Rashmi Parekh Bhandari

All Publications

• Clinical utility of CAT administered PROMIS measures to track change for pediatric chronic pain. The journal of pain Bhandari, R. P., Harrison, L. E., Richardson, P. A., Arce, A. B., You, D. S., Rajagopalan, A., Birnie, K. A., Sil, S. 2021

  Abstract

  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

• Pediatric pain psychology: Guidelines for advanced subspecialty training. Clinical Practice in Pediatric Psychology Benore, E., Bhandari, R., Harbeck-Weber, C., Logan, D. E., Banez, G. 2017; 5 (1): 17-35

  View details for DOI 10.1037/cpp0000174

• Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR): a learning health system to guide pediatric pain research and treatment. Pain Bhandari, R. P., Feinstein, A. B., Huestis, S. E., Krane, E. J., Dunn, A. L., Cohen, L. L., Kao, M. C., Darnall, B. D., Mackey, S. C. 2016; 157 (9): 2033-2044

  Abstract

  The pediatric adaptation of the Collaborative Health Outcomes Information Registry (Peds-CHOIR) is a free, open-source, flexible learning health care system (LHS) that meets the call by the Institute of Medicine for the development of national registries to guide research and precision pain medicine. This report is a technical account of the first application of Peds-CHOIR with 3 aims: (1) to describe the design and implementation process of the LHS; (2) to highlight how the clinical system concurrently cultivates a research platform rich in breadth (eg, clinic characteristics) and depth (eg, unique patient- and caregiver-reporting patterns); and (3) to demonstrate the utility of capturing patient-caregiver dyad data in real time, with dynamic outcomes tracking that informs clinical decisions and delivery of treatments. Technical, financial, and systems-based considerations of Peds-CHOIR are discussed. Cross-sectional retrospective data from patients with chronic pain (N = 352; range, 8-17 years; mean, 13.9 years) and their caregivers are reported, including National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) domains (mobility, pain interference, fatigue, peer relations, anxiety, and depression) and the Pain Catastrophizing Scale. Consistent with the literature, analyses of initial visits revealed impairments across physical, psychological, and social domains. Patients and caregivers evidenced agreement in observable variables (mobility); however, caregivers consistently endorsed greater impairment regarding internal experiences (pain interference, fatigue, peer relations, anxiety, and depression) than patients' self-report. A platform like Peds-CHOIR highlights predictors of chronic pain outcomes on a group level and facilitates individually tailored treatment(s). Challenges of implementation and future directions are discussed.

  View details for DOI 10.1097/j.pain.0000000000000609

  View details for PubMedID 27280328

• Patient vs Parent Proxy Reports: The Asian Experience in Pediatric Chronic Pain Ma, R., Bhandari, R., Kim, Y. K., Sujan, A. C. OXFORD UNIV PRESS INC. 2024: 149

  View details for Web of Science ID 001271423400304

• Differences in Parent Protective Behaviors in Pediatric Chronic Pain between Asian and Non-Hispanic White Families Kim, Y. K., Sujan, A. C., Bhandari, R., Ma, R. OXFORD UNIV PRESS INC. 2024: 145-146

  View details for Web of Science ID 001271423400296

• Bridging Access to Pediatric Pain Care: Telehealth Utilization. The Clinical journal of pain Sepsey, A. M., Sokol, O. E., Huestis, S. E., Bhandari, R. P. 2023

  Abstract

  Retrospective naturalistic design was utilized to evaluate subsequent shifts to patient access of tertiary pain management care following shelter in place (SIP) and increased telehealth during the COVID-19 pandemic.Data for this study were extracted from retrospective review of Pediatric-Collaborative Health Outcomes Information Registry (Peds-CHOIR) with additional demographic information collected via chart review. Participants were 906 youth who received an initial evaluation either in-person (n=472) within the 18 months before SIP or via telehealth (n=434) within the 18 months after SIP during the COVID-19 pandemic. Patient variables to assess access included geographic distance from the clinic, ethnic and racial diversity, and patient's insurance type. Descriptive characteristics for each group were analyzed using chi-squared test, percentage change, and t-test analyses.Results indicated that transitioning to telehealth resulted in maintained access rates between groups as measured by race and ethnic diversity as well as distance travelled from the clinic. A trend of increase in government-funded insurances was found, though no significant differences were identified between telehealth and in-person visits. Though the majority of participants (in-person: 52.75%; telehealth 55.81%) lived within 50 miles of the clinic, results indicated that telehealth allowed for a significant increase in evaluation access for families living further from clinic within a 50-mile radius.Overall, accessibility to pediatric pain management via telehealth during SIP was maintained despite significant declines in overall access to healthcare, with some trends in increased accessibility for patients with government insurance.

  View details for DOI 10.1097/AJP.0000000000001132

  View details for PubMedID 37195002

• Comparison of pain and psychosocial correlates among Hispanic and Non-Hispanic White youth with chronic pain. Pain reports Goya Arce, A. B., Richardson, P. A., Tran, S. T., Bhandari, R. P. 2022; 7 (4): e1020

  Abstract

  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[811] = -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

• Comparison of pain and psychosocial correlates among Hispanic and Non-Hispanic White youth with chronic pain PAIN REPORTS Arce, A., Richardson, P. A., Tran, S. T., Bhandari, R. P. 2022; 7 (4)

  View details for DOI 10.1097/PR9.0000000000001020

  View details for Web of Science ID 000826651700001

• Intensive interdisciplinary pain treatment for children and adolescents with chronic non-cancer pain: a preregistered systematic review and individual patient data meta-analysis. Pain Claus, B. B., Stahlschmidt, L., Dunford, E., Major, J., Harbeck-Weber, C., Bhandari, R. P., Baerveldt, A., Neß, V., Grochowska, K., Hübner-Möhler, B., Zernikow, B., Wager, J. 2022

  Abstract

  Chronic non-cancer pain in children and adolescents can be impairing and results in substantial health care costs. Intensive Interdisciplinary Pain Treatment (IIPT), an inpatient or day hospital treatment delivered by a team of three or more health professionals, may be an effective intervention for these children and adolescents. Based on previous reviews and meta-analyses, we updated the findings regarding the description of available treatments and estimated the effectiveness of IIPT, overcoming methodological shortcomings of previous work by requesting and analyzing individual participant data. On June 26, 2021, we searched five literature databases (PubMed, PsycINFO, Web of Science, Cochrane Library, and PubPsych) for studies examining the effectiveness of IIPT. Included studies employed a pre-post design, assessed patients under the age of 22 years, and presented their results in English, German, French, or Spanish. We used standard methodological procedures expected by Cochrane to pool treatment effects and assess risk of bias. We identified 13 different treatment sites with similar treatment inclusion criteria and treatment components, but the descriptions of those treatments varied widely. Regarding treatment effectiveness, IIPT may result in large improvements in mean pain intensity (g=-1.28), disability (g=-1.91), and number of missed school days at 12-month follow-up (g=-0.99), as well as moderate improvements in anxiety (g=-0.77) and depression (g=-0.76). The certainty of the evidence, however, was graded very low to low. We recommend future researchers employ more scientific rigor to increase the certainty of the evidence for IIPT and to standardize treatment outcomes for children and adolescents with chronic pain.

  View details for DOI 10.1097/j.pain.0000000000002636

  View details for PubMedID 35297804

• Author Response to "We Need Precise Interventions to Stem the Opioid Epidemic". American journal of preventive medicine Richardson, P. A., Birnie, K. A., Goya Arce, A. B., Bhandari, R. P. 2021; 60 (5): e237–e238

  View details for DOI 10.1016/j.amepre.2020.12.005

  View details for PubMedID 33888262

• Assessing disparities on caregiver factors known to affect children's pain and outcomes Arce, A., Hartmann, M., Bhandari, R. CHURCHILL LIVINGSTONE. 2021: 598

  View details for Web of Science ID 000661623200090

• Evaluating Telehealth Implementation in the Context of Pediatric Chronic Pain Treatment during COVID-19. Children (Basel, Switzerland) Richardson, P. A., Parker, D. M., Chavez, K., Birnie, K. A., Krane, E. J., Simons, L. E., Cunningham, N. R., Bhandari, R. P. 2021; 8 (9)

  Abstract

  Telehealth has emerged as a promising healthcare delivery modality due to its ability to ameliorate traditional access-level barriers to treatment. In response to the onset of the novel coronavirus (COVID-19) pandemic, multidisciplinary pain clinics either rapidly built telehealth infrastructure from the ground up or ramped up existing services. As the use of telehealth increases, it is critical to develop data collection frameworks that guide implementation. This applied review provides a theoretically-based approach to capitalize on existing data sources and collect novel data to inform virtually delivered care in the context of pediatric pain care. Reviewed multisource data are (1) healthcare administrative data; (2) electronic chart review; (3) clinical health registries; and (4) stakeholder feedback. Preliminary telehealth data from an interdisciplinary pediatric chronic pain management clinic (PPMC) serving youth ages 8-17 years are presented to illustrate how relevant implementation outcomes can be extracted from multisource data. Multiple implementation outcomes were assessed, including telehealth adoption rates, patient clinical symptoms, and mixed-method patient-report telehealth satisfaction. This manuscript provides an applied roadmap to leverage existing data sources and incorporate stakeholder feedback to guide the implementation of telehealth in pediatric chronic pain settings through and beyond COVID-19. Strengths and limitations of the modeled data collection approach are discussed within the broader context of implementation science.

  View details for DOI 10.3390/children8090764

  View details for PubMedID 34572195

• Clinical Correlates of Opioid Prescription Among Pediatric Patients With Chronic Pain. American journal of preventive medicine Richardson, P. A., Birnie, K. A., Goya Arce, A. B., Bhandari, R. P. 2020

  Abstract

  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

• A BRIEF 10-ITEM MEASURE FOR RAPID IDENTIFICATION OF PAIN-RELATED FEAR-AVOIDANCE IN YOUTH WITH CHRONIC PAIN Rush, G., Heathcote, L. C., Bhandari, R., Timmers, I., Harrison, L., Simons, L. E. OXFORD UNIV PRESS INC. 2020: S787

  View details for Web of Science ID 000546262401807

• Parent physical and mental health contributions to interpersonal fear avoidance processes in pediatric chronic pain. Pain Birnie, K. A., Heathcote, L. C., Bhandari, R. P., Feinstein, A., Yoon, I. A., Simons, L. E. 2020

  Abstract

  Theoretical models and evidence increasingly identify chronic pain as a family issue. To date, much of this work has focused on risk conferred by parental chronic pain status despite evidence suggesting parent mental illness and non-pain-related chronic illness may also contribute to poorer chronic pain outcomes in children. This study is the first to test interpersonal fear avoidance processes as possible mechanisms through which parent health (mental and physical) influences pediatric chronic pain functioning. We used structural equation models (SEM) to test such an integrative model using cross-sectional data from a large clinical registry of 448 dyads of patients 8-18 years old (M=14.57 years; SD=2.38; 327 females) with mixed chronic pain and their parents (403 mothers). As expected, poorer parent global health was indirectly related to greater child pain interference via higher parent pain catastrophizing, and then via greater parent protective behaviors, and child pain catastrophizing. The model demonstrated excellent fit to the data (chi[5] = 5.04, ns; chi/df = 1.01; CFI = 1.00, RMSEA = .004 [90% confidence interval (CI) = .000-.066]). Exploratory multiple-group comparison SEM revealed moderation of specific model paths based on child age group (8- to 12-year-olds versus 13- to 18-year-olds) and parent pain status (present versus absent). This study integrates family models of pain with the interpersonal fear avoidance model to extend our mechanistic understanding of parental physical and mental health contributors to pediatric chronic pain.

  View details for DOI 10.1097/j.pain.0000000000001820

  View details for PubMedID 32011420

• Factors Related to Agreement between Child and Caregiver Report of Child Functioning with Chronic Pain: PROMIS Pediatric and Parent-proxy Report. The Clinical journal of pain Birnie, K. A., Richardson, P. A., Rajagopalan, A. V., Bhandari, R. P. 2019

  Abstract

  OBJECTIVES: Valid and efficient assessment of patient-reported outcomes remains a priority to guide pain treatment and research. PROMIS pediatric self-report and parent-proxy measures offer feasible and rigorous evaluation of functioning in children with chronic conditions, including pain. A key challenge is determining the usefulness of multisource information from children and caregivers for understanding pain and function. Our primary aim examined child-caregiver agreement across child functioning domains. Our secondary aim examined child and caregiver factors associated with child-caregiver agreement.METHODS: A sample of 806 children with chronic pain (Mage=14.50▒y; 72% female) and a caregiver (Mage=45.82▒y; 85% mothers) completed PROMIS pediatric self-report and parent-proxy measures of anxiety, depression, fatigue, pain interference, and mobility prior to intake in an interdisciplinary outpatient pediatric chronic pain program.RESULTS: Agreement was poor to good depending on evaluation method (effect size, intraclass correlation, clinical significance interpretation). Caregivers generally reported worse child symptoms across domains compared to child self-report. Greatest discrepancy was observed for child anxiety, pain interference, and peer relations, with greatest agreement for child mobility. Greater caregiver-child discrepancy was found for younger children, girls, with higher child or caregiver pain catastrophizing, and poorer caregiver physical or mental health.DISCUSSION: Findings are discussed within the interpersonal context of pain and indicate relevance of both child and caregiver perspectives to personalize chronic pain assessment and treatment. Findings can be used by clinicians and researchers to guide whether and how to integrate multi-informant reports about child chronic pain functioning.

  View details for DOI 10.1097/AJP.0000000000000794

  View details for PubMedID 31876791

• Rapid identification and clinical indices of fear-avoidance in youth with chronic pain. Pain Heathcote, L. C., Bhandari, R. P., Timmers, I., Harrison, L. E., Simons, L. E. 2019

  Abstract

  Pain-related fear and avoidance are increasingly demonstrated to play an important role in adult and childhood chronic pain. The Fear of Pain Questionnaire for Children (FOPQC) is a 24-item measure of pain-related fear-avoidance in youth that has demonstrated good indices of reliability and validity, treatment responsiveness, and associations with brain circuitry alterations. This study describes the development and psychometric examination of the FOPQC-SF, a short form of the original measure. We selected 10 items for the short form that best represented the content and two-factor (Fear and Avoidance) structure of the original measure from a cohort of 613 youth (Mage = 14.7 years) with chronic pain. Next, confirmatory factor analyses from a second sample of 526 youth (Mage = 14.7 years) with chronic pain who completed the FOPQC-SF supported the original two-factor model but indicated that one item should be moved to the avoidance subscale. The FOPQC-SF demonstrates strong internal consistency and moderate-to-strong construct and criterion validity. Three-month test-retest reliability estimates (N=94) were strong and there was preliminary evidence of responsivity to change. To aid integration into intervention trials and clinical practice, we provide clinical reference points and a criterion to assess reliable change. The short form could be used for rapid identification of pain-related fear and avoidance in youth during clinic evaluations, and is optimized for clinical registries.

  View details for DOI 10.1097/j.pain.0000000000001742

  View details for PubMedID 31688496

• The role of fatigue in functional outcomes for youth with chronic pain. European journal of pain (London, England) Yoon, I. A., Sturgeon, J. A., Feinstein, A. B., Bhandari, R. P. 2019

  Abstract

  As a complex multidimensional construct, fatigue may play an important role in the physical and psychosocial functioning of youth with chronic pain. Based on a model previously tested in adults, the current study similarly utilized patient-reported outcomes measurement system (PROMIS) to examine how fatigue contributes to functional outcomes for youth with chronic pain. The model tested self-reported ratings of pain intensity, depressive symptoms and sleep disturbance as predictors of outcomes (mobility, pain-related interference and school functioning) as mediated by ratings of fatigue.Two hundred and eighty-five youth with chronic pain ages 8-17 years and their caregivers, completed surveys as part of their initial clinical evaluation at a tertiary paediatric pain clinic. Study measures included: paediatric PROMIS domains (mobility, pain interference, sleep disturbance, fatigue and depressive symptoms), Paediatric Quality of Life school functioning and pain intensity. All mediated effects were calculated via a 1,000-draw bootstrap estimation method in Mplus.Fatigue was found to be a statistically significant mediator of the effects of pain intensity, sleep disturbance and depressive symptoms on outcomes of pain interference, mobility and school functioning. While pain intensity was found to independently contribute to mobility and pain interference, depressive symptoms did not show significant effects on any outcome beyond its association with fatigue. Sleep disturbance predicted pain interference while fatigue predicted school functioning.Findings suggest that fatigue is an important intervening factor for functional outcomes among youth with chronic pain. Targeting fatigue may be effective in optimizing school functioning and reducing the deleterious effects of depressive symptoms.This cross-sectional study highlights fatigue as a potential clinical target by applying a path analytic model to understand its possible significance and distinction from overlapping constructs such as pain intensity, depression and sleep disturbance. Further study of fatigue may be important in understanding its importance in treatment of paediatric chronic pain.

  View details for DOI 10.1002/ejp.1431

  View details for PubMedID 31131940

• Interpersonal Dyadic Influences of Pain Catastrophizing Between Caregivers and Children with Chronic Pain. The Clinical journal of pain Parker, D. M., Birnie, K. A., Yoon, I. A., Bhandari, R. P. 2019

  Abstract

  Pain catastrophizing is an important predictor of pain-related outcomes. Caregiver and child levels of catastrophizing about child chronic pain are associated cross-sectionally, yet predictive associations testing interpersonal influences within caregiver-child dyads are lacking. The present study tested caregiver and child influences on partner catastrophizing about child pain over 1 month following initiation of interdisciplinary pain treatment and examined whether change in pain catastrophizing was associated with child pain interference.113 caregiver-child dyads (Mage=14.41) completed measures at the time of initiating care at a pediatric tertiary outpatient pain management clinic (baseline) and approximately 1 month later. Caregivers and children independently reported on catastrophizing about child pain and child pain interference at baseline and 1 month follow up.Caregiver and child pain catastrophizing decreased over 1 month following initial interdisciplinary pain evaluation, with average scores remaining in the moderate to high range. Change in caregiver, but not child, catastrophizing about child pain was predicted by partner baseline pain catastrophizing. Decreases in catastrophizing about child pain were associated with within person improvement in ratings of child pain interference.In the short period following initial pain evaluation, caregivers and children evidenced reductions in pain catastrophizing, which were associated with increased child function. Findings highlight the important role of child cognitive-affective responses to pain in influencing caregiver catastrophizing about child pain. Understanding the individual contributions children and caregivers make to interpersonal pain processes will inform future family-level clinical interventions.

  View details for DOI 10.1097/AJP.0000000000000773

  View details for PubMedID 31613833

• Profiling Modifiable Psychosocial Factors among Children with Chronic Pain: A Person-Centered Methodology. The journal of pain : official journal of the American Pain Society Richardson, P. A., Birnie, K. A., Harrison, L. E., Rajagopalan, A. n., Bhandari, R. P. 2019

  Abstract

  Targeting individually based psychosocial profiles when treating children with chronic pain and their families is key to effective behavioral health intervention and in line with tenants of precision medicine. Extant research is primarily driven by variable-centered models that focus on broad, group-level differences. The current study adopts a person-centered approach, latent profile analysis (LPA), to identify patient subgroups. Cross-sectional data are presented from 366 children (8-17 years; M=14.48; SD=2.36) with chronic pain and a primary caregiver (94% mothers). LPA indicator variables were, self-reported: fatigue, internalizing symptoms, pain catastrophizing, and pain acceptance; parent-reported: pain catastrophizing and responses to child pain. One-way ANOVAs examined the effect of profiles on child age, pain, and function. LPA identified a four-profile solution. Class 1 (12%) demonstrated the lowest scores (conveying least risk) across 5 of 6 factors. Class 4 (37%) had the highest scores (conveying greatest risk) across all factors. Classes 2 (12%) and 3 (39%) demonstrated more variability across domains. Results revealed significant effects of profile based on child age, pain, and function. This study highlights differential presentation of treatment-modifiable domains within a large sample. LPA methodology is showcased to potentially facilitate clinical conceptualizations and tailored approaches to intervention in pediatric chronic pain. Perspective: This article presents a methodological and statistical approach that may be beneficial to better assess individual profiles of pediatric pain functioning. Tools that allow providers to better match patient presentation and intervention are in line with the tenants of precision medicine and may ultimately serve to improve child outcomes.

  View details for DOI 10.1016/j.jpain.2019.08.015

  View details for PubMedID 31521795

• Risk and Resilience in Pediatric Pain: The Roles of Parent and Adolescent Catastrophizing and Acceptance CLINICAL JOURNAL OF PAIN Feinstein, A. B., Sturgeon, J. A., Bhandari, R. P., Yoon, I. A., Ross, A. C., Huestis, S. E., Griffin, A. T., Simons, L. E. 2018; 34 (12): 1096–1105

  View details for DOI 10.1097/AJP.0000000000000639

  View details for Web of Science ID 000450434900002

• Traumatic Stress and Pediatric Pain: Towards a Neurobiological Stress-Health Perspective. Journal of child & adolescent trauma Kao, G. S., Bhandari, R. P., Huestis, S. E., Golianu, B. 2018; 11 (2): 249-255

  Abstract

  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.

  View details for DOI 10.1007/s40653-017-0145-0

  View details for PubMedID 32318154

  View details for PubMedCentralID PMC7163901

• A Pilot Study of Mindfulness Meditation for Pediatric Chronic Pain. Children (Basel, Switzerland) Waelde, L. C., Feinstein, A. B., Bhandari, R., Griffin, A., Yoon, I. A., Golianu, B. 2017; 4 (5)

  Abstract

  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.

  View details for DOI 10.3390/children4050032

  View details for PubMedID 28445406

• The Effect of Pain Catastrophizing on Outcomes: A Developmental Perspective Across Children, Adolescents, and Young Adults With Chronic Pain. journal of pain Feinstein, A. B., Sturgeon, J. A., Darnall, B. D., Dunn, A. L., Rico, T., Kao, M. C., Bhandari, R. P. 2017; 18 (2): 144-154

  Abstract

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

  View details for DOI 10.1016/j.jpain.2016.10.009

  View details for PubMedID 27825857

• Pediatric pain and traumatic stress: Towards a neurobiological stress-health perspective Journal of Child and Adolescent Trauma Kao, G. S., Bhandari, R. P., Huestis, S. E., Golianu, B. 2017

  View details for DOI 10.1007/s40653-017-0145-0

• Social Risk and Resilience Factors in Adolescent Chronic Pain: Examining the Role of Parents and Peers. Journal of pediatric psychology Ross, A. C., Simons, L. E., Feinstein, A. B., Yoon, I. A., Bhandari, R. P. 2017

  Abstract

  The current study focuses on social risk and resilience in an adolescent population with chronic pain. Prior research identifies parental cognitions and behaviors as influential in youths' experiences of chronic pain and pain-related disability. Adolescent development is characterized by greater autonomy from parents and an increased emphasis on peer relationships. Study aims explore the potential protective effect of high-quality adolescent peer relationships on associations between parent and adolescent cognitive and behavioral responses to pain.238 adolescents with mixed-etiology chronic pain and their parents completed Pediatric Collaborative Health Outcomes Information Registry (Peds-CHOIR) electronic questionnaires prior to their initial visit to a tertiary pediatric pain clinic. Variables in this study include parent catastrophizing, parent protective behavior, adolescent peer relationship quality, adolescent catastrophizing, adolescent functional impairment, and demographic and pain characteristics.As expected, associations between parent and adolescent cognitive and behavioral pain responses were moderated by peer relationship quality. Contrary to expectations, for adolescents endorsing low-quality peer relationships, maladaptive adolescent outcomes were elevated across levels of parental cognitions and behaviors. For adolescents endorsing high-quality peer relationships, adolescent and parent pain responses were linearly related.This study highlights the salience of both family and peer processes in functional outcomes among adolescents with chronic pain. Results suggest that adolescents' adaptive responses to chronic pain may be best supported by the simultaneous presence of adaptive parenting and high-quality peer relationships. Understanding the larger social context in which an adolescent exists is informative in specifying models that predict adaptive outcomes or magnify risks.

  View details for PubMedID 29048554

• Multi-family pediatric pain group therapy: Capturing acceptance and cultivating change Children Huestis, S. E., Kao, G., Dunn, A., Hilliard, A. T., Yoon, I. A., Golianu, B., Bhandari, R. P. 2017; 4 (12)

  View details for DOI 10.3390/children4120106

• Traumatic stress and pediatric pain: A neurobiological stress-health perspective Journal of Child and Adolescent Trauma Kao, G. S., Bhandari, R., Huestis, S., Golianu, B. 2017; in press
• Spotlight on the Pediatric Pain Psychology Special Interest Group Clinical Practice in Pediatric Psychology Harbeck-Weber, C., Benore, E., Bhandari, R., Logan, D. E., Banez, G. 2017; 5 (1): 15-16
• The Impact of Pain Catastrophizing on Outcomes: A Developmental Perspective across Children, Adolescents and Young Adults with Chronic Pain Journal of Pain Feinstein, A. B., Sturgeon, J. A., Bhandari, R. P., Dunn, A., Rico, T., Kao, M. C., Darnall, B. D. 2016

  Abstract

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

  View details for DOI 10.1016/j.jpain.2016.10.009

• Restrictive parenting buffers head start students from stress INFANTS AND YOUNG CHILDREN Bhandari, R. P., Barnett, D. 2007; 20 (1): 55-63

  View details for Web of Science ID 000243050000005