, 68%) youth ages 8 to 17 years (M = 14.00; SD = 2.54) completed a survey at their initial visit to a pain clinic. Independent sample t tests investigated mean differences in psychosocial factors at the individual and social levels. Chi-squared tests investigated differences at the systemic level. Bivariate correlations for each group were compared using Fisher r-to-z transformations.Hispanic youth reported higher levels of pain intensity (t = -2.75, P = 0.006). Groups did not differ in reports of other individual or social factors. Non-Hispanic White youth were more likely to have private insurance (OR, 5.66). All examined variables were significantly correlated among NHW youth. Correlations were weaker or nonsignificant among Hispanic youth. Fisher r-to-z transformations revealed these group differences to be significant.Hispanic youth report higher pain levels than NHW counterparts and lower likelihood of having private insurance. Pain and psychosocial factors correlate differently among the 2 groups highlighting a need to better understand the chronic pain experiences of diverse youth because models derived primarily from NHW populations may not generalize across ethnic and racial groups.
View details for DOI 10.1097/PR9.0000000000001020
View details for PubMedID 35924081
View details for PubMedCentralID PMC9296181
Clinical utility of CAT administered PROMIS measures to track change for pediatric chronic pain.
The journal of pain
Patient Reported Outcomes (PROs) are utilized in clinical registries and trials, necessitating development of benchmarks to enhance interpretability. This study aimed to 1) examine if PROMIS measures administered via computer adaptive testing (CAT) were responsive to change, and 2) highlight one method of assessing clinically significant change for youth seen in a tertiary pain clinic. Clinically significant change was achieved if patients had significantly reliable pre-to-post-changes greater than Reliable Change Index (RCI) value and reported decreased symptoms by at least one severity level (e.g., moderate to mild). Participants were 328 youth (8-17 years old) seen in a tertiary pediatric pain management clinic. Small to moderate effect sizes were noted across PROMIS measures (except Peer Relations). Reliable magnitudes of change were estimated for this sample as approximately 6-point reduction for Pain Interference and Mobility, 9 for Fatigue, and 11 for Anxiety and Depression. Depending on the measure, 10-24% were categorized as improved, 3-6% as deteriorated, and 68-81% were either not clinically elevated at baseline or remained unchanged at 3-months. Overall, PROMIS CAT measures demonstrated responsiveness to change over time. Estimation of clinically significant change offers preliminary yet rigorous benchmarks for evaluating treatment response and sets the stage for understanding treatment effects. Perspective This study assesses responsiveness of CAT administered PROMIS measures and highlights one methodological approach of presenting clinical significance for assessing treatment outcomes in pediatric chronic pain. These benchmarks will allow clinicians and researchers to evaluate treatment response utilizing PROs while allowing for a deeper understanding of treatment effects.
View details for DOI 10.1016/j.jpain.2021.06.009
View details for PubMedID 34229073
- Author Response to "We Need Precise Interventions to Stem the Opioid Epidemic". American journal of preventive medicine 2021; 60 (5): e237–e238
Clinical Correlates of Opioid Prescription Among Pediatric Patients With Chronic Pain.
American journal of preventive medicine
INTRODUCTION: Up to 17%-20% of pediatric patients with chronic pain are prescribed opioid pharmacotherapy and face an increased risk of opioid misuse in adulthood. Little is known about the way clinical presentation may influence which children with chronic pain are prescribed opioids. This study examines the associations between child's and caregiver's report of child's pain, physical function, and socioemotional indices with opioid prescriptions in pediatric patients initiating treatment for chronic pain.METHODS: Participants were 1,155 pediatric patients (71.26% female, n=823) aged 8-17 years and 1 of their caregivers (89% mothers) who presented for evaluation at a tertiary care pediatric pain clinic. Data were collected from 2015 to 2019 and analyzed in 2020.RESULTS: Binary logistic regression analyses investigated the relative contribution of child's demographic, pain, and Patient-Reported Outcome Measurement Information System measures to opioid prescription status; separate models were conducted for child's and caregiver's report. Across child and caregiver models, findings were that child's age (older), pain duration (longer; child's report only), and increased physical limitations (mobility challenges and pain interference; caregiver's report only) were the most salient clinical correlates of positive opioid status. Contrary to the existing literature on adults with chronic pain, socioemotional indices (anxiety, depression, peer functioning) were nonsignificant.CONCLUSIONS: A greater understanding of how clinical presentation may relate to prescribed opioid pharmacotherapy informs the field's conceptualization of the sequelae of opioid use and misuse in the context of pediatric chronic pain.
View details for DOI 10.1016/j.amepre.2020.08.026
View details for PubMedID 33160799
Sociodemographic and Environmental Factors are Associated with Adolescents' Pain and Longitudinal Health Outcomes
JOURNAL OF PAIN
2020; 21 (1-2): 170–81
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.
View details for DOI 10.1016/j.jpain.2019.06.007
View details for Web of Science ID 000553361300014
View details for PubMedID 31255798
A Test of the Perfectionism Social Disconnection Model among Ethnic Minority Youth
JOURNAL OF ABNORMAL CHILD PSYCHOLOGY
2017; 45 (6): 1181–93
Perfectionistic self-presentation (PSP) has been identified as a vulnerability factor in the development of depressive disorders during early adolescence. The Perfectionism Social Disconnection Model (PSDM) offers a theoretical framework suggesting PSP leads to depressive symptoms via interpersonal problems and social disconnection. Previous studies have supported the role of social disconnection as a mediator in the relation between PSP and suicidal ideation, but have not evaluated interpersonal problems in the model. Furthermore, the generalizability of the model has not been established for community and ethnic minority samples. Using cross-sectional data, the present study addresses these gaps by evaluating the PSDM and including social anxiety and loneliness as indicators of interpersonal problems and social disconnection, respectively, as predictors of youth depressive symptoms. The sample includes 289 (51.2% females) predominately low income and Latino and African American youth in fifth through seventh grade in three public schools. As predicted, social anxiety mediates the relationship between both PSP and loneliness and PSP and depressive symptoms. Moreover, mediational analyses indicate that social anxiety accounts for the relation between PSP and depression. Consistent with the PSDM model, the relationship between PSP and youth depressive symptoms is mediated sequentially through both social anxiety and loneliness, but primarily among the Latino sample.
View details for DOI 10.1007/s10802-016-0240-y
View details for Web of Science ID 000406185000011
View details for PubMedID 27917458