Needle-Related Pain,Affective Reactions,Fear, and Emotional Coping in Children and Adolescents With Type 1 Diabetes: A Cross-Sectional Study

BackgroundThe self-care of type 1 diabetes (T1D) includes undergoing procedures with needles several times daily, which may cause pain and fear.AimsThe aim was to identify the degree of perceived pain, affective reactions, fear, and emotional coping among children and adolescents with T1D.DesignA cross-sectional survey was performed.MethodsChildren and adolescents 7-18 years of age (n = 197) and their parents (n = 123) completed the Coloured Analogue Scale (CAS), the Facial Affective Scale (FAS), the Diabetes Fear of Injection Questionnaire (D-FISQ), and the Faces Emotional Coping Scale (FECS) in relation to needle procedures.ResultsThe higher the values of the CAS, FAS and D-FISQ scores, the lower values for coping were reported by children and adolescents regarding treatment with insulin pen or pump, blood glucose test, and venipuncture (p < .001). Patients reported strong negative affect regarding insulin injections (35%) and blood glucose tests (32%), as well as negative affect (48%, 69%) and substantial pain (27%, 50%) for inserting a pump needle and venipuncture, respectively. Parents reported significantly higher values than children on all scales and procedures except D-FISQ (blood glucose tests) and FECS (venipuncture).ConclusionsChildren and adolescents who perceive greater pain during needle-related procedures have poorer coping ability. Pediatric diabetes teams need to identify those in need of extra support to develop pain coping strategies.     

A Pilot Randomized Controlled Trial Evaluating Essential Oils for Chemotherapy-Induced Peripheral Neuropathy

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is a painful, debilitating consequence of cancer treatment affecting up to 60% of patients. Pharmacological approaches to CIPN are often ineffective and cause adverse effects. Essential oils are an underutilized non-pharmacological approach to pain reduction.AimsTo ascertain the efficacy of an essential oil intervention to reduce CIPN.DesignA single-blind, pilot randomized controlled trial.MethodsParticipants (n = 27) were stratified by baseline pain scores and randomized to intervention (n = 13) and placebo groups (n = 14). Participants topically-applied the essential oil intervention or placebo every eight hours for six weeks. Pain was assessed using the Short-Form-McGill Pain Questionnaire-2 weekly and the Visual Analogue Scale daily. Quality-of-life was assessed using the Quality-of-Life: CIPN-20 and Quality-of-Life Adult Cancer Survivor questionnaires. Data were analyzed in SPSS using generalized estimating equations.ResultsNo significant difference was observed between groups in pain or quality-of-life scores over seven weeks, but improvement was observed in both groups. Participants using the intervention with pain medications showed a significant reduction in pain compared to placebo (p = .001). Educational level (p = .041) and annual income (p = .005) were significant covariates mirroring these social determinates of pain. Older participants felt less negatively about their CIPN (p = .002). Positive placebo effect and spatiotemporal interactions were observed.ConclusionsThis pilot study demonstrated that participants adhered to the intervention for six weeks. Essential oils have potential direct and adjuvant pain-reducing effects and should be studied further.     

The effects of pilates on posture and physical fitness parameters in 5–6 years old children: A non-randomized controlled study

BackgroundInactivity is a public health problem. Physical activity is beneficial at any age, but is even more critical in childhood for healthy development and growth.ObjectivesThe purpose of this non-randomized controlled study was to investigate the effects of Pilates on posture and physical fitness parameters in 5–6 years old healthy children.MethodsFour preschool classes were divided into two groups. Five-six years old 66 preschool children were assigned to the Pilates (n = 31) and control (n = 35) groups. The Pilates group received a Pilates program twice a week for 10 weeks. The control group continued their daily routines. Postural assessment was evaluated using the New York Posture Rating Chart test and physical fitness was evaluated with the Eurofit test battery. Children were blinded to assignment. The Mann-Whitney U test was used for comparisons between groups, and the Wilcoxon Signed-Rank test was used for within-group comparisons.ResultsIn this study, within-group comparisons showed statistically significant improvements in the New York Posture Rating chart test (p < 0.001), Flamingo Balance, Sit and Reach, Standing Broad Jump, 30-Second Sit-Up, Bent Arm Hang, and 20-Meter Shuttle Run test scores (p < 0.05).ConclusionPilates has positive effects on physical fitness parameters and postural evaluation in preschool children. This study suggests that Pilates can be an entertaining alternative physical activity in children aged 5–6 years.Clinicaltrials.numberNCT05210426.     

A More Comfortable Method of Skin Prick Testing in Children Ages 0-2 to Decrease Symptoms of Pain

BackgroundSkin prick testing (SPT) is the best initial diagnostic method for individuals of all ages who have potential allergies.AimWe aimed to investigate if recent breastfeeding has any effect on reducing the pain of children before SPT.DesignProspective, randomized, single-blinded study.SettingsAcademic hospital specialized in pediatrics.Participants/SubjectsSixty-four out of seventy-five children requiring SPT within ages 0-2 were included.MethodsAll participants in this study were breastfed children, and that group assignment randomized them to the control group (n = 32) if children breastfed 30-90 min. prior to arriving for SPT, and study group of children (n = 32) who were also breastfed 30-90 minutes prior to arriving for SPT who were then breastfed again just prior to the beginning of the SPT. The FLACC pain scale was used to test the sensitivity of all children for pain before, during, and 15 minutes after the SPT. The effect of breastfeeding on the pain score and the duration of crying were compared among groups.ResultsBoth groups were similar according to age, gender, and other socio-demographic characteristics (p > .05). The percentage of children that cried during SPT was significantly higher in the control group than the study group (p = .002). The FLACC pain scale values were significantly lower in the study group (p < .001).ConclusionRecent breastfeeding before SPT is correlated with less crying by possibly reducing the perceived pain of children ages 0-2.     

Effect of Guided Imagery Meditation During Laparoscopic Cholecystectomy on Reducing Anxiety: A Randomized Controlled Trial

BackgroundUp to 90% of patients still experience pain after abdominal surgery, which also affects their physical recovery and psychological anxiety.AimTo evaluate the effects of guided imagery meditation on ameliorating anxiety, improving the quality of sleep, and relieving postoperative pain in patients after laparoscopic cholecystectomy surgery.MethodIn the general surgical ward of a teaching hospital, patients were randomly assigned to usual care (n = 34) and guided imagery meditation intervention (n = 34) groups, using the method. The measuring outcomes included their anxiety score, quality of sleep, and pain control.ResultsIn terms of the anxiety difference, the experimental group scored 0.42 (standard deviation [SD] = 0.97), while the control group scored 4.79 (SD = 7.56), which indicates a statistically significant difference (F = 8.04, p = .01, partial eta² = 0.11). In terms of quality of sleep, the mean score of the experimental group was 2.67 (SD = 1.96), while the control group scored 7.55 (SD = 3.81), which indicates a significant difference (F = 39.99, p = .001, partial eta² = 0.39). The mean of the degree of postoperative pain was 2.11 points (SD = 1.39), and the score of the control group was 4.00 points (SD = 1.62), which indicates a significant difference (p = .001).ConclusionsGuided imagery meditation is a simple, non-invasive, non-pharmacologic intervention measure. It can reduce anxiety and postoperative pain, and improve the quality of sleep. Thus, it should be promoted in clinical practice.     

Evaluating Differences Between Participants With Various Forward Head Posture With and Without Postural Neck Pain Using Craniovertebral Angle and Forward Shoulder Angle

ObjectiveThe purpose of this study was to investigate differences between individuals with various forward head posture (FHP) severities with and without postural neck pain using craniovertebral angle and forward shoulder angle.MethodNinety participants age 20 to 50 years were categorized into the following 4 groups based on observational method and presence or absence of postural neck pain: (1) slight FHP group without pain, (2) slight FHP group with pain, (3) moderate-to-severe FHP group without pain, and (4) moderate-to-severe FHP group with pain. A digital imaging technique was used to measure the craniovertebral angle and forward shoulder angle in a standing position.ResultsA 1-way analysis of variance test showed a significant difference for craniovertebral angle in the 4 groups (F = 22.04, P < .001). Tukey's test showed the difference in this variable was significant between slight FHP groups (with or without pain) and moderate-to-severe FHP groups (with or without pain) (P < .001). Although overall F indicated a significant difference (F = 4.11, P < .009) of the forward shoulder angle in 4 groups, Tukey's test revealed this was only significantly different in 2 groups: slight FHP with pain and moderate-to-severe FHP with pain (P = .005).ConclusionThe craniovertebral angle in the 2 groups of moderate-to-severe FHP was significantly smaller than that in the 2 groups of slight FHP. However, the forward shoulder angle in the group of moderate-to-severe FHP with pain was only significantly smaller than that in slight FHP with pain. The results showed that including pain as a factor of categorization did not lead to a significant difference between various groups regarding craniovertebral angle and forward shoulder angle.     

Association of Musculoskeletal Pain With Sedentary Behavior in Public School Teachers: The Role of Habitual Physical Activity

BackgroundSedentary behavior has been associated with musculoskeletal pain in school teachers. However, our hypothesis is that physical activity practice could mitigate this association.AimThe aim of this study was to investigate the relationship of musculoskeletal pain with high screen-based sedentary behavior among public school teachers and whether physical activity could mitigate this relationship.MethodA sample of 246 teachers from 13 public schools were assessed (45.0 ± 10.4 years, 76.0% of women). Musculoskeletal pain was assessed using the Nordic Musculoskeletal Questionnaire, screen-based sedentary behavior was measured considering the sum of screen time in television, computer, and smartphone/tablet, and physical activity using the Baecke habitual physical activity questionnaire. Binary logistic regression was used to verify the associations between high screen-based sedentary behavior and musculoskeletal pain in school teachers (Model 1-unadjusted; Model 2-adjusted by age, sex, and socioeconomic status; Model 3-variables of Model 2 + adjusted by physical activity).ResultsHigh screen-based sedentary behavior was associated with pain in neck (odds ratio = 2.09; 95%confidence interval = 1.08-4.04), upper back (odds ratio = 2.21; 95%confidence interval = 1.07-4.56), and low back (odds ratio = 1.91; 95%confidence interval = 1.00-3.65). However, after inserting the variables, including physical activity, these associations were mitigated.ConclusionsHigh screen-based sedentary behavior was associated with musculoskeletal pain in public school teachers. However, this relationship was mitigated after the inclusion of confounding variables, including physical activity.     

Trajectories,Risk Factors,and Impact of Persistent Pain After Major Musculoskeletal Surgery in Adolescents: A Replication Study

Studies have identified high rates of chronic postsurgical pain in adolescents. Characterizing patterns of pain in the transition from acute to chronic following major surgery may pinpoint critical periods of recovery. This observational study modelled pain trajectories over 1-year following surgery to attempt replication of prior work and evaluate baseline psychosocial factors and 12-month health outcomes. Adolescents 10 to 18 years completed electronic daily pain reporting for 7 days and self-reported health outcomes, at 5 assessment timepoints. Group-based trajectory modelling identified two trajectories with similar starting points in-hospital but distinct recovery courses at home. Pain declined steadily in one group across the study period (“Declining Pain”; estimated probability,18.9%), but pain increased after hospital discharge and remained high through 12-months in the other group (“High and Persistent Pain”; estimated probability,81.1%). Pre-surgery pain (Aor = 1.86, P = .001) and sleep quality (Aor = 0.49, P = .029) were associated with the High and Persistent pain trajectory in multivariate regressions. This trajectory was associated with lower total quality of life (B=-9.79, P = .002), physical health (B = -15.93, P < .001), psychosocial health (B = -6.73, P = .06), and greater fatigue (B = -13.61, P = .001). This study replicated prior findings identifying two post-surgical pain trajectories with diverging pain in the first two weeks. Clinical detection of those with increasing pain and early intervention may interrupt persistence of pain.PerspectiveThis article replicates a prior study identifying distinct post-surgical pain trajectories, Declining Pain and High and Persistent Pain. The High and Persistent pain trajectory is associated with pre-surgery pain, pre-surgery sleep quality, and lower quality of life (total, physical, and psychosocial health as well as fatigue) at 12-month follow-up.     

Evaluation of Efficacy of Valsalva Maneuver During Peripheral Intravenous Cannulation on Pain

BackgroundAimsThe aim of this study was to examine the effects of the Valsalva maneuver during peripheral intravenous catheter (PIVC) insertion on procedure-related pain.DesignThis work was a prospective randomized controlled study.SettingsStudy was conducted in the orthopedics clinic of a university hospital.Participants/SubjectsMethodsThe sample of patients (N = 110) was allocated to the Valsalva maneuver group (n = 55) and control group (n = 55) by using blocked randomization to reduce bias and achieve balance according to age and gender. Pain was evaluated by using Numerical Rating Scale. Systolic/diastolic blood pressure and heart rate before and after the PIVC placement was recorded.ResultsThe patients in the intervention group had less severe pain during the PIVC insertion than the patients in the control group (p ? .001). After PIVC placement, systolic blood pressure was significantly reduced in both groups (p = .008), no other variables changed significantly. No clinical complication related to the Valsalva maneuver occurred in the intervention group.ConclusionValsalva maneuver can be used as a non-pharmacologic method to reduce pain during PIVC placement.     

The effects of a postural supporting “New Nesting Device” on early neurobehavioral development of premature infants

BackgroundExtended positioning is believed to have negative impacts on the neurodevelopment of the infants. Currently, many neonatal intensive care unit (NICU) in China do not have adequate posture supporting device for premature infants. Positional support has been done often by using bed sheet, washcloth or blanket. Inadequate posture support can hinder the neurobehavioral development of premature infants.PurposeThe study aims to compare the effects of neurobehavioral development outcomes between a “New Nesting Device” and a “Traditional-Nest” posture supporting interventions, for premature infants from NICU admission to 36th week of gestational age after birth.MethodsThe study followed the Quasi-experimental study design. A total of 95 participants were randomized to either a “New Nesting Device” group (n = 49) or “Traditional-Nest” group (n = 46) after admission. All participating premature infants were assessed at 34th and 36th weeks of gestational age, and posture, body movements and early neurobehavioral outcomes were measured. Posture and body movements were recorded once at 34th weeks and again at 36th weeks. Digital video camera was used at the bedside to record an uninterrupted 12-h-long session to obtain posture and behavioral data. All participating premature infants received aEEG and cranial ultrasonography examinations at bedside to evaluate early neurobehavioral outcomes when they reached 34th weeks and again 36th weeks of gestational age.ResultsThe “New Nesting Device” group had better effects on posture (p＜0.001 for both), and demonstrated more smooth body movements (p = 0.018, p＜0.001) than premature infants of the “Traditional-Nest” group at both 34th and 36th weeks of gestational age. The “New Nesting Device” group also captured higher frequencies of “sleep-wake cycling” (p = 0.049, p = 0.037) through aEEG examination compared to the “Traditional-Nest” group at 34th and 36th weeks of gestational age.Conclusions“New Nesting Device” can provide premature infants a comfortable posture support similar to the flex posture they had while in the uterus. Smooth body movements and non-extended extremities can promote early neurobehavioral development. This study demonstrates the effects of the newly designed posture support device on premature infants. It also introduced the features of the newly designed nesting device for clinical nurse to understand how the nesting device can enhance comfort and support the neurobehavioral development of premature infants.Implications for practice and researchFurther research is needed to determine the cost and long-term effect contribution to the overall neurobehavioral development of premature infants by continued use of this soothing posture support device after discharge from NICU. The study also provides reference for the selection of posture supporting intervention and outcome measurements for future similar clinical studies.     

Profiles of Pain Acceptance and Values-Based Action in the Assessment and Treatment of Chronic Pain

Pain acceptance and values-based action are relevant to treatment outcomes in those with chronic pain. It is unclear if patterns of responding in these 2 behavioral processes can be used to classify patients into distinct classes at treatment onset and used to predict treatment response. This observational cohort study had 2 distinct goals. First, it sought to classify patients at assessment based on pain acceptance and values-based action (N = 1746). Second, it sought to examine treatment outcomes based on class membership in a sub-set of patients completing an interdisciplinary pain rehabilitation program of Acceptance and Commitment Therapy for chronic pain (N = 343). Latent profile analysis was used in the larger sample to identify 3 distinct patient classes: low acceptance and values-based (AV) action (Low AV; n = 424), moderate acceptance and values-based action (Moderate AV; n = 983) and high acceptance and values-based action (High AV; n = 339). In the smaller treated sample, participants in the Low AV and Moderate AV class demonstrated improvements across all outcome variables, whereas those in the High AV class did not. These findings support the role of pain acceptance and values-based action in those with chronic pain.PerspectiveIndividuals with chronic pain can be classified with respect to pain acceptance and values-based action and these groups may respond differently to treatment.     

The effect of acupressure on quality of life among female nurses with chronic back pain

BackgroundChronic back pain is one of the most common work-related diseases and most important of musculoskeletal disorders in nursing professionals and because of the physical and psychological effects, has a significant impact on quality of life (QOL). Acupressure is a holistic form of complementary medicine. This study aimed to investigate the effect of acupressure on QOL among female nurses with chronic back pain.Materials and methodsThis randomized single-blind clinical trial was conducted on 50 nurses with chronic back pain working at the selected hospitals in Isfahan, Iran. After convenient sampling, the subjects were randomly allocated, through lottery, to the two groups of experimental (n = 25) and sham (n = 25). In the experimental group, acupressure techniques were performed during 9 sessions, 3 times a week for 14 min for each patient. In the sham group, points within 1 cm of the main points were only touched. Data were collected using the SF36 questioner, before, and immediately, 2 weeks, and 4 weeks after the intervention. Data analysis was performed using SPSS software.ResultsIndependent t-test showed that the mean total score of QOL before the intervention was not significantly different between the two groups before the intervention (P = .68). However, it was significantly higher in the experimental group compared to the Sham group, immediately, 2 weeks, and 1 month after the intervention (P < .001).ConclusionsAcupressure on specific points of the foot and back improves back pain and as a result, increases QOL. Therefore, acupressure can be used as a drug-free and low-cost approach without side effects to improve QOL in nurses with chronic back pain.     

Back Pain and Body Posture Evaluation Instrument for Adults: Expansion and Reproducibility

Background: The BackPEI questionnaire was developed and validated just exclusively to evaluate children. Aims: To propose, validate, and test the reproducibility of an expanded version of the Back Pain and Body Posture Evaluation Instrument (BackPEI), originally designed to assess back pain in school-aged children, for use with adults. Design: Validation Study. Methods: Five questions from the original BackPEI were replaced, resulting in the revised instrument (BackPEI-A) containing 20 questions. Three experts checked the content validity of the revised instrument, and the reproducibility was tested by trialing the questionnaire with 154 adults. Results: The reproducibility data for the questions regarding pain intensity, analyzed using the Wilcoxon test and intraclass correlation coefficient (ICC), indicated that (a) there was no difference between the medians and (b) the answers were highly correlated, both for lower back (p = .574) (ICC = 0.908) and cervical (p = .968) (ICC = 0.865) pain. The reproducibility data for the remaining questions analyzed using the κ coefficient were classified as moderate (0.4 < κ ≤ 0.6) or very good (κ > 0.8). Conclusion: The BackPEI-A is a reproducible, valid, and reliable instrument for use in the evaluation of back and neck pain and their associated risk factors. The instrument also facilitates the evaluation of postural habits in activities of daily living in adults.     

A detailed characterisation of pain,disability, physical and psychological features of a small group of adolescents with non-specific chronic low back pain

The objective of the study was to provide a detailed biopsychosocial evaluation of adolescent NSCLBP compared to those without LBP. NSCLBP was described by pain level, duration, levels of disability and kinesiophobia, aggravating factors and functional movements. Each pain subject was sub-classified using the O'Sullivan system. Groups were compared on physical activity levels, sitting posture, trunk extensor and thigh muscle endurance, psychosocial behaviour, depression, family functioning and exposure to stressful life events. Adolescents with NSCLBP reported moderate levels of pain (4.4/10 ± 1.9), disability (17.9 ± 10.1%) and fear avoidance beliefs (36.1/68 ± 7.1). Differences between control and pain groups were only found for back muscle (p = 0.033) and squat endurance times (p = 0.032) and stressful life events (p = 0.030). Differences in sitting posture between pain and no pain groups were only found when pain subjects were sub-classified (lumbar angle p = 0.001). In conclusion, adolescents with NSCLBP reported moderate pain and disability with deficits in trunk and squat endurance. That they remained physically active is at odds with the activity avoidance and subsequent deconditioning model proposed for adults with NSCLBP. Differences between control and pain groups on history of stressful life events suggest this may contribute to adolescent NSCLBP. Differences with sitting posture are only seen when patients were sub-classified.     

The Effect of Remote-Based Monitoring and Education Program on Cancer Pain Management in an Outpatient Pain Clinic

BackgroundPain is one of the most feared consequences of cancer for patients and their families. Many barriers may hinder optimal pain management.AimExamine the effect of remote-based monitoring and education program on cancer pain management, patient-related barriers, and level of adherence to pain medication.MethodsA sample of 134 patients was assigned to two groups; 68 in the intervention group and 66 in the control. The intervention group received three educational sessions by telephone. Both groups completed questionnaires at baseline and one month after the initial visit.ResultsSignificant differences were found between the groups in the levels of pain right now (p = .030), pain at its least (p = .016), and in the percentage of achieved pain relief (p = .048). Moreover, the intervention group experienced lower levels of interference with their general activity (p = < .001), mood (p = .011), and normal work (p = .004) post-intervention. The Attitudinal Barriers differences were statistically significant in the total mean (p = < .001), and the subscales of physiological effects (p = < .001), fatalism (p = < .001), communication (p = < .001), harmful effects (p = < .001). Participants in the intervention group exhibited higher adherence levels (p = .001).ConclusionsPatients suffering from cancer-related pain can benefit from remote-based monitoring and education programs to improve pain management outcomes, overcome barriers, and increase adherence. Further research is needed to investigate the different available educational methods and long-term effects.     

CpG Methylation Levels in HPA Axis Genes Predict Chronic Pain Outcomes Following Trauma Exposure

Chronic post-traumatic musculoskeletal pain (CPTP) is a common outcome of traumatic stress exposure. Biological factors that influence the development of CPTP are poorly understood, though current evidence indicates that the hypothalamic-pituitary-adrenal (HPA) axis plays a critical role in its development. Little is known about molecular mechanisms underlying this association, including epigenetic mechanisms. Here, we assessed whether peritraumatic DNA methylation levels at 248 5′—C—phosphate—G—3′ (CpG) sites in HPA axis genes (FKBP5, NR3C1, CRH, CRHR1, CRHR2, CRHBP, POMC) predict CPTP and whether identified CPTP-associated methylation levels influence expression of those genes. Using participant samples and data collected from trauma survivors enrolled into longitudinal cohort studies (n = 290), we used linear mixed modeling to assess the relationship between peritraumatic blood-based CpG methylation levels and CPTP. A total of 66 (27%) of the 248 CpG sites assessed in these models statistically significantly predicted CPTP, with the three most significantly associated CpG sites originating from the POMC gene region (ie, cg22900229 [β = .124, P < .001], cg16302441 [β = .443, P < .001], cg01926269 [β = .130, P < .001]). Among the genes analyzed, both POMC (z = 2.36, P = .018) and CRHBP (z = 4.89, P < .001) were enriched in CpG sites significantly associated with CPTP. Further, POMC expression was inversely correlated with methylation levels in a CPTP-dependent manner (6-months NRS<4: r = -.59, P < .001; 6-months NRS ≥ 4: r = -.18, P = .2312). Our results suggest that methylation of HPA axis genes including POMC and CRHBP predict risk for and may contribute to vulnerability to CPTP.PerspectivePeritraumatic blood levels of CpG methylation sites in HPA axis genes, particularly CpG sites in the POMC gene, predict CPTP development. This data substantially advances our understanding of epigenetic predictors and potential mediators of CPTP, a highly common, morbid, and hard-to-treat form of chronic pain.     

Feasibility of a self-management intervention in adolescents with headache (SMI-AH)

PurposeThis study assessed the acceptability and limited efficacy of a self-management intervention to improve lifestyle behaviors and headache outcomes among rural adolescents with recurrent headache.Design and methodsParticipants were randomly assigned to a self-management intervention for adolescent headache (SMI-AH, n = 13) or standard care group (n = 17). The SMI-AH group participated in goal-setting, self-monitoring, and information processing to modify lifestyle behaviors (missed meals, caffeine intake, and poor sleep). Independent samples t-test was used to compare the means of outcomes at baseline and 6-week follow-up between the treatment group and control group. Linear mixed model (LMM) was used to examine the intervention effects over time.ResultsThe mean age was 14.8 years (sd = 1.6, range, 12–17); with female participants accounting for 80% of the sample (n = 24) and persons reporting white race were 97% (n = 29). The SMI-AH group demonstrated a greater magnitude of change in lifestyle behaviors, including increased days of eating breakfast and lunch. The multivariate LMM showed significant intervention effect of lunch intake (p = 0.042 with Cohen's d = 0.42) and borderline significant effect of breakfast intake (p = 0.064 with Cohen's d = 0.38). Participants reported the intervention was easy to use and helpful to monitor behaviors.ConclusionsAmong rural adolescents, a self-management intervention is a feasible approach for engaging youth. The SMI-AH provides an opportunity for the adolescents to talk about their behaviors and participate in goal setting as well as the plan of care with the provider. Challenges identified in this study are manageable and a full study is feasible with modifications.     

Effects of Transcutaneous Occipital Nerve Stimulation and Instrument-Assisted Soft Tissue Mobilization in Chronic Migraine

ObjectiveThe purpose of this study was to examine the effects of transcutaneous occipital nerve stimulation (TONS) and instrument-assisted soft tissue mobilization (IASTM) on pain, sleep, and quality of life in patients with chronic migraine.MethodsForty-five female patients with chronic migraine were randomly assigned to control (n = 15), IASTM (n = 15), and TONS (n = 15) groups. Neck exercises were given to all groups once per day for 5 weeks. IASTM, using a smooth metal scraping massage tool, was applied to the patients in the IASTM group twice per week for 5 weeks. Patients in the TONS group were treated with transcutaneous electrical nerve stimulation 3 times per week for 5 weeks. The outcome measures were a Numeric Pain Scale, the Headache Impact Test-6, the Pittsburgh Sleep Quality Index, and the Short Form-36.ResultsThe IASTM and TONS groups had significantly lower mean Headache Impact Test-6 scores than the control group in the last measurement (F = 3.908, P = .028). The IASTM and TONS groups had lower mean Numeric Pain Scale scores than the control group (F = 13.861, P = .001). The IASTM group had a lower mean Pittsburgh Sleep Quality Index score in the last measurements than the other 2 groups (F = 6.792, P = .003). There was no difference between the groups in the general health perception scores obtained in the last measurements (F = 1.585, P = .217). In the last measurement, the IASTM and TONS groups had higher mean general health scores than the control group.ConclusionIASTM and TONS applications reduced head and neck pain and improved sleep and quality of life in patients with chronic migraine. Neither had superiority over the other.