ABSTRACT:Self-report is the gold standard for assessing pain intensity, although the method of acquiring pain reports may influence the ratings obtained. Retrospective reports of pain intensity are often found to be elevated relative to daily diary reports, possibly due to recall bias and the influence of psychosocial factors on memory. In this study, we sought to examine differences between retrospective reporting of average pain intensity in the past week vs averaged daily diary reporting of pain intensity in a sample of adolescents with juvenile fibromyalgia (JFM). We also sought to determine the predictive effects of pain catastrophizing, functional disability, and depressive symptoms on discrepancies between retrospective and daily diary report. As part of a randomized controlled trial, 317 adolescents with JFM (Mage = 15.7, SD = 1.6, 88.4% female) completed daily diary and one-week retrospective pain intensity measures, the Children's Depression Inventory-2, Functional Disability Inventory, and Pain Catastrophizing Scale at baseline, post-treatment, and 3-month follow-up. We examined the predictive effects of psychosocial factors on mean differences between averaged daily and one-week retrospective reports of pain intensity. Retrospective reports of pain intensity were significantly higher than diary reports across time. A longitudinal multiple linear regression model showed that the magnitude of discrepancies between daily diary and retrospective reports was not significantly predicted by functional disability, depressive symptoms, or pain catastrophizing. These findings raise the possibility that other factors such as cognitive biases (eg, threat interpretation, saliency, recency bias) may play a larger role than psychosocial factors in explaining pain reporting discrepancies.

ABSTRACT:Juvenile fibromyalgia (JFM) is a complex and disabling chronic pain condition for which treatment options are limited. The objective of this randomized controlled trial was to compare the relative efficacy of 3 group-based interventions: cognitive-behavioral therapy (CBT) alone, graded aerobic exercise (GAE) alone, or CBT combined with specialized neuromuscular exercise (Fibromyalgia Integrative Training [FIT] Teens), in reducing pain-related disability for adolescents with JFM. Patients with JFM (ages 12-17) who experienced moderate-to-severe pain and pain-related disability were eligible. A total of 317 adolescents (86.4% girls, 84.2% White, mean age 15.8 years) were randomized to receive 8 weeks (16 sessions) of CBT (N = 110), GAE (N = 104), or FIT Teens (N = 103), followed by 4 booster sessions. Our primary hypothesis that the FIT Teens intervention would be superior to CBT or GAE was not supported. Rather, participants in all treatments showed significant reduction in disability with no differences between groups at the 3-month primary endpoint (main effect estimate = -3·94 [95% CI: -6·62 to -1·26]) and at 6-, 9-, and 12-month follow-up (main effect estimate = -4·52 [95% CI: -7·35 to -1·68]; -4·21 [95% CI: -7·13 to -1·29]; and -4·76 [95% CI: -7·84 to -1·68], respectively). Pain intensity was significantly improved at 9- and 12-month follow-up. Although the overall magnitude of improvement in disability was small, approximately 1 in 4 patients in the FIT and CBT groups had clinically remarkable improvement. Cognitive-behavioral and exercise-based treatments are promising for the management of JFM. Further research is needed to examine the characteristics of treatment responders and the mechanisms of improvement.

Background:Individuals who experience social marginalization, such as transgender and gender-diverse (TGD) youth, have increased risk for poor health outcomes, including chronic pain. A better understanding of the impact of chronic pain in these populations would improve treatment and aid in reducing health care disparities. Our retrospective review of clinical data examined psychosocial correlates of pain in TGD and cisgender youth with chronic pain. Aims:The study aim was to explore differences in psychosocial variables between TGD and cisgender youth with chronic pain. In alignment with the minority stress model, we hypothesized worse pain and pain-related disability, poorer quality of life, and more internalizing symptoms in TGD patients. The secondary aim was to explore associations among psychosocial variables in TGD and cisgender youth. Methods:Data were collected from 140 youth (48 TGD, 92 cisgender) evaluated in pediatric pain clinics. Independent samples t-tests examined group differences in pain intensity, functional disability, quality of life, pain catastrophizing, and internalizing symptoms. Bivariate correlations were conducted for each group, and differences in the strength of correlations were evaluated using Fisher r-to-z. Institutional review board (IRB) approval was obtained for all study procedures at each participating institution prior to extraction of retrospective clinical data (Indiana 240 University IRB Protocol No. 12506, The Ohio State University College of Medicine IRB Protocol No. 16-00937). Informed consent was not required or obtained due to the retrospective nature of the study. Results:Cisgender patients reported worse pain intensity, whereas TGD patients reported lower quality of life and more internalizing symptoms. In the combined sample, pain intensity was correlated with worse functional disability, poorer quality of life, and more catastrophic thinking. No group differences in the strength of correlations were found. Conclusions:Results suggest that for TGD youth with chronic pain, internalizing symptoms and quality of life are important targets for treatment and improvement.

Chronic pain and eating problems frequently co-occur, with disordered eating behaviors such as emotional eating, food restriction, and appetite fluctuation contributing to adverse outcomes. However, there are no validated screening tools specifically designed for assessing eating problems in chronic pain populations. This study aimed to validate two brief eating disorder measures, the Eating Attitudes Test-8 (EAT-8) and Eating Disorder Examination-Questionnaire-8 (EDE-Q8), for English-speaking adults presenting for chronic pain treatment. Participants included 173 adults seeking treatment at a pain evaluation service. Participants completed the EAT-8 and EDE-Q8 alongside self-report clinical measures. Demographic and clinical data were extracted from medical records. Statistical analyses assessed internal reliability, construct validity, and differences in eating disorder measures by BMI and eating disorder history. Both the EAT-8 and EDE-Q8 demonstrated acceptable internal reliability (McDonald’s omega ≥ 0.7) and strong construct validity, with significant correlation between the two measures (r = 0.77). Scores varied significantly by BMI and eating disorder history, with higher scores observed among participants with obese BMI or a history of eating disorders. However, less than 20

Chronic pain and sleep impairment frequently co-occur in children. Appraising one’s pain as unjust (“pain-related injustice”) has been associated with unique variability in cognitive, emotional, and functional outcomes among children with chronic pain. Less is known about the relationship between pain-related injustice and sleep impairment. The purpose of this study was to 1) examine the associations between pain intensity, injustice appraisals, and sleep impairment in children with chronic pain, and 2) examine whether injustice appraisals mediate the relationship between pain intensity and sleep impairment. The sample included children with chronic pain (N=249, Mage=14.3 years, 73.5% female, 89% White) receiving care at an outpatient university-based pain clinic. Children completed measures of pain intensity, pain-related injustice, and sleep impairment. Pain intensity was positively correlated with pain-related injustice (r=.32, p<0.01) and sleep impairment (r=.22, p<0.01), and pain-related injustice was positively correlated with sleep impairment (r=.37, p<0.01). Bootstrapped mediation analysis indicated that injustice appraisals mediated the relationship between pain intensity and sleep impairment (point estimate of indirect effect=.28, 95% CI:.15,.48). These results suggest that injustice appraisals about pain may play a mechanistic role in the association between pain intensity and sleep impairment in children with chronic pain. Longitudinal studies are needed to confirm the causal direction of these relationships. Ultimately, this line or work may inform justice-focused, cognitive-emotional interventions to reduce pain, enhance sleep, and maximize quality of life among children with chronic pain.

Parental perspectives are particularly important for children with chronic pain. Research suggests that discrepancies between child and parent reports impact pain-related outcomes. We aimed to 1) understand discrepancies in child- and parent-reported perceptions of the child’s pain and 2) examine whether discrepant reports were associated with child outcomes. Our sample included children with chronic pain (N=185, Mage=14.3 years, 75.7% female, 87.6% White) and their parents receiving care at an outpatient university-based pain clinic. Children completed self-referenced measures of pain intensity, pain-related injustice, depression, anxiety, functional disability, and quality of life. Parents completed child-referenced measures of pain intensity and pain-related injustice. Child- and parent-reported pain intensity and injustice significantly differed, with parents reporting higher perceptions of their child’s pain (t(148)=2.15, p=.033, dz=0.18) and pain-related injustice (t(184)=-8.54, p<.001, dz=-0.63). We created difference scores between child- and parent-reported pain and injustice and entered these as independent variables in regression models predicting child-reported outcomes (depression, anxiety, functional disability, and quality of life). Regression models predicting depression (R2=0.12, p=.011), anxiety (R2=0.09, p=.038), and quality of life (R2=.14, p=.006) were significant. Injustice difference scores (parent>child), but not pain difference scores, were associated with more depressive (t(72)=2.84, p=.006) and anxiety (t(72)=2.61, p=.011) symptoms and lower quality of life (t(68)=-3.29, p=.002) for the child. These results suggest that parent-child discrepancies about pain-related injustice may have a stronger impact on the child’s emotional experience and quality of life than does parent-child discrepancies about pain.

ObjectiveJuvenile fibromyalgia (JFM) is a complex chronic pain condition that remains poorly understood. The study aimed to expand the clinical characterization of JFM in a large representative sample of adolescents with JFM and identify psychological factors that predict pain interference.MethodsParticipants were 203 adolescents (ages 12–17 years) who completed baseline assessments for the multisite Fibromyalgia Integrative Training for Teens (FIT Teens) randomized control trial. Participants completed the Pain and Symptom Assessment Tool, which includes a Widespread Pain Index (WPI; 0–18 pain locations) and Symptom Severity checklist of associated somatic symptoms (SS; 0–12) based on the 2010 American College of Rheumatology criteria for fibromyalgia. Participants also completed self‐report measures of pain intensity, functional impairment, and psychological functioning.ResultsParticipants endorsed a median of 11 painful body sites (WPI score) and had a median SS score of 9. Fatigue and nonrestorative sleep were prominent features and rated as moderate to severe by 85% of participants. Additionally, neurologic, autonomic, gastroenterologic, and psychological symptoms were frequently endorsed. The WPI score was significantly correlated with pain intensity and catastrophizing, while SS scores were associated with pain intensity and all domains of physical and psychological functioning. Depressive symptoms, fatigue, and pain catastrophizing predicted severity of pain impairment.ConclusionJFM is characterized by chronic widespread pain with fatigue, nonrestorative sleep, and other somatic symptoms. However, how diffusely pain is distributed appears less important to clinical outcomes and impairment than other somatic and psychological factors, highlighting the need for a broader approach to the assessment and treatment of JFM.

Objective: Although insomnia symptoms and chronic pain are associated, less is known about the temporal nature of the associations between these variables or the impact of internalizing symptoms on the associations. Concurrent and longitudinal associations were examined among insomnia symptoms, internalizing symptoms, and pain in youth with chronic pain in this retrospective analysis of clinical records. We hypothesized the following: (a) pain, insomnia symptoms, and internalizing symptoms would be significantly interrelated at all waves, (b) insomnia symptoms would more strongly predict future pain than the reverse, and (c) internalizing symptoms would mediate the longitudinal association between insomnia symptoms and pain. Method: Youth (N = 132; age M = 15.34 years, SD = 1.86 years) were assessed at their initial and two subsequent appointments (time between appointments M = 6.48 months, SD = 4.43 months). At each appointment, youth reported their pain severity, insomnia symptoms, and internalizing symptoms. Confirmatory factor analyses (CFAs) and cross-lagged panel models using structural equation modeling were conducted. CFAs and the cross-lagged panel model with pain and insomnia symptoms as latent constructs converged. Results: Pain and insomnia symptoms were positively correlated within each wave. We found bidirectional longitudinal associations between insomnia symptoms and pain. Conclusions: Overall, these data demonstrate a bidirectional relationship between insomnia symptoms and pain, as well as weak support for internalizing symptoms mediating the association between pain and insomnia symptoms. Treatment of youth with chronic pain should prioritize concurrent or early treatment of comorbid insomnia symptoms to maximize response to pain treatment.

The aim of this narrative review was to provide an overview of what is known about the health care transition process in pediatric chronic pain, barriers to successful transition of care, and the roles that pediatric psychologists and other health care providers can play in the transition process. Searches were run in in Ovid, PsycINFO, Academic Search Complete, and PubMed. Eight relevant articles were identified. There are no published protocols, guidelines, or assessment measures specific to the health care transition in pediatric chronic pain. Patients report many barriers to the transition process, including difficulty attaining reliable medical information, establishing care with new providers, financial concerns, and adapting to the increased personal responsibility for their medical care. Additional research is needed to develop and test protocols to facilitate transition of care. Protocols should emphasize structured, face-to-face interactions and include high levels of coordination between pediatric and adult care teams.

Objective:To describe protocol adaptations to the Fibromyalgia Integrative Training for Teens (FIT Teens) randomized controlled trial in response to the COVID-19 pandemic. The overarching aims of the FIT Teens multi-site 3-arm comparative effectiveness trial are to assess whether a specialized neuromuscular exercise training intervention combined with cognitive-behavioral therapy (CBT) is superior to CBT alone or graded aerobic exercise alone. Design/methods:The trial was originally designed as an in-person, group-based treatment with assessments at baseline, mid- and post-treatment, and four follow-up time points. The original study design and methodology was maintained with specific modifications to screening, consenting, assessments, and group-based treatments to be delivered in remote (telehealth) format in response to COVID-19 restrictions. Results:Study enrollment was paused in March 2020 for five months to revise operations manuals, pilot remote treatment sessions for accuracy and fidelity, complete programming of REDCap assent/consent and assessment materials, train study staff for new procedures and obtain regulatory approvals. The trial was relaunched and has been successfully implemented in remote format since July 2020. Trial metrics thus far demonstrate a consistent rate of enrollment, strong attendance at remote treatment sessions, high retention rates and high treatment fidelity after protocol adaptations were implemented. Conclusions:Preliminary findings indicate that FIT Teens protocol adaptations from in-person to remote are feasible and allowed for sustained enrollment, retention, and treatment fidelity comparable to the in-person format. Methodologic and statistical considerations resulting from the adaptations are discussed as well as implications for interpretation of results upon completion of the trial.

Pain appraisals are closely tied to pain and functional outcomes. Pain-related injus-tice and pain catastrophizing appraisals have both been identified as important cognitive-emo-tional factors in the pain experience of youth. Although pain-related injustice and catastrophizing have been linked to worse pain outcomes - as primary predictors and interme-diary variables - little is known about whether they operate as independent or parallel media -tors of the relationship between pain and functioning in youth. We tested pain-related injustice and catastrophizing appraisals as candidate mediators of the relationship between baseline pain intensity and 3-month functional outcomes in adolescents. Youth with chronic pain (N = 89, 76% female, 89% White, average age = 15 years) completed measures assessing pain intensity, pain-related injustice, and catastrophizing at baseline, as well as measures assessing functional disability and overall quality of life 3 months later. Multiple mediation analyses indicated that injustice mediated the relationship between pain intensity and 3 month quality of life. Explor-atory analyses of specific quality of life domains indicated that injustice mediated the relation-ship between pain intensity and 3 month emotional functioning, whereas catastrophizing mediated the relationship between pain intensity and 3 month social functioning. The findings suggest these pain-related appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes. Perspective: Pain-related injustice and catastrophizing appraisals play different intermediary roles in the relationships among pain and future psychosocial outcomes in youth with chronic pain. Treat-ments targeting pain-related injustice appraisals in pediatric populations are needed to complement existing treatments for catastrophizing. (c) 2021 by United States Association for the Study of Pain, Inc.

Mechanisms explaining the relationship between pain-related injustice appraisals and functional outcomes in youth with chronic pain have yet to be examined. In studies of adults, greater pain-related injustice is associated with worse depressive symptoms and greater pain through greater anger. No study to date has examined anger expression as a mediator in the relationships between pain-related injustice appraisals and physical and psychosocial functioning in youth with chronic pain. The current sample consisted of 385 youth with varied pain conditions (75% female, 88% White, Mage=14.4 years) presenting to a university-affiliated pain clinic. Patients completed self-report measures assessing anger expression (anger-out and anger-in), pain-related injustice, pain intensity, functional disability, and emotional, social, and school functioning. Bootstrapped mediation analyses indicated that only anger-out (indirect effect= -.12, 95% CI: -.21, -.05) mediated the relationship between pain-related injustice and emotional functioning, whereas both anger-out (indirect effect= -.17, 95% CI: -.27, -.09) and anger-in (indirect effect= -.13, 95% CI: -.09, -.001) mediated the relationship between pain-related injustice and social functioning. Neither mode of anger expression mediated the relationship between pain-related injustice and pain intensity, functional disability, or school functioning. Collectively, these findings implicate anger as one mechanism by which pain-related injustice impacts psychosocial outcomes for youth with chronic pain. PERSPECTIVE: Anger expression plays a mediating role in the relationship between pain-related injustice appraisals and psychosocial outcomes for youth with chronic pain. Anger represents one target for clinical care to decrease the deleterious impact of pain-related injustice on emotional and social functioning.

OBJECTIVE Neuropathic pain is undertreated in children. Neurosurgical treatments of pediatric chronic pain are limited by the absence of both US Food and Drug Administration approval and pediatric-specific hardware, as well as weak referral patterns due to a lack of physician education. This study presents a single-institution retrospective case series of spinal cord stimulation (SCS) in children ≤ 19 years of age and a systematic review of SCS in children. The authors’ findings may further validate the role of SCS as an effective treatment modality for varied neuropathic pain syndromes found in pediatric patients. METHODS The study was a single-center, single-surgeon, retrospective case series of individuals treated between July 2017 and May 2022. The outcomes for pediatric patients with chronic neuropathic pain syndromes indicated by the multidisciplinary pain clinic for evaluation for SCS were cataloged. A systematic review and individual participant data (IPD) meta-analysis was performed for cases treated until May 2022, using PubMed, EMBASE, and Scopus to characterize outcomes of children with neuropathic pain treated with SCS. RESULTS Twelve patients were evaluated and 9 were indicated for percutaneous or buried lead trials. Seven female and 2 male patients between the ages of 13 and 19 years were implanted with trial leads. Eight of 9 (89%) patients went on to receive permanent systems. The average trial length was 6 days, and the length of stay for both trial and implant was less than 1 day. Complication rates due to CSF leaks were 22% and 0% for trial and implant, respectively. Visual analog scale pain scores decreased from 9.2 to 2.9 (p = 0.0002) and the number of medications decreased from 4.9 to 2.1 (p = 0.0005). Functional status also improved for each patient. A systematic review identified 13 studies describing pediatric patients with SCS, including 12 providing IPD on 30 patients. In the IPD meta-analysis, pain was reduced in 16/16 (100%) of patients following surgery and in 25/26 (96.2%) at last follow-up. Medication use was decreased in 16/21 (76.2%), and functional outcomes were improved in 29/29 (100%). The complication rate was 5/30 (16.7%). CONCLUSIONS SCS effectively decreases pain and medication use for pediatric neuropathic pain syndromes. Patients also report improved functional status, including improved matriculation, gainful employment, and physical activity. There is minimal high-quality literature describing neuromodulation for pain in children. Neuromodulation should be considered earlier as a viable alternative to escalating use of multiple drugs and as a potential mechanism to address tolerance, dependence, and addiction in pediatric patients.

OBJECTIVE:Pain-related appraisals, including pain-related injustice, impact the development and maintenance of chronic pain. This cross-sectional study aimed to examine the relationship between the cognitive-emotional components of pain-related injustice-blame/unfairness and severity/irreparability of loss-and functioning in a mixed sample of adolescents with chronic pain.METHODS:Pediatric patients age 11-18 years (N = 408) completed forms assessing pain-related injustice, pain intensity, and physical and psychosocial functioning as part of their routine assessment in a pediatric chronic pain clinic between January 2014 and January 2019. A series of hierarchical regressions were used to evaluate the relationships among the separate components of pain-related injustice appraisals and functioning.RESULTS:Pain intensity and blame/unfairness appraisals were significantly associated with emotional functioning with blame/unfairness being the stronger association (β = -.27). Blame/unfairness appraisals, severity/irreparability appraisals, and pain intensity were significantly associated with physical functioning with pain intensity being the strongest association (β = .36). Pain intensity, blame/unfairness appraisals, and severity/irreparability appraisals were significantly associated with social functioning with blame/unfairness being the strongest association (β = -.34). Pain intensity and severity/irreparability appraisals were significantly associated with school functioning with severity/irreparability being the stronger association (β = -.19).CONCLUSIONS:These results lend further support to incorporating pain-related injustice appraisals in standard clinical pain assessments. Treatment practices should target the specific injustice appraisals and domains of functioning impacted for each pediatric patient with chronic pain.

Background: Meditation is gaining recognition as a tool to impact health and well-being. Samyama is an 8-day intensive residential meditation experience conducted by Isha Foundation requiring several months of extensive preparation and vegan diet. The health effects of Samyama have not been previously studied. The objective was to assess physical and emotional well-being before and after Samyama participation by evaluating psychological surveys and objective health biomarkers. Methods: This was an observational study of 632 adults before and after the Isha Samyama retreat. All participants were invited to complete surveys. Controls included household significant others. Surveys were completed at baseline (T1), just before Samyama (T2), immediately after Samyama (T3), and 3 months later (T4) to assess anxiety, depression, mindfulness, joy, vitality, and resilience through validated psychometric scales. Voluntary blood sampling for biomarker analysis was done to assess hemoglobin (Hb), HbA1c, lipid profile, and C-reactive protein (CRP). Primary outcomes were changes in psychometric scores, body weight, and blood biomarkers. Results: Depression and anxiety scores decreased from T1 to T3, with the effect most pronounced in participants with baseline depression or anxiety. Scores at T4 remained below baseline for those with pre-existing depression or anxiety. Vitality, resilience, joy, and mindfulness increased from T1 to T3 (sustained at T4). Body weight decreased by 3% from T1 to T3. Triglycerides (TG) were lower from T2 to T3. Participants had lower HbA1c and HDL at T2, and lower CRP at all timepoints compared with controls. Conclusions: Participation in the Isha Samyama program led to multiple benefits. The 2-month preparation reduced anxiety, and participants maintained lower anxiety levels at 3 months post-retreat. Physical health improved over the course of the program as evidenced by weight loss and improved HbA1C and lipid profile. Practices associated with the Samyama preparation phase and the retreat may serve as an effective way to improve physical and mental health. Future studies may examine their use as an alternative therapy in patients with depression and/or anxiety. Clinical Trial Registration: www.ClinicalTrials.gov , Identifier: 1801728792. Registered retrospectively on 4/17/2020.

Background: In the pediatric population, complex regional pain syndrome (CRPS) is a debilitating chronic pain syndrome that is classically treated with escalating polypharmacy and physical therapy. Failure of therapy is often encountered in both adult and pediatric patients with CRPS, after which invasive neuromodulatory therapy might be considered. Intrathecal drug delivery systems and spinal cord stimulation (SCS) have been reported in the literature as forms of neuromodulation effective in adult CRPS; however, SCS remains inadequately researched and underreported in the pediatric CRPS population. Owing to the differences in patient population characteristics and the specific vulnerability of adolescents to drugs that might be used to manage refractory cases, including but not limited to opioids, we believe that early effective pain management without the use of chronic pain medications is of paramount importance.Methods: Recent evidence suggests that neuromodulation can be useful toward improving function and managing pain, while also reducing medication use in chronic pain patients. A representative case a review of the literature is performed.Results: We report the effective treatment of CRPS in a pediatric patient following implantation of an SCS device typifying the improved pain scores, decreased medication use, and substantially improved functional abilities in pediatric patients following SCS.Conclusions: The manuscript objective is to stimulate a discussion for SCS use earlier in the therapeutic management of CRPS in children.

PROBLEM During the first years of life, the brain is developing rapidly and is especially vulnerable to the effects of trauma and or stress. Early exposure to such early trauma or stress predisposes young children to mental health problems. The practice of infant mental health (IMH) focuses on preventing negative mental health outcomes in infancy and toddlerhood. Currently, IMH is not standard practice in nursing. To enhance IMH in nursing, this manuscript provides an overview of IMH practice models, discusses nursing implications of each model and presents a model for integrating IMH into nursing practice. METHODS A scoping review was conducted with a literature search utilizing the keywords "infant mental health" AND "models of care" in the PubMed and CINHAL databases from 2002 to 2018. FINDINGS Twenty of the publications retrieved met search criteria. Among the 20 articles, 10 addressed clinical-based content related to IMH practice and 10 addressed nonclinical-based content associated with IMH educational training, policy development, or system-based models of care. CONCLUSIONS Nurses are well positioned to impact IMH. The model presented provides the nursing process as a practical framework for the integration of IMH in nursing practice that can be expanded upon as IMH evolves.

Peer support has found applications beyond the mental health field and is useful for managing several chronic disorders and supporting healthy lifestyle choices. Communication through telephone and the Internet allows for greater access to those who cannot meet in person. Adolescent chronic pain would seem ideally suited to benefit from online peer support groups. Research is lacking, however, to characterize benefit in terms of pain and function, despite a clear desire among adolescents for access to such programs. More rapid development of online applications is needed for peer support, and research into the associated outcomes will be necessary to optimally design such programs.

Background In the pediatric population, complex regional pain syndrome (CRPS) is a debilitating chronic pain syndrome that is classically treated with escalating polypharmacy and physical therapy. Failure of therapy is often encountered in both adult and pediatric patients with CRPS, after which invasive neuromodulatory therapy might be considered. Intrathecal drug delivery systems and spinal cord stimulation (SCS) have been reported in the literature as forms of neuromodulation effective in adult CRPS; however, SCS remains inadequately researched and underreported in the pediatric CRPS population. Owing to the differences in patient population characteristics and the specific vulnerability of adolescents to drugs that might be used to manage refractory cases, including but not limited to opioids, we believe that early effective pain management without the use of chronic pain medications is of paramount importance. Methods Recent evidence suggests that neuromodulation can be useful toward improving function and managing pain, while also reducing medication use in chronic pain patients. A representative case a review of the literature is performed. Results We report the effective treatment of CRPS in a pediatric patient following implantation of an SCS device typifying the improved pain scores, decreased medication use, and substantially improved functional abilities in pediatric patients following SCS. Conclusions The manuscript objective is to stimulate a discussion for SCS use earlier in the therapeutic management of CRPS in children.