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OBJECTIVES This study investigates the relationship between anxiety reduction and functional outcomes in children and adolescents receiving intensive interdisciplinary rehabilitation services for chronic pain (CP). Specifically, we evaluated whether: (1) anxiety changes over the course of treatment; (2) anxiety covaries with functional outcomes to rehabilitation; and (3) change in anxiety predicts change in functional outcomes from rehabilitation for CP. Using 3 separate measures assessing anxiety-related constructs, we hypothesized that anxiety would be associated with functioning, both before and following intensive rehabilitation for CP. Further, we hypothesized that a decrease in anxiety-related symptoms following rehabilitation would predict a positive change in functional outcomes. MATERIALS AND METHODS Our sample consisted of 119 children and adolescents treated for CP in an interdisciplinary rehabilitation program between 2007 and 2012. Children completed 3 measures related to anxiety (general anxiety, pain-specific anxiety, pain catastrophizing) and 2 functional outcome measures (eg, Bath Adolescent Pain Questionnaire, PedsQL) as part of clinical care. RESULTS Measures of anxiety-related constructs were significantly correlated with measures of impairment and functioning, both at admission and at 1-month postdischarge. Regression analyses demonstrated that, after controlling for age, sex, and pain level at admission, a decrease in anxiety significantly predicted between 14% and 40% unique variance in functional outcomes. DISCUSSION The findings of this study support existing research on anxiety and CP, specifically the relationship between anxiety and pain-related disability. This study also supports the benefit of intensive interdisciplinary rehabilitation for both reducing anxiety and increasing functional outcomes, suggesting a possible link in children's response to intervention. Study limitations and future directions for related research are discussed.

Preparation for and induction of anesthesia in children has evolved significantly over the last decade, with particular reference to the reduction of perioperative anxiety reduction by nonpharmacologic and pharmacologic means. Several new large population studies and meta-analyses further scrutinize the current techniques.Many nonpharmacologic methods to reduce anxiety are effective λU similar to sedative premedications, with the exception of parent present induction of anesthesia. Healthcare providers can be taught to increase anxiety-reducing behaviors through an educational intervention. Clonidine and dexmedetomidine have many similar or superior qualities to midazolam.Larger studies still need to be conducted before wide-scale application of many nonpharmalogical interventions such as parental acupuncture. Similarly, more investigation should be done on outcomes such as onset, emergence, and discharge times, as well as the postoperative response with reference to emergence delirium and postoperative nausea and vomiting prevention to outline the differences among sedative premedications such as midazolam, clonidine, and dexmedetomidine.

Anxiety reduction procedures as adjuncts to medical treatment have almost invariably been reported to benefit asthmatic patients in individual case studies. However, the results of more systematically controlled studied are clearly inconsistent. This discrepancy is understandable in view of what is now known about anxiety in asthma. Four catches, each based on what has been reported about the roles and forms of anxiety in asthma, are presented. Each catch argues against general, across-the-board application of anxiety reduction procedures in asthma. Careful evaluation leading to more problem-oriented treatment is needed in view of the different roles of anxiety in asthma.

The present investigation examined the importance of considering age-related conceptual abilities when designing preparation interventions for hospitalization and medical procedures. Forty-eight children, ages 3-5 years and 7-10 years, viewed videotaped information about an upcoming medical procedure. The children were assigned to one of three treatment conditions: control, developmentally appropriate information, developmentally advanced information. Results suggest that information which is designed to match the age-related conceptual abilities of the recipient more effectively reduces anxiety and increases cooperation. Implications for future research evaluating efficacy of preparation strategies are noted.