title: Pain interference in youth with neurofibromatosis type 1 and plexiform neurofibromas and relation to disease severity, social-emotional functioning, and quality of life.
abstract: The physical manifestations of neurofibromatosis type 1 (NF1) can cause chronic pain. This study investigated the impact of pain in youth with NF1 and plexiform neurofibromas (PNs) and its relationship to disease factors, social-emotional functioning, and quality of life (QOL) within a biopsychosocial framework. Caregivers of 59 children and adolescents with NF1 and PNs (6-18 years), and 41 of these youth (10-18 years), completed questionnaires assessing social-emotional functioning and QOL, including an item on pain interference. Measures of disease severity included total PN volume by percent body weight and number of disease complications. Both caregiver (73%) and self-report (59%) ratings indicated that pain interferes with the child's daily functioning despite 33% taking pain medication. Based on caregivers' behavior ratings, more symptoms of anxiety and larger tumor volumes predicted greater pain interference, while greater pain interference, worse depressive symptoms, and more disease complications predicted poorer QOL. As rated by adolescents, more symptoms of anxiety predicted greater pain interference, while greater pain interference and social stress predicted poorer QOL. Further, social-emotional problems mediate the relationship between pain interference and QOL. Thus, pain interferes with daily functioning in the majority of youth with NF1 and PNs even when using pain medication. The impact of pain interference, disease severity, and particularly social-emotional problems on QOL highlights the interaction between physical and psychological states in NF1. Future research and treatment of pain in this population should utilize a biopsychosocial approach and involve multidisciplinary therapies including psychological interventions that target social-emotional functioning.
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Wolters
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland.|Department of Psychology, The George Washington University, Washington, District of Columbia.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Burns
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Staci
authors.initials: S
authors.lastname: Martin
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Baldwin
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Eva
authors.initials: E
authors.lastname: Dombi
authors.affiliation: Clinical Research Directorate/Clinical Monitoring Research Program, Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Frederick, Maryland, 21702.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Toledo-Tamula
authors.affiliation: Department of Public Health Education, School of Health and Human Sciences, University of North Carolina at Greensboro, Greensboro, North Carolina.
authors.forename: William N
authors.initials: WN
authors.lastname: Dudley
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gillespie
authors.affiliation: Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland.
authors.forename: Brigitte C
authors.initials: BC
authors.lastname: Widemann
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000293:Adolescent; D017028:Caregivers / Q000523:psychology; D002648:Child; D004644:Emotions / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000473:pathology / Q000523:psychology; D018318:Neurofibroma, Plexiform / Q000150:complications / Q000473:pathology* / Q000523:psychology*; D009456:Neurofibromatosis 1 / Q000150:complications / Q000473:pathology* / Q000523:psychology*; D010146:Pain / Q000209:etiology / Q000473:pathology / Q000523:psychology*; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: children; neurofibromatosis type 1; pain; plexiform neurofibromas; quality of life