Background Chronic pain affects up to 20% of the population and often results in significant distress, disability, and reduced quality of life. Despite compelling evidence for behavioural treatments, treatment access remains limited. To improve access, a digital behavioural treatment for chronic pain was developed as part of the multi-phase ‘DAHLIA’ project. The present study evaluates the effects of this newly developed digital behavioural treatment. Methods Data were collected in a single-arm, iterative trial using a replicated single-case experimental design (SCED). In total, 56 participants received treatment (mean age 47, 87% female, varied pain regions). Participants completed twice daily digital diaries and questionnaires at pre-, and post-treatment, and at 3- and 6-months follow-ups. Diary items and questionnaires assessed psychological flexibility and acceptance, pain-related functioning, pain intensity, and general well-being. Daily diary data were examined using a combined p-value approach to conduct a meta-analysis of the SCED data, and questionnaire data were analysed using linear mixed models. Results Meta-analyses of daily diary data showed significant improvements in most pain-related items, indicating the utility of treatment in everyday life. Linear mixed model analyses of effects showed significant improvements over time in key outcomes with the largest changes observed in pain acceptance and psychological flexibility and smaller effects in pain-related functioning. Conclusion This study provides initial evidence for the newly developed digital behavioural treatment for chronic pain. Findings suggest that the treatment can improve resilience, daily functioning and symptoms and suggest the potential of the treatment as an effective evidence-based treatment for chronic pain.

OBJECTIVES:Pediatric chronic pain is a global health problem associated with psychological comorbidities and declines in functioning. Recent research indicates a large number of autistic youth experience chronic pain, and a significant number of autistic youth identify as gender-diverse. While the exact prevalence is unknown, there is growing recognition that a number of youth with chronic pain identify as gender-diverse. To date, little is known about the experiences of youth with these intersecting identities. This study sought to understand the lived experiences of youth with chronic pain who identify as gender-diverse and autistic. METHOD:Semistructured interviews with youth with chronic pain who identified as gender-diverse (N = 6) and self-reported the identity of autism were conducted to understand the individual, lived experiences of these youth. Data were analyzed using interpretative phenomenological analysis. RESULTS:Interpretative phenomenological analysis produced four group experiential themes consisting of nine personal experiential themes. Group experiential themes included: The compounding impact of identities, wrestling with labels, health care as a maze to be navigated, and the impact of society as the additional identity in the room. CONCLUSIONS:Youth with chronic pain who are autistic and gender-diverse experience unique stressors in the context of their identities. Understanding the experiences of these youth is essential for providing equitable and inclusive pain care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background:Pain Rehabilitation Virtual Reality (PR-VR) is a novel tool designed to engage youth with chronic pain in exercise as a part of physiotherapy. PR-VR has been evaluated in day-treatment and outpatient settings, but not for at home use. Aims:To evaluate the feasibility, acceptability and safety of PR-VR at home for youth with chronic pain. An exploratory aim evaluated the preliminary effectiveness of PR-VR on pain and disability. Methods:This was a 3-arm pilot randomized controlled trial (registration #NCT04912817). Each study arm included four 60-min physiotherapy sessions via Zoom (1: commercially available VR; 2: custom-developed PR-VR; 3: standard physiotherapy care). Feasibility metrics included enrollment, accrual, and drop-out rates. Acceptability was measured via satisfaction surveys and qualitative interviews. Pain and disability were measured via self-report, physical performance, and actigraphy. Results:Thirty-seven of 70 eligible patients approached were enrolled and randomized (53% enrollment rate, 100% accrual rate), including 28 females (76%) aged 10-17 years. Twenty-eight participants completed the study (33% drop-out rate; reasons include pain resolution, medical complexity, dissatisfaction with assignment to control). Ten minor adverse events were reported across study arms. Participants and physiotherapists expressed high levels of VR acceptability. Of the participants who completed arms 1 and 2 (n = 17), 94% were satisfied/very satisfied with VR and 100% rated VR as easy/very easy to use. Conclusions:Results from this study demonstrate the safety and acceptability of VR in pediatric pain rehabilitation. These feasibility results will inform the design of future large-scale trials, including consideration of a wait-list control group. Trial Registration:ClinicalTrials.gov, NCT04912817.

Introduction Shared decision making (SDM) in healthcare is an ethical imperative and essential to patient-centred care. SDM is particularly useful when several preference-sensitive treatment options exist and in the setting of chronic conditions or longitudinal management. Chronic pain management embodies these characteristics, yet SDM often remains insufficient in this population. Decision aids are designed to facilitate SDM by helping patients and clinicians understand treatment options, clarify patient values, and guide collaborative decision processes. Despite their importance, the use of decision aids in pain management is inconsistent and their reported effectiveness has been variable. However, the current landscape of decision aids for pain management has not been described. This lack of understanding of what tools exist, how they are structured, what decisions they address and how they were developed makes it difficult to advance implementation efforts or identify meaningful gaps in available resources. As such, the purpose of this systematic review is to identify and characterise decision aids for pain management across the lifespan. Specifically, this review will describe the clinical decisions addressed, decision aid structures and delivery formats, development processes and outcomes used to evaluate the impact of existing decision aids.Methods and analysis Electronic searches were performed in PubMed, CINAHL and Ovid Embase from inception through January 2026. Studies will be assessed for quality using the Mixed Methods Appraisal Tool. Data will be extracted and presented with the aim of describing the: (a) content and structures of pain-related decision aids, (b) development processes used to create existing pain-related decision aids and (c) outcome measures used to evaluate the impact of decision aids in clinical care.Ethics and dissemination This review does not require ethics approval. Findings will be disseminated to clinicians, researchers and patients through journal publications, conference presentations and in collaboration with patient partners.PROSPERO registration number CRD420251085288

Background/Objectives: Fatigue is a known predictor of disability and reduced quality of life in youth with hypermobility and chronic pain in general. Given the added relationship between chronic fatigue and connective tissue disorders, including hypermobile Ehlers–Danlos Syndrome (hEDS), this study aims to investigate the comparative role of fatigue on important predictors of outcomes for youth with and without hEDS who have chronic pain. Methods: In this retrospective study, pediatric patients with chronic pain diagnosed with hEDS (n = 100) were compared to an age- and sex-matched group of youth with chronic pain without diagnosed hypermobility (n = 100). Participants completed measures of pain-related distress (PCS-C), avoidance (FOPQ-A), and pediatric PROMIS measures for fatigue, anxiety, and pain interference. Data were analyzed using chi-square tests, t-tests, and ANCOVAs in RStudio. Results: Fatigue scores were higher and clinically elevated fatigue was more prevalent in those with hEDS than in matched chronic pain peers. Fatigue was significantly positively related to pain interference, avoidance, and pain-related distress in youth with and without hEDS. Conclusions: The current study supports the need for multidisciplinary treatment and rehabilitation for pediatric chronic pain and hypermobility and suggests that fatigue may be an important factor to consider when treating youth with hypermobility.

Observing your child in pain is inherently distressing. In the context of chronic pain, caregiver responses can powerfully impact child pain-related functioning. The Parent Empathy in the Context of Pain model postulates that parent empathic distress may hinder adaptive responses to child pain, thus playing a key role in the link between parent responses and child functioning. Here, we examined how parent empathy is related to parent and child pain-related constructs within the Parent Empathy in the Context of Pain model, using an adapted Empathy for Pain Scale (EPS) for use in parents (P-EPS). Data were collected from 190 parents of youth with chronic pain (170 mothers; children aged 8-18y) and their children. Structural equation modeling (SEM) showed support for the theoretical model. Parent pain-related beliefs were associated with behavioral responses via affective responses of empathy for pain (affective distress) and emotion regulation (emotional suppression), which in turn were associated with child pain-related functioning. Moreover, higher levels of parent empathic distress to observing their child’s pain was significantly associated with more general empathic distress, poorer perspective taking and more maladaptive emotion regulation strategy use (emotional suppression). Our findings underscore the involvement of parent affective responses in driving parent maladaptive behavioral responses to their child’s pain and emphasize the role of affective empathic distress as well as its regulation. In addition to providing information on its assessment, this empirical investigation provides novel insights into the construct of empathy in this context. Perspective This article presents initial data supporting the Parent Empathy in the Context of Pain model. Findings show involvement of parent affective responses in driving parent maladaptive behavioral responses to their child’s chronic pain and emphasize the role of affective empathic distress as well as its regulation.

OBJECTIVE:Pain acceptance predicts better quality of life, physical functioning, and treatment outcomes in youth with chronic pain. However, we know little about the factors that promote pain acceptance in youth. This study investigated body mindsets and their associations with facets of pain acceptance, specifically pain willingness and activity engagement, in adolescents with chronic pain. METHODS:The sample comprised 102 adolescents with chronic musculoskeletal pain (aged: 8 to 17; 72.3% female, 49.5% Caucasian/White) attending a tertiary pain clinic. Hierarchical linear regression analyses examined associations of body mindsets with pain acceptance, controlling for demographic factors, pain and mental health symptoms, and basic functioning. RESULTS:There was significant variation in the mindsets that adolescents with chronic pain held about their bodies-some endorsed the mindset that their Body is an Adversary, others endorsed the mindsets that their Body is Responsive or Body is Capable. Hierarchical linear regression analyses indicated that endorsing the mindset that their Body is an Adversary was associated with lower willingness to experience pain, while endorsing the mindset that their Body is Capable was associated with greater engagement in valued activities despite pain, even after accounting for demographic factors, pain characteristics, and basic functioning. Together, all 3 mindsets explained 6.6% to 26.8% unique variance in pain acceptance. DISCUSSION:Body mindsets are significantly associated with pain acceptance in youth with chronic pain, even after controlling for pain characteristics and basic functioning. Experimental research should investigate whether body mindsets are modifiable in this population and whether they could represent interventional targets fostering pain acceptance.

ABSTRACT:The Pediatric PainSCAN is the first screening tool for neuropathic pain (NP) and complex regional pain syndrome (CRPS) designed for pediatrics. Prior research developed the tool and established content validity. The tool has 3 parts, part A is a preface (pain location, severity, duration), part B discriminates NP or CRPS from other pain conditions, and part C discriminates CRPS from NP. This study aimed to evaluate the tool's reliability and validity. A multicentre cross-sectional survey was administered to participants with NP, CRPS, and other pain conditions in pediatric chronic pain clinics. Test-retest reliability was evaluated by readministering the tool after 7 days. Criterion validity (sensitivity [SE] and specificity [SP]) was evaluated by comparing participant scores to a clinician diagnosis. Convergent validity was evaluated by comparing participant scores on the tool to existing NP screening tools. Participants (N = 221; 56 with NP, 57 with CRPS, 108 with other pain) were aged 9 to 18 years and 81% female. Test-retest reliability (intraclass correlation coefficients part B = 0.76 and part C = 0.82) was sufficient (>0.70). Criterion validity (part B: SE 76%, SP 63%; part C: SE 83%, SP 77%) was sufficient (>70%) except for SP of part B. Convergent validity was sufficient (correlation coefficients aligned with hypotheses: painDETECT [0.73], self-report Leeds Assessment of Neuropathic Symptoms and Signs [0.73], and Patient-Reported Outcome Measurement Information System Neuropathic Pain Quality [0.59]). The Pediatric PainSCAN demonstrated sufficient reliability and validity to screen for NP and CRPS in pediatric chronic pain clinics. Future research is needed to evaluate the tool in other settings and determine the utility of implementing the tool in clinical practice.

Pain avoidant behavior is a predictive factor for reduced function in children with persistent pain. A model to explain this is the Fear-Avoidance Model of Pain (FAM). In FAM pain-related fear plays an important role in the development and maintenance of avoidant behavior. The Fear of Pain Questionnaire-Child Report Short Form (FOPQC-SF) was developed to assess pain-related fear in children 8 to 18 years old. Self-report questionnaires must be translated and adapted to the language and context where they will be used. The aim of this study was therefore to develop a Swedish version of the FOPQC-SF in collaboration with children. Translation and linguistic adaptation of the FOPQC-SF was performed using the dual-panel method in two steps. First, a bilingual panel created a first Swedish version of the questionnaire. This first version was then presented to a panel of five children without persistent pain and revised according to their feedback. Secondly, the translated and revised Swedish version of the FOPQC-SF was used for individual cognitive interviews with six children with persistent pain. The bilingual panel found the FOPQC-SF unproblematic to translate and consensus was easily achieved. Revisions were made regarding instructions, response options, item-wording and layout. The children also found the questionnaire acceptable and relevant. In conclusion, we consider the Swedish version of the FOPQC-SF to be a relevant and useful tool in research as well as in clinical practice to assess pain-related fear. Psychometric testing will provide further information about the tool's clinical usefulness.