{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:42:23Z","timestamp":1760146943263,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T00:00:00Z","timestamp":1735603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIAMS of the National Institutes of Health","award":["K23AR081409","K24AR078950"],"award-info":[{"award-number":["K23AR081409","K24AR078950"]}]},{"name":"Rheumatology Research Foundation","award":["K23AR081409","K24AR078950"],"award-info":[{"award-number":["K23AR081409","K24AR078950"]}]},{"name":"Snider Foundation","award":["K23AR081409","K24AR078950"],"award-info":[{"award-number":["K23AR081409","K24AR078950"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: To assess the feasibility and acceptability of freelisting for adolescents with chronic musculoskeletal pain (CMP) and use freelisting to identify how adolescents with CMP cope with pain. Methods: This was a mixed-methods cross-sectional single-center study of patients 12\u201318 years old, diagnosed with CMP. Twenty-seven subjects participated in an interview which included the freelisting exercise, probing questions, Connor-Davidson Resilience Scale 10-item, and semi-structured interview. Feasibility was pre-defined as \u226585% completion. A list of \u2018standardized\u2019 freelisting terms was created, and we calculated Smith\u2019s salience index. Freelisting terms were grouped into individual, family, friends, school, and medical domains. Results: In this predominantly female population, resilience levels were low to moderate, and on average, participants had moderate pain intensity and functional disability. The freelisting exercise was feasible and acceptable among females, with low recruitment of males. Salient words to describe adolescents\u2019 pain included frustrating, upsetting, annoying, and painful. Participants identified family, friends, teachers, guidance counselors, and health professionals as key sources of support. Many participants reported difficulties communicating their pain. Helpful coping strategies included rest, distraction, relaxation, endurance, and extracurricular participation. Conclusions: Freelisting was well perceived among female adolescents with CMP. Supportive relationships with community members play an important role for this population. However, perceived stigma may deter female adolescents from talking about their pain. Purposive sampling of male participants and recruitment strategies ensuring diverse patient representation are necessary to ensure generalizability of future results when using the freelisting method for adolescents with CMP.<\/jats:p>","DOI":"10.3390\/children12010048","type":"journal-article","created":{"date-parts":[[2024,12,31]],"date-time":"2024-12-31T14:21:12Z","timestamp":1735654872000},"page":"48","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Pilot Study on the Freelisting Method Among Adolescents with Chronic Musculoskeletal Pain: Feasibility, Acceptability and Study Findings"],"prefix":"10.3390","volume":"12","author":[{"given":"Sabrina","family":"Gmuca","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Rheumatology, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"Center for Pediatric Clinical Effectiveness, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"PolicyLab, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1120-6605","authenticated-orcid":false,"given":"Dori","family":"Abel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Rheumatology, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"PolicyLab, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6209-4733","authenticated-orcid":false,"given":"Mackenzie","family":"McGill","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Rheumatology, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"Center for Pediatric Clinical Effectiveness, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"PolicyLab, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daneka","family":"Stryker","sequence":"additional","affiliation":[{"name":"Drexel University College of Medicine, Drexel University, Philadelphia, PA 19129, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eda","family":"Akpek","sequence":"additional","affiliation":[{"name":"Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Whitney","family":"Eriksen","sequence":"additional","affiliation":[{"name":"Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pamela F.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Rheumatology, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"Center for Pediatric Clinical Effectiveness, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"PolicyLab, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter F.","family":"Cronholm","sequence":"additional","affiliation":[{"name":"PolicyLab, Children\u2019s Hospital of Philadelphia, Philadelphia, PA 19104, USA"},{"name":"Mixed Methods Research Lab, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA"},{"name":"Center for Public Health, Department of Family Medicine and Community Health, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1016\/j.pain.2011.07.016","article-title":"The epidemiology of chronic pain in children and adolescents revisited: A systematic review","volume":"152","author":"King","year":"2011","journal-title":"Pain"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.pcl.2018.04.004","article-title":"Pediatric Pain Syndromes and Noninflammatory Musculoskeletal Pain","volume":"65","author":"Weiss","year":"2018","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1097\/00004703-200002000-00011","article-title":"Impact of recurrent and chronic pain on child and family daily functioning: A critical review of the literature","volume":"21","author":"Palermo","year":"2000","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.pain.2005.10.027","article-title":"Parent and family factors in pediatric chronic pain and disability: An integrative approach","volume":"119","author":"Palermo","year":"2005","journal-title":"Pain"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s11916-010-0095-9","article-title":"Resilience: A new paradigm for adaptation to chronic pain","volume":"14","author":"Sturgeon","year":"2010","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jpeds.2019.03.006","article-title":"The Role of Patient and Parental Resilience in Adolescents with Chronic Musculoskeletal Pain","volume":"210","author":"Gmuca","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1093\/jpepsy\/jsv037","article-title":"Topical Review: Resilience Resources and Mechanisms in Pediatric Chronic Pain","volume":"40","author":"Cousins","year":"2015","journal-title":"J. Pediatr. Psychol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2539","DOI":"10.1097\/j.pain.0000000000002241","article-title":"Core outcome set for pediatric chronic pain clinical trials: Results from a Delphi poll and consensus meeting","volume":"162","author":"Palermo","year":"2021","journal-title":"Pain"},{"key":"ref_9","first-page":"1","article-title":"Elicitation Techniques for Cultural Domain Analysis","volume":"Volume 3","author":"Schensul","year":"1998","journal-title":"Ethnographer\u2019s Toolkit"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Weller, S., and Romney, A. (1988). Systematic Data Collection, Sage Publications, Inc.","DOI":"10.4135\/9781412986069"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Liamputtong, P. (2019). The Freelisting Method. Handbook of Research Methods in Health Social Sciences, Springer.","DOI":"10.1007\/978-981-10-5251-4"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"E04","DOI":"10.5888\/pcd18.200355","article-title":"Practical Guidance for Studies Using Freelisting Interviews","volume":"18","author":"Keddem","year":"2021","journal-title":"Prev. Chronic Dis."},{"key":"ref_13","first-page":"S385","article-title":"Using freelisting to identify, assess, and characterize age differences in shared cultural domains","volume":"63","author":"Schrauf","year":"2008","journal-title":"J. Gerontol. Ser. B Psychol. Sci. Soc. Sci."},{"key":"ref_14","unstructured":"Bernard, H.R. (2002). Research Methods in Anthropology: Qualitative and Quantitative Approaches, AltaMira Press. [3rd ed.]."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jpag.2011.11.006","article-title":"Pregnancy, contraception and emergency contraception: The language of urban adolescent young women","volume":"25","author":"Mollen","year":"2012","journal-title":"J. Pediatr. Adolesc. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1363\/3518003","article-title":"Where does reproductive health fit into the lives of adolescent males?","volume":"35","author":"Marcell","year":"2003","journal-title":"Perspect. Sex. Reprod. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e12833","DOI":"10.1111\/mcn.12833","article-title":"In-depth assessment of snacking behaviour in unmarried adolescent girls 16-19 years of age living in urban centres of Java, Indonesia","volume":"15","author":"Blum","year":"2019","journal-title":"Matern. Child. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1080\/03670244.2017.1343725","article-title":"Healthfulness, Modernity, and Availability of Food and Beverages: Adolescents\u2019 Perceptions in Southern India","volume":"56","author":"Shaikh","year":"2017","journal-title":"Ecol. Food Nutr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"20160105","DOI":"10.1515\/ijamh-2016-0105","article-title":"Sexual and reproductive health priorities of adolescent girls in Lagos, Nigeria: Findings from free-listing interviews","volume":"30","author":"Iwelunmor","year":"2017","journal-title":"Int. J. Adolesc. Med. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1136\/ip.2008.018572","article-title":"Teen perceptions of good drivers and safe drivers: Implications for reaching adolescents","volume":"15","author":"Barg","year":"2009","journal-title":"Inj. Prev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: A systematic review of empirical tests","volume":"292","author":"Hennink","year":"2022","journal-title":"Soc. Sci. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1177\/1049732316665344","article-title":"Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?","volume":"27","author":"Hennink","year":"2017","journal-title":"Qual. Health Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How Many Interviews Are Enough?:An Experiment with Data Saturation and Variability","volume":"18","author":"Guest","year":"2006","journal-title":"Field Methods"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1093\/jpepsy\/jsu094","article-title":"Risk and Resilience in Pediatric Chronic Pain: Exploring the Protective Role of Optimism","volume":"40","author":"Cousins","year":"2015","journal-title":"J. Pediatr. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s13012-016-0437-z","article-title":"A systematic review of the use of the Consolidated Framework for Implementation Research","volume":"11","author":"Kirk","year":"2016","journal-title":"Implement. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009","journal-title":"Implement. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1002\/da.10113","article-title":"Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD-RISC)","volume":"18","author":"Connor","year":"2003","journal-title":"Depress. Anxiety"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"S431","DOI":"10.1002\/acr.20639","article-title":"Measures of juvenile fibromyalgia: Functional Disability Inventory (FDI), Modified Fibromyalgia Impact Questionnaire-Child Version (MFIQ-C), and Pediatric Quality of Life Inventory (PedsQL) 3.0 Rheumatology Module Pain and Hurt Scale","volume":"63","author":"Flowers","year":"2011","journal-title":"Arthritis Care Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/acr.20140","article-title":"The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity","volume":"62","author":"Wolfe","year":"2010","journal-title":"Arthritis Care Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/j.pain.0000000000000378","article-title":"Longitudinal evaluation of patient-reported outcomes measurement information systems measures in pediatric chronic pain","volume":"157","author":"Carle","year":"2016","journal-title":"Pain"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1016\/S0304-3959(03)00121-0","article-title":"The child version of the pain catastrophizing scale (PCS-C): A preliminary validation","volume":"104","author":"Crombez","year":"2003","journal-title":"Pain"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Gmuca, S., Weiss, P.F., McGill, M., Xiao, R., Ward, M., Nelson, M., Sherry, D.D., Cronholm, P.F., Gerber, J.S., and Palermo, T.M. (2022). The Feasibility and Acceptability of Resilience Coaching for Adolescent Chronic Musculoskeletal Pain: A Single-Arm Pilot Trial. Children, 9.","DOI":"10.3390\/children9101432"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/1525822X9300500301","article-title":"Using ANTHOPAC 3.5 and a Spreadsheet to Compute a Free-List Salience Index","volume":"5","author":"Smith","year":"1993","journal-title":"CAM"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1016\/j.pain.2011.02.050","article-title":"Clinical utility and validity of the Functional Disability Inventory (FDI) among a multicenter sample of youth with chronic pain","volume":"152","author":"Flowers","year":"2011","journal-title":"Pain"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Overstreet, D.S., Strath, L.J., Jordan, M., Jordan, I.A., Hobson, J.M., Owens, M.A., Williams, A.C., Edwards, R.R., and Meints, S.M. (2023). A Brief Overview: Sex Differences in Prevalent Chronic Musculoskeletal Conditions. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20054521"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1037\/a0030737","article-title":"Gender differences in emotion expression in children: A meta-analytic review","volume":"139","author":"Chaplin","year":"2013","journal-title":"Psychol. Bull."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Wakefield, E.O., Puhl, R.M., Litt, M.D., and Zempsky, W.T. (2021). \u201cIf It Ever Really Hurts, I Try Not to Let Them Know\u201d: The Use of Concealment as a Coping Strategy Among Adolescents With Chronic Pain. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.666275"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Wakefield, E.O., Kissi, A., Mulchan, S.S., Nelson, S., and Martin, S.R. (2022). Pain-related stigma as a social determinant of health in diverse pediatric pain populations. Front. Pain Res., 3.","DOI":"10.3389\/fpain.2022.1020287"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"813","DOI":"10.2105\/AJPH.2012.301069","article-title":"Stigma as a Fundamental Cause of Population Health Inequalities","volume":"103","author":"Hatzenbuehler","year":"2013","journal-title":"Am. J. Public Health"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/1\/48\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:57:32Z","timestamp":1760115452000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/1\/48"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,31]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["children12010048"],"URL":"https:\/\/doi.org\/10.3390\/children12010048","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2024,12,31]]}}}